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()(4) PF7 OF iNSPFCT ,10',NS S1Le Plan //!)Ic)L Plcari -',I101,171iiU c?-I1 lxjilda::,i� e LO Lpropc— y 711-7 7 7---�' - 0(�La(-1,.— I I ne'��: ------------- Fajinc' dea'd,131le j: no'U!l IZeviewed. e-,I et-v lhuLa Jay co '4j Ale#<1 � e M ♦�o � O a 6 f�l+tisxcfltsarlta DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ' WORKER'S COMPENSATION INSURANCE AFFIDAVIT (Ii /permittee) with a principal place of business/residence at: (phone#) (street/city/=W2ip) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Comp my/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insuuance Company/Policy Number) (Expiration Date) (attach addiliocni sheet ifn<ocnary to include iafocmaIIoa patniuing to all ocatre f3) i ( I am a sole proprietor and have no one'w' orking for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeowo=who ernploy person to&=a itcaancc cons ruction or repair work on a dwelling of not more than throe units in which the homeowner rezides or oa the grounds zpputteuaat thereto art not gcnaatly ooandcrcd to be cmploytrs under the worktes sa oa Act(GLr52,SS t(5)),application by a homcovmcr for a lio==or permit may evidmcc the legar ctsetua of an employer under the Workoes compomation Act I undastand that a ropy of thin uatemcni may be forwarded to the Deperta cni of Indu3trial Accidcn&Offioo of In urwoe for the covaage vcri&caiioa MW that failure to Secure oovaw under section 25A of MOL 152 can lead to the impositioa of aimia.� penalties ooatist of a fine of up to S1,500.00 and/or impri3oanxrzt of up to one year and civil pmaltia in ehe focm of a stop Work ordc and a fmo of s 100.00 a day agyinst ma fFor dcp:r�—Daly ` Permit Number A-4/A Map'{ Lot# r i&aW=of LiccLseeRermiqe4 e s P I k N RICICE'�" 8 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �iV3ilyT �s0 %P2 �� License Number s-n S Lb E A— D ® 43 -Z�Q A ress Expiration Date 33o/rbo igna ure Telephone -7 y v"effl"eWV6=hta( Not Applicable ❑ Company Name Registration N mber Address Expiration Date T7 9-J #7�DrC�Ze- . �9 Telephone S CT10N 13U WORK ERS':COMPENSATION INSURANCE-AFFIDAVIT(M G.L. c: 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance oJAhe building permit. Signed Affidavit Attached Yes....... No...... The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature n r' PROP c a .x 3hc y S CTIO .;MO " ,.S,rYi. �` '�:�vW�;'�",saa ,j1ta ai +i�raa^.;^.3'1�� �$`�• i '.'.- 'a'a.:7,..»,Nl.3.t,yn� `.`.°:,� 3. .:..t . �:7�' .�,3. New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0 Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ Siding[ ] Other[ ] Brief Description of Proposed Work: .1.2� Alteration of existing bedroom Yes No Adding new bedroom Yes C'-_/ No Attache"'Narrative o Renovating unfirshed basement Yes N Plans Attached Roll ❑• Sheet :flit o to, z stirs uo sin cri 1; a. Use of building: One Family `° Two Family Other b. Number of rooms in each family unit: t Number of Bathrooms__ c. Is there a garage attached? `�o d. Proposed Square footage of new construction. Dimensions 23 1 e. Number of stories? Z f. Method of heating? /FYI L Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. 0 Mascheck Energy Compliance form attached? U h. Type of construction_( _Uf7 0 i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building an Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a k 30WNER AU1'HORIZATION�=TO BE COMPLETED' WHEN OWN1 ft5 AGENT OR GOYNX C OR2 APPLIES �OR3-Gl11LDING PERINIT as Owner of the subject property hereby authorize Ail �O,u i1�( /�.r�! to act on my ben i all matters r e to ork authorized by this building permit application. Signature of Owner Date as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size l / f d ngOV-0 Frontage ~� Setbacks Front Side L. •2-R: L: R: ' Rear 6 02 Building Height Bldg.Square Footag �y ,� %Open Space Footage / % �D (Lot area minus bldg&paved /(jam parking) #of Parking Spaces Fill: volume&Location x A. Has a Sped I Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are ere any proposed changes to or additions of signs intended for the property ?YES _ No IF YES, describe size, type and location: � 3 nn i y rthampton �J Buil epartment JUL 2 ? L00221 a n Street 00 100 oi��,��,��� .RC q(rnpto , MA 01060 No Fax 413-587.1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SEC1rfON.1-SITE I.NF.ORMATION 1.1 Property Address: LS t),,' A-1 cc Ma - V r WWI "St SECTION District . SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: j Name fi fr) F , Current Mailin Are��:; ?f Telephone `J �� Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SEC TION.3-'ESTIMATED CONSTRUCTION'COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by ermit applicant 1. Building UL (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection _ 6. Total =(1 + 2 + 3 +4 + 5) Check Number This Section For Official Use Only Building Permit Number: © -rl"� Date Issued: Signature: - - Building'Commissioner/lnspector of•Buildings Date File#BP-2003-0078 APPLICANT/CONTACT PERSON ANTHONY COMFORTE III ADDRESS/PHONE 71 AUSTIN ST (413)330-1160 PROPERTY LOCATION 38 STILSON AVE MAP 17C PARCEL 112 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 23 X 8 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 063290 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Co ssion 2� Signature of Building O icial Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. 38 STILSON AVE BP-2003-0078 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 112 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2003-0078 Project# JS-2003-0165 Est. Cost: $5000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ANTHONY COMFORTE 111 063290 Lot Size(sq. ft.): 11238.48 Owner: PURCELL HARRY R&ELSIE E zoning:URB Applicant: ANTHONY COMFORTE I I I AT. 38 STILSON A`vE Applicant Address: Phone: Insurance: 71 AUSTIN ST (413) 330-1160 CHICOPEEMA01013 ISSUED ON.811102 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 23 X 8 DECK POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation:#OG C 5 p f.5 Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: ,s Final: Smoke: Final: THIS PERMIT MAY BE REVOKL ) BY THE CITY OF NORTHAMPTON UPON VIOL ON OF ANY OF ITS RULES AND REGULATION Certificate of Occu anc Si nature: Fee Type: Receipt o• Date Paid: Check No: Amount: Building 8/1/02 0:0T00 4095 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo