07-009 (3) GIS a; _ COMMO = }e «' qt ETTS
Map:Block:07-009 CITY OF NORTHAMPTON
Lot:-001
Egrndfi Building
catmint BUILDING PERMIT
ggmnitIt BP-2003-1086
Protect it IS-2003-1718
Egt.Cost$10000.00
Fee:$98.SQ PERMISSION IS HEREBY GRANTED TO:
Coast.Class_ Contractor: License:
Use Group: R4 Homeowner as Contractor_
Lip Size(sq.ft.}; 1032372.00 Owner; WADE ROBERT N&AUDREY S
Z�. nine:Rtt 44 �-F=cnt: WADE'. ROBERT N &AUDREY S
AT: 422 NORTH FARMS RD
Applicant Address: Phone: Insurance:
422 NORTH FARMS ROAD
NORTHAMPfONMA01060 ISSUED ON:6/2/03 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 38' X 26' TOOL SHED
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: lin tS C'h /e?-7-Oc/
Driveway Float: -
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation: /j,
Final: Smoke: Final: OK Qi >t JJ-OP .(7_ -
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHA: N U V'ONId I. OErny'"t
ANY OF ITS RULES AND REGULATIONS. ,.s- r
Certificate of Occupancy *�1r Sienatore:
FeeTvpe: Receipt No: Date Paid: Check No: Ampnnt:
Building 6/2/03 0:00:00 1826 $98.80
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
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File#BP-2003-1086
APPLICANT/CONTACT PERSON WADE ROBERT N&AUDREY S
ADDRESS/PHONE 422 NORTH FARMS ROAD
PROPERTY LOCATION 422 NORTH FARMS RD
MAP 07 PARCEL 009 001 ZONE RR lIJJ4 1 NS
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out (f{l
Fee Paid /filo / o'
Typeof Construction: CONSTRUCT 38'X 26'TOOL SHED
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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO
ire,
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 Commissio L/
�ZL ir-`�- ,E//fes
Signature of Building OfficaT 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.
fir , cr �_ -
City-o4_ Northampton S 6
ttiosAi ,
C Budding Department Ct o `t' '1 T+sn , t,
{ , t`n� _ -- 212 Main Street 'Soo°/S p3Y ats. jtRf c
- Room 100 t/ tat�t71P¢ax. 'r
MAY 2 8 2C09orthampton, MA 01060 T dSAItteail alarree
phone 413-587 1240 Fax 413587-1272 No JSite r to
__.."r r _z . v
APPLICATION TO.CONSTRUCT,JALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 i SITE INFORMATION
This
sectionto be cpleted rby Hee,Property Address
r s �.TY -
—. I 1 (12q / l /"14 Map__0„/ Littenr aA Urtt
Zones& l/itArerIay/Di tritctr E`e
Elm St.District CS District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1
2.1 0wer of Record. J
Name(Print) _.yew, _m1mg Addre,“
27 Y 2f /
r;';
Sigc eLre 1
2.2 Authorized Agnj
Name(PJ mti .sa 1.mnli lb Aiormes':
Signmme
SECTION d . ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to he Official Use Only
completed bypermit aopi c. .t
.ldi,ng J 0 O I
t c (a)Building Permit Fee
_I ;masted Total Cost o1
rl t nnstn.cMor from (6)
3 Donnice Budding Permit roe
0
4 Mei hlu'uca. :HVAC) 1
5- Fire Protectse 1
6. Total tl - 2 + + + 4 + 5) Jo 00C _—, ] Croak Number /flL �` lle
This Section For Official Use Only
Building Permit Number: nDate Issued.
Signature:
L _. _ ..._..
Building Commissioner/Inspector of Buildings Date
Section 4.
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
D tib 5-6 Building Department
Lot Size (723-7o (6O, oro
Frontage
Setbacks Front // 70 -7or°
Side L: teVR: //5° L:/5/0 R: 6 3 /0
Rear f / P
/O
Building Height /412. /
Bldg. Square Footage /on % /000 01 g
Open Space Footage
(Lot area minus bldg&paved /0900&+ 9% I gS70
parking)
ft 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 X
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
IFYES, describe size, type and location:
.r c lifelk`3aie7 : ®"r O • SOS O f'VbR c Jf:a .. irdiab e Tru t,
New House ❑ Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 0
Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other( ]
Brief Description of Proposed Work: J5v\'i(d i d of
("\./...o I ig
Alteration of existing bedroom Yes / No Adding new bedroom Yes No
Attached Narrative 0 \, Renovating unfinished basement Yes No
Plans Attached Roll 0 • Sheet
)k
totiaddititnitorexitin"Ohou3ing, c rn I'OteSthitRSImin.
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?
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
SEC.TO OWAU
NERTHORIZATION -TO BE-COMPLETED WHEN
OWft S''JaAGEN7��wR.CONTRgCTOR'APPLIES FOR BUILDINGPERMIT
I, , 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 �y Date
I, bb kIAJ , as Owner/Authorized Agent
hereby eclare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Sig,nggd under the pains and penalties of perjury.
�Ya j%-e I AlV/i( nL
Print Name ///
.. l `17. =. :2..,C_.L
Signature of Owner/Agent Date sS — 0 '7 _ [^ -3
zS .,ItOhda v;,)-67 .8pIGN SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name al License Holder
License Number
Address Expiration Date
Signature Telephone
Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone
SECTIO 0 SVO,RKERS'.COMPENSATION INSURANCE,AFFIDAVIT(MAL-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 Yes 0 No ❑
111.- trJuU5te '@(GY"'1 arItit; l o. a,
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 , 1 / "di c c c /( L
o
•
io
Do-ttuNnro . .
H
B en t.
�if1r of Uztliampfon 1 '
'1,4.'k -'• DEPARTMENT OF BUILDING INSPECTIONS /l• t°
212 Main Street ' Municipal Building o
Northampton, Mass. 01060 _)-
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
.
(Iiccnstrr nlitl.c) -�
with a principal place of business/resideuce at.
(phone-')
(ctmcUci 1 trogrornp)
do hereby certify, under the pains and penalties of perjury, till. -
O I Sill an employer providing the following worker's co mpCOS=_IO II coverage For my
employees workring On this job-
- (lnsurance Company) (Patios-Number) (Fwir Sen Datc)
() I am a sole prounetor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the foilo;vin workers compensation policies:
(Nome of Contractor) lnsurvnc:Company/Polito?Number) (lactorattan Date)
(Name of Contractor) _ - (Insurancr Cor:_,w1oIrct NudC-c (Escoi coon Date)
--
(Name of Coatractor) (Insurance Co dv a ic: Numb-rt =ion Date)
- (Name of Contractor) (Iasarutce Cornocsny,ToLicy Numbs) (1LSe.no n Date)
(.mtl). d .al end Ti trolGk Gforintrion bra_ a>-_ce.-.
) I nnl a sole proprietor zud have no one.vorki,g for me.
I nut a home owne. performing all the x',.. myself.
NOTE:irks--Incnowt that c Eax-..r _ _ C , _
morn a"Rlaat t o _ v 3Sownt of
as loyc,un❑.0 tort, 1c:d �e Iwv_-eou rhe r •o -aao - ,"" dl _ n h
a:ploycn uof Orwrn{y.m;tz;um Kt(GL I52s+1CActi;.Cvcoby.noma��a for n rcmnt a paml:r?.r,-3.a<C_
lepil nan.r of an cryroyet Grist Tian W ak.lt Compern.Ira�Art.
I u..& rand dint a copy of vammwy b f nniWloa Dq>.,:a.oflnlnnid Amlwf Of 5m of Gnornor for the
vmgevvjfatioo ndhct Churn to rarc'^vcrag tadr,eica ISA of MOL.157 can lvd to Eh imn0liticc of mti:_I pool/rot
moaning oft Lx of up to S 1.100-OO.ator clucarnnnd of up to co!Sv.N cirl prnaPro In Ec loon of a S'kt Work ONc nr4 n
Lrc of 2I W.OQ.day.gain mc.
Far d�,u . . ,t u,., vJy
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4 J� Petrol! Nuntt>Lr __---
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BCP, RTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060
e
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as 1.is/her construction sup-. .Mos. The stare 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
I, ��?' ` �1ices,e_-,c--. 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.
Date _5 — 1 O
Address of work / � � ` /
location ��`� '11 X17 :�\ (/'
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