28-030 (6) N
N
140"
2
Window
32" by 48"
Smoke detector
F
-n
-s
O
v New Bedroom
Storage area 140" by 165"
rn o
0
O
0
Door
30" by 80"
Lj
o
o °O
N �
112"
165" � - CO
Back
door Four seasons room
Middle
Door to door
garage
Bath Smoke detector
room
Kitchen Bedroom
Dining Room
Smoke detector
Carbon monoxide detector .
ii
N
m
ea
a
as
U- Living Room Smoke detector Smoke detector
Bedroom Bedroom
Front
door
=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
NOTE:
SUBJECT TO EASEMENTS AND
RIGHTS OF WAYS OF RECORD.
n
120.00'.±
BOOK 9131, PAGE 296 (n
PLAN BK. 45, PG. 1
LOT #1
I 0
o / �
J #284 (�
=� Ld
Ld
_0
120.20'±
RYAN ROAD
TO: FLORENCE SAVINGS BANK &
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTAT10N 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: THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
of , -MORTGAGE LOAN INSPECTION PLAT-
NORTHAMPTON, MASSACHUSETTS
RAE ALL PREPARED FOR
v IZER y
MIRIAM BUCHANAN
#35032 SCALE: 1"=30' JUNE 2, 2008
HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CI1R 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 (beforg 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 occupancv
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, P as 017 Q k 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.
Address of work
location
/D rgan,, e
J11A o/a,6 .Z_
The Cojszmoizwealth o1 Ilcssachmsents
=x Depnrrment of Industrial Accidents
O,fzce of Investi;ations
600 IT ashirzgton Street
Boston, -41=I 02111
_ x-wx�.mass.a ov/dig
orkers' Compensation Insurance -Afrdadt: Builders/Contractors/EIectricians,Tlumbers
A>;alicant information Please Print Legibly
�'a-rle (Business,%Organi:atioalnd:vidua:):
Citv,'State/Zip: Phone r:
Are you an employer" Check the appropriate box: Type of project(required):
4. I am a general contractor and I
1.❑ I am a employer with 0 6_ ❑New construction
employees (full and/or part-time). have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. C Remodelins
ship and have no employees These sub-contractors have S. ❑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 doins all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp_ right of exemption per MGL 12.7 Roofrepairs
insurance required.]' c. 152, §1(4),and we have no
employees. [NTo 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.
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 of the sub-contractors and state whether or not those entities'rave
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 thepolicy andjob site
information.
Insurance Company Name:
Policy or Seif-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 tiiGL c. 152 can lead to the imposition of criminal penalties of a
tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine
of up to 3250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investiaatiors of the DLz for insurance coverage verification.
I do hereby-certify under the pains andpenalties ofperjury that the information provided above is true and correct.
Si�ature �[�JA Date: 0 / t
Phone ii7
01Jicial use only. Do not r,rite in this area, to be completed by city or Lawn offi
City or Town: PermitZicense
Issuing Authority(circle one):
1.Beard of Health 2.Building Department 3. City/ own Cler 1: q.Electrical Inspector 5. Plumbing Inspector
6. Other
i Contact Person: Poore :
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Sucerrsor_ Not Applicable ❑
Name of License Holder:
License Number
address Expiration Date
signature Telephone
i.Redistered Home lmnrovement Contiacror-:" Not Applicable El
:omoanv Name Registration Number
ddress Expiration Date
Telephone
ECTION 1.0-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 1152,§25C(6))
'erkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
the denial of the issuance of the building permit.
cned Affidavit Attached Yes....... ❑ No...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings ofone(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a Icense, provided ghat the owner acts
as supervisor.CNIR 780. Sixth Edition Section 1033.5.1.
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 considereld a homeowner.
Such"homeowner"shall submit to the Building OfEcial,on a form acceptable to the Building Official.thpt he/she shaD 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,durmi a 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 152 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may beFNable for person(s)
you hire to perform work for you under this permit.
The undersizned"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 Signatur
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all avolicabie)
l+
New House ❑ Addition ❑ Replacement windows Alteration(s) ❑ Roofing
Or Doors Ei�'
Accessory Bldg. ❑ Demolition ❑ New Signs [ED] Decks [Q Siding [77, Other[CI]
Brief Des ti 9n of Proposed �L�
work: QLfzaA 4&4:r Ole 4/LZU 1z����ri ar�r
Alteration of existing bedroom Yes i/ No Adding new bedroom ✓ Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. t€New i ous as or adcii ori=to''ezisf r g fiaus>na.comii ete t i of awing:
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 Wcodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. is construction within 1GO ft. of wetlands? Yes No. Is construction within 100 yr. flocciplain 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 Pnvate well City water Supply
SECTION 7a-OWNER-AUTHORIZATION 7013E COMP€.�ETED-WKEN.
OWNERS AGENT OFMONTRACTOR APPLIEt FOR SUII=DINGPERMIT
i &L4 Y7 ��� as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters reiative to work authorized by this building permit application.
Signature of Owner Date
i &L— �c�� , as Owner/Authcnzed
Agent hereby deciare that the statements and information on the foregoing application are true and accurate, to the best cf my knowledge
and belief.
Signed under the pairs and penalties of perjury.
P'Int Blame
-.cr,ab rc:r Cwne 'Aceni --ate , t7
~~ '
Section 4. ZONING ALI information Must Be Compieted. Permit Can Be Denied Due To Incomplete Information
Exisiang Proposed Required by Zoning
nis column to be filled in by
Building Department
PLot Size
Fronmae
Setbacks Front
Lot I-e
Rear
Building Height
131da Square Footage %
Open Space Footage %
(Lot area minus bIdg&paved
rwlanir
#of Parkine Spaces
(volume&Location)
A. Has a Special Permit/Vahance/Rnding ever been issued for/on the site?
NO 0 DON7KNOY vk YES 0
|F YES, date bsued:- .
IF YES: Was the permit recorded atthe Reggistry of Deeds?
NO �� DON7KNOYY Yt]
\_�
IF YES: enter Booki � Page and/or Document#| �
B. Does the site contain abrook, body of water orwetlands? NO V- DONTKNOY 0 Y[� 0
IF YES, has apermit been or need to be obtained from the Conservation Commission?
Needs tobeobtaned �-\ Obtained �-\ Date
' \_� ' \_� ' ' ____ _
�'
C. Doa�y�gns exist on the prope� x"
y� 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:
E. Will the construction activity disturb(clearing,grading, excavation, or filling)over 1 acre or|ait part pfa common pian
that will disturb over 1acre? YES � } NO K ^�~-
�� ��
IF YES, then a Northampton S§ErmM������gementPennit from the DPW isrequired.
�
�
�
�
�
�
Department use only
City of Northampton Stags of Permit
�� Siding Department
Curb-Cut/Driveway,
— i.n , ' ail 4,2��12 Main Street SevieslSepfidRvailability
`� -- Room 100 watetAUelFAvaitability
/n
Northampton, MA 01060 Two seti'6f structural Plans ,
JUN 'p�-l;013-55i-1240 Fax 413-537-1272 Plot/S to Plans
�..� pe
Ofher, _
t Albl?L1£ATICINO CANa1TRUC— LTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:? j1
Z4 fix/I ked Map Lot Unit
l l/r l e Gt C�6 Z Zone Overlay District
Elrri St District CS District
SECTION 2-PROPERTY OWNERS HIPIAUTH.ORIZED AGENT
2.1 Owner of Record:
Ko uN ef xie74
Name(Print) Current Mailing Address:
C`__ Telephone
gnature
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 permit aoolicant
1. Building �� (a)B0d.ing Permit Fee
2. Electrical / (b) Estimated Total Cost of
Construction from(6')
3. Plumbing ( Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
O
6. Total= (1 +2+3+4+5) f�U Chedc'Number
This Section For Official:Use Only
Date
Building Permit Number Issued:
Signature:
__ .-_ ----------Building.GommissioneT/Inspectoro, ui mgs Cate
File#BP-2008-1155
APPLICANT/CONTACT PERSON CHEA ROEUN&SOVANNARY
ADDRESSIPHONE 284 RYAN RD FLORENCE (978) 866-0707 Q
PROPERTY LOCATION 284 RYAN RD
MAP 29 PARCEL 030 001 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
T_ypeof Construction: CONVERT GARAGE INTO BEDROOM
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 F947LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I F 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
Demolition Delay
O
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.
BP-2008-1155
. 'aV
GIs#: COMMONWEALTH OF MASSACHUSETTS
r CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category BUILDING PERMIT
Permit# BP-2008-1155
Project# JS-2008-001704
Est. Cost: $800.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 13547.16 Owner: CHEA ROEUN&SOVANNARY
Zoning:URA Applicant: CHEA ROEUN & SOVANNARY
AT. 284 RYAN RD
Applicant Address: Phone: Insurance:
284 RYAN RD (978) 866-0707-0
FLORENCEMA01062 ISSUED ON.613012008 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONVERT GARAGE INTO BEDROOM
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 6/30/2008 0:00:00 $50.00240
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo