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17C-124 (3) 188 8" _ 3 1t 152 4" 12"- 24" ! M - ZO N t3� � N 4.DISH-IQ R3633L M 67$" ( 12`x---2 it 4 " 36" a �-4311-36" - 48;6' 36•` 6�4�r ___ , All dimensions_size designations This is an original design and must Designed:2/12/2009 given are subject to verification on not be released or copied unless Printed:2/12/2009 job site and adjustment to fit job applicable fe as been paid ob conditions. order plat 2050018.kit rE,13 Drawing#: 1 � V 7n 8 n n t� t tt 3 18"-// w%J "3)'18 ) W113E 18 r WA2436L 1836 MW.HOOD oa 00 O❑ —NT REP1 1 REP1 12.90{R} Mill L t ®T ®®T 33. F2-2D - — N EZR363 0-GAS-RANGE BDIff I OM rf ... .......f �/Vw 1 �� tt tt 48�� 1 to 3 n 2 8 All dimensions_size designations This is an original design and must Designed:2/12/2009 given are subject to verification on not be released or copied unless Printed:2/12/2009 job site and adjustment to fit job appliicab fee has been paid or job conditions. order�etl. 2050d01 S.kit El 12 Drawing#: 1 Corey&Rise Fox 68 Sheffield Lane Florence,MA 01062 1371' Kraftmaid Cabinetry 24" 9" 30" 18" 36" 18" Door Style:Hayward Maple Finish:Honey Spice „ 52 3-, — All Plywood Construction Mounting Hiaght for Cabinets:90" 1 " 1 18" 3 1 v 11 12 Legend 13 1: BD12 q 14 a- BD12 w to 0-GA -R NGE 10= d 2: S(SB4 BUTT) 3: BF3 'e — (BF3) Z;= 4: EZR3633L - O (EZR3633L) 0 5: WCA1236L at customers requeii tall y (WCA1236L) fillers have been re i oved from 6: WA2436L row of cabinets A (WA2436L) 7: BD18 installer to move gas line (BD18) 8: REP11/2.90(1-} (REP 1 1/2.90(L)) 9: REP11/2.90(R) CO i (REP11/2.90(R)) 10: BOBC18.FH d cabinets,for i land need (BOBCIB.FH) CO i -4 to be p stio ed far enoug — 00 11: 936L ap away to 011o for counter to o �a (W936L) overhan ani I leave at leas 12: X31018) 36"pass,thoagh from edge - 4 w 1 W 13: W1836L 36a w o handles o fridge (W1836L) CSI 14: WR3618 'e ilestone yOur ter top will ne (WR3618) sr � upport Huth a 12"overhang 15: WOC1836 (WOC1836) 16: B18L.FH $ (B18L.FH) installer o close opening 17: B018(13D18) 18: BD18 ^h� (BD 18) t` ^� w M V 47g -- --52 �J —387 — 76-91' 137W All dimensions-size designations This is an original design and must Designed:2/12/2009 given are subject to verification on not be releasedAr copied ess Printed:2/12/2009 job site and adjustment to fit job applicable fee d r i. conditions. order placed. 2050W18.kit Fp i Drawing#:1 r,. �q y� w1 i T 6" a R + s, t! �., .. •.-•.:"... ••..r••".+•.•"r?.n'cww.`tR.T!hW.D.'.CTeW:st'ta.'WSMrNFS.:I. RYia.^e�n'gH / J t 111' F 7' \V uz r �gEL�O i • � ' •-` • • ille . . • • k , ` y t{ S t ' � 3 j 1 ; i r 9 ; L Massachusetts General Laws chapter 152 requires ail emplovers to provide worke s' compensation for their employees. P: suant to,this statute,an employee is defined as"...every person in the service of another under any contract of hire, express orIimplied, oral or written." An employer is defined as "an individual,partnership,association.corporation or other legal entity, or any two or note of the foregoing en gaged in a)omt enterprise, and including the leg representatives ofa deceased employer,or the receive:or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dweLtina house having not more than three apartments and who resides therein, or the occupant of the iweIIing house of another who employs persons to do maintenance, construction or repair work on such dwelling house ?r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." 1GL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or °newal of a license or permit to operate a business or to construct buildings in the commonwealth for anv :)plicant who has not produced acceptable evidence of compliance with the insurance coverage required." dditionaily,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall .ter into any contract for the performance of public work until acceptable evidence of compliance with the insurance luirements of this chapter have been presented to the contracting authority." ,plicants ase fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if essary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of trance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP_)with no employees other than the fibers or partners,are not required to c workers'co quiz airy compensation insurance. If an LLC or LLP does have Ioyees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial idents for confirmation of insurance coverage.. Also be silre to sign and date the affidavit. 'The affidavit should -rurned to the city or town that the application for the permit or license is beins requested,not the Department of strial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' )ensation policy,please call the Department at the number listed below. Sells insured companies should enter their nsurance license number on the appropriate line. or Tows. Officials be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant be sure to fill in the permit/Iicense number which will be used as a reference number. In addition,an applicant ust submit multiple permitilicense applications in any given year,need only submit one affidavit indicating current information.(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or "A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the fit as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filed out each here a home owner or citizen is obtaining a license or permit not related to any business or commercial venture oz license or permit to burn Ieaves etc_)said person is NOT required to complete this affidavit. 'ice of Investigations would like to thank you in advance for your cooperation and should you have any questions, ' o not hesitate to give us a call. ar=ent's address, telephone and fax number: The Commonwealth of Massachusetts D,_-partnenat of Industrial Accidents office of Investigations 6600 `'v'ashinaton Street Boston, Mr 0-1111 Tel. - 6_7-722 7-_'*0I e,�: ,i06 OF 1477-�,'(:^S>ci r J_ Fax_# 61 i-/')-:f=tq .L: T T he Commonwealth of!Ylassachirse s rn- Department of Inaitsarial Acc dents -- `- - Office oflnvesti-arioj:s ` 600 I�ashin Lon Street Boston,lkl--1 02III _ r www.rnnss.aoi/tdia Workers' Compensation Insurance Aflidai-it: BuildersiContractors,,Electricians/PIL bers Dr)licant Information Please Print Lesibly Naine(Businessor?ani2a^on/Individualj: T� .ddress: Al City/StateiZip:( (4 A 0 1 Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I ate:a employer with *• ❑ I am a general contractor anal I * have hired the sub-contractors 6. ❑New construction �Ioyees (foil and/or part-time). � _/ Z I am a sole proprietor or partner- listed on the attached sheet. 7. emodeliiig Erayself hi and have no'employees These sub-contractors have S. ❑Demolition lno for me in any capacity. employees and have workers' 9 ❑Building addition workers' comp.insurance comp. insurance.* red.] 5. ❑ We are a corporation and its 10.❑EIectricaI repairs or additions homeowner doing all work officers have exercised their I L Plumbing repairs or additions - o workers' co right of exemption per MGL _ 12_D.Roofrepairs nce required.] t c. 152, S 1(4), and we have no employees. [-No workers' 13.❑ Other to=.ine z ce required.] *Any applicant that checks box'I rmst also 5111 out the section below showing their workers'compe nsanon policy information. Homeowners who subrn t this affidavii indicating they are doing all won.:and then hire outside cont:actors ust subrit a new afrdavit indicating suc . Conner=ors that check this box must attached an additional sheet snowing the name of the sub-con=tor and state whether or not tlsose e:�rities nave cnmloyees. If the sub-contractors have e:rrployees,they rmst provide their workers'ccrrp.policy number_ I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy andjob site information. Insurance Cotrpany Name: Policy#or Self-ins.Lic. ;r: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 2f'A of MGL c. 152 can lead to the imposition of criminal penalties of a Er--up to $1;500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of I vestigations of the DL- for ins=anrce coverage verification. I do liereby certi�fv under thepains and penalties of perjury thar the information pro-iided above is true and correci S;_ma Date J �;1rcral rose or.! . Do,nor write i:n this area, ro be compered by car✓or town a fzciaL i i City or Town: Per-mit'License Issuin-Authority(circle one): 1.Board of Health 2. a ld:n g Depart:tent 3. CI-L;/Town Cler'K -.EIectrical inspector =. P:ul:bang Inspector i 5. Oz per Phone SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �.. . �_ G S a License Number 2,Z 75 N1 O"'Q S1- ,5 2609 Address Expiration Date �.-•� �___S r_- s� 4113 . 2.Z►- -7141A Signature Telephone 9.Registered Home Improvement Contractor: Not^Applicable ❑ &I (-.�; v Company Name Registration Number Address �f Z -r T Expiration Date 2cf0 K&W ST..• QS Jm Telephone X13'22i��41q --r SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.152,§26C(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 of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ 11. - Home Owner Exemption 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 buildine 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all awlicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [CJ Siding[t-3] Other[a Brief Description of Proposed p,C�s W ork: k' t7l t'R'm- A Ar'CIr G 64 t ET s $ CT U1 UMV s yP�.B-Y 0 w►+l a_ 2 Alteration of existing bedroom Yes V"'-No Adding new bedroom Yes No � / Attached Narrative Renovating unfinished basement _ Yes _�ryo Plans Attached Roll -Sheet Ba.If New house and or addition to existing housing, complete the following: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions_ e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 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 and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Si nature 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. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DONT KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'f KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ® , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO o IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 WaterNVell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans rSpecr APPLICATION TO CONSTRUCT,ALTER,REPAIR;RENOVATEOR-EkMbLdH A°ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION i 2 7 2009 1.1 Provertv Address: This section to be completed by office J �D 8 Shesietd� Map _ L It Unit (l(,r D6 2Z Zone ��Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Core 4 -Po X E L V Name(Pri Current Mailing Address: ,�... �-�►l � - �'�lo�3550 Telephone Signature 2.2 AuthorizedApent: • G��R.rt'� 2'Z 3 ba An N S. . Limos N A Na� Current Mailing Address: "13 - 2Z1 - -7 LA I) Signature Telephone SECTION 3-E§TIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building c�( ` �-� r/'0 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing �y 4wu9p, 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 ermit Number: Date g Issued: Signature: Building Commissioner/inspector of Buildings Date File#BP-2009-0716 APPLICANT/CONTACT PERSON KAREN CARTER ADDRESS/PHONE 223 Main Street Leeds (413)221-7419 Q PROPERTY LOCATION 68 SHEFFIELD LN MAP 17C PARCEL 124 001 ZONE URB000)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid Typeof Construction:_UPDATE KITCHEN CABINETS/COUNTERS&FRAME 2 DOORWAYS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 070008 3 sets of Plans/Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Commission Permit DPW Storm Water Management Demoli ' n Delay 20d Signature o Building Official 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. Slii�r LE BP-2009-0716 Gls , COMMONWEALTH OF MASSACHUSETTS :. CITY OF NORTHAMPTON Lot: ! PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pern„, Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Cttc,, BUILDING PERMIT Pc:,,I: BP-2009-0716 Proic JS-2009-001060 Est. C S10000.00 Fee: o PERMISSION IS HEREBY GRANTED TO: Const ;s: Contractor: License: Use ( KAREN CARTER 070008 Lot 1, 1. ft.): 25003.44 Owner: FOX COREY A zol ii. 1,B 100 / Applicant: KAREN CARTER AT. 68 SHEFFIELD LN ALL)/, it Achlress: Phone: Insurance: 223 11 Street (413) 221-7419 O Leec A01053 ISSUED ON:31412009 0:00:00 :' :RFORM THE FOLLOWING WORK.-UPDATE KITCHEN CABINETS/COUNTERS & FF?A 2 DOORWAYS PO JIIS CARD SO IT IS VISIBLE FROM THE STREET Ltspc of Plumbing Inspector of Wiring D.P.W. Building Inspector ulidk� end: Service: Meter: Footings: Rc ,• Rough: House# Foundation: Driveway Final: F;, Final: Rough Frame: Go,: Fire Department Fireplace/Chimney: Row- Insulation: Fi,;,,; Smoke:. Final: T1: : :RAIIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF Af N ITS RULES AND REGULATIONS. Cc ie o OCCupancy Signature: Fvc , Date Paid: Amount: Bi 3/4/2009 0:00:00 $60.002118 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo