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36-136 (2) Quick Open Space Calculations Coverages house existing 864 Lot area existing proposed deck existing 15043 1688 2303 drive existing 200 shed existing 624 Open Space 13355 12740 shed existing total 1688 Open % 89% 85% pool new 615 new WSP URA Open Space Requirement new 85% total 2303 I0 414 �� 36 PLaT 136 � o � � o 3� ti U Lor O O � HAS 'Aq S c._ Ip3,0o' e00 L' Z's L w This plan is not to be used to establish property lines or to erect fences or hedges. z OF Note "/� �1�4t,uy4� This plat is compiled from other plans, deed dimensions and other sources of information, is not to be construed as an accurate survey, and is subject to � " 1"17, 31.7 I changes as a more accurate survey may disclose. '�-r�S i E.• To the i l i LC G,,i Po A-A N Tr1 L0, - - and the To the best of my knowledge and beleif, I hereby report that I have examined the premises and that this inspection plat shows the buildings as located on the premises described, that the buildings are entirely within lot lines and that there are no enchroachments upon the premises described by buildings of any adjoining premises except as indicated. I further report that to the best of my knowledge, there are no easements of record affecting the tract shown hereon, except asnoted. I further report that this property is uzT located in the established flood hazard area. Owner : M 1(nU e-L- i--)r.,L C PLAN of LAND at N1 AL L6�,1"� :o Same Address : 1 T l_,t\-�,1 C,\/ 117 \1 C) '"1 A. Date 2-0.0'7 Scale : d�' 4-0 ,.t,,-;11p5111ZECounty Book of Plans : b9� ANDERSON ASSOCIATES Page No. : 12Z Lot No. S I 375 Walnut Street Ext. Deed Book 2 1.. P.O. Box 382 Agawam, MA 01 001 Page No. : a! , 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 1assachusetts Departrrtent of Industr•tal.4ccidertts ©ffi•ce of Investigations 7 600 Tf�ashbi-on Street Boston, M.4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Leaiblv Name (Business/Organization/Individual): Address: U I L Lj,P fJ(a�2 - City/State/Zip: t A p V Phone#: C-( 1 -3 6 c.(-] Are 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 pan-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 g, ❑ Demolition working or me in an capacity. employees and have workers' g Y P n'� 9. F-1 Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.7 Electrical repairs or additions 3.4 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing 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. }Contractors that check this box must attached an additional sheet showing the name ofthe 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: Policy#or Self-ins. Lic.#: Expiration Date: 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 andpenalties ofperjury that the information provided above is true and correct. Sianature7�'°L' GtI?/ �+�G /'� � Date: L(- b� Phone# Of ficial use onl).,. Do not write in this area, to be completed by city or town officiaL Citv 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.d Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date 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....... ❑ No...... ❑ Home Owner 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-vear 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 - "' I SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F7 Addition F7 Replacement Windows Alterations) ❑ Roofing Or Doors (] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [CI Siding[a] Other[fr Brief Description of Proposed / Work: �uT %N �J©U�cq/loylVc! S�i'w►n�ia19 PoD1 Alteration of existing bedroom Yes No Adding new bedroom Yes y No . / Attached Narrative Renovating unfinished basement Yes Y No Plans Attached Roll -Sheet sa.if New house 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 f 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 j 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. i Signature of Owner Date Owner/ thorized Agent hereb declare that the statements and information on the foregoing application are true and accurate,to the es of my knowledge } and belief. Signed under the pains and penalties of perjury. I _ ' Print Nfarne r/Agent Date Signature of Ow Poo L jSection 4. ZONING i Ali 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 '. ..� . v 3 Frontage Setbacks F ' .._ ._ Side L:_ R L ? .._. R .,,. Rear -- : m Building Height Bldg.Square Footage % _._.. S . Open Space Footage _ _ % � flITQ _. (Lot area minus bldg&paved _.� „ - r_ parking-) #of Parking Spaces 1 Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 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 Or 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 , 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 0 NO 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 NO IF YES,then a Northampton Storm VVater Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb CutlDaveway Permit 212 Main Street Sewer/Septic Availability Room 100 WaterlWell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PlotfSrtePla ' � = OttierS�p d APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLI A ONE OR TWO FAMILY DW LING SECTION 1 -SITE INFORMATION` i T is sec iprrtu 4elooMp1et6d b�office 1.1 Property Address: r Ma (- Lot Unit 1 5 Zone Overlay District E"a Elm St District CB District r SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: A,11- a C( /N1 a lAo rte,"AJ P W9 v i E k1 1)1? Name(Print) Current Mailing Add : � �� / � / fi Telephon�fi Signatur / ' 2.2 Authoriaej Agent: Name(Pnni} -- __ Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building lPermit'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) ± �r ,;>,�G" Check Number 46-7 oZS This Section For Official Use.0nl Date Building Permit Number: Issued: Signature: Bwlding,Commissioner/inspector o ui mgs' " Date File#BP-2008-0892 APPLICANT/CONTACT PERSON MALDONADO MIGUEL ADDRESS/PHONE 12 LONGVIEW DR NORTHAMPTON (413)341-3647 Q PROPERTY LOCATION 12 LONGVIEW DR MAP 36 PARCEL 136 001 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: INSTALL ABOVE GROUND POOL 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 F OWING 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 Demob ' elay 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. r BP-2008-0892 GIs#: COMMONWEALTH OF MASSACHUSETTS A , CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) cla—te-qq-,� BUILDING PERMIT Permit# BP-2008-0892 Project# JS-2008-001351 Est. Cost: $4000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 15028.20 Owner: MALDONADO MIGUEL Zoning: URA Applicant: MALDONADO MIGUEL AT. 12 LONGVIEW DR Applicant Address: Phone: Insurance: 12 LONGVIEW DR (413) 341-3647 O NORTHAM PTONMA01 060 ISSUED ON:411712008 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL ABOVE GROUND POOL 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 4/17/2008 0:00:00 $25.001210367 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo