07-052 (4) BP-2002-0906
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permits BP-20020906
Protect# JS-2002-1480
Est.Cost: $3300.00
Fee:$25,00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Robert Carrier Jr 059154
Lot Size(sa. B.): 34717.32 Owner: STRONG KENNETH A&LINDA E
Zoning:RR Applicant: Robert Carrier Jr
44T: 384 NORTH FARMS RD
Applicant Address: Phone: Insurance:
16 David St (413) 527-0333
SO UT HAM PTON M AO 1073 ISSUED ON:4/22102 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL CEDAR CLADBOARD ON GABLE
ENDS
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 4(22/02 0:00:00 1584 $25.00
212 Math Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
R
pr •
OFty of Northamptonontur
Budding Department � � cu
7 212 in Street eneuir i4u
o m 100
�� C-)it/pri,rin is
Northemp on, MA 01060 �i ^se na a�ar1, r
phone 4135$7.1 0 Fax 413-587.1272 r i ely arta_ k. ,c
APPLICATION TO CONSTRUCT, ALTER, REPAIR,RENOVATE OR'OHM0LISTIA ONE OR TWO FAMILY DWELLING
APR 2 '_ :1C2
SECTION 1-SITE INFORMATION -'
1.1 Property Address: -_ - )- —LTl"s� vat be comp eted by office
z 701' (ASA. R#nS PO4-4 f'(O kap : 3 � xn
Zone w; `Over)a piste ct ie•,
Elm St.District CB District_
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Rekord:
iteareatitailfe.(ley clef-areal „et airy . 1 e✓ 1 t
Name(Print) Curren. Mallin Atltlress
) 1SY 62,4.5
Telephone
Signature
2.2 AuthorizedrrAgent:
el LTA Carr( c 10 " S �l. ,. v Mc- 0r073
Namur(Pia ) Current Mailing Address:
•
Signature Telephone
SECTIONS • ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit 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 et(1 + 2 + 3 + 4 + 5) 3300. W Chock Number
This Section For Official Use Only
Building Permit Number: Date Issued: -... .....
Signature:
Building Commissioner/Inspector of Buildings 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 Special 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 there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
SECTIONa5- DEtbbRiSdNtth ROPOSED WORRK(check all applicable)
New House 0 Addition ❑ Replacement Windows Alteration(s) 0 Roofing ❑
Or Doors ❑
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding [Pr Other[ ]
Brief Description of Proposed Work: - • .Xts� - cal Feb AA'Y✓-. Yn.�Z .,. L.4 lotsE• - fZe. ut
u+t'�' 1 /diY(o CeaQr- Cie �.e✓ -
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll 0- Sheet C
601fiNrwMirdtiMMITIffadditioThttreltitithDidiftitir, complete"tfh'e€f3t1b'Sr.In :
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. Mascheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ftof 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, k nrti etil J-✓ ,u ek , as Owner of the subject property
hereby authorize n rru¢✓ _ to act on
my behalf, in a mat relative to work authorized by this building permit application.
Y-62 —Ch X
Signature of Owner
�( Date
I, Q9py,/t l la an r t P , as Owner/Authorized A t
hereby declare that the statements and information on the foregoing application are true and accurate, to e best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
(( pai
le V
Print Name
21_0.,4v , Y / 9--cD
Signature of Owner/Agent Date
•
•
SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder `izioir-f i-/rt e ✓' _ 65??/Sv
1, •
y� License Number
/ A 0 C
01,/ (. '1f Ocot/3 9--3f— 0
Add Expiration Date
}�a cd5IR ^ 333
Signature Telephone
nn
rr_� tfYdt7;s"i x .:.wr#` .'LLE,5x ). Not Applicable ❑
�3/Lrrte S' �. ., a 0 h 4( /0/1 33
Company Name 1 r ( Registration Number
(6 bszjej ch l zvff�n, i OIq- 610'73 lv 3.5=0.1
Address Expiration Date
Telephone 5',),7-0 33-51
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 B" No 0
The current exemption for`homeowners"was extended to include Owner-occupied Dwellings of one(I) 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
•
itialPi. L\
9 foo- 4`t• (Elt�T of Northampton =*==e
MAL
DEPARTMENT OF BUILDING INSPECTIONS 4 -2'1-
212 Main Street e Municipal Building
Northampton, Mass. 01060 on
/r WORKER'S COMPENSATION INSURANCE. AFFIDAVIT
I, L-ej lA ria 1 it ✓
diceaur/perminrr) _with a principal place of business/residence at:
/& 51. si .
Lie ,- a 0/073 (phone:) ) ) 7._ 0333
(street/city/nate/zip)
do hereby certify, under the pains and penalties of perjury, that.
O I am an employer providing the following workers compensation coverage for my
employees woiking on this job:
(Lvturancc Company) (Policy N'o her) (Expiration Date)
O I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following workers compensation policies:
(Name of Contractor) (Insuranco Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Issuance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Comna iy/Policy Number) (Emlrtion Date)
(euatl,aidetenil i'act hinconnary to nc2udo ufcmaiw p -t.istrog to all cvGaCen)
([/J I am a sole proprietor and have no one working for me-
( I am a home owner performing all the work myself
NOTE:plc"c be nwaee Wit while be oxeeaa whoemploy peaa:.n to de rvi2taamr,w.w:eim or:cpav Hotk m.d..tning of
not more th ro thra units in which the h.,rtsda or m LSE gnouMi apput<rvwt theco.a ox&a-aerate mnaideci to be
employ=nada the workere flim An(GL152,nl(5)),ndplimtion by n homwxw fora Lemic or pry ran en, in tits
legal ruble dm employer undertlu V./chats Compeon.tion Art
I undo-rind that a copy of this asst®w may ho fwwwied to rho Deputmmt ofleSeaid Andean.?°Moo of Lain/not for t c
COV- ge verification and tlut(inane to A-.oe mvcnge wd¢ssction 25A of MGL 152 an lad to the tmpowm ofawmil pmelties
coc irtmg ors fine al up Co S1,500.00 mllor bnprnmto one yip"metc f l civil pcaCties in of Stop Wore Ordee aod ..
fine of5100.00 a day'pima me.
For dial nue ocily
Permit Number
V ol.+v.-u�t. 17 9—n,)- Map%: Lot
i ; „Signature of LicameeJPcrmittee Date