28-009 (2) 04123/2003 08: 34 4132689355 BALDWIN C PAGE 01
ACORD,�+ CERTIFICATE OF LIABILITY INSURANCE 09/0 X2002
PRODUCER FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Fi nck & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
63 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW „N
Florence, MA 01062 INSURERS AFFORDING COVERAGE
INSURED Charles Baldwin 31 Son INSURER A: National Grange Mutual Ins. Co
44 Hyde Hill Road INSURER B:
Williamsburg, MA 01096 INSURER C:
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR POLICY EFFECTIVE POLICY EXPIRATION LIMITS
TYPE OF INSURANCE POLICY NUMBER DATE MMfDD1YY DATE MWOD
GENERAL LIABILITY MPIS3099 07/16/2002 07/16/2003 EACH OCCURRENCE S 300,OO
X COMMERCIAL GENERAL LIASIILITY FIRE DAMAGE(Any one nra) S SOO,OO
CLAIMS MADE T OCCUR MED EXP(Any One person) S 10,0001
A PERSONAL d ADV INJURY S 300,00(
GENERAL AGGREGATE $ 600,00C
GENT-AGOREGATF LIMIT APPLIES PER: PRODUCTS•COMPIOP AGO S 600,00(
POI.ICv PR
JEC.O T LOG
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY S
SCHEDULED AUTOS (Per oerson)
HIRED AUTOS BODILY INJURY S
NON-OWNFO AUTOS (Par acident)
PROPERTY DAMAGE S
(Per aocldenl)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ,
ANY AIJ10 OTHER THAN EA ACr,I s
AUTO ONLY: AGG S
EXCESS LIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE S
DEDUCTIBLE
RETENTION S -- $Fr
WORKERS COMPENSATION AND I5309 06/06/2002 06/06/2003 TORY LIMITS ER
EMPLOYERS-LIABILITY
E.L.EACH ACCIDENT S 100,000
E.L 015EASE-A EMPLOYEES LOO,OO
E.L.DISEASE-POLICE'LIMIT $ � Soo,00
OTHER
DESCRIPTION OF OPERATIONS rtOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER ADDITIONAL INSURED:INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Northampton EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Attn: Karen 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
212 Main Street BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Municipal Building OF ANY KIND UPON THE COMPANY ITS AGE S RE ESENTATIVE$
Northampton, MA 01060 AUTHORIZED REPRESENTATIVE I -
ACORD 25-S (7197) FAX: S87-1576 OACORD CORPORATION 1988
�'tNAMP�,
C T
itV of Nort1jamptor z
M �
AaSSaCIt Its rIts
DEPARTMENT OF BUILDIT;G INSPECTIONS
INSPECTOR 212 Main Street @ Municipal Building
�y e`
Northampton, MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as iris/leer construction sul c: , :sor. 'he stare defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two family
dfvelling, 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
I 4-<
understand the above.
(Home o*iielf/resid it'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
C�zf�L �7f artl1alllp!Lill ( - —
g = 6 J3'<rrsarscflccsrlls �^
Ii EPARTMENT OF BUILDPl G INSYECI'IONS —
212 Amin Street ' Municipal BuiHini,
Northampton, Mass. 01060 A __W
NVOF I'_KER'S COMI'1sNSAT1ON INSURANCI% AThLDAVjT
(licr�� /�c,m lice)
\:'ith a principal place o; busKess/rwdence at
(phunr--
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do Why Ccnw, lii' ul MY ll,.!iLi ar,(l pC;il<?lt1cS o p .Tjlll}-,
I am 'tI1 Cnlpioyn pr Ovk m the i )HO's w" Y,'O[r_CKS COfI1lWIISfl aml Cove .. ' 1b; pr'
C111pl "ccs "�'Uikillii' un U"IS j('f), {
E
(Inc irattc� Corn L,y) (Folic;Number) (I :;?i;r.tion Date)
4
i
� I mi a SOIL pIou to tai, gum 1::IA c')Il mcroi �� I:G11C0\III GlP OI1C'� nr ]l' i1ltU �
t_he Contractors On, b.,iov,'? have the fbko v _, t, , S compansamo , `1 ws
"c' ---- �_ `�✓ r.S -a G�/�
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t 1 am a :;UI:C l;iOp!iC;C�)i :.il';l ;l(1VC Im oll:' '.`,'0? ;iii I01 illy.
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❑ot atcee l}s.❑tlucc u:v�l i:;�ci�t;t J.c f.xr:o•.��,cr rep:._s„-on t1�.-�.-:�.:e.�ap�.Itt:rr.r�Lxxdc e:c n.-<�ecxnlly c,.-r.::: :ai:�•'t:.
� } __._. ,.C:(CiLli2•.z;(511,r{;''�.--_IC,�yafcrt:x��'rr!crnL� :ucs
4PI MM;of an oe Vhyx under li:a vV v4a',Con;mritlon AcL
I tuAc_vmd Ana Ivry of A cto--A may I- to tl-,o D.-j—t_ c t of 1n1i tncl Act-iL�nt�Oflico o(: au u>o for t}x
COVrZySC vc'iflcslloct r_-Id tlut f^ilurc IO :1:lIlC 25A Of MGM.152 can lyd t0 the I:7.;}DS1f 7011 of C:L":i l fYrslt:CS
Cociistmg of a lux of up to S 105100 an of IIp to cn:}cs a'j Civil 1xraltia in t'fi n Of Sir,,A'ti'mi�-
f l-IC of SIP�.(?0 a tf.-iy ignirc.t In-. - -
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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
''tReetstered'Nome'IlinprovementCoiitractort1 Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10- WORKERS';COMPENSATION INSURANCE AFFIDAVIT(M.GL. 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...... ❑
1 . = t ome ®<wgnerE em tin
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 he 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 thejob site will be required from time to time, during and upon
completion of the work fk 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 Lavv,s Annotated, you maybe liable for person(s)
you hire to perform work for�rou 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 ❑
Accessory Bldg. ❑ Demolitiono New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: )�'l21 V
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet ❑
6a:If`NeW:WdU§J or"!addition to existing-ho'usinfr complete h6461'16win :
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
l 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 to a"` or.
my behalf, in all matters relative to work a,.! horized by t1hiF 7uilding 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 nny
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature KOwneVAg6nt
��— 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 iz
Fronta e
Setbacks ont
tde L: R: L: R:
Rear
uilding 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 f 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 t#
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:_
a _x
City of Northampton S atuso�Pe. _rt .
BuiPding Department G0r Q
212 Main Street s r-S p-fe.';. a►labr >:
PR 2 <v Room 100 1Na eIWeI /�vtia "
Q" -Northampton, MA 01060
phone 413-587-1240 Fax 413.5871272 Plot/SIte�Pans
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section,to be,compliated by office
Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
2.2 Authorized Agent:
I
^Ja;r-ie(Print) C„ rent Mailing Address:
i;ignai,,re
":Iephone
SECTION 3_ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Doll f , lC fie Official Use Only
completed by perrni' ar "I
(a) Building Pert-nit flee —
(h' tirnated Total Cost of
h lm�
j _ �-onstruction from (6)
Building Permit Fee
4 lvlech,mic-�l (HVAC)
ICI i
5. Fire Protection
6 otal -(1 + 2 + 3 4 + heck Number
This Section For Official Use Onl
Building Permit Number. Date Issued:
Signature: ,
— ----- ---------------------------------- -- -----------
�_ Building Cornmissioner/Inspector of Buildings Date
File#BP-2003-0923
APPLICANT/CONTACT PERSON LINGNER KATHRYN R
ADDRESS/PHONE 320 SYLVESTER RD (413)584-2605 ()
PROPERTY LOCATION 320 SYLVESTER RD
MAP 28 PARCEL 009 001 ZONE RR
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: DEMO BARN,CHICKEN COOPS&SHED(NO UTILITIES)
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 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
s-1114—
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.
320 SYLVESTER RD BP-2003-0923
G1S#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 28-009 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2003-0923
Project# IS-2003-1480
Est. Cost: $6450.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 815443.20 Owner: LINGNER KATHRYN R
Zoning:RR Applicant: LINGNER KATHRYN R
AT. 320 SYLVESTER RD
Applicant Address: Phone: Insurance:
320 SYLVESTER RD (413) 584-2605 O
FLORENCEMA01062 ISSUED ON.5 11103 0:00:00
TO PERFORM THE FOLLOWING WORK.-DEMO BARN, CHICKEN COOPS & SHED (NO
UTILITIES)
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• Receipt No: Date Paid: Check No: Amount:
Building 5/1/03 0:00:00 3237 $20.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo