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17D-049 (4) 7T O 0 V L g 0C L :saxcflnsrtla m P AR NT OP BUILDING INSPECTIONS OEN Rtp0,1ploN,IMAO 06 am Street Municipal Building Northampton, Mass. 01060 ' WORYCER'S COMPENSATION INSURANCE Ali t AAVIT Nl-�ttce) with a principal place of business/residence at: 01 Lx Nix �1'1Y" "(phone#) (strr..,t1 ty/stn d2ip) 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: (Inw=ce Company) (Policy Number) (Expiration D=) ( ) 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'. Vj U ULJ��-�C,tC�c 'S +�L ��L l ,�" �Q 7 , 1 (Name of Contractor) (lnsurancc Compary/policy umber) (Expiration Date) 5 a L-1 �,IAA— 600S? 4." (Name of Contractor) (Insurance Company olicy Number) (Expimdon Date) (Name of Contractor) (Insurance Company/Policy Number) (Ex-pim6on Date) (Name of Contractor) (Insurance Company/Poky Number) (E)piration Date) (atta.rh additioml rbcct ifmocu to incJudc idwmutioo percaiaing to all 000jxn.dorz) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:pleaac be awut that whilo homcoKnm wfio caplay persow w do •imm,acc 0=st ioa or repair work on a dwelling of not morn than throa units in wb3ch the homoowocr rpidcs or ea tb.o VmLad3 ippiutenant tbeccto ere not gcna lly ooandcrcd to be cmployera under the worker`s compcmeica Art(GI-152,s 1(5)),applimtioa by a homcowncr far a liococ or permit tray cvidcnoo the lepi etaw o£an omployec underthn Workceg coav-c ion Act I understand dm&x oopy of thu rrit®ms may bo forvnuded to tho Dcpartmcat of Indtutrid Aoadc&OfSoo of fusuusnoo for dw coverige verification and that fad=to&==covcrago under socuon 25A of MOL 152=lad to the imposition of crimind pa>attia oomisting of a fine of up to S1,500.00 and/or imprison of tip to one Yar and civil panlGa is the form of a Stop Work Order and a firm oC5100.00 a day agaitut tnc. For do —oaty � permit Number ® w4Mao IAt# signature ofLiccnsccfPcrmittcc __ _ _ ......_. _ __. ... _ . ... ..__ 1111 SECTION:B. ..._ SECTION 8 ... ........... _ 1111 . .............. ... ..... 8.1 Licensed Construction Supervisor: Not Applicable ❑ C7 Name of License Holder: _ -----___---- ----- A— License Number LO ------------------------------ �� -? ------------ Address Expiration Date --------- -- ---- --------+1.5--- _` IZU, Signature Telephone .........e...p........e..r..e......l......t......:.'..I.t.r..l....t.e..i......t...l.e..t..t.:..::._.:....p....t...........a...r.::..»..:<.:.>.::.>.;<.:.>.:«..:.;<.:.>..::.....:............>:>....:...:...>...:...>...:...>...:...>...:...>...:...:...>...:...>...:...»... :1<.:..<....>...:..<....»......:...»...:..>::::: ::::. : : : . :>>.:. : < ........:.:..:.:.....:...:<....:..:.:..>...:.«..... .: . Not Applicable ..........................................».............. .............. Company Name Registration Number ------------ Address Expiration Date ---------- ----Telephon _ J U ZZ .. . ...__........ ...1111.. _......... SECT[ON 1D-?4WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L:c. 15 §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 buildigg permit. Signed Affidavit Attached Yes....... No...... ❑ ......... .................................................................................................... .................................................................................................... .................................................................................................... .... :;;:;::<:>:<:::>:<_:>11 11>::;;:;;:>::>: >:.... .........>:>:> 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 SECT ON S-DESCRIPTION.GF PROPOSED:WORK icheck all applicable} New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding( ] Other[ ] Brief Description of Proposed Work: Y4kGN qer U CC , Auk `S F-t cYt P DC3 yi'- Alteration of existing bedroom Yes o Adding new bedroom_--_____Yes _!'"____ Attached Narrative Renovating unfinished basement -------Yes ---�,l11O Plans Attached Roll - eet :#;: a. Use of building : One Family-_- A e-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 constructi n. Dimensions--------------------------- _____ e. Number of stories? f. Method of heating?------—_______ _ Fireplaces or Woodstoves------- -_Number of each------ g. Energy Conservation Compliance.___ ________________Mascheck Energy Compliance form attached? h. Type of construction______________ i. Is construction within 100 ft.of wetlan ?______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 A JITHORIZATION-T4 5E COMPLETED WREN OWCJERS AGENT»R C©NT,RACTOI APPLIES FOR BUILDING PERMIT . .... . .. l /�' ___-- 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 V0VW-,9-kC f V`X,(� ,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 ains and penalties of perjury. Print Name ------------------- --------------- -------------------- --------------------- L> c> _ -L 4 al--------------------------- 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 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 Speci 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 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT 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 an signs exist on the property? YES NO Y g IF YES, describe size, type and location: __-- D. Are there any proposed changes to or additions of signs intended for the property?YES--- No IF YES, describe size, type and location: "PTA :::E.::: :::::::::::.:::::::::: .::.::::._:::::::::::::::::::::.::::::. of Northampton € :v.::::sre >.:::::::::::::::::::::::::::::::::::.::::::::::::::::::::::::::::::::::::::::::::::::. Y P ldin Department <> _ > »<>> >«« > < «« .. 12 Main Street E........................ :...w..... r,:.. . < M. .. Room 100am ton MA 01060 3`;b i t r > > < < >>`> > > >> « ' >' >»>` >_ ...-127 7 1240 Fax 413 587 2 .::.;:.>�?.::.::.::;�:::::.�::M.w..�::...�::..�.::.;:.>:.>:.>:.>:.;:.;;:.>::.;:.::.>:.;;;;::>:::;::<.;:.;;>:.;:.>:.;;>;;:,:.;:;.;:.;:. APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING £G7CON 1-SiT.�ANFORMATIDN 1.1 Proaerty Address: T# ikio»t�:ti�::�arnp# # d b... TC >« > ' p.m .i; � � r1 2 4t1s .. �sSt 1 to (o 2-PROPERTY OWN£RSHIP/AUTf ORIZED AGENT ............... 2.1 Owner of Record: C �j —TA--- '�---A"'1`?---VV"-- ----J I.L?�'ll� ----L?& c-` -r tA-i r&v K-�—���2EN CAL- Name(Pr t) Current Mailing Address: ----------------+A3 _S�7- -04-1S- ----- ---- —� �� -- ------------------------- Telephone Signature 2.2 Authorized Agent: ----- 4�` ------- --` �---SI�t��C ��- f Name(Pri Current Mailing Address: 413 _ cL 12Z -------- -- -------------- ------------------------- ---------------------------------------------- Signature Telephone SECTION 3 ::ESTtMATEOZONSTR:1CTION COSTS Item Estimated Cost(Dollars)to be Oiiiciat Use only completed b permit applicant 1. Building {a)Btxiiding Permit Fee 2. Electrical (b)Estimated Tots!Cast of • Construction from 6x 3. Plumbing Building Permit Fee C1-4 cx) . 4. Mechanical(HVAC) Z- 5. Fire Protection 6. Total=(1 +2+3+4+5) Z C;) Cheek Numt�er This Sectlon for Officiat Use Onl building Permit Numlaer:__w w_ `a _ Date -- w w Issued: Signature: -- ------ Building GomlY3is&QnCr/ln&peCtar of Buildings Date File#BP-2002-0365 APPLICANT/CONTACT PERSON Robert Walker ADDRESS/PHONE 36 Service Center (413)584-1224 PROPERTY LOCATION 88 STRAW AVE MAP 17D PARCEL 049 001 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: KITCAN REMODEL,ADD 1 ST FLR BATH WITHIN EXISTING New Construction Non Structural interior renovations Addition to Existing AccessoKy Structure Building Plans Included: Owner/Statement or License 034783 3 sets of Plans/Plot Plan THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,PMATION PRESENTED: pproved Denied PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan OR Special Permit and Site Plan Major Project: Site Plan OR Special Permit and 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 s' 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-2002-0365 GIs#: COMMONWEALTH OF MASSACHUSETTS 1D=09 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:renovation BUILDING PERMIT Permit# BP-2002-0365 Project# JS-2002-0547 Est.Cost:$32000.00 Fee: $110.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Robert Walker 034783 Lot Size(sq.ft.): 8581 .32 Owner: SWANN ROBERT P&ANN MARIE Zoning_URB Applicant: Robert Walker AT. 88 STRAW AVE Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:10 15101 0:00:00 TO PERFORM THE FOLLOWING WORK.KITCHEN REMODEL, ADD 1 ST FLR BATH WITHIN EXISTING 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 sienature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/5/010:00:00 1092 $110.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo „ , . .. k �r...r.:„:M } „•'x>, ct ,t„r• ;-:'. ..r. ,,. T _..:.. .> -5 F'"-a_..x "n`-.. ,_:.� S ....� xf. L "Y •M a � 5' e':` 5 ,a r, -n.,..r. ”. ...?w'...'' s3�,.,. #;, ...:.�. ...,r.,.. .,. P- :...» ,< :., .r. , , ,�.::. ,.•°.v s r�§ .n: ''' _. 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Const.Class: Contractor: Licenser Use Grou, Robert Walker 034783 Lot Sim(n.fo: 8581 .32 Uwner: SWANN ROBERT P&ANN MARIE zoning:URB Applicant: Robert Walker AP 88 STRAW AVE ApplicantAddress: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAM PTO NMA01060 ISSUED ON.10 15 1010:00:00 TO PERFORM THE FOLLOWING WORK.-KITCHEN REMODEL, ADD 1 ST FLR BATH WITHIN EXISTING 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: l �,y�y�, 1 House# Foundation: Y"' Drivewa Final: Final:f Final:/ 2 3)a�) Rough FramexO/z 8—.,7,3-6r � I Gas: Fire Department Fireplace/Chimney: _ Rough: Oil: Insulation: Final: Smoke: Final: ©k THIS PERMIT MAY BE REVOKED BY THE CITY OF ORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. - ' Certificate of Occupancy si nature. Fee Type: Receint No: Date Paid: Check No: Amount: 4 Building 10151010:00:00 1092 $110.00 f I 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo