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17A-147 (3) +413-744-4331 1 MASSMUTUnL CORP TAX 974 P02 UU1 dej U'( r LISIG rim arolesk is lowd a a matter of infemutim GnIY U-6 woft"son rigbos upw Ow makabe 7IxokW- Tbb w46AV,4D- I'hc Uimbw Industries Self-IfAUM4 GrmWTMM vist awma,exteni! or alter IbecoverMe Offbw*d by ft 1110116:ie-� PO Aux 3773 (.:Oncord,Nit 03302-1773 Mark post ccunpanles Affbirding Covem9e i r'M woodwarl&s&luc. 163 KingOM RMd COMA"A Thnvilic,NH 03919 LrnmR COWANY 8 Safety N260M)CASUSILY Cory, i IN41 prAiCy is effeCbVt ML 12'.01 ILM, On JIV2007, and Will expire at 11:59 pan. on JM112007. This policy w 1 rcftwed drilco aMfied by either party by Oclobci 31 Of any find Yew. Tian i•m cauty that ft Workols'Componsation and Employer'-i UWUty Insw%ow has bftu issued ca the insated named AhGvr,for!he i-Uav poricid iftdirwmd.rAt widuAwdins any m%nileffiUM tom ew condition of any calarw or athol docment.with respm-t W whic'n tvnificalt may bv ironed or nay pramn,the insunowc: Warded by the pwicico described herein is AlIblect to all the hIrMA,lexr.,111rions t-wehiseww%of such prAiues, Policy LIMITS Type of Insorawx&)uTIor Pouty Manter EfIlldift 1&11266u . w14 gtahftvy Limits Liability 11,1-Each Accivirmt laver LT07031 January 1,2007 December 11,2007 JEI�DiseaseIV Lima'M. bWu*W SeliLlunited rwow Two FI.L DisMw-Each LMP Wwkers'Comwnsation 425.M"', SPIBIS Isnuaty 1,2007 January 1,2008 Safety NadmW Casusity CwP Em0ayW9 Li4bilitV 'AW M thmW so of the above described policies be c&ACV)'XI bcfLw !-IC itwilan dwo ftnof,the i sali"agalway will cudeftykir lei MAil, M notice to the cmificate holdw,flatter to the. kl:fl, h,;.:' flatift'-to*mil such rafic* snail itfipow no obligation to kability wV kind upon the CompallY,A1 agents Or tVW-Cnlativ0S- 3106 ANAMind ReVM"nftfi-- Dole +413-744-4331 MASSMUTUAL CORP TAX ' 974 P01 OCT 23 107 09:25 441.1 '144-4331 MRSMITURL COW TM rat CoanttaAWOdO of MMtaeAat OM Depot mt ist of Ix&ftri l,40Cm*A0 O1a(featx of Jm"I em 600 WAWIALVIOX Swet Aosftxf MA 02111 ewww�u+Rgott/d�a Worlwa• Compawitlon Lmur•mce Affidavit:HuitderdConftaMarwTJoeWicianaMiusiben tt Nun(Husinewor�misaSicxdinQivfdwl}: .1�� • Address, c sty/ : _.1 #: 3-3 • fig.`/ Are you n employer?Mettn tae apprope'inso type ofproject(regarread): i.[,] I am-r a mpiuyw with 4. [? I yam a general cautrae�oor and t e mploycoi;(full wwor part•time) have hired the sub-c Aabon 6 Q New cemstruction 2.[3 1 am a sole proprietor or por"er listed an the attached sheffil 7 [�Rearigdetietg SNP and have nn employes Then sill-votttfwetors have R. (�Deenolitiem working far mein nay cap"it'y employees and have warken, 9. Buddint addition (No wodun'camp.insurance COMP.bnsorattce. requited.) S. © We are a corporation aai its 10.n Flcctrical repairs or addidui.- 'I.[„] t sun a hterneowmw dais;all WNW officers havw exercised their 1 i.[]Plwnbiaa rain or addhxrib nsytelf.[No weultOts'comp. rivet of ex4ieesgoe per MGL 12.❑RooF rop its inato-emae required 1 f c. IS2,11(4).cold we have no t3.�Ot?ter17dR C Sfl�..� Yom•[No wadws - -- -�. eotltp.insurance Me,ired _ •Arty Mplkmffi den Chealrs bft•1 emrr dw AM GO 010 reetlon WOW sAMiNI diet M0ke'omnpt Ibft idiry ieteMlfft, 4 itOineart4ua wire autKnit tl>It tQb/AN�iodtiMt{ny Afq+see Ooina tit.vak cad Aim tore ewlM oeearoeary mwrt sMtrMf�aer sQMiwe inAiellint lt,cA 14•AAeaMn Ant kedi"loos Win 4R4OM an add UMW Shier ftWift tae Meta of Ole SabPOMMIMM aced Ask whoo/f er eat deeee cndtim hAve enytaye+rs irtn.ab•oorr~wdrr Me4K anptoy.oe.Alec 4euee e> sratpq'4isrAp patty neueloer. _:l etas�ean�eer�is jnrr�wurten'eatapestarNas�airtasct for nv�� /e4,r is atit'otky rated job sirr -_.- bisurance,C onilmy Name. �'-�•_`�'"Z' �F,. ..._._..., __._ . Policy R or Set{bas.Leer N: �L!0 70 3� . _ .__. expiratiao Dec: Job Sko Address a aU'f -..1/t 1•- � �.,city/Sta ip: Cl�-Q .... ,.,,.' 'La, Q�r�..::. Attach a e M of tke workers'e9aspee=bm policy decbtrniiou PV(showift the policy atunpar cad esprratiaa date). Failure to Vmure eowerpge ols eequiMd ueAer r+octioa 25A ofMGL e.M con Icad to flat imposition of criminal penalties of a fine up to S1,500.00 RM/or offtear imprlsot writ,a9 well as civil powtits in dte form of a STOP WORK ORDLR cad n f: of up to$290.00 a dry asabnst Ike violetMmr. tie advised that it oopy of this salty rat may be lbrwwded to the Office of lnvestigatti=of fl>:e E31A for Wurwnce covetaae verification. - I Flo dram aw preepwif A*~is*W and rvrrNf. own O we new• Do wow wrbe ks Oir v+ee,plow by 0&a tewli ¢ ti: _leroab/Liaeattu M } MOM 2.lsaildi ne DepArtuent 3,City/Town Clark 4.dlottr•tral faspectar S.Mombiny Inspector ron• � I p�P�szO QUn1 G sled � I a, /6 � � r b i i I 17A -l 7 180 i b§ N i I I asp m EF J -; SF � ,"NoJSe dtittn E� - IoSP� P b H SP j 4u�e 3T 0' 16 6' C0vc"�P` b C ItC s i rev� s T 6f\ The Commonwealth of!Y_rassachusezts 17� ,Department of Indmstiial Accidents 0j'11,ce oflnvesriga.*ians 600 Washington Street Boston,JL4 02111 �.� www.mass.gov/dig Workers" Compensation Insurance A.fiidaNit: Builders/Contractors/Electricians/Plumbers ADplieant Information Please Print Le4ibly NaMe(Business/Or�-,aniza6on/Individual): Address: City/State/Zip: Phone Are you an employer?Check the appropriate box: Type of project(required)_ 1.❑ I am a employer with 4. ❑ I am a gene.a.l contractor and I employees (full and/or part-time)-* have hired the sub-contractors ors -New construction 2.❑ I am a sole proprietor or partaer- listed on the atr ched sheet. 7. n Remodeling ship aTd have no employees These sub-contractors have S. ❑Demolition world for me in any capacity. employees and have workers' 9. ❑Building addition o workers'comp.insurance comp.insurance.+` required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions ❑ I am a homeowner doing all work officers have exercised their 11.❑Pltmmbiag repairs or additions myself. [No workers' comP_ right of exemption per MGL 12.[]Roof repairs inctTrance required.] t c. 152,§1(4),and we have no employees.[No workers' 13-❑ Other comp,in.cnrance required_] . ttIIy app scan caerxs aox anus a so out me scaon oeiow snowma ther works'corrip a on policy information. T Homeowne s who submit tins affidavit inmczrine they are dome an work and then hire outside coattacesors aids*subnut a new affidavit indicating such. tContractocs that check this box must.anached an additional she- showma the name of the sub--contractors and stare%nether ornot those entities have ezroloyees. If the sub-contractors have emplov= they tr=provide their workers'comp.policy number. I am an employer that is providing workers compensation insurance for my employees Below is the policy and job site informazzon. Insurance Company Name: Policy#or Self-ins.Lic. Expiration Date: Job Site Address: City/State/Zip: Attach a cony of the workers' compensation policy declaration pace(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Iead to the imposition of criminal penalties of a fine 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 3250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investizations of the DIA for insane.-coverage verification- 1 do hereby cert<fy under thepains andpenaldes ofperjary-than the information provided above is true and correct Date: Phone T: vfxuu use only. Vo not write rn this area,to be completed by city or town oociciaL City or Town: _ _._------ -- _-__ - -P-ermit/License f Issuing Authority(circle one): 1.Board of Health 2_Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6. Other Contact Per son: Phone.#: :sue ^) L L��J J s ,:.Y��5;�7?�?.�? 1► �_l._—^�--��Z�^, DEPARTMENT OF BUMLIHNIG LVSPEGTIOIYS lNSPECTCK 212 Main Street * Municipal Budding c Norrb,unpton, MA 01060 �-- HOME OWNER EXEMPTION ACICNOWL ED(:.'T,MEEIvT The State of Massachusetts allows the homeowner the right under 780CMR 708.33.4to act as ;.isIer construction sup- .- sor. TI he state defines "Homeowner" as, "who owns a parcel on which he/she resides or intends to be, a one or two fadwelling, attached or detached structures accessory to such use and/or farm sperson�w}ho constructs more than one home in a two-year period shall not be home O IMI er.77 The buildi -department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction vupenrior to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footinas (before back-filI). sonotube holes (before oour). a rough building inspection°(before work is co-n-cea-leda. i-asula-tion._insuection (if required)and aTi building insnection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy u die-work can--be.insbected If the homeowner hires other trades to perform work(electrical,plumbing&gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections.Failure of the individual trades to secure the permits and inspections as required can DDZAY the project until such time as the proper permits and inspections are made understand the above. (Ho a owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date tcJi Address of work location 1-2 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 9 Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'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 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 building yermiit. 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,St to and Local Zoning Laws and State of Massachusetts General Laws Annotated. C Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. Demolition ❑ New Signs [o] Decks [0 Siding[0) Other[01 Brief Description of Proposed Work: 1A)s I C a�� /�/k 16 Skeet Ciyy e�eci�/t�c �IUM�/N� 0/_1 �La Alteration of existing bedroom Yes XNo Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _ XNo Plans Attached Roll -Sheet 6a. 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 1 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. Signature of Owner Date Own Authorized Agent Areby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. i Signed under the pains and penalties of perjury. r / ��^y\Cl. - C) W Y-\vl U Print Name 3� r Signaillre of Owner/Agent Date Quick Open Space Calculations Coverages existing 2040 HOLAS( + �A2A�C Lot area existing proposed existing 480 22361 2520 2712 existing existing Open Space 19841 19649 existing total 2520 Open % 88.7% 87.9% new 192 new new total 2712 Section 4. ZONING All Information Must Be Completed. Permit Can M benied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 5 c2e s Frontage O Setbacks Front Side L: R: L: R: Lf Rear Building Height to i �J Bldg.Square Footage 9� % 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 O DONT KNOW © YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON-r KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only °ity of Northampton Status of Permit: !i . �--�; I tJilding Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability OCT 2 3 2G07 Room 100 WaterMell Availability '�• Northampton, MA 01060 Two Sets of Structural Plans L --'Phone-413-5$7-1240 Fax 413-587-1272 Plot/Site Plans „`S I Other S p ify ec A-PkICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office ,�q 56 ckeANJ S4 Map Lot Unit /vap��e A 0/0 6 OL Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Edw,N A 0 (-d/VNO(L C. Q. �-� 0�ro^iW� PaNNa aS6 e6es-�Ivj S�- �-'�uReni« fij� Ol 62 ame N Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (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 ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2008-0438 APPLICANT/CONTACT PERSON O'CONNOR EDWIN M&DEANNA L ADDRESS/PHONE 256 CHESTNUT ST FLORENCE (413)524-8102 O PROPERTY LOCATION 256 CHESTNUT ST MAP 17A PARCEL 147 001 ZONE URA 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: ERECT 12 X 16 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE F LLOWING 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 Manage ent Signature of 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. BP-2008-0438 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit# BP-2008-0438 Project# JS-2008-000648 Est. Cost: $6000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 22346.28 Owner: O'CONNOR EDWIN M&DEANNA L Zoning:URA Applicant: O'CONNOR EDWIN M & DEANNA L AT. 256 CHESTNUT ST Applicant Address: Phone: Insurance: 256 CHESTNUT ST (413) 524-8102 O FLORENCEMA01062 ISSUED ON:1012612007 0:00:00 TO PERFORM THE FOLLOWING WORK.-ERECT 12 X 16 SHED 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType• Date Paid: Amount: Building 10/26/2007 0:00:00 $25.00388 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo