17A-149 (9) 6'
45' Shed= 45'
80sgft
81'
15' Garage= Breeze
440sgft
way=
120sgft
House=
1168sgft 15'
30'
I
Patrick Mahoney
28 Fox Farms Road
Florence, MA 01062
04/24/01
Scale 1"=20'
a r
' �.�ttAMPpQ
B rill! of wort4allipto t
11 ZI
9 B �Iasaacilnsctta
DEPARTMENT OF BUILDING INSPECTIONS '
212 Main Street a Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
with a principal place of busine esidcn at:
kwor cL
(etreet/city/statelup)
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 woridng on this job:
(Insurance Company) (Policy Number) (Expiration Date)
x..
( ) I am a sole proprietor, general contractor r homeown (circle one) and have hired
the contractors fisted below who have the fell wing nor er's compensation policies:
SHoe wM ObI"lGl3(9 l411OCO 9 llqlol
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifnecetu y to include information pertaining to all coatrc d )
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be avram that while homeowners who employ petsoas to do maintemaeq oomtuction or repair work do a dwelling of
not atom than throe units in wbich the homeowner reside or on the grounds apputmard 1hardo are tot generally oomidaai to be
employers ruder the nonce's aap-sation Act(GL152,ss 1(5)).application by a homeowner for a Grease or permd may cvi&nce the
legal elatna of an employer under the Worker's Compamation Ad.
I understand that a oopy of this etatemmt may be forwarded to the Depwu.,01 of Industrial AcMants'ofhoo of Itwcsooe for the
covaxge vrrificatiot and that failure to aeatro coverages under section 25A of MAIL 152 can kad to the imposition of aU=Al penalties
comistiag of a fine of up to$1,500.00 and/or iatprisonnat;of up to one year and civil pem des in the form of a Stop Work Order and a
fine of 5100.00 a dty agiiad me.
.� For dotal uaa mtY
Permit Number
V t VV w Map# Lot#
Pam. _ Stgnattlre of Liccnsee/Permitxee _
a
Licensed Construction S'uAprervisor: Not Applicable ❑
Name of License Holder: Won n 11 - �V-Y IV-74 GS # 671 5-3�0
License Number
Address Expiration Date
2d1 - 1boo
Signature Telephone
Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
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.
Maned 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 persons)
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
i
New House ❑ Addition ❑ Replacement Windows Alteration(s)❑ Roofing ❑
Or Doors ❑
Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: 5 `/ Yk 16W y IO i S vi e
Alteration of existing bedroom Yes_�No Adding new bedroom Yes X No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0- Sheet
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?
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
I IM
MEOW
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
1, Ira ^c-lc M a
as
Owner/ uthorized Agent
hereby declare that the statements and information on th foregoing application are true and accu the best of my
knowledge and belief.
fined under the ams an penalties of perjury.
1 Pn c
Print Name
Signature of OwntAgent Date
y Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
i DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size L41-1 S b
Frontage (�
Setbacks Front 3
Side L: R• L: S R:
Rear 8 (�
Building Height
Bldg.Square Footage (-1 g '� % �[�� •3
Open Space Footage % b �y
(Lot area minus bldg&paved ;j vZ te tp
parking)
#of Parking S aces 5 s�
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. 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:
1 D. Are there any proposed changes to or additions of signs intended for the property?YES—
No
IF YES, describe size, type and location:
r
, 4
rI -- ity of Northampton
uilding Department
212 Main Street
Room 100
thampton, MA 01060
hon 413 587-1240 Fax 413-587-1272
DEPT OF BUTDING INSPECTIONS
-APPLICATION TO C TRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
1.1 ProRerty Address:
a�
�t o c�ivt t,e
MA
Q, I
f
2.1 Owner of Record: F�,-Y-vvt-> P-0 ai4
i��l L k fi %Atl-1 try V�ti�-t o-� r.� e—r Div► Lt AAA 0 T o L�--
Name(Prin�i Current Mailing Address:
1 Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
Item Estimated Cost(Dollars)to be � �� s , � E
y , R r:' 'Y. a
CO n letec� by permit a IlCant sr S. .
1. Building I ��
RawW a 3 a
2. Electrical
6
3. Plumbing ORf
4. Mechanical(HVAC) � � C s r" k a `3 3i' 001, z
5. Fire Protection
X
6 Total (1 +2+ 3 +4+5)
u °a
File#BP-2001-0856
APPLICANT/CONTACT PERSON MAHONEY PAT
ADDRESS/PHONE 28 FOX FARMS RD
PROPERTY LOCATION 28 FOX FARMS RD
MAP 17A PARCEL 149 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:_CONSTRUCT 8 X 10 SHED
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THVOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
7/'Approved as presentedibased on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § _w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § _w/ZONING BOARD OF APPEALS
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 Co on Permit from CB Architecture Committee
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.
BP-2001-0856
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:shed BUILDING PERMIT
Permit# BP-2001-0856
Project# JS-1999-0779
Est.Cost:$1350.00
Fee:$25.00 PERMISSIOA'IS HEREBY GRANTED TO:
r
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 14810.40 Owner: MAHONEY PAT
Zoning.URA Applicant: MAHONEY PAT
AT: 28 FOX FARMS RD
Applicant Address: Phone: Insurance:
28 FOX FARMS RD
FLORENCEMA01062 ISSUED ON.
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 8 X 10 SHED
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
a
4
Final: Final:
j Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMft69;a69 I TION OFD'
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy si nature:
Fee Type: Receipt No: Date Paid: Check No: ount:
Building 6 ( 1014 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo