25A-118 . _ —, „,yu UIIIc�rt ODUKI'L-, AND IS NOT
or_ c,UN'- (RUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED,
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
9
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� '�-�•�`"�`�=-�� �->t-�`1 ^-,ice-=-y ��-..�`��`'�`�`
TO: SUNTRUST MORTGAGE, INC. &
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMiNE D THE PREMISPES AND BASED 014 EXIS T iNG
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATIEI) ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE L04 LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE:: DAPS FOR
f COMMUNITY 21)010 7
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THIS ; �T Ci � RT it
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�� HAROLD I., I A�-ON AND ASSOCIATES, INC,
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DEPARTMENT OF BUILDING INSPECTIONS I f
INSPECTOR "212 Main Street • Municipal Building '
Northampton, MA 01060 S Y
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as 1:1s/tier construction sup<r,,i sor. The state defines "Homeowner" as, ".Person(s)
who owns a parcel on which he/she resides or intends to be, a dine or bi0_ rn y --
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 buil mg-departmernf for tile-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 eegulations. 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 occupanev
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, � N/\J 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 rite.
Date-
Address of work
location
r
I
.51:3.ar3lnsrlle'
o DEPARTMENT OP BUIL.DD-,'G INSPECTION'S
j 212 Alain Strcct Municipal Building
i Northampton, Mars. 010GO
NY RlT-. I CONUENSATTO.N L'1SURANCE :'.h=AArZ`T'
,ViLh a principal place of business/residenec at: - --
j
(phone:-)
(stztrtici ty/s=12c p)
do hereby certify, under the.ppiu s and penalties of perjury:, hat
am an employer providing the following %vorkcr's coinocasa:J'on coverage Ior im
emplovees %vortang on tills job:
(L2sur--n= Conn) (Polk; Nu=mb-cr) -- (r:piratSor.DzL}
( ) I am a sole proprietor general contractor or homeowner (ccie or!e) and have hired
one contractgrs Listed below «ho have the ioUot�ri p, workers camoep-"aeon policies:
i
(c±amc
Of Contractor) (InRranc; Compan)vi'ouc,- NIurn=<r) :p1.Je Date)
(Namc of Conracior) (Insuranc: Como mylpolic- Nun6_.0 (.,mim6on Date)
I
(Name of Coa=Md,-) (L>,suranee am-pany/policy N:unh'-J) (-g)iraoa Dale)
I
(Namc of Contractor) (Irsurancz-
(att�G'r aal iiComczny/Poucy Numbr) aLr
.:i�oo! _xv,if nccc. -1to a�cudf Lat D-
oc - -- .
it
I
j O I
am'a sole proprietor and have no one world.ng for me.
( am.a home owner performing all the work myself.
I
i
NOTE:pl==be=wise Ti—..jz;Jc hcmcowoc a wbo=^ploy Pc-.om to do -• c=s.:woc c rgau.+uric ca t d--mo=o of
not more tb a ttso_-L-"i,,is t�6 the bomoownc rondo a oa the p-oun6 xppurtcc,=tbeao c-c oot C _Uy a.-ccd.-ni w be
cxploycs trnG=the r�-ti---''oa A=(GLII 52-=1(5)�:pplinEoo by.bommax fc-lip.cx pcmit 2y=video«tL-
lc-�.1 ct:3rc of.a e=Ployw Ueda,dtw black e.compem.,;*a AeL
I
I uadest+ad tb.a a copy of tbr.mL=: =d..y be foc—.d<d to the Depertmee¢of Indaauic!Aecd..:Ly Office or ltra�for U.
cove o^c`rcirc-sioa and tlru C:.iltac to"==l-ovCmy t=dc=Mica 25A of MOL 151 cza lcd to tho imaositioc of c mical p=asha
eoosi:r=S Of,.line of up to SI-300.00&rzfor iaz;siyc or up to ooe yr_r end evil Pm+fua io 6,roan or.Stop Work 01- a and s
Crsn of S 100.Qo i d:y cpjc�j// Uy-
-------
j Pcrm�t NU.Mt---
97aattrrc of Liccn-sc—lPcrmitfnn La ce I IL
9
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SECTION 8-CONSTRUCTION'SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
g4Reaste'red'ttomelmpraver"rtecCoetracare '� Not Applicable ❑
Company Name Registration um er ---- —
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE'AFEIQAVIT`(KG:L.c.1b2,,§•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...... ❑
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 1083.5.1.
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 Z ni.ng Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature G'�d
f
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check allraaplicable)
New House ❑ Addition ❑., Replacement Windows Alteration(s) Roofing
Or Doors D
Accessory Bldg. LJ Demolition ❑ New Signs [01 Decks [p Siding [E3] Other[O]
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes L,-Nc Adding new bedroom Yes 1--vo .
Attached Narrative Renovating unfinished basement Yes
Plans Attached Roll -Sheet
„..; .,"-.; '^� " ,e==*"�`ti U.-c:. &'.R�mzT`°•.`:.ar^ ".�-�« .:�. ;rrcc, S•:�?t,*;° w° �,"t�' w�`sp '%
6a.�€�Ne��tro se��tck�addr�ia"Ito.�exlsttrlc� toas�nc�,'co�ptete�h��+�Eia��na:
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.
1. Septic Tank City Sewer Private well City water Supply
SECTION Ta-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
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.
Print Name
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
un ry, This column to be filled in by
�G G Building Department
Lot Size
Frontage — 76 �0
Setbacks Front ±
Side L: L:� R.
Rear
Building Height i -
rPuncL ---ao
Bldg.Square Footage % r--
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: i
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q 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 er----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 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,exca n,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES r NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
s
r
City of Northampton
Building Department eve ecirt
a
212 Main Streett td
Room 100 k
Northampton; MA 01060 10 e s o�5t�traftai �
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: M This section to be completed by afEice
< A
fi` Y
ib .S'ttL f'yh f XW Map Lot Unit
ti1� �tL�C�G 4,'ff � m
Ak!Q 4' (�N% Zone Overlay,D►strrcf
c Elm SE District _. CB DGStF�c
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEQ'AGENT'
2.1 Owner of Record:
Name(136N) Current Mailing Address:
, Telephone
ature
2.2 Authorized Agent: -5"4" A S
h-w— . &O A/c"
Name(Print) Current Mailing Address:
SignatuW Telephone
SECTION 3-'ESTIMATED CONSTRUCTION COSTS
Item - Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 0-10 fil" �^ �� (a)Building Permit 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) Check Number aS
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2006-0623
APPLICANT/CONTACT PERSON QUINN JAMES&ROSALEEN
ADDRESS/PHONE 16 SHERMAN AVE NORTHAMPTON ()585-0331 Q
PROPERTY LOCATION 16 SHERMAN AVE
MAP 25A PARCEL 118 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid 171V A02
Typeof Construction: ERECT 8 X 12 SHED
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
IN 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 Commission
ZO
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
16 SHERMAN AVE BP-2006-0623
G1S#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 25A- 118 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0623
Project# JS-2006-0914
Est. Cost:$2500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 6969.60 Owner., QUINN JAMES&ROSALEEN
Zoning: URB Applicant: QUINN JAMES & ROSALEEN
AT. 16 SHERMAN AVE
Applicant Address: Phone. Insurance:
16 SHERMAN AVE O 585-0331 ()
NORTHAMPTONMA01060 ISSUED ON.1211312005 0:00:00
TO PERFORM THE FOLLOWING WORK.-ERECT 8 X 12 SHED
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 12/13/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo