28-062 (12) 619 RYAN RD BP-2019-0069
GIS#: COMMONWEALTH OF MASSACHUSETTS
MamBlock:28-062 CITY OF NORTHAMPTON
Lot: .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Above ground Pool BUILDING PERMIT
Permit# BP-2019-0069
Proiect# JS-2019-000103
Est.Cost:$3800.00
Fee:$40.0 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor_
Lot Size(sP ft.): 287496.00 Owner., EARLE AMY L&ROBERT T
zoning: Applicant. EARLE AMY L & ROBERT T
AT: 619 RYAN RD
Applicant Address: Phone: Insurance:
256 BROOKSIDE CIR (413) 313-7435 n
FLORENCEMA01062 ISSUED ON:8/2/2018 0:00:00
TO PERFORM THE FOLLOWING WORK27 ABOVE GROUND POOL
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 k Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fimplace/Chimney:
Rough: QL 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:
FeeType: Date Paid: Amount:
Building 8/2/20180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File 4 BP-2019-0069
APPLICANT/CONTACT PERSON EARLE AMY L& ROBERT T
ADDRESS/PHONE 256 BROOKSIDE CIR FLORENCE (413)313-7435 Q
PROPERTY LOCATION 619 RYAN RD
MAP 28 PARCEL 062 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid P. l
Building Permit Filled out
Fee Paid
TvoeofConstruction: 27"ABOVE GROUND POOL
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
INFQRMATION 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 Delay
SignatureBuilding g Offic Date Z we)
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
P ()ot-
-Department use oray
ity of Northampton Stable of Permit:
018 uilding Department Curb CWONsonly Permit
( 212 Main Street SawedSeptc AwAabwly
- '( Room 100 WaterMoll Aaadebft
PMl— Northampton, MA 01060 Tec Seb of Shuawal Plans
opt -587-1240 Fax413-587-1272 PIoUSts Piano.
OtterSpedfy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION t -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map 14 Lot 60-�;tt' Unit
Zane Overlay District
Elm St Would ce District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner f Roc rd:
34,�
Name(Pon � Current Mailing Address:
Telephone y/3 ,3/3-711�e
Signature '
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item AG. pfot Estimated Cost(Dollars)to be Official Use Only
completed by pernnit applicant
1. Building 1-5 $DO (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee D
4. Mechanical(HVAC) L401 0
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number: Date
issued:
Signature:
Budding Commisslon.nim pector of Buildings Data
4z/U�1 n S1-Dil 5 X53 @ 5r�� Cam
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
—aso r
Setbacks Front tl
Side Lf 30'4 Rt-/"L, L: R:
Rear c7,S0
Building Height 30,
Bldg. Square Footage /d0 %
Open Space Footage %
(Lot area minus bNy&paved 6.6A
pukinno
ff of Parking Spaces z
Fill:
volume&Location
A. Has a5 ial Permit/Variance/Finding ever been issued for/on the site?
NO ff DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW J& YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
f a ri
Needs to be obtained O Obtained 0 SewAo'At
A 1� , Date Issued: `,co, 1(brn p2P��
3o
C. Do any signs exist on the property? YES O NO ' J po �G� '/
IF YES, describe size, type and location: T
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(Gearing,grading,"vation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alleration(s) Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [pi De/ck�s,jSiding 101 Other[,
Brief Description of Proposed &VVN (Di' .O �DO(
Work: !-P7 �7
Alteration of existing bedroom_Yes oN Adding new bedroom Yes X Nop
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ga.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. Numberofstones?
I. Method of hearing? 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
I. 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT
r7,O�R CONTRACTOR APPLIE
S FOR BUILDING PERMIT
I, /'%/1� `�"�'✓lam as Owner of the subject
property
hereby authorize �'r"--'«'e'�'ri )
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner_- Date
as Owner/Authorized
Agent hereby declare that the stat ments and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signs tl ontler a pains and penalties of perjury.
Print Na
Sgnatu OwnerlAgent Dale
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
Address 1J/ License Number
Expiration Date
Signature Telephone
9.Rsalsterstl Hama lmnrowmi Contractor: Not Applicable ❑
Company Name Registration Number
N
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.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 Yes....... No...... ❑
The Commonwealth ofMassachuseus
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-20177
wwhemass.govAlia
\\orkers Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lestibly
Nagle (Business/Orgapniaati.Wiindiviidual): 46rrt
Address:
City/State/Zip: r rIof-A4 /110 OMO— Plane#:
Are you an employer?Check the appropriate box: Type of project(required):
I.[]lamaempioycrwith employees(full anchor part-time)' 7. ❑New construction
2.FJ l am a sole proprieamor pvmeship and have no employe.working barriers 8. Remodeling
y capacity.[No workers'comp.romance rsyuired]
3 I am a homwwner doing all were myself[No workers'camaa
p.irencerequired.]1 9. Demolition
4.111 am a homeowner and will be ensure mmrs hong can tmcmrs m conduct all work on my10❑Building addition
e-1, (will
that all ntmeeimer have workers'comaaron ivsnre «.r
pennam sole ILQ Electrical repairs or additions
propriew.with no employees.
12.[]Plumbing repairs or additions
5 Tame general m,twxhaand 1 have hired dmsub-mntactoalisted onthe znachcd sheet. 13. Roof repairs
These subcontractors have employmn and have workers'comp.insmv¢el A
6.�We are a corporation and its officers have exetvisal their right of exemption per MGL c. 14. Other
152,§1(4),and we have no employees.[No workers comp.commence required.]
"Any applicant that checks his 41 at atm fill out the section below showing their workers compensation policy information.
i Homeowners who submiuhis madmit indicating dey are doing all work and then hire outside cameraman must submit a new affidavit indicating such.
IConirseme,and check this box most attached an additional sheet showing the reme of the subconcr etors and sate whether or not Inose entities have
employees. Wise subconttacmrs 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 andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Dale:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL a 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify an the irts dpenalaes ofperjury that the information provided above is true and correct
Signature: Date
Phone#'
Oficial use only. Do not write in this area,to be completed by city or town ofciaL
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
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street,Room roo sf 1Y,pc
Northampton MA o1060
(413)587-1240
Plot Plan Drawing
To be submitted with permit applications for 1- or 2-family additions, decks, porches, pools, and
detached accessory structures. ��r
Property address: rg. k� /7j
Proposed work: IA—'O7f.v L[st7✓k-'S-r'D4 '26d
Y
Information/detail requirements: • Septic system tank and drain field (if applicable).
• Street(s) by name • All existing structures including decks, pools,
• Front of house detached garages, carports, sheds,etc.
• Driveway • All proposed additions, decks, porches, pools,
• Easement(s) detached garages,carports, sheds, etc.
•All property line dimensions • Distances of existing and proposed structures to
lot lines and other structures.
-]u ^
3n - �,y0-��LiroP line
i
fl�pny ( tJo sec F k)
b -
67 oD
a
I
o'
�oulc I� ids /o pn>P ( nom
LJ .18-oL-� Peon
ars' f� pip
hno
4 '
(Example on back) b
Plot Plan Example
Cen1eMlle Street
zu !
Exsting Porch_
Fran:of Ee ltma Nouse
Existing Nouse 1 Garage "-- 50--
15-- Existing
,.'.,
Shed ', '.
New Deck New
Septic lank Addition '''...
00 0
Ensbna Dram FxYO_. 10
a _
. . Replacamen:Dram Fieid
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