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23D-187 (3) • .VAST. , BP-2004-1089 GIS#: COMMONWEALTH OF MASSACHUSETTS tom. CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-1089 Project# JS-2004-1624 Est.Cost: $3000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): 8058.60 Owner: ERLANDSON MARCIE J&MYLA O'CONNOR Zoning:URB Applicant: ERLANDSON MARCIE J & MYLA O'CONNOR AT: 91 HINCKLEY ST Applicant Address: Phone: Insurance: 91 HINCKLEY ST Q 585-1684 O FLORENCEMA01062 ISSUED ON:5/10/04 0:00:00 TO PERFORM THE FOLLOWING WORK:ENLARGE EXISTING DECK 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: FeeType: Receipt No: Date Paid: Check No: Amount: Building 5/10/04 0:00:00 MO $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2004-1089 APPLICANT/CONTACT PERSON ERLANDSON MARCIE J&MYLA O'CONNOR ADDRESS/PHONE 91 HINCKLEY ST FLORENCE ()585-1684() PROPERTY LOCATION 91 HINCKLEY ST MAP 23D PARCEL 187 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out A D �0 ......_ Fee Paid Typeof Construction: ENLARGE EXISTING DECK 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 F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 C 'ssion Signature of Building Official Dat 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 City of Northampton Status of Permit: Building Department Curb Cut/priveway 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 413-587-127- ` ' lot/Site Plans ?ther Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ti SECTION 1-SITE INFORMATION 1.1 Property Address: This section to be completed by office i ( l i✓l c ice�le i Map r Lot / ' Unit r• Zone f / Overlay District Elm St.District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Maxi"C:1 a fir (yi Czy+ = c ct. o►1-e • Name nnt) � �(6-nriteigiatone Current Mailing Address: S lure 6 [� / �+/� 2.2 Authorized Agent: V C7 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 5000 2. Electrical l(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 7/5 5-6 " This Section For Official Use Only Building Permit Number: &P.Og/ Or9 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date _ i 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 oa Lot Size 77,5 , /by _ Frontage I / Setbacks Front £l' c 01 )÷- en Side L: 31+' R: r L: Lb _R:627_ J S Rear CV 2- Building Height Bldg. Square Footage C 76) % Open Space Footage % (Lot area minus bldg&paved if � parking) _ ce / #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ` DONT KNOW YES IF YES, date issued: I I. IF YES: Was the permit recorded at the Registry of Deeds? N 1 0' NO DONT KNOW YES IF YES: enter Book Page and/or Document # ,e B. Does the site contain a brook, body of water or wetlands? NO VV` DONT 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: 14 ; D. Are ere any proposed changes to or additions of signs intended for the property ?YES No r IF YES, describe size, type and location: Hit • SECTIONS :DESCRIPTION-OF PROPOSED WORK(check.all applicable) ' New House 0 Addition 0 Replacement Windows Alteration(s) I Roofing 0 Or Doors 0 Accessory Bldg. 0 DemolitionD New Signs [ ] Decks [� Siding[ J Other [ J / 6 it Brief Description of Proposed Work:' 'f�i� c�. �Nris "AA. icldi -c `1' Si�� 6, `4,-- ,c ) Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0• Sheet 0 i5a' :f e—WM t se ancror :dditfon toe gningro g, EOThrlete l elfdliWirt: 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? ' )O cve ex.'eK.Te 1Gz d. Proposed Square footage of new construction. Src.,( . bimensions �' ti{ e. Number of stories? f. Method of heating? Nf 4 Fireplaces or Woodstoves t f 4_ Number of each 10/1.4 g. Energy Conservation Compliance. A) Mascheck Energy Compliance form attached? h. Type of construction Dt."-fitrt►ric.) + i. Is construction within 100 ft. of wetlands? Yes i/ No. Is construction within 100 yr. floodplain Yes Nc 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 , as Owner of the subject property hereby authorize to act or my behalf, in all matters relative to war uthorized 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. /V yla CbnritiK Print Name 1 r/14 v m Signature0 ,joy,,/a nt Date • • SECON CON • S RUGTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : License Number • Address Expiration Date Signature Telephone .e: ea oiri' rrror:.overeritk. ontracto - - z Not Applicable 0 Company Name Registration Number Address Expiration Date Telephone gsEGTIONIO VORKERS' COMPENSATION itSuRANCE 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 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 dwell; g,attached nr detachedstnicturss accessory to_such ust_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 Zo ing Laws and State of Massachusetts General Laws Annotated. omeowner Signatur / (t�f f • -tttAxpTa _.° �iftJ cf ti7rflicuiipfoit its/�- 'CI6 &�cssttcllusttts' .17 t � • '���. tis j DEPARTMENT OP BUILDING INSPECTIONS 4 za, 212 Main Street ' Municipal building Northampton, Mass. 01060 ors• woreCER'S COMPENSATION INSURANCE Ali ,11)AV1.T t ' Oiccns:.Jr.crmittec) with a principal place of business/residence at: — —• _(hone?=)--- -- - — (stre t/eitt/:>'tate ip) do hereby certify, under the pains and penalties of-perjury, that: ( ) I am an employer providing the followint worker's compensation coverage for my employees worlang on this job: - ("Insu-anc Company) (Policy Number) (Expiration Date) ._- • a • Nl koiaa_l a sole proprietor, general contractor 0- .onheowner circle one) and have hires the contractors listed below who have the follo-:v.t-l$ s. e s compensation policies: (Name of Contractor) (Inrumncc Company/Policf Number) (Expiration Date) (Name of Contractor) {7nsuranc Comptury/Policy Number) (Expir Lion Date) (Name of Coati-actor) (Insuranec Company/?olic:Number) (Exf. rauoa Date) (Name of Contractor) (Ins,:rance Comp✓y/Policy Number) (Expiration Date) (attach actditienal shoot if:.-'-.^-a.^ to incl.: .. cr:r.,.ioc,: ir.:, :,i;o;c -__..,.-1 ( ) I am a sole proprietor and have no one -svorking for me. ( atn a home owner performing all the work- ttt•rsclf. NOTE:plc.ate t o ew re that wile becnoo..1r_-s..tea en-spicy pczc-s to e.)Oa r-n.race,car- -radim cr:epair",•;:_M:4....t i. of not trtoce then throe units in tet:ie+t the b tntowoer raie:a cc o:the :13 xr•u-'-r_rtt thcao art not Ccrsally c«:::::_:r. :3 be employes under the tvocices 0u.3�:s_:icn Act(GLI52-13 1(5)),appti=atio:by a bet•wow=fora ticm a cc p;r:tti:t:av-.',once 11Y: legal etatuc of stn CC*loyec uotlrr the Workers Cocapar stion Act_ I un4-er taad that a copy of this etatct* taay be Iorwnreled to t✓I)1 srtnxnt of l,.vrial Ao6Lersts'Office of h_oaranoo for the coverage vctiricatioo and that failure to rocare cover ttr3,::cc:ion 25A of}.(GI.132 can lead to the imposition of resit 1 penalties . coasuttng of a floc of up to S I..500.00 agora in.-ttrir-x:rn of up to cr t y o:r sr.-1 civil penaltics in the roan of a Stc;,Work Or :...-.d a rim of S 100.00 a day 1.47sn-1 err_ . For dqustm rsal use only _ _......_ . Permit NurriYs ----_.-----_— -i 1.fap Ot.�� 1, -r. 1-t Sign; re c)t I.iccn. aPcrmittc_t, T+.i• r'- l __ . 4 (ri# of Paz#1#ttnt #mt 1- _^ u tf-. a .==,,._ 'Massachusetts = _ '��''"== DEPARTMENT OF BUILDTNG INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton,MA 01060 . HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction super.. sor. The state defines"Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill)1 sonotube holes (before pour), a rough building inspection (before work is concealed). insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made ll i I, M��'C i z r l#. Sm- . understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. / n Date 9- 2_1 70 q" Address of work location I f C S�` .FI-0ie ;cc i pip 0 ( ac3Z d MORTGAGE LOAN INSPECTION LOLUS REFE2E_AICE 12,„,\( 55,11 T'w,c,E 3 I /Ov ' ± DEED N H - Ln > '151k-- i , 011 Pc\,..._ 3,-r } r- -nz►utuAq a i Viz, CIF h < 1 c.ri o 1 rn ry 1n �z^ • } .-lam! ra 1 2ii+ /O7._'± rv\&rt. log 'DEE.D y: J 1-iI' 1JKLEY 5T2cEr ci L,�- ;— by • ,( . --)--i— 5,_ vr- y e ,„ /,_ '\L . vso- , / _ (..., ,d>t �1 " T 6\N f 00 - * 1It � � — — �. I 7 i , SIrt.4 tg.. OIQaV ) -- , - -,. : I r° ca0445/So t,,,ute . to 4cceo+ — pe...4.wCeM :/1X 6" Toe 2tx)1 j 2e1C Tt6 ps gakt 1 w�j `J" ,.- 5/0 4" Tof -Pa,-! • 7,x04 undex.-R-ai(— px?. '621141. y`' 5p f.. 6.4 v,tpt n 4 2-kt--- S. • Ytot40,t; 90, Ata(„guy 14fe. SN)a4,,J EL A i v w11161.1 -1 _ I \I 4___ , , � 1 — r —I --I ' I 1 i II i I 1 r ��� f