24D-292F _ _
o61'
REFRAME WALL: ci Z
—INSTALL 51MP50N
SHEAR YiAL.L BRAI j' N 9
PANELS AND LU
STRUCTURAL LVL
HEADER PER. FINAL 0)w m W
MANUFACTURER/SUPPLIE w �o
0<212
K CALCULATION AND a
SPECIFICATIONS
: '. 0 .
-FRvWr. N&% OPENING -. Ix
FOR N&4 OVEREAS7
DOOR T'-6" X 10"-0"
._'•. s t
—FRAME NEW OPENING
FOR NEW 5'-0" X 6'-8"
HINGED DOOR O w
—VERIFY PRIOR TO
CONSTRUCTION: "' g
FINAL SIZE OF
OVERHEAD DOOR, LVL,O
AND 5HMAA BRACING w a
PANEL SIZING v c g
CL
`p04O v -
NEW 6" THICK FOUNDATION *.`4i �: 09D8.24WALL AND 5" X 16"
FOOTING. BOTTOM OF 46.
FOOTING MIN. 4 BELOWfir
FINISH GRADE
i
! 2'6" 10'-0" 2'0" 3-0"
4 18'-0"
z
SFEET NAME
FRAMING
DIAGRAM
SOUTH ELEVATION EETNUMBER
1 SCALE: 3/8" = 1'-0" SIC '
10/27/2008 11:00 FAX 773 0896 FCCIP 2006/006
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA, 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plunn
Name (Business/Organization/Individual):
Address
City/StaWzip:�jzi�,!P�i (� I t h% ►"� (�1 Phone #: U l L
Are yo an employer? Check the appropriate
box:
1, 7m an employer with
4. ❑ 1 am a general contractor and I
Employees (full and/or part-time)*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. t
Ship and have no employees
These sub -contractors have
Working for me in any capacity.
- workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
C. 152, § 1(4), and we have no
insurance required.]t
employees. [No workers'
comp, insurance required.]
0
Type of project (requir
d):
6.
Cl New Construct;
n
7,
p Remodeling
8.
O Demolition
9,
O Building Additic
n
10.
O Electrical repair
or
11.
❑Pl bing repair
or
12,
oof repairs
13.
a Other �
" Any applicant that checks box 41 must also fill out the scction below showing their workers' compcnsation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating
t Contractors that chock this box must attach an additional sheet showing the name of the Sub -contractors and their workers'
1' am an employer that is providing workers' compensation insurance for my employees. Below is the policy and Job
Insurance Company Name; AJ, M 1.1 nyTo -
Policy #, or Self -ins. lemic. ``#: W`M Z 000 '� 7 7d 1 2_tXl� >�'ntion Date:
Job Site Address: /l0 �r�514 n, City/State/Zip
Attach a copy of the workers' compensation policy decia ation page (showing the policy number and expiration
Failure to secure coverage as required under Section 25A of MGT. C. 152 can lead to the imposition of criminal penalties qf a fine uo to
$ l ,500.00 and /or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of u to $250. 0 a
day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of theIA for
insurance coverage verification.
I do hereby ce tfy der the
Signature
Phone #:
that the information provided above is true and correct.
_3QL
Official use only. Do not write in this area, to be completed by city of town afoetal.
City or Town:___ .
Issuing Authority (circle one):
1. Board of Health 2, Building Department
6. Other
Contact Person:
Permit/License
3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Insp
k,
Phone #:
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicablel
New House ❑
Addition ❑
Replacement Windows Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. ❑
Demolition ❑
New Signs [❑] Decks [[] Siding [❑] Other[E31
Brief Description of Proposed (� ,
Work: -' ly &O � Y`21 wl P :J d� C OPI A `�
Alteration of existing bedroom Yes ✓No Adding n bedroom Yes No
Attached Narrative Renovating unfinished basement
Plans Attached Roll - Sheet
6a. if Newhouse and or add s° exististg housing. complete the w"'aW' :
a. Use of building: One Family Two Family Other /
b. Number of rooms in each family unit Number of Bathroom
c. Is there a garage attached? 1 j
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? /
7
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Z Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. etlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or ar floor below finished grade
k. Will building conf m 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
as Owner of the subject
property
hereby authorize r v
to act on m in all matters rela ' work a orized by this building permit application.
S nature o Date
I, Ja 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.
TV
Print Name
Signature of Own Agent Date
Section 4. ZONING
All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
I I Ibis column to be filled in by
� #ufPu6jue8oucea
(volume & Location)
A. Has a Special. Permit/Variance/ Finding er been issued for/on the site?
IF YES, date issued:.
IF YES: Was the permit recorded at t e Registry of Deeds?
IF YES: enter Book Page and/or Document #'
-
B. Does the site containbrook, dy of water or wetlands? NO 0 DON'T KNOW 0 YES
IF YES, has a permit been need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist
IF YES, describe siz type and Location:
D. Are there any propo changes to or additions of signs intended for the property ? YES 0 NO 0
IF YES, describe ize, type and location:
E. Will the constructi n activity disturb (clearing, gradingon, urfilling) over 1 acre oris itpart ofacommon plan
that will disturb 1oure? YES� �� � NO K ��3
|F YES. dhen modhampton Storm Water Management Permit from the DPW \o required.
SECTION I - SITE INFORMATION
N'
Cfty'of Northampton
1.1 Property Address:
BL'ildi Department
R-0
ain Street
sk
om 100
o 0(
ofthampton, MA 01060
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
phorto 413-587-1240 Fax 413-587-1272
2.1 Owner of Record:
xf
Name (Prin
'APRL16ATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I - SITE INFORMATION
1.1 Property Address:
This section to be completed by office
17.2
Map Lot Unit
4cv\
Zone Overlay District
Elm St. District CS District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
"7
Name (Prin
Current Mailing Address:
-
Telephone
Si
2.2 Authorized Aaent:
70� VL Lex-,,qh�
rik �/t4,
Name (Print)
Current Mailing Address:
Y/ ? - "?-0 y
Signaturev
Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollars) to be
Official Use Only
completed by permit applicant
1. Building
r,
(a) Building Pennit Fee
2. Electrical
(b) Estimated Total Cost of
Construction from (6)
3. Plumbing
Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total= 0 +2+3+4+5)
OriO
Check Number 771-79"
This Section For Official Use Only
Building Permit Number:
Date
Issued:
Signature."
Building Commissioner/Inspector of Buildings
Date
File # BP -2010-0325
APPLICANT/CONTACT PERSON JOHN LANDRY
ADDRESS/PHONE 104 NORTH ELM ST NORTHAMPTON (413) 204-9880
PROPERTY LOCATION 152 CRESCENT ST
MAP 24D PARCEL 292 001 ZONE URB(100)//
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Typeof Construction: STRIP & SHINGLE GARAGE ROOF & FRAME NEW GARAGE DOOR OPENING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 093450
3 sets of Plans / Plot Plan
THE F LOWING 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
Major Project: Site Plan AND/OR
ZONING BOARD PERMIT REQUIRED UNDER:
Finding Special Permit
Special Permit With Site Plan
Special Permit With Site Plan
Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW
Septic Approval Board of Health
Water Availability Sewer Availability
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
Demolition Delay
Signature of Building O ficial 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.
152 ."
BP -2010-0325
GIs #: COMMONWEALTH OF MASSACHUSETTS
"44 4 0" CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
CategorX_
Pernut # BP -2010-0325
Project # JS -2010-000434
Est. Cost: $5000.00
BUILDING PERMIT
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN LANDRY 093450
Lot Size(sq. ft.): 4965.84 Owner: CHAPUT CHRISTOPHER R
Zoning: URB(100) / Applicant: JOHN LANDRY
AT. 152 CRESCENT ST
Applicant Address: Phone: Insurance:
104 NORTH ELM ST (413)204-9880 WC
NORTHAMPTON MAO 1060 ISSUED ON: 11/6/2009 0.00:00
TO PERFORM THE FOLLOWING WORK. -STRIP & SHINGLE GARAGE ROOF & FRAME
NEW GARAGE DOOR OPENING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W.
Underground: Service: Meter:
Rough: Rough: House #
Driveway Final:
Final: Final:
Gas: Fire Department
Rough: Oil:
Final: Smoke:
Building Inspector
Footings:
Foundation:
Rough Frame:
Fireplace/Chimney:
Insulation:
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 11/6/2009 0:00:00 $55.00
212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272
Building Commissioner - Anthony Patillo