Loading...
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 1 Q.1twfP2 o' o � (!irt al Nn t!ianpfhn s __; -a jffl r, V..T1B gasaarhnsrtta la _ •�_ 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