23D-061 (9) 18 LONSDALE AVE BP-2007-0091
GIS#: • COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D-061 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category_ BUILDING PERMIT
Permit# BP-2007-0091
PrQect# JS-2007-000142
Est. Cost: $2500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Ccnst_Class_ Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 12588_84 Owner: MACDONALD CATHERINE
Zoning_URB Applicant: MACDONALD CATHERINE
G-rr 4 4 ^R i m r, •.1 r A,. crz
Applicant Address: Phone: Insurance:
18 LONSDALE AVE (413) 582-1866 O
FLORENCEMA01062 ISSUED ON:8/4/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:FINISH ATTIC WALLS
POST THIS CARD SO IT IS :'ISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P. V. Building Inspector
U rid rground: Service: Meter:
Footings:
Rough: Rough: y/y/,//¢y`" House# Foundation:
-7 --..__ Driveway Final:
Final: Final: .7hh9/6 (
p� // Rough Frame: '"
Gas: Tire Department Fireplace/Chimney:
`
vLtL
Rough: Oil: Insulation: o(< t I 6 7 06 L
final. ;_rm.z; 'i. . : riK 4Zel 10 in LeA.At I
THIS PERMIT MAY BE REVOKED BY TH 1 CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGUL ,ION
Certificate ofOccupanc signature: rf
FeeType_ Date Paid: Amount_
Building 8/4/2006 0:00:00 $50.00MO
212 Main Street,Phone(413)587-1240, Fax: (413) 58'7-1272
Building Commissioner-Anthony Patillo
•
File#BP-2007-0091
APPLICANT/CONTACT PERSON MACDONALD CATHERINE
ADDRESS/PHONE 18 LONSDALE AVE FLORENCE (413)582-1866 Q
PROPERTY LOCATION 18 LONSDALE AVE
MAP 23D PARCEL 061 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /� d ^J
Fee Paid (
Typeof Construction: FINISH ATTIC WALLS
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
INF 1 MATION PRESENTED:
1/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 Co sion
lip' f g Svc)
Signature of Building 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.
Department use only
\--4of Northampton Status of Permit:
181%u 4ding Department Curb Cut/Driveway Permit
` t 12 Main Street Sewer/Septic Availability
2006 Room 100 Water/Well Availability •
V" 2 5 Northampton, MA 01060 Two Sets of Structural Plans
__phone 41, 587-1\240 Fax 413-587-1272 Plot/Site Plans
. 1NSrtLtiP
�1 n� pIrs,n Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
1S)/ LOnS tt.at2 AV? • Map Lot Unit
c'i�( _ �'r)Ga Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
PJA1 'ln L c 1) Ave .
Nam- (Print) Current aili Address:
r�'�� Telephone(3) Ei r2. i Vo(�
Signature
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 permit applicant
1. Building (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
6. Total=(1 +2+3+4+5) 2-hC;, Check Number /M
This Section For Official Use Only
Date
Building Permit Number Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
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
Setbacks Front I ir' 1
Side L: 1 `' Ra
Rear
Building Height
/ .
Bldg. Square Footage / %
Open Space Fy
%
(Lot area minus b I
parking)
#of Parking S
Fill:
(volume&Location) I
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES Q
IF YES: enter Book Page; ' and/or Document#
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 i Obtained Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: j
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
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 [D Addition ❑ Replacement Windows Alteration(s) Roofing i 1
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [D Siding[O] Other[D]
Brief Description of Proposed r �( �+
Work: re - i� 1+-N"h r u-�I� A tS
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
.. :bn� ,#.",,�" ".;"'.,�,�per,.�.w-.M ,:a"`7sx°£�' a'�"_.r•.z�-�-r rrr�* ..,,� :nx-. _...-*fir��� 'c<"�za`�'".._"H^
sa.ifNew.'house�andlkor addiflon to exrstm4.housrnq;�.�comptete' e I orlurri :
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 AGENT OR CONTRACTOR APPLIES FOR.BUILDING PERMIT
CMNV1n&- tc7:0-$-y\ ,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
,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.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
J Reciistered`ttome "ma_o_emeri ocittacto Y, `r Not Applicable ❑
Company Name • Registration Number
Address Expiration Date
Telephone
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 Yes ❑ No 0
11 n TO ° nei xennp on
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 Zonin Laws and t of Massachusetts General Laws Annotated.
Homeowner Signature C91--
OTC tv}f p?.O
`_, •�1E ( '1I of
� �,, Northampton
7• �Isa.Rchncrite' �—
mirar
DEPARTMENT OP BUILDrNG INSPeCTiONS 4 •
212 Main Street ' Municipal Building
Northampton, Mass. 01060
\\'OR1G R'S COIN'Q'ENSATION LNSURANCE AFFEDA\TIT
•
(li ccosx/permi tte,e)
v ith a principal place of business/residence at:
(phone') .
(sur_ t/city/staicfrip)
do hereby certify, under the pains and penalties of perjury; that
•
( ) I am an employer providing the following worker's cornoensation coverage for my
employees worming on this job:
Conte') (Policy Number) ('= pirction Dale)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors Listed below who have the followinR worker's compensation policies:
(Name of Contractor) (Insurance Cotrloally/PoUe-i NuQ1k:) (l'_:pirauon Date)
(Name of Contractor) (Insurance Coman�•/Po!ic-; Numc-r) (L•4ir,:tion Date)
•
•
(Name of Connaeto,-) (Insurance Compaey/Pol•,cy N;uekr) • (Expiration Date)
•
(Name of Contractor) (Iasuranca Company/Policy Number) (Expiration Date).
(oath i ocai rboct if acoaary to atdudo infortaoo pert..iuiag to.11«tere.coa)
( ) I am a sole proprietor and have no one worldng for me.
XI am-a home owner performing all the work myself.
NOTE:plesc be ew-xrt the wtJe b cono,-ccro sxbo caploy pa-loos w cia ca--=--..e,00 c rcpau•Drat oa.d..<ii: of
not @Ort thz LLsow t:ir.,in wbid,the bomoowncr rtaide cc oa the p-our :.ppurtcn_a tlren r_-r oa g-.J=-tily oono&rcd to be
rwxPloycs" the wwkers T pr—'-rion Act(GL152�a 1(5)),ppticwoo by.bosti000-ocr for a lion_or IA- rosy o idmrx the
losol rto.n,or to eoployor uodcr dso Wortdr Coccq>emitiot Aeti
I uodc uaad fiat a Dopy of thi.m.irmo=m.y b.for-srdod to tho Dot of Aced.31Y Off oo of to-ui+000 for th.
covcrx,so veilasioa nad th1 Eiltae to soc uc bovcrnse trader soetion 25A of MOL 152 na led to the i ytion ofa-tonics!pcatiltio
coosising of a floc of up to S I SOO.0O ar,dfor i ii riyoom or up to Doc ycmr e.od civil pmaltio n do form or.Stop Wort Ordc-Lod
firms o(SIOO.00 a thy tgai24 coc.
For dep.>•tis.oar u.e ody
/ - Pc-r-tnit NumtxJ
Lot ~
Sig fnature o Lia�uce/Pc •tics Date Map. -- i F`
t4 44 0.4 (City >afoz#llantruxt • 7
; IV" t.4,iOA assadyttseits 1"/
,7.. =_-.1.._ IM
'Td� DEPARTMENT OF BUILDING INSPECTIONS ,ii 4 /;
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060
0
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sup : ,'isor. 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
/I, CtriL(2 `L ,,I,1'SL 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
Address of work
location
CIS EL( piq j ,n � (
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