17A-152 (9) 54 FOX FARMS RD BP-2017-0483
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 152 CITY OF NORTHAMPTON
Lot: -00( PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MOL c.142A)
Categma: GARAGE BUILDING PERMIT
Permit BP-2017-0483
Proiect s JS-2017-000797
Est. Cost: $3200.00
Fee:$65.00 PERMISSIO V IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEVEN ZUCCH'^ 0 021356
Lot Size(su.ft.): 15681.60 Owner: STENSO' gin L&JANE R EVANS
Zoning: URA(106)/ Applicant: STEV::N ZUCCHINO
AT: 54 FOX FARMS RD
Applicant Address: Phone: Insurance:
70 Gleams Road (413) 584-3878
NORTHAMPTONMA01060 ISSUED ON:10I1'?0J6 a:00:00
TO PERFORM THE FOLLOWING WO :REMOVE EXISTING 16' OVERHEAD GARAGE
DOOR & REPLACE WITH A 12' GARAGE DO. & A 3' PASSAGE DOOR
POST THIS CARD SO ITIS VISIBLE FROM 1 E STREET
Inspector of Plumbing Inspector of Wiring I; \'. Building Inspector
Underground: Service: V
Footings:
Rough: Rough: 1. : :+ Foundation:
Dr wny Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE (• 'V OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amon-
Building
rnow -Building 10/13/2016 0:00:00 565X.
212 Main Street, Phone(41:1587-1240,Fax:(413)587-1272
Louis Hasbrouck i uilding Commissioner
File II BP-2017-0483
APPLICANT/CONTACT PERSON STEVEN ZUCCHINO
ADDRESS/PHONE 70 Gleason Road NORTHAMPTON (413)584-3878
PROPERTY LOCATION 54 FOX FARMS RD
MAP 17A PARCEL 152 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid (V #c7o a 694- -
Building Permit Filled out
Fee Paid
Typeof Construction: REMOVE EXISTING 16'OVERHEAD GARAGE DOOR&REPLACE WITH A 12'
GARAGE DOOR&A 3' PASSAGE DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 021356
3 sets of Plans/Plot Plan
TH OLLOW ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ORMATION 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 Dela
cii /o-/ - 0204
Signature of Bui i inial ' 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.
•> / ����
City Of Northampton SlebNdPamt
Bulkinrit
212 iDepStreet eent t�bt Pat
Roan 100 WatMWd AMNatONy
Northampton, MA 01060 Teo Sets o %wheal Porro
phone 413-587-1240 Fax 413-587-1272 PlatMate PW.
Cgs Specify
APPLICATION TO CONSTRUCT,ALTER,REPAR RENOVATE OR OEMOLISH A OM OR TWO FAMILY DWELLNG
SEC110N 1-SITE NFOWIATION
1.7 Pnetrritr Addea� r This section to be completed by Mike
TJX red's.. (43“-Q Map Lot Unit
Zone Overlay District
Bon a District CB ob.lct
SECTION 2-PROPERTY OVAERBIM/AUTHORZED AGENT
21Omer d �.,I 1 j�
Gct ✓�$Gh cal Fok F�/�'h t2 —1
None Curetmating moms:
k ( — T°l""'°signature 530 83-11r
S abh ZuCCI1Lo go Op,,s -, I' oci Nei gn7a‘
Nana
55n� GYM /� Current Mang Mere=
Telephone
SECTION 3-ES111NT®COIISTRUCITON COSTS
Item Estimated Cost(Dollars)b be Official Use Only
completed by pima applicant
1. Budding (a)Building Permit Fee
#3)-33 —
2. BeNiral (b)Estimated Total Cost of
Caebecimfrom(6)
a Plumbing — Balang Pernik Fee
4. Mechanical(FRAC) —
5.Fee Protection
6. Total=(1+2+3+4+5) Yin).{ Chert Number— ChNumber 9,5,05 7 5
This action For Official IM Only
Budding PewitN mber: Date
Issued:
B dig Convelselonerfinspeetar at B&flga Dna
SECTION s OEatSiRON OF PROPOSED RCM Idsce r aopficabl.)
New Hasa El maim ❑ y O Alam...(.) Roofing
*Dews ❑
bran pnlpde
r�Bldg. 0 newsc t I D New Min fl / vDicta CI Siding A) Other XI
&id DmWork: Nune� /LID:Y.k..A acr')p -Yipr c,.e4 fait e•.fIc /.�.tit_ b- .4 w3/p,„r� C�%1 -.
Ntadnd Nana ve bedroom yes :� Ib a Yet J No
Yes No
Plans Attadrd Raft •SMG
t af Nn house and or addition to edam housing.comol-'I the folowbla
a the of building:One Frilly Two Family Other
b. Plumber of isms in each fatly mit Number of Gafaoarn
a b tem a mime skid ed?
e. Pmaaeed Spua.e footage of new ca baaut Dimensions
a Mother of sbrles?
t Method of heeling? Firepeces or Woadeb es Number of each
g. Enegy Conservation Ca pfaum Monodie & Energy Caratimme Corn attached/
h. Type of construction
madam sir fog 4 of weiada? Yes lit Is construction MOM Igo yr. aoodplain Yes No
j. Dept G basement or oder floor below Cached grade
t Wa baling conform b se DuitI g end Zoning imputations? Yes No.
t Septic Tack_ Cfiy Sorer Private wee City w.lr Supply
SECnOu7a-OWNER NINIORVATgR-TO SE COMPLETED WHEN
°man AGER OR CONTRACTOR AfPIES FOR ra r.w PET
- - v-- es Ower a the scblea
Man
hereby wears. K" _- -- S T,h+.7!.,rll;'w
to as m my What in a m.bnf.Yv bleat ale m
authorized by die bkliig pnit.ppliration.
Yl/ 10/lSlmeture rt Omer Deis
l/SIL
L SiQuw. 2scc.11i.- as O.teDAusvtoad
Agent hereby de dee bei the aalernere and i Ton nt on on the fomgoi g eppaadm am Yue and mucin$,to the beat of my knowledge
and belt
Signed
dl under thee lairs and ratsof pay.
ls
La
sL . ucciI l^b
La i. 4 i IC
Section 4. ZONING At Int cometion ram le Co plete&Perot Cay as Pealed owe To Yrmpete btometon
Existing Proposed Required by Zoning
rias memo be Gore io by
Boibba Prar t
La SS
Frontage
Setbacks Feint
Nide L: it:
Building Height 1 r
Bldg.Square Footage
Open Space Footage
OM w w®boli&ens
reMtl
M of Puking Spaces
Fill:
fides a rnrril2
A. Has a Special Permit/Variance/Finding ever been Issued for/on the site?
NO 0 DONT KNOW 0 YES O
IF YES,date Issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES O
IF YES: enter Book Page and/or Document a
B. Does the site contain a brook, f wat or (� nds? NO O DONT KNOW 0 YFS 0
IF YES, has a permit been or to the Canservauon Commission?
Needs to be obtained O Obta �.. , Dote Issued:
C. Do any signs exist on the property? YES O NO 0
IF YES, describe size,type and location:
D. Are there any proposed changes to or additions of signs Intended for the property? YES O P40 O
IF YES, describe sire, type and location:
E. W II the construction activity disturb1 .grading,(�x�ceretion,or filing)over I acra e is it pan nn
of a cannon pion
But wit giant aver 1 awl YES( NO V
IF YES,the a Nuthesrplon Storm Water Management Perms born M DPW b requited.
SECTION I-CONsrnucnoN SERVICES
0.t Licensed Construction Suer4u: Not Applicable 0
them of Ouse llpgg: 5 tOen 2uCtil;M Cs- Odd 356
Voleaee Number
70 (hsualit)/ A{ th N�n MA t res eoGtealli
575- aasc /
9gWa U Telephone
;l.Raeklaud Nana YeeeMeiont Cemmaer Not Apia:able 0
100,9`1
Canter Nana Registration Number
Sr Pit ( re 1.01(
Address Dale
Telephone
SECTION 16 WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.o.k.c.152,S S))
Workers Compensation innate Aida*oast be exapNled and suMtdrled Sh this application.Faiure to provide this affidavit VI result
in the denial mtthe issuance dM butting permit
Signed AttNevit Attached Yes. A No.._. ❑
11.- Home Owner Exemption
The current exemption for'homeowners-was extended to include Oweeroeen led 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 wervWr.CMR 780. Sixth Edition Settle*1983.5.14
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 xenon who cenareets more than one home Ina two-veer Period shall not be considered a homeowner.
Such"homeownu"shall submit to the Building Official,one form acceptable to the Building Official,that he/she shell be
responsible for a8 soul work performed ander the building Berndt,
As acting Conahwake Senervker 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,av be table 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
City of Northampton 212 Main Street,Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, SM, 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: 541 FU& r ter"- 113'.P
The debris will be transported by: lets, c-fit+,„
The debris will be received by: Vc/%,k Pec y c/; ivX
Building permit number: U
Name of Permit Applicant 5iv+ lice- Ii,n.o
Cc,.
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
i.=_
_ Department oflndustrialAccidents
_.*=Ci
Office of Investigations
MISS�j 1 Congress Street,Suite 100
=5�?— Boston,MA 02114-2017
•1/4,a wwn:masagov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information f Please Print I.eaibly
Name(Business/Organiaadon/lndiv�idual): /S/EQA-%� 2ilcc`/t 1 no
Address: Til CJsAso. 1 `yo^.�(p 'b'
City/State/Zip: /y1',di„,Qi7' till Phone it: x-113- 575-3.251
Are you an employer?Cheek time apdrnpriate box: Type of project(required):
1.❑ I m a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).• have hired the sub-contractors 6. ❑New construction
2121 I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in my capacity employees and have wodmrs' 9. 0 Building addition
[No workers' comp insurance romp.ms'°aoce.i
required] 5. 0 We arc a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing an work officers have exercised their 11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL
12.0 Roof repairs
inamance ,]t C. 152,§1(4),and we have no
employees. [No workers' 13.0 Otherr7s"lf�cQPr n J._
camp.insurance required.]
*Any applicant that checks box#1 must also fill our the section below showing their wakes'compensation policy information.
t 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 subaonlacton and state whether or not Wore entities have
employee. lithe orb-contractors have employee,they must provide their workers'comp.policy number.
I am an employer that is providing workers'coapensaton insurance for my employees Below is the policy and job site
informs lot
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attack 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 . . I' ander the pains and penalties of perjury that the information provided above is true and correct
Signature: 4 ren. 1 Date: WO/24/6
Phone# 11/3- S-6 -2-D-56
Official use only. Do not write in ads area,to be completed by city or town official.
City or Town: Permit/License It
Essig Authority(circle see):
1.Board of Hearth 2.Btu Department 3.City/Tow.Clerk 4.Electrical Inspector 5.Plumbing Inspector
f.Other
tl xl
1
I �
T, , {
v ,h____
,.ti.
7„
,, . , _, / XPi /.,C.