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41-008 (2) New England Remodeling General Contractors Inc. 67 Division Street Easthampton, MA 01027 Phone (413)529 -0801 Fax (413)529 -0006 www.neremod eling.net 03/24/2009 To: National Grid Please remove power from 45 loudville rd. Northampton, Ma 01062, for house demolition. Northampton does not have a utility sign off sheet. Meter #95453573 Remove asap Account # 51458 -69017 Contact Tom Bacis Cell # 413- 478 -5272 Tom Bacis President, New England Remodeling General Contractors, Inc. New England Remodeling General Contractors Inc. 67 Division Street Easthampton, MA 01027 Telephone #: (413)529 -0801 Fax #: (413)529 -0006 www.neremodeling.net To: Work Request Date: 03/24/2009 From: Tom Bacis Fax #: (888) 266 -8094 Number of pages including cover page: 2 This transmittal is intended for the use of the individual or entity to which is addressed, and may contain information that is privileged and confidential. If the reader of this transmittal is not the intended recipient, or the employee or agent responsible for delivering the transmittal to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is prohibited. If you have received this communication in error, please notify us immediately by telephone and return the original transmittal to us. 03/27/2009 09:28 27681 NHAMPTON METER PAGE 01/01 nationalgrid March 27, 2009 New England Remodeling Attn: Tom Bacis 67 Division St. Easthampton, MA 01027 To Whom It May Concern, This is to verify that National Grid has removed the electric service and meter at 45 Loudville Rd, Northampton, Massachusetts, Building Demolition. W A (T i d Ij Sincerely, I VQ / i/ m Nichols Supervisor Distribution Design JN /ekp 5 48 Haydenville Road, Leeds, MA 01053 w www.natlonalgrid.corn Northampton, MA Property Detail Page 1 of 2 City of Northampton, MA: Residential Property Record Card New Search Property Type Classification Code Reference Card 1 of 1 Parcel - Location - Zoning - Assessment Map- Block -Lot: 41 - 008 -001 Zoning: Assessment: Location: 45 LOUDVILLE RD Neigborhood: 2 Land: 119,500 #Living Units: 1 Deed Book: 8951 Building: 148,100 Class: R -101 Deed Page: 168 Total: 267,600 Dwelling Information Building Sketch Style: Conventional Year Built: 1935 Story Height: 1.5 Attic: None Descriptor /Area 6 14 Basement: Full A:1.5Fr /B 748 sgft Total Rooms: 7 1 Fr B:1 Fr 2CE 20 C 280 sgft Bedrooms: 3 C: FBAY Full Baths: 1 24 sgft D:OFP Half Baths: 0 5 22 146 sgft Exterior Walls: Alum/Vinyl 8 E:EFP 3 120 sgft Unfinished Area: 0 F: OFP Ground Floor Area: 748 IC 20 sqft 3 1.5Frf B Total Living Area: 1613 34 3 34 a Finished Basement Living 0 X 0 Area: D 8 Basement Recreation Area: 0 X 0 Woodburning Fireplace 5 Stacks /Openings: 0 / 0 F 4 Metal Fireplace 0 / 0 Stacks /Openings: Heat /Central A/C: Basic Heating System: Warm Air Fuel Type: Oil Addition Information: Quality Grade: C Physical Condition: Average Interior /Exterior: Same Condition /Desirability/Utility: AV Lower 1st Story 2nd Story 3rd Story Area Vacant /Dwell /Oby Status: Dwelling Basement One Story Frame Half Story Frame 748 Additional Features: One Story Frame 280 Brick Trim: 0 X 0 Frame Bay 24 Stone Trim: 0 X 0 Open Frame Porch 146 Remodeling Data: Enclosed Frame Porch 120 Year Remodeled: 0 Open Frame Porch 20 Kitchen Remodeled (Y/N): http: / /www.northamptonassessor.us/ noho /propertydetail.php ?map_no = - 008 - 001 &pagecard =1 4/13/2009 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. 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 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), 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 I, 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. Date Address of work location .. The Commonwealth of Massachusetts a Department of Industrial Accidents �„ Office Of Investigations 600 Washington Street -:. Boston, MA 02111 . ,r www.nzass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information / J Please Print Legibly • Name ( Business /Organization/Individual): •� (/f ! C� ri14 l4 4 l! a er,it / ( r 6-i e . f i Address: o 1 7 D Ai' 1 5 i >n S77 City /State /Zip:(U fl 4k 0n ✓ U lad ? Phone #: 52 qr -c71=-42' Are ou an employer? Check the appropriate box: ��� Type of project (required): 1. I am a employer with 7 4. El I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. E] officers have exercised their I am a homeowner doing all work 1 1. ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] `Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating 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 must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: .W5-5 / '4 t ''' ( e� P/ ®- e . fir'? 5, Co, 2C' Policy # or Self -ins. Lic. #: wC Sad ‘ ( S-6) 1 ? Expiration Date: Sal ' �� Y, Job Site Address: C ` d'-d 1) I% 2 ,) ../t/ C ity /State /Zip: l/ / -7/'/ G-t ci 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. 152 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sienature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : ' yh (1 C c £ / ? 7 006 / License Number '7 S) 5 c t Addres� Expiration Date Signature Telephone 9 Registered Home Improvement Contractor ' , ; „�. Not Applicable ❑ Company Name Registration Number 1 Addr ss f Expiration Date C G 7h f 4 q � Telephone 5- 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 k No ❑ 11., Ho © nerEx6441) 6 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 _ SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition Replacement Windows Alteration(s) n Roofing n Or Doors EJ Accessory Bldg. ❑ Demolition P: New Signs [ED] Decks [Q Siding [EDI] Other [O] Brief Description of Proposed � Work: ��I1�Q ► et/ se- / 9 3S_ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes Plans Attached Roll - Sheet 6a If New house and or addition to existing. housing; complet 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. Masscheck 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 , 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 I j^\ 04 07 .. Owner /: thorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the •- of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Sig ure of Owner /Agent Date E 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 Lot Size Frontage Setbacks Front Side L: R: ._..__ L R .__..._... Rear - .- Building Height Bldg. Square Footage , Open Space Footage ° /o (Lot area minus bldg & paved parking) 1 i # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book - Page' and /or Document #,` B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO iti IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. - Department use only __,Cityof Northampton Status of per1tilt h `` i c� ' ililding Department curb Cutfpr v ay I�ern,rF Y v __ 12 Main Street Sewe rSeptrcAvaabittty ' Room 100 WakerNUeti Availablllty y A' 1 3 2.009 Nor mpton, MA 01060 Two Sets of Structural Plans phone 413- 587'1240 Fax 413 - 587 -1272 PIo Site ans +S i Other Spefy APPLICATION TO CO &TRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION / , r This section to be completed, by office 1.1 Property Address: coud i,‘ ° llC (Id Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: nn (� / q - " i(Gr 1 ay f/ �. °yrr �il0r ffa/I Si; Name (Print Current Mail' ddress: Telephone Signature 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 (a) Building Permit Fee 2. Electrical (b) Es timated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) 6 Check Number L�'— This Section For Official Use Only Building Permit Number: IIsssued: Signature: Date Building Commissioner /Inspector of Buildings File # BP- 2009 -0434 APPLICANT /CONTACT PERSON THOMAS BACIS ADDRESS/PHONE 67 DIVISION ST EASTHAMPTON (413) 529 -0801 PROPERTY LOCATION 45 LOUDVILLE RD MAP 41 PARCEL 008 001 ZONE RR(100) //WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �� Fee Paid Typeof Construction: DEMOLISH HOUSE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 070061 3 sets of Plans / Plot Plan THE FOLLOWING A ION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION P SENTED: ` 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 Pettnit from CB Architecture Committee rmit from Elm Street Commission Permit DPW Storm Water Management t Demolition Delay , 6 , '''''" o c,( f ( ) Signature of Building fficial Date g g 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. 4 �,':fi } a Z."4 t i fi g , o-x .i', ,,„ ,, ...P.,i.0A--,0".0. „. . ,-, ;444os ' ,, -, -, - ... : '',' i ..i. f 4 1: * '..'l4. 11 ' 1 ,'' _ � _ ; 1 g ' 'rips ' tij ;taM R s i ro- tf � L c ��, �„ 1 v 5 ,.,- / r� 1 i H • pp 4 Y fii $ { % X Y9 Tsa t f.: �!- {J.-.e x F'- i, ' ':' % . ; t n ' . ' : ," , ''''' ' '' g II , 1 , ' , . : i._. .,,,.:„.. ',. t t °r :...,t . . - j i b i b'' ,.: mS.' � e` a s t Il : ^e >, x w. s ' . ,� ' � 5 � r:' > r z k� #� # t t 4.i ' ,s '* r , K . - - ,-„ q { ,', .t"n+tR >,` 1 ems" r r:'!' : . n * ^ .'` ' e �.- ^tx w �»e �t a mot, �€ ,' «e, ' ^ n " "" al , _ , ,.: °S+' .- a`'- - tom c` RS ,�°Q _:.:u� „4'747. + �, � � ': . ,,. ,�,,.., „ x . e' '` ° 6 ':fi � �s - ....' ' } * ',,,lr. I---- tl! ..";:l.■.. + ,` u»u i p. 3 s sP , ! h ` T :„, '” ',. 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Northampton, MA Property Detail Page 1 of 2 City of Northampton, MA: Residential Property Record Card _ New Search Property Type Classification Code Reference Card 1 of 1 Parcel - Location - Zoning - Assessment Map -Block -Lot: 41 - 008 -001 Zoning: Assessment: Location: 45 LOUDVILLE RD Neigborhood: 2 Land: 119,500 #Living Units: 1 Deed Book: 8951 Building: 148,100 Class: R -101 Deed Page: 168 Total: 267,600 Dwelling Information Building Sketch Style: Conventional Year Built: 1935 Story Height: 1.5 Attic: None 6 Descriptor /Area Basement: Full A: 1.5Fr/B 748 sgft Total Rooms: 7 1 Fr 8:1 Fr 2tE 20 © 280 sgft Bedrooms: 3 G: FBAY Full Baths: 1 24 sgft D:OFP Half Baths: 0 5 22 146 sgft Exterior Walls: Alum/Vinyl 3 E: i F sgft Unfinished Area: 0 F: OFP Ground Floor Area: 748 8 `C 20 sgfe 3 1.5Fr /B Total Living Area: 1613 343 34 c Finished Basement Living 0 X 0 Area: D8 Basement Recreation Area: 0 X 0 Woodburning Fireplace 5 Stacks /Openings: 0 / 0 F 4 Metal Fireplace 0 / 0 Stacks /Openings: Heat /Central A/C: Basic Heating System: Warm Air Fuel Type: Oil Addition Irifonnation: Quality Grade: C Physical Condition: Average Interior /Exterior: Same Condition/Desirability /Utility: AV Lower 1st Story 2nd Story 3rd Story Area Vacant/Dwell /Oby Status: Dwelling Basement One Story Frame Half Story Frame 748 Additional Features: One Story Frame 280 Brick Trim: 0 X 0 Frame Bay I 24 Stone Trim: 0 X 0 'Open Frame Porch 146 Remodeling Data: Enclosed Frame Porch 120 Year Remodeled: 0 Open frame Porch 20 I Kitchen Remodeled (Y/N): i,tt„- /hxnxnx, nnrthamntnnacceccnr_nc /nnhn/ t t --t- -^--- ` The Commonwealth of Massachusetts y ;Tx , ... m :: , Department oflndustrialAccidents T i Office bflnvestigations 600 Washington Street `- Boston, MA 02111 �;> www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/PIumbers Applicant Information 614_14 Please Print Legibly • Name ( Business /Organization/Individual): •� /J (s' (� 4 t ) I n ` rtriB G!►'t l? 1 �i __ Address: (s - 1 D Ali `3 i A 57 City /State /Z i p :( ' r� � � 4 1'' ��n ✓✓� U j�) ? Phone #: 52 q -67 a-a Are J ou an employer? Check the appropriate box: Type of project (required): 1.t am a employer with - 4. O I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑ New construction listed on the attached sheet. 7. 0 Remodeling 2. ❑ I am a sole proprietor or partner- ship and have no employees These sub- contractors have 8. 0 Demolition for me in any capacity. employees and have workers' working Y P n'- 9. 0 Building addition # [No workers' comp. insurance comp. insurance. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.0 Plumbing repairs or additions 3. ❑ I am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating 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 narne of the sub - contractors and state whether or not those entities have employee's. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: •i ( / > oG ® re el ( epi P" ` 6 Ye f c, CO) c- Policy # or Self-ins. Lic. #: �/C C S' exo is'( $2 1 0 23 Expiration Date: S �� t �` � � Job Site Address: C if -- t e'vd v' /A, I c City /State /Zip: ,..4 / - 7hi/' flirt 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. 152 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION S- DESCRIPTION OF PROPOSED WORK (check, all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing r--1 Or Doors 0 Accessory Bldg. ❑ Demolition P.1 New Signs [D] Decks [Ea Siding [0] Other [D] Brief Description of Proposed c � Work: �e (� 1°,v / 9 3J Alteration of existing bedroom Yes No Adding new bedroom Yes /((/ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a_ If:New. house . an=l or eadatio lxeo ,existing roushi oo`h olete 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. Masscheck 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 SECT ION 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 to work authorized by this building permit application. Signature of Owner Date I (f Y\ a4 cif -. Owned. thorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the • - of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name 0 Sig ure of Owner /Agent Date ` - o a e F f1.sie^So , ai i` s t x • z a " of Northampton °$ ' '' r n ( di it ' Min g De §-, 0 0- e 5 t x -- , - ----- " —"�' 12 Main Street = . 1 3 1 i Room 100 � R Y 3 p n-0,,, r a yak a s `` 4 2009 Nalm ton MA 01060 ' B - „ ��4 phone 413-- Fax 413 -587 -1272 ' , �� , � , - 1 APPLICATION: TO- CA , ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: 11 ) %--Ot Ef (if lit 1j , _ Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner at Record: n Q �^ rt la Gf i ( (- ! rcaPtr7i S , / /') CO 6 ? O iI ) Fy ' 'f1 J7I Name (Print Current Mali ddress: /..L. Telephone Q �� Signature 2.2 Authorized Agent: Name (Print) Current Mailing Address: signature Telephone iECTION 3 - ESTIMATED CONSTRUCTION COSTS'' em Estimated Cost (Dollars) to be Official Use Only completed by permit applicant Building (a) Building Permit. Fee Electrical (b) Estimated Total. Cost of Construction from (6) Plumbing Building Permit Fee Mechanical (HVAC) Fire Protection Total = (1 + 2 + 3 + 4 + 5) Off A, Check Number ii-- This Section For Official Use Only Date (ding Permit Number. Issued: iature: Dulhllny CunimhSSltltt flnspector buildings Date. File # BP- 2009 -0434 APPLICANT /CONTACT PERSON THOMAS BACIS ADDRESS/PHONE 67 DIVISION ST EASTHAMPTON (413) 529 -0801 PROPERTY LOCATION 45 LOUDVILLE RD MAP 41 PARCEL 008 001 ZONE RR(100) //WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out y� Fee Paid Typeof Construction: DEMOLISH HOUSE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 070061 3 sets of Plans / Plot Plan THE FOLLOWING A ION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION P SENTED: ` 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 L/ P -. ermit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 62.e........ ©� �� �� Signature of Building fficial 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. I I o DEMOLITION REVIEW APPLICATION APR 2 7 2009 Activity Tracking Sheet ,_ y s Property: 45 L.0Q1 Map g1 Parcel Received in Building Department. 11 Referred from Building Department: Aq Action Taken/ Northampton Historical Commission Action Taken By: / ' Entire Commission 1/ Sub Committee of the Commission Commission Designee/ Staff Date Action Taken: 12-1 / /0 9 Initial Determination (( Public Meeting held Public Hearing Held Determination Made: Property has been determined not to be Significant according to Ordinance definition. No further action will be taken. Demolition Permit may be issued. Property has been determined to be Significant according to the Ordinance definition and a Public Hearing has been /will be scheduled. Demolition Permit may not be issued at this time. Public Hearing has been held, Property was determined Significant but not Preferably Preserved. No further action will be taken/ Demolition Permit may be issued. Photo documentation may be required. Public Hearing has been held. Property has been deemed to be Preferably Preserved. The demolition review period has been initiated. No demolition permit may be issued until the Historic Commission approves an alternative plan or the twelve month period concludes. Alternate plan has been approved/ delay terminated. Demolition may or may not be approved as part of plan. Twelve month time period has expired, demolition p ermit may be issued. Referred by: G�i & ( id of Date z 0 Q 9 � 1 File # BP- 2009 -0434 APPLICANT /CONTACT PERSON THOMAS BACIS ADDRESS/PHONE 67 DIVISION ST EASTHAMPTON (413) 529 -0801 PROPERTY LOCATION 45 LOUDVILLE RD MAP 41 PARCEL 008 001 ZONE RR(100) / /WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out -y Fee Paid Typeof Construction: DEMOLISH HOUSE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 070061 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 a �e%G 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. 45 LOUDV1LLE RD BP- 2009 -0434 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 41- 008 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- 2009 -0434 Protect # JS- 2009 - 000587 Est. Cost: $5000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Coast. Class: Contractor: License: Use Group: THOMAS BACIS 070061 Lot Size(sq. ft.): 123231.24 Owner: BACIS PROPERTIES INC Zoning: RR(100) / /WP Applicant: THOMAS BACIS a T. 45 LOl JDVILLF RD Applicant Address: Phone: Insurance: 67 DIVISION ST (413) 529 -0801 WC EASTHAMPTONMA01027 ISSUED ON :10/20/2008 0 :00 :00' TO PERFORM THE FOLLOWING WORK: INTERIOR DEMOLITION TO INSPECT STRUCTURE POST TIIIS 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: 'doom! 11 Foundatitn: Driveway Fi..al: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NCRTIIMTPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy - Signature: Date Paid: Amount: +�:. ,s,�- s. � y c�„` i - �s vti a x x s .suet 'E' �" t , TMs ;4 '�' �,*u "F`''�'''y'�+ 45 LOUDVILLE RD 1 v BP- 2009 -0434 GIs #: COMMONWEALTH O F MASSACHUSETTS , _ Map:Block: 41 008 CITY OF NO R THAM PTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTER Permit: Building DO NOT H AVE ACCESS TO THE GUARANTY FU ND {MGL C.142A) Category: BUILDING PERMIT Permit # BP -2009 -0434 Project # JS- 2009 - 000587 Est. Cost: $5000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License Use Group: THOMAS BACIS 070061 Lot Size(sq. ft.): 123231.24 Owner: BACIS PR OPERTIES INC Zoning: RR(100) //WP Applicant: THO MAS BACIS ! ��• A TV t� � .. : -.- .. �.- ApplicantAddress: Phone Insurance: 67 DIVISION ST (413 529 - 0801 WC EASTHAMPTONMA01027 I SSUED OIV:4/30/2009 0 :00 :00 TO PERFORM THE FOLLOWING WORK: DEMO HOUSE POST THIS CARD SO IT IS VISIBLE FROM THE STREET • Inspector of Plum Inspector of W i r ing D.P.W. Bu In spetor Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: i Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: t Final Smoke: Final: �6 c- n ►(l�'�� - V� 1 IS . Fina THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAM UPON VIOLAT OF ANY OF ITS RU AN REGULATIONS. ,. .---' C6I it�diTi Signature: ount: FeeType: Date Paid: Am Building 4/30/2009 0:00:00 $55.004298 -- v 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo C