23D-072 (4) 56 WARNER ST BP-2001-0420
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D-072 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: chimney rebuild BUILDING PERMIT
Permit# BP-2001-0420
Project# JS-2001-0714
Est. Cost: $2000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Andrew Church 104480
Lot Size(sq. ft.): 17990.28 Owner: CUDDY BRUCE
Zoning: URB Applicant: Andrew Church
AT: 56 WARNER ST
Applicant Address: Phone: Insurance:
174 Spring St (413) 586-0918
FLORENCEMA01062 ISSUED ON:10/20/00 0:00:00
TO PERFORM THE FOLLOWING WORK:LINE CCHIMNEY SUPUFLU CAST IN PLACE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: 0(< (D -0`7 O O .-111
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT ON OF
ANY OF ITS RULES AND REGULATIONS. /
Certificate of Occupancy `. Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/20/00 0:00:00 1751 $25.00
212 Main Street,Phone 0413)587-1240,Fax: (4+1 3)587-i 272
Building r.,r,,,,nit•sionNr-Aif a-9y Pciilli,
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City of Northampton _.
Suitding-Department _
212 Main Street
Room 1:00
Northampton, MA 01062
pborte 413,587-1240 Fax 413-587.1272 3
APPLICATION-TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY'DWELLING
) i '1 �"1,'fi�G•, ale . ;" •
3.1 Oar at%wort-
le1-Hc e �'�Lii� `j.. et)tuAuf
Name(('rant) ✓ Current Mailing Address: C7 i L
•
Telephone
grtature -
a
ZZ/WUTM fit:
1
Name(Print) Current b0ailir+g Address:
Signature Telephone
StatratAnarcONSTAVaiattifeen-
Item Estimated Cost(Dollars)to be Official.Lila Order
&amine -(411140deli Perri*F
.t 1 •1' Aar u d-: � -
2. Electrical .1#
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3. Plumbir►g —1111_64410011*00.-
4. Mechanical(HAG)
5-Fire Protection (:)-wa ,, ��r vrNr1J 1' A
6 Tata(=42 +2+3+4+5) a 1; crtbar t: i
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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 Y. 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 Pc 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:
i
LION: .`DES N O F V ohe+cl 0 eppltcable)
New House 0 Addition Ll Replacement Windows Alteration(s)❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ . Demolitions 'New Signs . I Decks [ }I Siding[ p} Other
Brief Description of Proposed Work: /- -ne c1 .. S,,,JJOp1//' �1���`'�'�
Alteration of existing bedroom Yes No Adding new bedroom Yes !e No
Attached Narrative 0 Renovating unfinished basement Yes ik No
Plans Attached Roll -Sheet CI
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 Errergy 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 weft City wafer Supply
41-r1' :e4**4t. ::t'ttWr*cSitaot:HO4r:*itarzfgtOpMfij:1-,,,yoigN .
I1, ..-f)yt'V 'J A , as Owner of the subject property
hereby authorize to act on
my behalf utter r ative to work aut rortze-cf try this building permit application,1.
nature of Owner Date l
, 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 un r the Gain perrltje of p
Gt
Print N Ct//L - {�
Signa ure of Owner/Agent Date
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a 1 icenaeA r_nnstrnctinp Supervisor Not Applicable 0
Name el Lican's bolder Andrew Church DM Chimney Saver 040943____
License Number j.
174 Spring St Florence Ma 01-062 _L1.0z.2.002. _
Address Exoiratior Date
41 3--586 O9t-8-
Signat referMo re
: u R�r ... . = . .m: : ` Not Applicable LT-
Andrew Church DBA Chimney ney Saver 104480
C.pmpanviilame Registration Number
174 Spring-St Florence Ma 01462 7-1-2002 -
Address Expiration-Oats
Teigjxhans_ 4 f 3-586-0918 _
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 tic No 0
The current exemption for"homeowners"was extended to include Owner-occupied Dweilipv 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 78p. Sixth Edition Section tO&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 moreJhan one home in a two-year period entail 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 workperfornted under the balloting permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,doing 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)ofthe Massachusetts General Laws Annotated,you may be liable for persons)
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
.0tiAHpp,
,� ��y! Gift? of �iart[�alitpfn11 >I
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1 J�F• \ C^f F Pisaachasitte
DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street ' _Municipal Building
Northampton, Mass. 01060 ow
WORKER'S WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I Andrew Chirch
(Iic nsee/permirtec)
with a principal place of business/residence at:
174 Spring St Florence Ma 01062 (phone#) 413-586-0918
(suttt/clty/statehip)
do hereby certifyt-under the pains.andpenaities..of.petjtuy, that.
( ) I am an employer providing the following.worker's compensation coverage for my
employees working on this job:
(insurance Company) (Policy Narnbrr) (Expiration Date)
i ( ) 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:
(Name of Contactor) (Insurance Company/Policy..Number) (Expirauon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contracts:) a nsuran=Cnmpaoy/Policy Nun'b-r) (Expiration Date)
(Name of Contractor) (Insurance Company/Paticy Nurnher) (Expiration Dale)
Wools additional Meet if accessary to induce information pertaining to all comments)
(X) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself
NOTE:please be aware that while homeowners rs who employ pasont m do nmamao o onnnuCion a Matta work on L dwcitieg of
oar move than three units in which:the bomoowoer rides or oa the Lezuah appurtenant thereto are not gmrraty aowidcted to be
employers under the worker's occopeescalion Act(GLI52,n l(5)),application by*boesoowoer fax a hoe=a permit may evidence the
tegsl status of an.a>ptoyar*odor the Woheh Cempeptatjen Act.
• I understand that a copy of thin ebueoaem may ba forwarded to the Department of Inmisrial A 4e. .?Otfioo of laesnme for the
coverage vet ifitttioo sad that failure to secure coverage under sotsion 25 A of MOL 152 can Ind to the impasdiaa of aitoinsl penalties
consisting of a Erne of up to S t,S00,00 uetdlor isapraoamcc of up to ore yeuraod tits peonies is the form of*Stop Wort Ord r and a
fuss 015100.00 a day apical me
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For cep. meew son ody
Permit Number _ fl
ignature of Licensce/Pcrmitttx "— �-