25-007 146 RIVERBANK RD BP-2017-0064
GIS s: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25-007 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permits BP-2017-0064
Project 4 JS-2017-000116
Est.Cost:$20000.00
Fee: $130.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 24001.56 Owner: HAYWARD HELEN A
Zoning: Applicant: HAYWARD HELEN A
AT: 146 RIVERBANK RD
Applicant Address: Phone: Insurance:
71 FORT MEADOW DR (978) 562-3582 0
HU DSONMA01749 ISSUED ON:7/20/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR FRONT PORCH & CHIMNEY & INSTALL
REPLACEMENT WINDOWS/DOORS
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:
FeeTvoe: Date Paid: Amount:
Building 7/20/2016 0:00:00 $130.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File tt BP-2017-0064
APPLICANT/CONTACT PERSON HAY WARD HELEN A
ADDRESS/PHONE 71 FORT MEADOW DR HUDSON01749(978)562-3582 0
PROPERTY LOCATION 146 RIVERBANK RD
MAP 25 PARCEL 007 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid a1106 ( 6T
Building Permit Filled out
Fee Paid
Tvueof Construction: REPAIR FRONT PORCH&CHIMNEY&INSTALL REPLACEMENT
WINDOWS/DOORS
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
INFORMATION PRESENTED:
proved 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
•-molition Delay
Signature uil.ing 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.
DePoc- 9,rusatinlyr rP s _
CG .., City of Northampton Status ofPermh+li:ixt l ,gt t :- e - t
R — \ Building Department Gurb`cut/Drlveway PermlP g+ :,
I Ill212MainStreet Sewer/ epE-----131. 1 "
tRoom 100 l_� Northampton, MA 01060 rfitiv'f Str4ytufal PlnpEn .
phone 4413-587-1240 Fax 413-587-1272 Plof/sit Plans -
otfien05.44.T- i
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: / - Thls section to be compleedtby office
/76 / 4N2 6*i / / Map L6f Unit
=Zone Overlay District
Elm S_t.District'. CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
47
7/ I/77116th
S -rO
d�Current Mailing Address: /p7CName(Print) o..7
CTelephone
2.2 Authorized Anent:
Name(Print) Current Mailing Address:
V-7 -4))
/yn f
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS ��� Cry `1--1 -
Item Estimated Cast(Dollars)to be Official Use Only -
completed by permpplicant
1. Building
-1_,
-7C �� �it a (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 ee ,y(/�3t/11
fi. Total=(1 +2+3+4+5) Check Number # �C fX/,, /
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspectar of Buildings. Date
I
Section 4. ZONING A11 Information Must Be Completed.Permit Can Be Dented Due To Incomplete Information
Existing Proposed Required by Zoning
This cotwnn to be filled inby
JUL
�/y Building Department
—
Lot Size ici_ x/0 —E -_ = -�
Frontage J :___ _ � i
--_-.- -_. .._ .._
Setbacks Front F4i ( Lc/j L. J
Side L: /5 11 R: L:LL_. RIO fli
Rear t.t2_I 1 Oi i-i
Building Height 1-151 1 1
Bldg.Square Footage % ; ---1_ •
Us,� Fem i 1.---1
Open Space Footage �� % r—�', i
(lot area minus bldg&paved Orel [.. 1 Fri i I_,C_ 1 t
Parking)
_._..
#of Parking Spaces ( ii r- (, 1
Fill: 4t
(volume&Location) :
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW er YES Q
IF YES, date issued:',
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW YES Q •
I Page J and/or Document pE i
IF YES: enter Book _____J ____„
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained
0 , Date Issued: L J
C. Do any signs exist on the property? YES Q NO CEJ
IF YES, describe size,type and location: ,I I
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO err
IF YES, describe size, type and location: 1 {
E Will the construction activity disturb(clearing,grading,excav n,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
•
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ ReplacemenW' lows Alteration(s) n Roofing n
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [r1 _hacks [II Siding[0] Other IO]
Brief Description of Proposed /
work Ac icer/MY [✓ nt4445 DOOK3",i,z X 2rcl9 h +
Alteration of existing bedroom Yes Y No Adding new bedroom Yes ✓ No /CA Off Mr�
Attached Narrative Renovating unfinished basement Yes v""-No
Plans Attached Roll -Sheet
6a, If New house and or addition to existing housing, complete the following:
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. Masscheck 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
OWNERS
SAAGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
-40•7 ,as Owner of the subject
property / / ,///// T / ni
hereby authorize 'R//�V / /S--rsr M1 ( ! �/ r G' 3
to act on my behalf,in all matte relati a to work authorized by this building permit application.
SC
Signature of Owner /Date
'/ ft FS �1 L �7 y � as Owner/Authorized
Agent lhhereby declare that the statements and information on the foregoing applic tion are true and accurate,to the best of my knowledge
and belief.
Signedunder, the pains and penalties of perjury.
7( '71/4 en A, {7/a f&etrce 07a/5
Print Name
L R. .-.yrTl f" CC/ / o7r/5
Signature of Owner/Agent o Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ,l/� ,//�Jf ._— Not Applicable E
Name of License Holder: g/ ,y ez i/
/ �^ / License Number
(3 C47e✓e eell Ac l�/°s/I4 e pie,-
Address Expiration Date
r /."— F, —/ 3 0 /
Sign lure Telephone
9:Registered Homet provemenfLontractor ` " Not Ap licable £
r, rr/ , ereur Tc /7V/t? rO c /111V7:3
Company Name/� /�� Registration Number
i%/t eel T� /Ale X ere veto
Address Expiration Date
ci C4. 1 axe 01 A-e / /y// phone r/y" qy/ /70/ , 7 / /
/01 � �
/
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 es.:11).. £ No £
11. --Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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
uctures.Aperson 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` g
andLocal Zoning Laws a and State of Massachusetts General Laws Annotated.
Homeowner Signature /
/`2 C��YIyNsefiC
The Commonwealth of Massachusetts
e Department of Industrial Accidents
TT Office of Investigations
(t! ��� 600 Washington Street
iff t Boston,MA 02111
` ,„.,as' www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information '//,7 /�/`�`� Please Print Legibly
Name (Business/Organization/Individual): 7,^'/t// :Parr
Address: [3 di/e to I Ae
City/State/Zip: /t�/9#4/e/ /49 Phone #: ,/7 it;/ �-jn
Areu an employer? Check the appropriate box: Type of project(required):
1. I am a employer with 0 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑❑� N//eyy++construction
2.El am a sole proprietor or partner- listed on the attached sheet. 7. [Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
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 the policy and job site
nur .Insurance Company Name: � / (A r/Sr
/
Policy ft or Self-ins.Lic. #: /ei / CO 4'327-2 Expiration Date: /`/,/7
Job Site Address: /91 (<rr'ltL /7,9/1 /{ City/State/Zip: p7dinea 4
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 MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under thepains and enatties of perjury that the information provided above Li true and correct.
Signature: G%T770) V-/30 /
/ Date:de/T =-1
/ Q/
/7
Phone#: 7�l '
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
City of Northampton
l;
yr^3'a ' ;4> Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS I n
212 Main Street a Municipal Building
Northampton, MA 01060 rgy. yjP-
`0
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 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 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 -�� QQQ /��
I, ` `` rte a. `4b�9+y��"`'' understand the above.
(Home owner/resident's si /Mature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date OaI /, y
Address of work location
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: je,I It ,41/!/t( ,e
The debris will be transported by: , , v f 1
The debris will be received by: -TT/ Victs%e 01-S fasg/
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
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11/06/14 11:23:19 AM
RESIDENTIAL PROPERTY RECORD CARD CITY OF NORTHAMPTON, MASSACHUSETTS EFFECTIVE DATE OF VALUE: JANUARY 1, 1998
PARCEL ID: 25 -007-001 142 RIVERBANK RD PLOT: LIVING UNITS: 1 CLASS: R - 109 CARD #: 1 OF 2
CURRENT OWNER/ADDRESS NEIGHBORHOOD ID: 20.00 FINAL VALUE FLAG: COST
HAYWARD HELEN A LAND DATA
- ASSESSMENT INFORMATION -
71 FORT MEADOW DR TYPE SIZE INFLUENCE FACTORS LAND VALUE
PRIME SITE 12000 60,700 PRIOR COST CURRENT
HUDSON MA 01749 SECONDARY 12000 30;700
400
BLDG 157,500 1117,200 117,X200
DEED BOOK: 5677 TOTAL 254,900 208,600 208,600
DEED PAGE: 280 SALES INFORMATION
DEED DATE: TOTAL ACREAGE: 0.551 TOTAL LAND VALUE: 91,400
LAST UPDATE/COST: 20141106 DATE TYPE PRICE VALIDITY
19990401 LAND * BLD 50,000 A
LAST UPDATE/COST: 20141106
ADDITION DATA
X DATE:
Lower Level First Floor Second Floor Third Floor Area
DATA COLLECTION INFORMATION
A Bsmnt 1sFr 175
ENTRANCE CODE: UNOCCUPIED B EFP 132
INFORMATION SOURCE: C OFP 20
DATA COLLECTOR: MC D
DATE: 19991204 E
F
DWELLING INFORMATION G
H
STYLE: CONVENTIONAL
YEAR BUILT: 1930
STORY HEIGHT: 2.00
ATTIC: UNFIN
Basement: FULL
TOTAL ROOMS: 7
TOTAL BEDROOMS: 3
FULL BATHS: 1 ADDITIONAL DWELLING INFORMATION 25
Hatt Baths: 1
BASEMENT GARAGE(#CARS) ADDITIONAL FI%TURES: A
] LF LB
EXTERIOR WALLS: ALUM/VINYL BRICK TRIM: X 5
UNFINISHED AREA: STONE TRIM: X
GROUND FLOOR AREA: 675 °Pr
TOTAL LIVING AREA: 1525 REMODELING DATA 25
FINISHED BASEMENT LIVING AREA: X
BASEMENT RECREATION AREA: X YEAR REMODELED:
MY FIREPLACE STACKS/OPENINGS: /
METALETAL FIREPLACES: KITCHEN REMOD(Y/N)
HEAT/CENTRAL A/C: BASIC BATH REMODEL (Y/N)
HEATING SYSTEM: STEAM
FUEL TYPE: OIL
QUALITY GRADE: C PHYSICAL CONDITION AVERAGE
COND/DESIRABILITY/UTILITY FR INTERIOR/EXTERIOR SAME
OUTBUILDINGS & YARD ITEMS PERMIT DATA 27 A/lex/B
TYPE OTT YR SIZE1 51ZE2 GRD CORD DATE PURPOSE PRICE
NOTES:
11/99-VACANT, IT IS 146A
RIVERBANK RD.
22
EFP 6
govse /y2
11/06/14 11:23:19 AM
RESIDENTIAL PROPERTY RECORD CARD CITY OF NORTHAMPTON, MASSACHUSETTS EFFECTIVE DATE OF VALUE: JANUARY 1, 1998
PARCEL ID: 25 -007-001 142 RIVERBANK RD PLOT: LIVING UNITS: 1 CLASS: R - 109 CARD #: 2 OF 2
CURRENT OWNER/ADDRESS NEIGHBORHOOD ID: 20.00 FINAL VALUE FLAG: COST
HAYWARD HELEN A LAND DATA
- ASSESSMENT INFORMATION -
71 FORT MEADOW DR TYPE SIZE INFLUENCE FACTORS LAND VALUE
HUDSON MA 01749 PRIOR COST CURRENT
LAND 97,400 91,400 91 400
BLDG 157,500 117,200 117,2200
DEED BOOK: 5677 TOTAL 254,900 208,600 208,600
DEED PAGE: 280 SALES INFORMATION
DEED DATE: TOTAL ACREAGE: 0.551 TOTAL LAND VALUE: 91,400
LAST UPDATE/COST: 20141106 DATE TYPE PRICE VALIDITY
19990401 LAND + BLD 50,000 A
LAST UPDATE/COST: 20141106
ADDITION DATA
X DATE:
Lower Level First Floor Second Floor Third Floor Area
DATA COLLECTION INFORMATION
Bsmrt 1sFr 260
ENTRANCE CODE: UNOCCUPIED Bsnnt EFP 272
INFORMATION SOURCE:
DATA COLLECTOR: MC
DATE: 19991204
DWELLING INFORMATION
STYLE: CONVENTIONAL
YEAR BUILT: 1930
STORY HEIGHT: 1.50
ATTIC: NONE
Basement: FULL
TOTAL ROOMS: 6
TOTAL BEDROOMS: 3
FULL BATHS: 2 ADDITIONAL DWELLING INFORMATION
Half Baths: 26 e
BASEMENT GARAGE(#CARS) ADDITIONAL FIXTURES:
EXTERIOR WALLS: FRAME BRICK TRIM: X
UNFINISHED AREA: STONE TRIM: X 10 IF 10
GROUND FLOOR AREA: 651
TOTAL LIVING AREA: 1399 REMODELING DATA
FINISHED BASEMENT LIVING AREA: X
BASEMENT RECREATION AREA: X YEAR REMODELED:
MASONARY FIREPLACE STACKS/OPENINGS: /
METAL FIREPLACES: KITCHEN REMOD(Y/N) .. /e
HEAT/CENTRAL A/C: BASIC BATH REMODEL (Y/N)
HEATING SYSTEM: WARM AIR
FUEL TYPE- OIL
QUALITY GRADE: 0+ PHYSICAL CONDITION AVERAGE
COND/DESIRABILITY/UTILITY VP INTERIOR/EXTERIOR SAME EFF/B
OUTBUILDINGS 8 YARD ITEMS PERMIT DATA
TYPE OTY YR SIZE1 SIZE2 GRD COND DATE PURPOSE PRICE 24 24
NOTES:
11/99-VACANT, IT IS 146A
RIVERBANK RD.
15 2
3 9 3