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D m Q 21 west st. - west hatfield, ma. - 01088
4132014 8:40:30 AM
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Brick Trim: 0 X 0
Stone Trim: 0 X 0
Remodeling Data:
Year Remodeled: 0
Kitchen Remodeled (Y/N):
j Bath Remodeled (Y/N):
Land Data Outbuilding Info
I Square Foot Type €
Utilities
;Type FQ Value — '
no
i Prime `s information
i 41,5001 116,020] ----- --' --
Site ! Type Qty,Year Size l;Size2 Grd Conde j
- - j no information
Acreage Type � � _— {
j Street/Roadl 1
Type Acres Value no
no
E ° information
information;
Sales Info ;Permit Info - — �-E
Date Type Price]Validity, a t Permit# Price Purpose=
F no information; no information!
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New Search Property Type Classification Code Reference Card 1 of 1
Parcel - Location Zoning Assessment
Map-Block-Lot: 30A-062-001
p- Zoning: Assessment:
Location: 242 FLORENCE RD Neigborhood: 6 Land: 116,000
#Living Units: 1 Deed Book: 1912 1 Building: 104,100
Class: R-101 Deed Page: 167
Total: 220,100
Dwelling Information Building Sketch
Style: Ranch
DescriatorlArea
Year Built: 1965 F A 1FrlB
Story Height: I 7232sgft
8:FG
Attic: None; 1--- --1 440 sgft
C:Wood Deck
Basement: Full wood neck 720,gft
Total Rooms: 5 4� �a
E
Bedrooms:
3 '
F6 ,,
; Full Baths: 1 22 `440 �2
Half Baths: 0 28 1232 2S 20
Exterior Walls: Frame j
I
' Unfinished Area: 0 44
Ground Floor Area: 1232
Total Living Area: 1232; E
Finished Basement Living
ox0
Area:
I Basement Recreation Area: 0 X 0 Addition Information:
9
Woodburning Fireplace 0/0
Stacks/Openings:
Metal Fireplace r
0/ 0
r Stacks/Openings: s
Heat/Central A/C: Basic,
Hot
Heating System: Water
Fuel Type: Oil
Quality Grade: C+'
Physical Condition: Average l Lower l st Story 2nd Story 3rd Story Area
Basement One Story Frame 1232 3
Interior/Exterior: Same EF IjFrame Garage
Condition/Desirability/Utility: AV ----]Wood Deck 1201
Vacant/Dwell/Oby Status: Dwelling
Additional Features:
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City of Northampton �•
•j Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS 5 ,
212 Main Street • Municipal Building
,r
Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
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 any 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
L, 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
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
y www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): c,"f4it4 U�`f�l��✓ �..
Address: A c 4 f4 !r
City/State/Zip: 03� Phone#:
Are you an employer? Check the appropriate box: Type of pro' ct(required):
1.❑ I am a employer with --"-7 4. ❑ I am a general contractor and I
employees (full and/or part-time).
* have hired the sub-contractors 6. ew 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 for me in any capacity. employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
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.F-1 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.
tHo meowners 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: V
Policy#or Self-ins. Lic. #: �G�/ �o Expiration Date:Ll
Job Site Address: � 7 cZ ��'"cL � 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 a' s and penalties ofperjury that the information provided above is true and correct.
Signatu re: Date: 9/ f
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: 10 ' -163
License Number
Address Expiration Date
Signature TelepTione
9.Registered Homeampi^ovement Cont"rector M Not Applicable £
1O t s 3 3
Company Name Registration Number
Address Expiration Date
Telephone ��'�
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(6))
Workers Compensation Insurance affidavit ust be completed and submitted with this application. Failure to provide this affidavit will result
I - g p
in the denial of the issuance of the ermit.
Signed Affidavit Attached Yes.LX No...... £
11. .Home Own er,E" a"mptiolQ
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) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[0]
Brief Descripti n of Proposd (` ' 1
Work: �} ( h
Alteration of existing bedroom Yes No Adding new bedroom Yes o
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a, if Neriv house and'or'addition to exisfingµ'housing, complete 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? if
f. Method of heating? 1'k'fi "AtZ'!Z. Fireplaces or Woodstoves
g. Energy Conservation Compliance. / Masscheck Energy Compliance form attached?
h. Type of construction 0
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
%5i0 S
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 2 0,
to act on my behalf, in all maters relative to work authorized by this building permit application.
Signature of Owner Date
I ,as Owner/Authorized
Agent ereby 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./
Print Name ! G
�' d- d
Date
Signature of Owner/Agent
'
^ -
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Tliis column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear FP40 =50
Building Height
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Yahance/Rnding ever been issued for/on the site?
NO v�/ DON7KNOYY r YES «��x~~�
IF YES, dateisxued� �
' 'L_____-_'___J
IF YES: Was the permit Deeds?
�� YY
NO DONTKNO YES
�_/
IF YES: enter 8nnk Page= and/or Document#1
�� �� ��
B. Does the site contain obrook, body ofvvaterorvvet\ands? NO ��, DONTKNOVY �~� YES «~�
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tubeobtained �~\ �bta(ned �~� Date
��/ �~� ' .
C. Dn any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed chanQestooradditionsoydgnsintendedhorthep,operty? YES 0 NO
IF YES, describe size, type and location: �
E. Will the construction activity disturb(clearing, grading n.nrfi|Ung)over 1 acre nriud part ofo common plan
' that will disturb over 1acre? YES NO
|F YES,then a Northampton Storm Water Management Permit from the DPW iarequired.
City of Northampton ��=_ � t s of � nlr4J ryIif k rer,Ne k 7¢
,� i� I Nam,k, �kl� ..;�?fia�
Building Department ' Gtrr Wc�[r�cerar ei'rrtl#'r
212 Main StreeterlSgptic� val b►lily �� t rx
FN
Room 100 C— a�lteit�4yalla flit� M r
r
Northampton, MA 0106 Twp refs ctf'str oral Pfans
TLI
hone 413-587-1240 Fax 413- 7
phone �t Pl n`a i' _ r
4
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
1.1 Property Address:
Th1s sectlorr to be'completed by office
7 Map Lot Urnt
7
I
n Zone Overlay District
_
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:_..z L
%12; 7
Telephone
jo
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 ermit applicant
1. Building Building Permit Fee
2. Electrical
CY—7 (b)(b)Estimated Total Cost of
Construction from 6
3. Plumbing 3 6'�' Building Permit Fee
J
4. Mechanical(HVAC) a Q
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector'of Buildings Date
L
File#BP-2014-0965 v N k�
APPLICANT/CONTACT PERSON ROY OMASTA
ADDRESS/PHONE 21 North St HATFIELD (413)247-5666
PROPERTY LOCATION 242 FLORENCE RD
MAP 30A PARCEL 062 001 ZONE URA(100)/WSP(100)/
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: CONSTRUCT 6 X 10 REAR BATHROOM ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accessoa Structure
Building Plans Included:
Owner/Statement or License 006763
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
Signature of Buildi g O frcial 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.
242 FLORENCE RD BP-2014-0965
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-062 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit# BP-2014-0965
Project# JS-2014-001679
Est.Cost: $10875.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROY OMASTA 006763
Lot Size(sq. ft.): 41512.68 Owner: SINGH JASPAL
Zoning: Applicant: ROY OMASTA
AT. 242 FLORENCE RD
Applicant Address: Phone: Insurance:
21 North St (413) 247-5666 Workers Compensation
HATFIELDMA01038 ISSUED ON:41312014 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 6 X 10 REAR BATHROOM
ADDITION
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 4/3/2014 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner