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25C-037 i Yl BOARD OF BUILDING REGULA1 0 A LlGense: CONSTRUCTION SUPM> `r:_,;�€' Number: CS 081793 Birthdate: 04/11/1960 ` Expires: 04/11/20017 Restricted: 00 DANIEL A 'HATHAWAY ,r 2 OLD COSFdE"N RD a + b'VILLIAk SE LJRtS, MA 09096 �drninistratu: — BEAM LAYOUT RUGG LUMBER CO CUSTOMER -- DANH 24 W. STREET DATE 07/25/102 REF SANDY W. HATFIELD, MA 8' S 3/4" V 6 1/4" __ �` S 2- CUSTOM VIEW ?sx? CUSTOMER DANH DATE 07/25/102 REF SAN ' cz E f� 15T)."12 r JiL�J 'r RUGG LUMBER CO 24 W. STREET W. HATFIELD, MA -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 0 Ci sue ` TO: CHITTENDEN TRUST COMPANY, d/b/a MORTGAGE SERVICE CENTER & COMMONWEALTH LAND TITLE INSURNACE COMPANY TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF I HEREBY REPORT THAT 1 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 —NOTE— SURVEYOR _ xqj�' THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY AA —MORTGAGE LOAN INSPECTION PLAT— NORTHAMPTON, _ ofSc MASSACHUSETTS RANDALL PREPARED FOR E. VICTORIA A. WHITE a ILLK H 035032 SCALE: 1 "=20' JULY 2 , 2002 e�ti q L. EATON AND ASSOCIATES, INC. QrcicTrRFn PRnFFSSInNAI I ANO Sl1RVFYORS Q�ttMfPT0 o � aIi3f AChttf CllS DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE Ar' ' AVIT (liceusee/pe=ttee) with a principal place of business/residence at: 2 at- o 4-c—i 4V U a:5-324 (phone#) Z6S• 3 3 7 (street/ci ty/stalr/ap) do hereby certify, under the pains and penalties of perJury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) 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 Comparly/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiraton Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Nagle of Contractor) (Laurance Company/Policy Number) (Expiration Date) (anach additional sheet ifneo=m ry to ine}ude infvrtuatioa pertaining to all ooa7aciors) ( I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:pkaaa be aware that while homcowo=wbo cmplay p=0=to do[Hint .nH construction or repair wort;on a dwelling of not moo than throe units in which the homeowner rrsidca or oa the grounds appurtenant iherdo arc not fly oomidcrcd to be cmployrr3 under the worku z ati n Act(GL152,,s 1(5)),application by a homeowner for a Haase cc permit may evidcnoe the legal stahss o£an employer under tiro Wortrces con pemaiion Arc. I undera=d that a copy of this shlcmmt may be forwarded to the Dcpartux of Dial Acci&=&Ofhoe of Imursnee for the revenge verification and that failure to sxure coverage under sccUon 25A of MGL 152 can lead to tha imposition of triln7 s penalties ooasisting of a fine'of up to S 1,500.o0 arW-imptisoamw of tip to one year and civil pent,,in the form of a stop Work Order and a firm of 5100.00 a day against mo. For al use oaly umber •v 0 2 Lot 4 R Sim of Lioansee/pe 'tfee • L , SECTION iB OCONSTRUCTION SE R1/ICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Doc"Iet- f Ob ( N License Number 1411 , /0(, Ad Expiration Date Signature Telephone ue end° n r r� , 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...... ❑ 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 SECTI`ON��DES( PTION`O��P1Z POSED WORK�� ch ck al a licable New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors iT-- Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks 14 Siding[ ] Other [ ] Brief Description of Proposed Work: f,,LVT14L DW U'-QGA6-E'9 NC- 96-C'k--10' Alteration of existing bedroom Yes_�No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet Q-" sIffJewho s �nd�odcliti6ntoexist�n ho�usin ,com''plefetheXfol.l.owiri : g 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? 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 OWNSAG INGPERM17 C7UARPLfEFOR BENO ILD n, 1, V /C �o/ls /-1 �l r t� as Owner of the subject property hereby authorize 4ti /< f fps <�✓ `/ to act on my behalf, in all matters relative to work authorized by this h1jilding permit application. Signature of Owner Date I, V( c A /e 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 �pe(n/altiess of perjury. / Print Name Signature of Owner/Agent 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 hI Building Department Lot Size Frontage s � Setbacks Front 2 ejOe►ME Side L: R:�$� L:__C R: —S i Rear .3eL Building Height Bldg. Square Footage «.pp 1-4 Open Space Footage �iT % (Lot area minus bldg&paved Ljr parking)l #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. Dues 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 _ N o '; IF YES, describe size, type and location: i Northampton �� ----BSI' Department r" ain Street om 100 �U k\ � i Nort am on, MA 01060 -P an 7-1 40 Fax 413.587.1272 Ste PLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION-1 SITE INFORMATION ?This section:tobe completed '°ffice W 1.1 Property Address: Map° Lot U ElmSt..District" CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: V t&n0-1z-r 6- UJI,0-) �'� jai �TLNc�N uTy�s btzT1 �rrx l�.l Name(Print) Current Mailing Address: x Sty- *Lco Telephone 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. Buildingy'l� �� (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 This Section For Official Use Only Building Permit',Number: P� � 170 TDatelssued: Signature::t =, Date, Buil�ti 'm ng'Comissioner/lnspector of Buildings 4N r oS tty 6 i M t A l jQ log/ —A2a4 ZV 1, 051 ��, �'�.J-...•^'•""wry'._... oo/ '^' _ � • 4 File#BP-2003-0170 APPLICANT/CONTACT PERSON WHITE VICTORIA ADDRESS/PHONE 15 NORTHERN AVE (413)584-8600 Q PROPERTY LOCATION 15 NORTHERN AVE MAP 25C PARCEL 037 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid —4 G-0 C, - Typeof Construction: CONSTRUCT 12 X 10 DECK&RELOCATE DOOR 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 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 Signature of Bu 11 g Officikl Jf 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. BP-2003-0170 GIS#: COMMONWEALTH OF MASSACHUSETTS k. CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: ADDITION BUILDING PERMIT Permit# BP-2003-0170 Project# JS-2003.0319 Est. Cost: $5100.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DANIEL HATHAWAY 081793 Lot Size(sc . ft.): 5009.40 Owner: WHITE VICTORIA Zoning.URB Applicant: DANIEL HATHAWAY AT. 15 NORTHERN AVE Applicant Address: Phone: Insurance: 2 OLD GOSHEN RD (413) 268-3135 WILLIAMSBURGMA01096 ISSUED ON:8128102 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 12 X 10 DECK & RELOCATE DOOR 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 8/28/02 0:00:00 592 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 15 NORTHERN AVE BP-2003-0170 GIs#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 25C-037 CITY OF NORTHAMPTON Lot: -001 Permit: B u i I c i ng Category: ADDITION BUILDING PERMIT Permit# BP-2003-0170 Project# JS-2003-0319 Est. Cost: $5100.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DANIEL HATHAWAY 081793 Lot Size(sq. ft.): 5009.40 Owner: WHITE VICTORIA Zoning. URB Applicant: DANIEL HATHAWAY AT. 15 NORTHERN AVE Applicant Address: Phone: Insurance: 2 OLD GOSHEN RD (413) 268-3135 WILLIAMSBURGMA01096 ISSUED ON:8128102 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 12 X 10 DECK & RELOCATE DOOR 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: H01,6S D �-qr Final: Final; Driveway Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: 04- q_o?Y—p - THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. 01 Certificate of Occupancy Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 8/28/02 0:00:00 592 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo