29-410 (3) s
Timothy & Wendy Lussier
105 Sandy Hill Road
Florence, Ma 01062
(413)584-5432
4�
Anthony Patillo 1, (� l' V� E
Building Commissioner r �
City of Northampton L JAIl ^ 0 2002
212 Main Street
Northampton, Ma 01060 , .
UE}�(Or Bii I 4G N�INSPECTIONS
' IliI MA 01060
January 30, 2002
Dear Mr. Patillo,
This letter is to confirm our intentions for use of the transformed garage. We will be
converting this space into a family room and small studio. These rooms are not intended
to be used as bedrooms. The sole purpose of this conversion is for more family space for
the kids toys, computer, and general living space.
If you have any questions or concerns, please feel free to contact us. We are open to
any questions or comments you may have.
Sincerely, r:
Timothy VLussier
Wendy E. Lussier
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THIS PLAT NOT FOR RECORDING PURPOSES
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SANDY H�[.[. RD.
T'D : S O jv Q G F ON& M 0X7-&A6,F C OR?- C cMMONWA4A rW J.'W0 7'1TAX /NS. CO.
I HEREBY REPORT THAT I HAVE D MAINED THE PREMISES,AN BASED ON DUSTING MONUMENTATION,ALL EASEMENTS,ENCROACHIMENTS
AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES.I FURTHER
REPORT THAT THE PROPE IS NOT LOCATED IN A FLOOD PRONE AREA AS SHOWN ON FEDERAL INSURANCE MAPS FOR COMMUNFTY
NU1u0ER o�+?CJL�eZ ,
DATED: 3" -o O NOTE
THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES
SURVEYOR: NOT CONSTITUTE A PROPERTY SURVEY.
MORTGAGE LOAN INSPECTION PLAT
�tylit of N0RrIYAMPTAV) MA&5
RICHARD 0 VV n/x-n
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134503
R'icAard J.LeBarpe,Sr.,Registered Prolesslonal Lind Surveyor
110 Klnp Stro.t,Northarnplon,Massachusetts WOW
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m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AFFIDAVIT
L
p►censee/permittee)
with a principal place of bu-sinessIresidence at:
414 1 b fWC,Q 0 1 61�4hone#) 1 "-3,
(hrCe city/statrlap)
do hereby certify, under the pains and penalties of pegury, that
( ) I am an employer providing the following worker's compensation coverage for my
employees worlang on this job:
(Insurancc Company) (Policy Number) (Expiration Dale)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Poky Numbcr) (Expiration Date)
(Name of Contractor) (Insurance Compauy/PoGcy Number) (Expiration Date)
(Name of Contractor) (Insurance Compacy/PoUcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Poky Number) (Expiration Date)
(attach additiooal shod if necesvry to include infbc n oa pcxtnining to all ocatrn )
( ) I am a sole proprietor and have no one working for me.
I am a home owner performing all the work myself.
NOTE:plisse be aware that while hoaxowaen who employ pazoat to do n„ imcnncc coa tn=on or rrpair work on a dwelling of
not Moro than three units in which the homoowv rides or oa the grounds appurtenant thacto arc oot gcncnlly coasidarcd to be
employers undo the workers ccmp==tioa Ad(GL152,s3 l(5)�application by a homeowner for a liccase or permit may evidence the
legzl etsdua of an employer uodertho Workeez C.ompematiou Act-
I unde stsad that a copy of this ru tcmmt maybe forwarded to the Dtpartnsmt of Indush iat Accidm&ol5oo of La Au—for the
-V Mge vaificatioa and that failure to sea=coverage under soctoa 25A of MGL 152 can Iced to the imposition of criminal pcnaW-
oomistmg of a fine of up to S 1,300.00 andloc imprbomnerd of up to one year and civil peaslties in the form of a Stop W orlc Order and a
f=of 5100.00 a day ign inst ttx.
EMap4 'l
use�
mber
Lot#
of censclPermit� e
SECTIO��» COI V RUCTION SER1/ICES
8.1 Licensed Construction Su ervisor: Not Applicable
Name of License Holder :
License Number
�5
di A
Address r Expiration Date
Signature Tele ho�ne . •-
f/
me t1zr.. Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 1 11 0-WORKERS' COMPENSATION INSURANCEAFFIDAVIT(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....... ❑ No...... ❑
'ff e U axe n
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 Zing Laws and State assac General Laws Annotated.
omeowner Signature
Al
SEOQTIOhI -D R 419001 �ROROSED: ORK c cka Ira"''licab e "
New House ❑ Addition ❑ Replacement Windows Alteration(s)\9( Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ j Decks
[ ] Siding[ ] Other[ J
Brief Description of Proposed Work: a ) / j
Alteration of existing bedroom Yes No Adding new bedroom_ Yes No
Attached Narrative❑ Renovating unfinished basement --Yes No
Plans Attached Roll 0• Sheet
C� Ifi ' ' e e o c�� tfn tae i"s�`n $" o�rssingcom�tete'�' fl'o'"�'�"n";�•
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?
In. 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
SE TION t0 BE COMPLETED >WHEN.
OWNERS AGENT OR CONTRACTOR PL ES 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
1, 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.
. t- i
Print Nam
111/ e-(,-I r,
Signature of Owne gent IV Q 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:
rthampton
uil epartment
21 in Street
JAN 2 5002 0 100
Northa pto , MA 01060
124 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION.1-SITE INFORMATION
��$This seeti o� `'�compl'�t� bjrofftc� °'
1.1 Property Address: ii
- ;
1.L
I /r` �j \L Zone ask; Overta is r"I
Elm St.'District" = .� GCB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(P * t) t Current Mailing Add r ss: A/3
Telephone lVJ Lll [�
j Si nature t 4 -
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
Building /"J (a) Building Permit Fee
Electrical r^ >{\ (b) Estimated Total Cost of
,J V Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 +4 + 5) ~ C> > Check Number
This Section For Official Use Onl
Building Permit Number Date Issued:
Signa#ure '`
Bu'Id hng.Commissioner!_lnspector�of°.Buildings. Da-
File#BP-2002-0674
APPLICANT/CONTACT PERSON LUSSIER TIMOTHY S
ADDRESS/PHONE 105 SANDY HILL RD (413)584-5432 O
PROPERTY LOCATION 105 SANDY HILL RD
MAP 29 PARCEL 410 001 ZONE URA
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: CONVERT GARAGE INTO FAMILY ROOM/STUDIO
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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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 Co ssion
Signature of Building O Zcial 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.
105 SANDY HILL RD BP-2002.0674
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map.Block: 29-410 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
CateQoU:Non structural interior renovations BUILDING PERMIT
Permit# BP-2002-0674
Project# JS-2002-1086
Est.Cost: $3000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group
Lot Size(sg. ft.): 12414.60 Owner: LUSSIER TIMOTHY S
7onina: URA Applicant: LUSSIER TIMOTHY S
AT. 105 SANDY HILL RD
Applicant Address: Phone: Insurance:
105 SANDY HILL RD (413) 584-5432 O
FLORENCEMA01062 ISSUED ON.1/30/02 0:00.00
TO PERFORM THE FOLLOWING WORK:CONVERT GARAGE INTO FAMILY
ROOM/STUDIO
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: if����
Rough Frame: e7 f-
a
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation: C7I-Ir ( -7, o 02
Final: Smoke Final: Gj_d2L-
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc Si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 1/30/02 0:00:00 3374 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo