Loading...
23D-091 (3) 171 FEDERAL ST BP-2001-0994 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D-091 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2001-0994 Project# JS-2001-1788 Est.Cost: $2500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Ronald Mistarka 118693 Lot Size(sq. ft.): 23609.52 Owner: BYROM HENRY G&RITA A Zoning: URB Applicant: Ronald Mistarka AT: 171 FEDERAL ST Applicant Address: Phone: Insurance: P 0 Box 205 (413) 584-5140 NORTHAMPTONMA01061 ISSUED ON:6/4/01 0:00:00 TO PERFORM THE FOLLOWING WORK:STR I P & SHINGLE ROOF 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: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 6/4/01 0:00:00 800 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability_ ____ Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION 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 / ea ef,/ki r ,I Map Lot Unit r,/U I k7. / Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: , , C . cl, Po , /7/ -Q4 ef/fi Name(P int) � Curre ling Address: �lGv. U/O(0 2-- Telephone ignature cS7�Q-39 2- 2.2 Auth ized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee r-- 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 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 l 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: SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing d„.-- Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: 61-0 r� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative o Renovating unfinished basement _Yes No Plans Attached Roll ❑ • Sheet❑ Oa, I � +ru� �" !tlitfo Y-` ghousing, 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. Mascheck 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 I, / A../ , as Owner of the subject property hereby authorize leo/kJ /€f/4 i-Ai4 to act on my behalf, i all matteative ork authorized by this building per it ap lication. Signature of 0 Date , 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. Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: &fig 6'7/ 5 .&(71 �-, 9‘ ( �..3 /� } A / License Number //-✓\ ` �� I v y r f //d G'/_ Address Expiration Date c4 /24/t — "1c/ Signature Telephone 1- at Itt Not Applicable 0 rf & (o / �� it' s' 3 Company Name Registration Number tt 71—/ 0°_3 ddress Expiration Date Telephone S 77 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 0 No AlQ 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 • 0 tt/0-f p,. • °ti (rift of Northampton I. Vii/,tr f145sncltncctla' DEPARTMENT OP BUILDING INSPECTIONS 212 Main Street ' Municipal Building • Northampton, Mass. 010G0 WORKER'S COMPENSATION INSURANCE AFI"D)AVIT • (li ccuscdpermi ttec) with a principal place of business/residet(cc al: (phone:') (sar-f/city/stale zip) 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 worlOng on 11is job. (lnsur;nt~ Company) • (Polio:Nu abcr) (r —pinion Dale) ( ) I am a sole proprietor, general contractor or homeowner (cifce one) and have hired the contractors listed below who have the following worker's compensadon policies: (Name of Co tractor) (insurance Company/ 0UC{ Num:cC:1 (-rlirdtionDate)• (Name of Coo tractor) (lns-,uancc Company Po!icy Nurncrr) (Ex-pir:i on Date) • (Name of Conn-acto,) (Insurance Company/Policy Number) (Expiration Date) (Name of Coatz-actor) (Iilsurarncv Company/Policy Number) (Expiration Data) (ettada ab iocil r'.uci ifn....—s.ry to,nduck inform...00 pctaining to.n ooa>acon) ^Lam a sole proprietor and have no one worfdng for me. ( ) I am.a home owner performing all the work myself. • NOTE:p-icz cc be ea-uc the.Mt.Ijo�0C0cc0WOCCT3 wbo� c iploy�lpG ctai._t1o_lSJ n-n NlY coo a rcpau Wort oo.d.•<i ing of ont moon tb-cm tam vc=it,in ll�cb'be bomoor oc R71U0 oc OO thn g)ouodi appurtcnara tb o LT we ccxrnAy oeer:d&cd o be cci ployct t,rV the v.-cc-keel ocrpcsatioo Act(GL152sa 1(5)),npplitation by•bomooa' for:Anna":oc permit to:y cvidcooc the Iegil rtanu of an ex9loy -under tho Wock.olr Cocopomaiioa Ad_ I uodustaad theta Dopy of this etatemmt may be forwarded to tbo Dopsrtmast of lndutrid Aradec 'Olrloo of Irwrrooa for the °Overige verification and tlt_t f-dime to'Deane boverage under souioa 25 A of MOL 152 can lcsd w the imposition of criminal pcnsltics oomisting of■floc of up to S 1)00.00.nd/or imprisocancc1 of up to occ year end civil pciutio io the form of.Stop Work Ordrr and a fino of 5100.00 s thy.print me For dep.rtm —s..l use only Permit Number lviapg Lot t lgnatun:of Li crmiucc e .1