32C-306 -NOTE —
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
REFERENCE:
BOOK 9892, PAGE 262
C BOOK 426, PAGES 350-351
NOTE:
SUBJECT TO EASEMENTS AND
"N.)1 RIGHTS OF WAYS OF RECORD.
88'±
LOT #20 1---
1131 W
to / I3,
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-sr BD
0 °
#48-52 z3 , >-
21
W
T
I 1 y
78.7'±
HOCKANUM ROAD
TO: MEMBER ADVANTAGE MORTGAGE Sc
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY t•FORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
r- ) —NOTE —
SURVEYOR7K(S, Lt1 ! THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
'� I AND DOES NOT CONSTITUTE A PROPERTY SURVEY
—MORT GAGE L OAN INSPEC PLAT —
, , NORTHAMPTON, MASSACHUSETTS
1 f RANDALL PREPARED FOR
IZER N JENNIFER NORMANLY
'35032 SCALE: 1 " =20' OCTOBER 3, 2012
f' HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
The Commonwealth of Massachusetts
t• _ 1 Department of Industrial Accidents
E; ,, 'lw _ Office of Investigations
v la m , '= 1 Congress Street, Suite 100
.: `' , Boston, MA 02114 -2017
''2: ,. www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
Name (Business /Organization /Individual): v`, an Natta co LLC
Address : 403 south mountain rd
City/State /Zip: Northfield, ma. Phone #: 413 498 -2698
A you an employer? Check the appropriate box: Type of project (required):
1. I am a employer with 4. ❑ 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 employees and have workers'
g for me in any capacity. 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10. Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11. lumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12. ❑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.
tContractors 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: Guard insurance group
Poli ins -Eic. #: Vawe309891 Expiration Date: 6/15/2013
48/52 hockanum rd. Northampton, ma
Job Site Address: City/State /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. 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
, V — 1/22/2013
Signature: Date:
Phone #: 413 498 -2698
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 #:
i
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
Erik Van Natta 104203
License Number
175 Parmenter rd 12/11/2013
Address Expiration Date
Bernardston, ma 01337. 413 834 -0054
Signature Telephone
a, r, b�o h .a ,Y' hG- .1'kF` "s r d y � E F' J •'��,
9- Reaistered orn i �r .a r� at�: � °. `. t : : �:N ` as r,� �M Not Applicable ❑
Van Natta Co LLC 132102
Company Name Registration Number
403 south mountain rd 11/13/2014
Address Expiration Date
Northfield,ll/fA 01360 Telephone413- 498 -2698
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 t/ No ❑
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 buildine 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) Roofing
Or Doors goth Interior remodeling Porch roof
Accessory Bldg. Demolition New Signs [ ] Decks [ ] SidingN Other [ ]
• Wok epia winnows and exterior doors 48 and 52. Remodel bathroom, kitchen 52. new furnaces 48/52
Alteration of existing bedroom Yes No Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll - Sheet
6a. = LILL , "'�`
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
Jennifer [Uormanly , as Owner of the subject
property
Erik Van Matta
hereby authorize
to act on my beh If, in all matters relative to work authorized by this building permit application.
/// - 1/3
Signature of Owner Date
•
I, rrll WO fl , 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.
Err f. va7
Print Name 441 0111111111/11 11111. " ---
Signature : Owner /Agent Date
poi— Pion praCn 4
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 �� S'�• )(1
Frontage i 0 N
Setbacks Front ,g l,,/
Side `'L:�S' R: ( 5 - '✓ L:
Rear 16
Building Height N
d
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 KNO 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? CO 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:
E. Will the construction activity disturb (clearing, gran , excavation, 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.
: _ City of Northampton �
:,', : ' i ., _ ,,, "_-- - : ______ --
j Building Department
FJAN_ 2 4 '2013 212 Main Street
Room 100
Northampton, MA 01060
DEPT. OF S Ui!_ D . ��. " -erlp q 13- 587 -1240 Fax 413- 587 -1272
NORTH MA 01060'- �`'
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: Tttls secttwn to be compteted by office
y (22 - S 2 1 � c kca n n1 r 7 Map Lot Unit
Zone Overlay District
Elm St. District CB Dist
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2. Owner of Record:
�t') n ' � ,�Ur�vra l� C �D �� 2 2 �% t /i �/ovy
Name (Print) Current Mailing Address: 1
<n, �//3 S 3 S3 S �l�r
Telephone
Signature 9, 3 y 2 2 ( -w��
2.2 Auth ' ed 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 1 " (a) Building Permit Fee
2. Electrical 4-,-ioo (b) Estimated Total Cost (6) of
Construction from
3. Plumbing } l g •Z 1)° Building Permit Fee
4. Mechanical (HVAC) T / v l l Dv
�
5. Fire Protection f y� -1
fl c? /'/ % t�'
6. Total = (1 + 2 + 3 + 4 + 5) �/ 5c? Check Number This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
p
-Q.
File # BP- 2013 -0716 W (
APPLICANT /CONTACT PERSON JAMES VAN NATTA 1I J (143 (jeA
ADDRESS/PHONE 403 SOUTH MOUNTAIN RD NORTHFIELD (413) 834 -5329 0
PROPERTY LOCATION 48 HOCKANUM RD
MAP 32C PARCEL 306 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out n /�� r�
Fee Paid `/
Typeof Construction: REPLACE SIDING,WINDOWS & EXT DOORS, REMODEL BATHROOM,KITCHEN
#52
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 040620
3 sets of Plans / Plot Plan
THE FOL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
-molition Delay
Signature of Bu' ing 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.
48 HOCKANUM RD BP- 2013 -0716
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C - 306 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2013 -0716
Project # JS- 2013- 001202
Est. Cost: $92500.00
Fee: $555.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JAMES VAN NATTA 040620
Lot Size(sq. ft.): 5662.80 Owner: NORMANLY JENNIFER
Zoning: URC(100)/ Applicant: JAMES VAN NATTA
AT: 48 HOCKANUM RD
Applicant Address: Phone: Insurance:
403 SOUTH MOUNTAIN RD (413) 834 -5329 () WC
NORTH Fl ELDMA01360 ISSUED ON:1/28/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE SIDING,WINDOWS & EXT DOORS,
REMODEL BATHROOM,KITCHEN #52
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 1/28/2013 0:00:00 $555.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner