23D-194 (3) ,.31 r BP-2003-0961
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0961
Project# JS-2003-1549
Est. Cost: $1415.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: John Corbett 104000
Lot Size(sq. ft.): 156816.00 Owner: 665-667 MAIN ST HOLYOKE LLC
Zoning:URB Applicant: John Corbett
AT: 70 RIVERSIDE DR
Applicant Address: Phone: Insurance:
56 Dimock St (413) 586-8712
LEEDSMA01053 ISSUED ON:5/6/03 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
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 5/6/03 0:00:00 1557 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
'-_.�v r � Y � � to $ a?1 �. � 4' r, ,24,
+ , � City of Northampton Status of Per Itr .
_— --` Building Department CurbCut/D vex a 'e air 'r '�
212 Main Street Sewer S ptic;. allabi /21,
APR 3 0 2003 Room 100 �iVaterlWellAvaf ab itltys z � '�`'
t j;
Northampton, MA 01060 Two Sets of Strdcturall!P,la nis
-phone 413-587- 240 Fax 413.587.1272 Plot/Site Plans :
Other Specify ._.Mf "
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
-70 i Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: C.41,1V wra-Y 4f.4-
Zvt Me-5 G, .—,a - pi-Go 3 6 Bosley /roofc 1-11
Name(Print) Current Mailing Address:
G.$ - 't97�
Telephone
Signature
2.2 Authorized Agent:
\.Se L v\/ cr-S,.-t( JJ/,+n oc,� .S1 �-�r1�L d i i1
Name(Print) Current Mailing Address:
ig ure 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) /V/S 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 0 Addition 0 Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. 0 Demolition❑ New Signs [ I Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: —Fz i IL-L- 6 e--eL-Ae.-e-yotsar c.tir e.44.rS
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ . Sheet❑
sa If.NeW"t Ouse 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, , 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
e , as Own /.Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, tithe best
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Own /Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
�.�RP. e g-r .. ...�e;,..iWe'.. .n +. 'eM , ':SAC IntW'� a`tRt _: 1 'm Not Applicable 0
egistered Nome Improve►nent=�(>ontractor.� „F, ,,�,�,�,;����,,�,. �,� �,�.��_,,�..�„�
(.fl/ 8 o c.L.1 COO
c, —L�
Company Name Registration Number
a e-.k-
Address/� // Expiration Date
GS- a/14- OC4 S� 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 0 No 0
,J VO:, O I -Exemption
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
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DEPARTMENT OF BUILDING INSPECTIONS
.
212 Main Street ' Municipal Building ,
..,,......
Northampton, Mass. 01060 -‹. ,..r.,..."/
NV 0 R1K1,12.'S COMP ENS A TIO N INSURANCE AFFIDAVIT
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----------__A ) &. 1/--C r--(L
(liccnsecipc_rmittec)
with a principal place of business/residence at:
e0S-i-
5"tp Di c Aa a (c. ..-C.I i-ie,r,....A.s 41A-
(sticcucity;:; tfizip) ()ilon ‘,, ,..57 IS 1"-?x ---
do hereby certify, under the pains and penalties or-perjury, thati
( ) I am an employer providing the follo\viiu: worker's compensation coverage for my
employees working on this job:
(Iusuranc.. Company) (Poli Cy Number) (Ex-pirz Lien Date)
( ) I ant a sole prourietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's corrmensL'tion 1)01.1c:es:
(Name of Contractor) (Ins.umnce Company/Policy Number) (Expiration Date)
- —
(Name of Contractor) (insurance Ccrripanyil'elic-v Number) (Expiration Daze)
— _(Name of Contractor) (Insurance (Thmpany/Polic-y Number) (Exiz:ratioa Date)
_
(Name of Contractor) (Insurance Comuany/Policy Number) (Expiration Date)
(attach ariditiocial b- if .•.:, .1..,..ic i:-.:-:-..::11:i c.,.c.p.r.tail:Ling 1.;ali coirtracti:•,-.)
sole proprietor- and have no one %vorking, for me.
( ) I am a borne owner 1)cl-forming all the work- myself
NOTE:picztae be aware that•iii-Itile lx.ncowners w'ao(=ploy pc:t•-•:11 LO(r)MA illiCalOCC,CXXV,Irs:C.i On el-lepair•..,6:.,..-::...,f,•ciiin F of-
not more th-tn tbroo units ir,whidt the lxi•mit-ow-tyx rraidza or oci tht p-t•Lit-wia Ippurtcr-trAtha•cto ale ncx Generally cxx-..:i(1•:::::1:::,Is:
cmployaa uo.,icr tlx akaacke:cori-icc-_-..atticn Act(C3 I-152.=1(5)),application by a homeowricr for a lic=vic cc pc-rrai:may ni,kr•:c tb-:
legal claws of an e=cployer under the,Wodcrea Consternation Ad
I uncL-Ttancl that A copy of(hi,rtatcrnent may be fory:anied to tbo Dcs.attat of Indautrial Artie:mt.?Office of Ilnurance for the
covcrage verification and that Eilurc to feaare col:crag,'und oction 25A of MOL 152 can Icad to the inipasitim of criminal penalties
cocaisting of a fine'of up to S1.500.00 Nor impriiiorariad of up to occ yczr and civil pcniltica in the form of a Stop Work Ordtz and a
Ono o(5100.00 a thy again.tt nv:..
For dcplutrnatx1 tr.c only
Permit Ntuntyr
' 1
Signature of Licri:-: :: ••.,','! :; ,.7!••- •• • 1-..;
9 t -"'si 1 1 . • toi trItta r
Or
I -"ININD.OW WORLD
flIC#104000
56 Dtmock St. i 7w :I
Leeds, MA 01053
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Telephone 586-8712
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