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AUG-17-99 08:24 AM ALMER.HUNTLEY.ASSOC. 413 586 9159 P.03
MORTC-AXE LOAN INSPECTION
THIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY
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DOE PRIVA � �
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THE PREMISES SHOWN ARE SUBJECT TO AND/OR TOGETHER WITH THE
BENEFITS OF ANY AND ALL EASEMENTS, RIGHTS, CONDITIONS, COVENANTS,
AGREEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD.
._,
AND THE FIRST AMERICAN TITLE INSURANCE COMPANY - ONLY
rwrnation and belief, frorn infcrrnot.on supplied to me. I hereby report that the premises hove been examined and thct
P shows the improvement of i!rtpra:emenls as i-xoted on 0'e promises described, that l.ie improvement or improcemen'•s
art enj;-e:V -t lo' lines, that there are no er,c:occhmCnts upon the pren•.:ees described by the improvement or improvements of cny
ad-"c :,re•-. and that there ore ro easements of record affecting the trod shown hereon, except as shown.
h.:r.CC- •-e,,. •`•�nt the p remises shown on this plon is nut locnted within o Flao•.I Hazad Area os shown or, .t �H�f
D—a,:-rcr.! U.D. Fed?rol Insaronce Administro;ion Mops, Yo PAUL
(r .r;t .,.,r 250167 0002 A LU8.4lER N
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A_PRIL No.29bd11
sita
O
HUNTLEY OWNER AGNES A. VALENTA
ALMER HUNTLEY, JR. & ASSOCIATES, INC. LOCATION 184 FEDERAL STREET
Surveyors • Engineers • Landscape Architects NORTHAMPTON, MASSACHUSETTS
30 Industrial Drive East
Northampton, MA 01060 JOB NO. DATE SCALE
LOiCe(413)584-7444 faz(413)586-9159 99-671 8-16-'1999 1"= 40>
of �\Touillalllpfoil
gE RltsexchnsrS(a
w�.
4� DEPARTME1,T OP BUILDf)\FG INSPECTIONS
212 Alain Strect ' Municipal Duildmp
Northampton, Mass. 01060
���oru,ilz�s C0MhrNSA110. MSURANCI- AFFLI)ANTY
(1 i ccusc�lpermi flee)
v"ith a principal place of business residence at
(trL 1)/n.11L/np)
do hereby certify, under the pains "I'd penalties of pc7rlry, 11h21
( ) I am <111 empioyel p101"Idin: the iollov,'ins wo'kcr's colnocn;_::ion covcr,:,,c ioi ur.,
enlplovcc; w0[ :1[1S_', (1n (iu1 jot)
0;
1 2111 a sole �):Oi?aCt01 S C1C:<il ConiYaCiOr Or !o'11°0'. tie: Cl: le O e) C; 11cVe hl e 1
the coiitTaciorS the ,vOFke,,,S COi;]JeI1S2.il0il �:'Cl!CIeS-
(Name of Cout,ac,or) (]nsurance. ComnamvPolic-�, OF X,)iration Dzte)
(Name of Contractor) (Inure= Companylpokcy Nutnb,z) ( \pirrtion Date)
(Name of Contractor) (Inswanc� Com auy/Pohcy Numbs) (I xPiration Date)
(anaf?]ad3i'u o¢�.1 r_+xd il nccc:u r::o �n:Jud�in.�orlaiti oo per::.:rum to e1J 0.-�-3G0:])
( ) I ain a sole proprietor and have no one working for me
( ) I am a home owner perfornung all the work myself
NOTE:plc-sc(x ewwr aw while board mcn who employ pci [o&a-*=r„ c«snC oo cr qac o ck on.d" 8 of
tine Moro th_n throo uni'j in u,Inch the lwmoowncr rtiid or oo the gouts at purtensm the do ere dot gan -.11y o x�idcroi to he
cWtoym under the wo:kri i aaz tiro Ac(GL152,s 1(5)�appticabon by e homroava far t bcm-x«PC—M,May cvt3—LLc
legal rtnhu of an cWloyor under do Woek.o .Cocapoaz..tioa Act
113, 1 undcrwt rid that>copy of thii cnt—rte—y bo forwurd.ed to tbo Doport of lnd.izri nJ Aaad-a&Offioo of tn�i for the
eovalt-g�vcriGe3lioo and aLut Lilttre to aoauc w—�under son oa 25A of N(GL 152 an Imd to Lb-Wg=ddoa cf avau-l penalties
ooasistiag of a ftnc of up to S 1,500.00 an&r m3priwamcci of up to ooc year usd avil pcmh o io the form of a Stop W o&Order and e
fim of s t oo-oo.day tit ty--
For dcpu�ux oatY
Permit Ntunbel
igliaturc of I-ocaisxJl'c[III itic� P
ECTION 8-CONSTRUCTION SERVICES
,.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : (It,�X, 0 o c)
License Number
Address Expiration ate
Signature Telephone
3, 6 a6
Not Applicable ❑
...............
a
Company N rn Registrdtioir Number
COO 112 ccm 5 . -
"t / oq
Address -Telephone 1( 16[3 6 - Expiratit Date
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.
A01"Kigned Affidavit Attached Yes....... ❑ No...... ❑
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4
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
C 1 N 5- D T10N O 0 0 E[O the II a l bl
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks '[ din [ ] Other [
-ea-VI e o
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
x .
JUN"'A 111ft
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? "()_ �j^I
d. Proposed Square footage of new construction. a Dimensions D
e. Number of stories? t
f. Method of heating? Cs L- -U^ VDO VC- Fireplaces or Woodstoves Number of each
40gk Energy Conservation Compliance. Mascheck Energy Compliance form attached?
Type of construction `Q-
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
OWNERS AGENT OR CONTRACTOR APPLIES FOR iBUILDING 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
I, / ,�j/,�L �I� 6c) " \ 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.
igned under the pain nd penaltie of perjury. 0 K 'ems C-tD 0
Print Name I
fJj
Signature o Owner/Agent Date
Section 4.
Aw 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
�/ v Building Department
Lot Lot Size 1 f X
Frontage
Setbacks Front
U
Side L: �-R:'5 L: R:
- / 5
Rear
Building Height ( ��
Bldg. Square Footage % J6
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 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:
D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No
IF YES, describe size, type and location:
Glyof Northampton
2000
19 Building Department
212 Main Street
~Room 100
MA 01060
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:
This section"'tobe completed by v, ce
r7e-Q-�'^Q l tS7� Map �ot 6
done ���iey Gisirf+�t
Elm St.'Wit
ri t=- CB 11litrict'
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
ame(Print) Current Mailing Address`
Telephone �L
Signa ure
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. Building (a)Building Permit Fee
a
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 e&
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature: Zd
Building Commissioner/inspector of Buildings Date
File#BP-2000-0904
APPLICANT/CONTACT PERSON COOK BENTON D
ADDRESS/PHONE 13 GROVE ST (413)268-3265 Q
PROPERTY LOCATION 184 FEDERAL ST
MAP 23D PARCEL 123 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PER_ MIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid /07 ��-
Typeof Construction: CONSTRUCT REAR PORCH 8 X 28
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 049209
3se1sets of Plans/Plot Plan
THE LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based 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 ission Permit from CB Architec a Committee
Ldoa
Signature of Building Official D e
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.
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X184 FEDERAL ST BP-2000-0904
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D- 123 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: ADDITION BUILDING PERMIT
Permit# BP-2000-0904
Protect# JS-2000-1672
Est.Cost: $7700.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: COOK & PIASCIK CONSTRUCTION 049209
Lot Size(ss .ft.): 9278.28 Owner: COOK BENTON D
Zoninsy:URB Applicant: COOK BENTON D
AT: 184 FEDERAL ST
Applicant Address: Phone: Insurance:
13 GROVE ST (413) 268-3265 O
HAYDENVILLEMA01039 ISSUED ON:4121100 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT REAR PORCH 8 X 28
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: `� d vT o
Rough: Rough: House# Foundation: 0
aUI b t6 �2:�6
Final: Final:
Rough Frame:6I<q_ a�,pe
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: 6}r -Gw�
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT N OF
ANY OF ITS RULES AND REGULATIONS. I I
Certificate of Occupancy si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 4/21/00 0:00:00 1033 $50.00
z 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo `
t