23D-113 (2) 200A FEDERAL ST BP-2003-0479
GIS#: COMMONWEALTH OF MASSACHUSETTS
iMap:Block:23D- 113 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2003-0479
Project# JS-2003-0799
Est. Cost: $5000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor_
Lot Size(sq. ft.): 85377.60 Owner: COMEAU JEANNE
Zoning:URB Applicant: COMEAU JEANNE
AT: 200A FEDERAL ST
Applicant Address: Phone: Insurance:
5 ORCHARD ST (413) 586-3344 ()
NORTHAMPTONMA01060-2324 ISSUED ON:11/14/02 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE PLASTER W/DRYWALL, INSTALL
WINDOWS & INSULATE WHERE NEEDED
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 Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 11/14/02 0:00:00 97 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2003-0479
APPLICANT/CONTACT PERSON COMEAU JEANNE
ADDRESS/PHONE 5 ORCHARD ST (413) 586-3344 O
PROPERTY LOCATION 200A FEDERAL ST
MAP 23D PARCEL 113 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 97 _
Fee Paidzycfej
Typeof Construction: REPLACE PLASTER W/DRYWALL,INSTALL WINDOWS&INSULATE WHERE
NEEDED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9 MATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With 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 'ssion
�// Z70L�
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.
.
� � c; e i`-� I of Northampton status;ot P3ermltir - y +x a. ( , *. r4.
i ing Department Curb Cut/D'ivewa -•er t ,_ ' '"' d•:L :��� , :
. ,.-;, nr--\ 2 Main Street Sewer/Septtc,A atlab.i ty g ' .`,41`,Y ,F„ „; .
N0V - 7 Nut l . Room 100 WateriWell Aga P ity i tV4-
j N�rtha pton, MA 01060 Tv✓o Sets of str, c tiral�Plans + , !
DfQ^0T gu�l2-0 b 4��3-587 1240 Fax 413.587-1272 Plot/Site flans
t. _..--- Other Specify:
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: a��
This section to be completed by office
200 A Fedcra./ St. d it' Map C>22 1) Lot //3 Unit
0,, 6 a 14 Fi U!d(pO' Zonei , Overlay District
Elm St. District _ __ CB District_ _ __
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
\..ieeLii/1 e F. corned G( S d re.ha-d cSf itie rG!t�c i im t41 A-
/
Name(Print) Current Mailin Addess:
F'G ivy
Telephone
S- ure
2.2 Authorized 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 �(I — (a) Building Permit Fee
,60a ,
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) 1 5, 0 pb Check Number a A>5L — -
This Section For Official Use Only
Building Permit Number: 63 of 7 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:
•
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition 0 Replacement.Windows Alteration(s) lI Roofing 0
Or Doors ig
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: 01 lame p kasiv Iva 115 W 431 npw jig KAI( I,1Sl-a 1' rle u> u� .yld ►�l�'$o
G&li 1115 K, vn to k re flea to( .
Alteration of existing bedroom $ Yes )6 No Adding new bedroom Yes )G No
Attached Narrative D Renovating unfinished basement Yes A. No
Plans Attached Roll ❑ - Sheet D
sa."If Newthduse a`id:Or`addition to existing°housing, complete the`folloWirig:
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
;. 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
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
, 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 I
Signature of Owner/Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable D
Name of License Holder : _
License Number
Address Expiration Date
Signature Telephone
;- Registered omelinprovement Contractor:`; , Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
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 ❑ No 0
•
i awHomc O�i� e Exempt on
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 Lo on s and State of Massachusetts General Laws Annotated.
Homeowner Signature
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CJ�,c _ DEPARTMENT OP BUILDING INSPECTIONS 4 _i f=
• 212 Main Street a Municipal Building
'Northampton, Mass. 01060 ' NW'"s
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
1, ieanne (i e4 L4
(licensedpermittec)
with a principal place of business/residence at:
,;2 bD ii rbra / / 7/are/lGC,10It 0/06)2(phone#) 6—F6 -3.391
(sti txt/ci ty/stalehi p)
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:
- (Insurance Company) (Policy Number) (Expiration Date)
0 I am a sole proprietor, general contractor or K� .�,�. " cle one) and have hired
the contractors listed below who have the following wor eras compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date)
(anach additional sheet ifnrrrt a ,to include information pertaining to all cc radors)
( ) I am a sole proprietor and have no one working for me.
(Xf I am a home owner performing all the work myself.
NOTE:please be aware that whim homeowners who ernploy pro ors to do-m.1. ..,:1:1112Cr,wrrSrudion cr rt,kir work on a dwelling of
not mace than throe unite in which the bomoowner resides cc oo the grounds appurtc:cat thcr .o are not Bally coatidcrcd to be
employers under the worker's ccenpensatioa Act(GL152,ss 1(5)),applimtion by a homeowner r for a license or permit may evidence the
legal ctatua of an employe<under the Work-nee Cornpewation Art.
I understand that a copy of this rtatemmt may bo forwarded to tbo Depart-lent of Inehut ial Anci.ta.rce moo of Iaw aocc for the
coverage vaificstioo and that failure to sxure coverago uadx section 25A of A(OL 152 can lead to the imposition of criminal penalties
oomisting of a fine of up to S 1,500.00 an& t�or imprisoomc of up to ore yt tr and civil prolific in the form of a Stop Weft order Ind a _
fine of 5100.00 a day against tux.
��y
for dear
��/b/0 Z map'tt Number Lot 4
4 Signature of LiccnseeJPermittce I )te L i