43-053 BP- 2010 -0319
GIs #: 1 COMMONWEALTH OF MASSACHUSETTS
CITE' 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- 2010 -0319
Protect # JS- 2010 - 000426
Est. Cost: $10000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin MARK LANDY 077431
Lot Size(sq. ft.): 15986.52 Owner: FOWLER DAVID J & CASEY L
Zoning: SR(100) //WSP II Applicant: MARK LANDY
AT. 91 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
P O BOX 61 (413) 625-6992
ASHFIELDMA01330 -0061 ISSUED ON. 912812009 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 12 X 8 MUDROOM /NEW ENTRY
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: Date Paid: Amount:
Building 9/28/2009 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
File # BP- 2010 -0319
APPLICANT /CONTACT PERSON MARK LANDY
ADDRESS /PHONE P O BOX 61 ASHFIELD (413) 625 -6999 Q
PROPERTY LOCATION 91 WESTHAMPTON RD
MAP 43 PARCEL 053 001 ZONE SR(100 )/ /WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 02C42 4
Fee Paid
T_ypeof Construction: CONSTRUCT 12 X 8 MUDROOM/NEW ENTRY
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 077431
3 sets of Plans / Plot Plan
THE FOLLOWING 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 Commission Permit DPW Storm Water Management
Demolition Delay
�. w. 7 ��o I
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.
City of Northampton�+�
Building Department�%�� Af>zeayet3��
212 Main Street 5ea�er$e Avat ¥ G
���
Room 100i h
Northampton, MA 01060
phone 413- 587 -1240 Fax 413- 587 -1272 I
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I - SITE INFORMATION
This section to be completed by office
1.1 Property Address _
l �fY���tt+►+��� `�l�t� Map Lot Unit
(w�� Zone Overlay District
EliitSt District ° CB District
SECTION '2 - PROPERTY' OWNERSHIP /AUTHORIZED AGENT
2.1�Ownerr o Record
Name (Print) Current Mailing cjdr — 1 . 4 q
Telephone - a I J
Signature
2.2 Authorized A ent:
Name r Current Mailing Address:
6
S f1gq � ��
4A; V o
Signature Telephone
-
SECTIO 3 - ESTIMATE6,6ONST.RUCTIOb COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical r b (b) Estimated Total Cost of
lJ" Construction from 6
3. Plumbing building "Permit. Feb.
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
— _— -
This Sectiran FW0frklit USe Onl
Date
Building Permit Number: Issued:
Signature:
Building CommissionerAnspectorof Buildings - Date
w '
J
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
St
m_
Lot Size
Frontage
Setbacks Front �.
Side L. R L ._: � R
Rear
Building Height
Bldg. Square Footage %
Open Space Footage _ % _...... ..._,
(Lot area minus bldg & paved
n [ A MP
arknr ., �tb
# of Parkin S aces - -+
b Fill:
s
Q
(volume & Location) ---j ._..._..._.
C,}`4
Has a Special Permit /Variance /Findin . ,ever been issued for /on the site?
NO DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Regis of Deeds?
NO DONT KNOW YES 0
IF YES: enter Book Page; and /or Document
B. Does the site contain a brook, body of water or wetlands? NO ON KNOW 0 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 0 NO
IF YES, describe size, type and location:
_.... _.___.._ . __. _ _ .. -.. �.. ._....
D: e tthere any propo` se2�c antes - o or a rtions o sl�nsmten ed fc the property ? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb {clearing, grading or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding,[I Other [0]
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes _�No Adding new bedroom Yes ✓ Nc
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa1f..Ney�t.house..arrd'�r �cidttton` . exisfil ';H'ousiri ` scorn "` lete:��he:folrourirz ':
a. Use of building: One Family Two Family Other
b. Number of rooms in each family unit: h Number of Bathrooms
y
c. Is there a garage attached? 0 t, 0
d. Proposed Square footage of new construction. Dimensions , d X k� At
e. Number of stories? JL
f. Method of heating? 1C�`�L ( 1`r` Fireplaces aadstouss Number of each R
g. Energy Conservation Compliance. IrA Masscheck Energy Compliance form attached? V
h. Type of construction UO� #- E
i. Is construction within 100 ft. of wetlands? Yes N o. Is construction within 100 yr. floodplain Yes t/ No
j. Depth of basement or cellar floor below finished grade WL A
k. Will building confo to the Building and Zoning regulations? �s No.
I. Septic Tank City Sewer Private well City water Supply
SECTION Ta - OWNER AUTHORIZATION'- TO BE COMPLETED WHEN
1, Co's W OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
f o W`* as Owner of the subject
property M
hereby authorize
to act on my behalf in al matters relative to authorized by this building permit application.
aiS�� " 9, - g nature o Owner _ ______ Date -
pti rk as 19 aver /Authorized
Agent hereby declare that the stat ents and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Sig ed under the pains and penalties of perjury.
' t Na d
Signatur of Owner /Agent Date '�
r ,
s
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supe v Not Applicable ❑
Name of License Holder \ A ww c 1 1 43 1
License N 710 er
1
6 piratioA Elate
--
Signatu a Telephone
istered,Homejm 'roue&&& Wi ctor: „ ., .. <.,. x . .. ,. Not licable ❑
ComDanv Name Registrat n lumber
«go
Expiratio - - ale
q 3 ' Sk- A440aW
Telephone
SEC 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 buildi ermit.
Signed Affidavit Attached Yes....... No...... ❑
"We-
--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 consi 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
n ampton r inancesi -mil. ttsFreneral- La- wsAnnotated.
Homeowner Signature
J
z
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
Boston, MA 02111
www.mass.gov /dia
-Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumb.ers
Applicant Information Please Print Leo-ibly
Name ( Business /Organization/Individual):
S OP
Address: VU V7r4X__LT
City /State /Zip: 6fXVskA JAAs M30 Phone. #: AkIAZ�' —Mci
Are you an employer? Check the appropriate box: Type of project (required):.
1.0 I am a employer with 4.. E] I am a general contractor and I 6. El New construction
employees (full and/or part-time).* have hired the sub- contractors
2JX I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no loyees These sub - contractors have. .g. Demolition _ ` _ _ '
working for me in any capacity. employees and have workers 9. � BuzZdiug addition
[No workers' comp. insurance comp..imurance. $
required -] 5. We are a corporation and its 10.0 Electrical repairs or additions
Qcersay�eLCis --1
3.0 I am a�omeo�vaer d����+ork- - - - - - -- - -- - 0- 1?lumbing . repairs or additions ,
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insuran required] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required j.
*Any applicant that checks box #I nu st also fill out the section belowshowing their workets' compensation policy information.
t Homeowners who submit this affidavit,indicxting they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
( Contractors that check this box must - attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. If the sub- contractors have employees, they nwst.provide their workers' comp. policy number.
lam an employer that is proW&ng workers' compensation insurance for my employees. Below is the policy and job site
f _
Insurance Company Name:
Policy # or Self-ins. Lic. #: Expiration Date:
Job Site Address: City /Stafe /Zip
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section - 25A of MGL c. I SZ can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one. -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. lye advised that a copy of this statement may be forwarded to the Office of
Investieations of the WA for insurance coverage verification
_ I do her_ a pains and penalties ofperjury.that the information pro . d - ove_is truezndcorrect:___
Si Lure: am
Phone #:
Fn� D6 oi4. nvt wrrte in this area, to - be completed by city or town afficiaL
n: Permit/License #
thority (circle one): Health 2. Buildi ng Department 3. City/Town Clerk 4. Electrica Inspector 5. Plumbing Ins ector- son: Phone #:
A,
58' -0" TO PROP, LINE
ORCH
� I w
co I ENTRY ROOM 4 DN
3
z
J
2 0
1 UP of
0 8' 4' -0"
o
2 4' -0" AT FOUNDATION
0
AL 5 ALE 1/ = 1' -0"
S E PLAN FOR NEW ENTRY ROOM
AT 91 WESTHAMPTON ROAD FLORENCE
NORTHAMPTON, MASSACHUSETTS
Proposal to Add New Side Entry Room
by David and Casey Fowler
ASPHALT SHINGLES 0 15# ROOFING FELT LAG INTO EXIT.
5/8" PLYWOOD ROOF SHEATHING STUDS OF HOUSE
2x8 RAFTERS AT 16" D.C.
SEE ROOF DETAIL
2x6 JOIST FRAMING
16" O.C.
3/4" WOOD CEILING T &G Z
J
W
0 0 EXISTING DOOR
o Of
1/2" SHEATHING = 2x4 STUD FRAMING 0
00 o
1/2" WALLBOARD i
z
V
z
3/4" WOOD DECKING T &G
:8's JOIST FRAMING 2x8 FLOOR JOISTS
EXIST. SILL AND
8' -0" JOISTS U in
LO
N
c
v
D
p
2x8 LEDGER ANCHOR BOLTED ° 1
INTO CONCRETE FOUNDATION
-H °
Z FRAMED LATTICE BTWN POSTS
6x6 TREATED POST
3RADE LIN ANCHORED,,TO CONCRETE��;
Ld
J
7'-9" FOOTING TO EXIST. CONC. FDN
O 0 p
O °,
�� 8" CONCRETE PIER ON FOOTING
O
J
L4 W
PORCH SECTION
SCALE: 1 /2"
16" MIN, POUR ON UNDISTURBED SOIL
II II
II II
II II
EXIST. 8" FOUNDATION
EXIST. STUD WALL
II II
II II
II
KITCHEN
FRAMED DOOR
WITH THRESHOLD
L— — — ------------ — — -- --------
0 � 7.5„
z 7.5" + STEP
w ,1 STEP
o I ti 4„
:2 o 5
0 u ` DOUBLE SASH I ENTRY ROOM I w PORCH
LL- WINDOW 10'- 6 "x7' -6" o 4
FLOOR SPACE I F I w
o -_ 3 o- It
~ I DOUBLE SASH I o '. �� 2 I w
WINDOW V) r
�— —
It
1 -t f-
I� I ROOF EDGE I
3 5'-5" 5' -5" 4' -3"
8 "0 CONCRETE PIER CENTERS OF 8" Q'ONC. PIERS
AND FOOTING 11' -4" 4' -0"
(4 PLACES)
SCALE: 1/4" = 1'-0"
FLOOR PLAN FOR NEW ENTRY ROOM
AT 91 WESTHAMPTON ROAD FLORENCE
NORTHAMPTON, MASSACHUSETTS
Proposal by David and Casey Fowler
REMOVE EXIST. VINYL SIDING
AND REPLACE' WITH NEW
\ THIS SIDE OF CHIMNEY.
EXIST.
7' -3.5"
—_ r - - --_- - NE ENTRY DOOR
_ _ f WITH STORM
f - NEW —_� NEW ��� _
- -- WINDGW -- i
J I Cl
2 I t�
1 t rn
EXIST. GRAD GRADE
NEW STAIRS
AND RAILiNCS
!
0 (n
5' -5 ,. �-
5 -5 - 4' -3" !il
SC 1/4 = 1' -0"
E!_EVA OF NEW ENTRY ROOM
AT 91 WESTHAMPTON ROAD FLORENCE
NORTHA.MPT(" +N, MAS SAC.HUSETTS
Proposal 6 David. end Casey ,.r owlbr
D
( J l �J l
SCALE: 1/ 4"