23D-130 (4) 20 WINSLOW AVE BP-2007-0332
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D- 130 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Categoi
BUILDING PERMIT
Permit# BP-2007-0332
Project# JS-2007-000495
Est. Cost: $1200.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD DENNO 066189
Lot Size(sq.ft.): 1 1586.96 Owner: PERRAS HENRY&GLADYS POWERS&
Zoning: URB Applicant: RICHARD DENNO
Applicant Address: Phone: Insurance:
551 FLORENCE RD (413) 584-0852
FLORENCEMA01062 ISSUED ON:9/26/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT HANDICAP RAMP
POST THIS CARD SO IT IS VISIBLE FROM THE STREET BuildingInspector
Inspector of Plumbing Inspector of Wiring D.P.W. p
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: OK ro165 vb tov�41
THIS PERMIT MAY BE REVOKED BY THE Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULA ONS.
Certificate of Occupancy Signature: .,4* ,..Ve"...0-- --- °,1r*:,
FeeType: Date Paid: Amount:
Building 9/26/2006 0:00:00 $50.00382906
212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo
•
File#BP-2007-0332
APPLICANT/CONTACT PERSON RICHARD DENNO
ADDRESS/PHONE 551 FLORENCE RD FLORENCE (413)584-0852
PROPERTY LOCATION 20 WINSLOW AVE
MAP 23D PARCEL 130 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 41 f fi, it50
Fee Paid D
Typeof Construction: CONSTRUCT HANDICAP RAMP
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 066189
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO NIATION 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 Commission
0 9/ 6,06
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.
"�� Department use only
(( , a 1. of Northampton Status of Permit:
- i', l'n •
`�'—r ��! gilding Department Curb Cut/Driveway Permit
12 Main Street Sewer/Septic Availability
SU 15 2006 \Room 100 Water/Well Availability
N4-tha pton, MA 01062 Two Sets of Structural Plans
phone 41 -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
ZW/7,5-/a 4
1/
,,-• Map Lot Unit
�/ 4 4'� /��f Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/ 0/�y ��P✓/t'I v?G' et/ ../ti
Name(Print) • ( Current Mailing Address:
c , � a s-4.r Telephone
Signature 96 7/,i c
2.2 Authorized Agent: ram/ c-2 "
Sr
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
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) /Zoo `L'`) 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
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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ ,Ne_w Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: "aidi )1/ /ehdt Carp,'-A —7o4p' Apr," ; i.J
Alteration of existing bedroom Yes DC No Adding new bedroom Yes '✓ No
Attached Narrative❑ Renovating unfinished basement Yes (l No
Plans Attached Roll n - Sheet n
6a. If New house and or addition to existing housing, 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, 1l•th V ���� V ✓ J , as Owner of the subject property
hereby authorize C 1, )11 U to act on
my behalf, in all matters relative to work authorized by this building permit application.
x a'.G�..
Signature Owner Date
I, / C I C , asLummsr/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 ❑Q
Name of License Holder : /�Cl��i C% �C 2H h o (Jg K/g l
License Number
. .5 f �Ld/ct1i c v ` / /l%l Z u/r 7
Address Expiration Date
��✓I f l�G1s/ a— -`3' �l ' 13 e, 2i
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable Cl
/Ze‘Ce
Company Name Registration Number
7ei.17 6-; / ‘(
Address Expiration Dat
.czc/ /72-e/4,4iv, Telephone .s—e
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 0
11.. :Ji. nae,Owner,.Exem.ption
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
� ry
�O�Zttn1-lp�O �
,
(ttp, of Northampton ► =
otassachnsella
-d DEPARTMENT OP BUILDING INSPECTIONS 41-
212 Main Street ' Municipal Building
Northampton, Mass. 01060 r'"�
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
- enl,ci
Ncenscdpermi )
with a principal place of business/residence at:
J p /o�2.
cs-i F7.e re C.* Bess (phoned) ft- Ot S2'
(stn=t/city/statehip)
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)
( ) 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 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)
(much additional sheet ifnxeury to inaude infatmatioa pertaining to all coo a nr )
Z( 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 wl>i]o boacowncn who employ persona to do construction or repair work oo a dwelling of
not moon than throe units in which the homeowner resides or oa the groundr rppurtcnsnt thceto are oat generally 000sidcrod to be
employers under the worker's compensation Act(GL1520:3 1(5)),application by a homeowner for a license or permit may cvidmoe the
legal statue of an employer under the,Woricoh Compamatioo Ad
I understand that a copy of thu rtutcme en may be forwarded to the Dopartmoca of Industrial Amadeu&OfGoo of Irnut 000 for the
cow:raze vaifiestioa and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
000sistiag of a fine of up to S 1,500.00 andtor inprisoaman of up to one year and civil pmaltics in the form of a Stop Work Order and a
frno of S 100.00 a day against use.
For dcparemrnesl use only
Permit Number
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