24D-045 (4) File# MP-2021-0044
APPLICANT/CONTACT PERSON DOHERTY DIERDRA
ADDRESS/PHONE 18 STODDARD ST
PROPERTY LOCATION 18 STODDARD ST
MAP 24D PARCEL 045 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Ail.612)
Typeof Construction: ZPA- 13X 17 CARPORT
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:
Approved Additional permits required(see below) 4-1 V02 G JAW Or C_o)4f GDR. Iola,
MuS7- h PLANNING BOARD PERMIT REQUIRED UNDER : § g�` µA N° KcAZ .1 9 0
Intermediate Project: Site Plan AND/OR Special Permit with Site Plan LA)l' 'ff .7 1 M
T S fiT rA(.3;
Major Project: Site Plan AND/OR Special Permit with Site Plan R QV\k' M
ZONING BOARD PERMIT REQUIRED UNDER: § r n
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
r � • _� , 3 /a)
Si! ature 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 the Office of
Planning&Development for more information.
RECEIVED
File No. FEB 2 4 2021
ZONING PERMIT APPLICATION (§io.4)
Please type or print all information and return this'form tot a Building
Inspector's Office with the $30 filing fee (check or money order)payable to the
City of Northampton
1. Name of Applicant: J7€1 rd re: 1-ter ')/
47‘/ a-7a7-3sa7
Address: cd C9Xa. S41 Telephonb7 W/3 -/75---6 Co 7/
lk
2. Owner of Property: -D e l V d rreTI k e r (-�, n.CQ -De.;rg r2Cab ra.l- el l";'ra` l 3
Address: I g 5-}p4 044_ sk, �L,// 3- -h L 7] ti -e
Telephone: /3 �y 7 7 5- ra7 J , .
3. Status of Applicant: Owner
,J � Contractrr Purchaser Lessee Other (explain)
4. Job Location: 1 g S46 taa,rc� 54,
Parcel Id: Zoning Map# Parcel# 0 District(s):
In Elm Street District In Central Business District
(TO BE FILLED tIN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: S1ngr'e it.tI1y ► es c1 e.nce
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
ck4I( 1olt b4 G.. 13/)c17' earpor-
7. Attached Plans: Sketch Plan ' Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW DC YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW ?"-- YES
IF YES: enter Book Page and/or Document#
9.Does the site contain a brook, body of water or wetlands? NO 7- 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:
(Form Continues On Other Side)
W:\Documcnts\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
y •
•
•
•
•
•
•
•
•
.. - ,t
•
L.L.
10. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO )(-
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO >
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
This column reserved
for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
re_ , llo acne
Frontage
670 CEO
Nd v�
Setbacks Front 3' Abp urc,4► t%' s" fi� e+,/e o►.-v.1 e.
f0260ek Side L:^ I " R: 19/ L: 5a Vne R: (o • L: R:
4,0 5Yt)€4. Rear
(03�
Building Height
a 5 1 a S itrrti
Building Square Footage +�0u s q C4-- (to& Slj.f
% Open Space: (lot area minus building a paved 3 y 7/, 5 u%
parking
#of Parking Spaces
a a
#of Loading Docks
► VA
Fill:
(volume Et location) N` K6 A
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
//� (i.n.a- 4c9. c..,A A.e
Date: t�rr��--�7, �, go a r Applicant's Signature �-�� /�c�-�-�
NOTE:Issuance of a zoning permit does not relieve an applicant's burde to comply with all zoning
requirements and obtain all required permits from the Board of Health,Conservation Commission,
Historic and Architectural Boards,Department of Public Works and other applicable permit granting
authorities.
W ADocuments\FORMS\original\Building-[nspector\Zoning-Permit-Application-passive.doc 8/4/2004
City of Northampton
4�"� Massachusetts 4e Zs &. �'�•,..
1 ` r,. * i
fir
I ` m .fit "r•
`i z DEPARTMENT OF BUILDING INSPECTIONS ;
212 Main Street • Municipal Building '. ^b'
Northampton, MA 01060 rst ill
� 4:
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 &2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s)and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5.Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner(if applicable).
9. Note any Conservation and/or special permit requirements(if applicable).
10. Driveway Permit(if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit-public land by DPW/private land by Building Dept.
13. Stretch Energy Code -all new construction will require a HERS Rater Affidavit to be submitted with
permit application before issuance of permit.
The Commonwealth of Massachusetts
1, Board of Building Regulations and Standards FOR
g ; Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: t gropp4p4. 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an accepted street?yes V no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
IQ ' / / ' 6o '
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public lTd 2" Zone: _ Outside Flood Zone?
Private❑ Check ifyesCd� Municipal IlitOn site disposal system 0
SECTION 2: PROPERTY OWNERSIiIP1
2.1 Owner'of Record: R.,"ty
Name(Print) PG(EPORE tate,ZIP
l 57 WA,rLP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition
Demolition ❑ Accessory Bldg.❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ "'7 so ,/-0
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) Total All Fees:S
/ ��� Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 1 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
A 12t'l e O1 3 x/3//22--
Licensee Number Expiration Date
Name of CSL Holder
o i n Q.fA ^ List CSL Type(see below)
No.and Street J 1 /� Type Description
l.)/a j'1 rri ac,D. 0 Unrestricted(Buildings up to 35,000 cu.ft.)
o R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
!3 SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Re rgisteereed Home Improvement
Contractor(HIC) 0 g. ,
v "4`�t EJ ( r'' 1 HIC Registration/Number Ex irati n Date
HIC CoL pap/ ee C Registra�tt 4N me
No.and Street-Q j' Email address
City/Town,State,ZIP Telephone
SECTION 6: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 Issuapce of the building permit.
Signed Affidavit Attached? Yes C9 No ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHk.N
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize ,James Pk a "btu
to act on my behalf,in all matters relative to work authorized by this building permit application.
e e son ril goat
Print Owner's Name(Electro c Signature)f 1 Q.a.,,ritedth( Date
SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Jr,4' V 171-144 1 o Z./
Print Owner's or Authorized Agent's Name(Electronic Signature) ate
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass_gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF NORTHAMPTON
SETBACK PLAN
• atfvwus--cool• c
MAP: LOT:
LOT SIZE: o•KA c-e'9'5'
REAR LOT DIMENSION
•
KEARYARD
SIDE YARD1 ' SIDE YARD19 I v �Syt
17r?o pbs P
C rz-pd WI" --�
FRONT:EIBACK_ 9..6 1
FRONTAGE 1 a I
RDICATE LOCATION AND DI ME NSJ ONS OF II OLE E;GARAGE.ADDITIONS OR ACCESSORY BUILDING, IIE
SURE TO INCLUDE FRONTAGE AND LOT SIZE(SQUARE FEET OR ACRIZS)
Calf TZA7Pf '
timTo..�; The City of Northampton
Building Department
ri„
"' ey 212 Main Street
44z.%JED NO' Northampton. Massachusetts 01060
Phone (413) 587-1240
Fax (413) 587-1272
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVAT ION PROJECTS)
In accordance with the provisions of MGL c40, s54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility as defined by MGL c 111, s150A.
The debris will be disposed of in: �""'
-Gte
Location of Facility Oa/Lett/ Pe—ejeLL-1
The debris will be transported by:
Name of Hauler
Signature of Applicant: Date: () 2—/
The Commonwealth of Massachusetts
i t Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information T Please Print Le_ibly
Name(Business/Organization/Individual): v Q f ft�g,, nn 4iJE,...1.t.
Address: 0-e- c 5g 1�--��-
City/State/Zip: W. t- L Phone#: 7 5 q 73
Are you an employer?Check the appropriate box: Type of project(required):
1. I a employer with employees(full and/or part-time).'
7. ❑New construction
2. a sole proprietor or partnership and have no employees working for me in $. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
3.�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9 El Demolition
10[t Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I ant a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.1:Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other
152,§I(4),and we have no employees.[No workers'comp.insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f 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 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
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
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 c. 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 er the pains and penalties f erjury that the information provided Bove is true and correct
Signature: Date: � o zr
Phone#: Z 7' C7 9q.3
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 CIerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
-f /
IF 5TemARPSr
ST:
I 4 i
0
Tz-ofos‘17
rtz
E/kph moo. Weyy_
g f7-01712A1Z-I sVT
110,1
/QI
{ a
I , 1
ci-rKICIQL5 Si
' o'r`ioro9 n 01 j/
"0,0
nZ h1 a1�Z
2 P art k74 7(Q ) 11 2 f
5- 119 T'1 9 )-1 V-1-MGV fi n /
)40
d cd 21,9 4.9 1
-NOTE—
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
REFERENCE:
BOOK 5616, PAGE 317
BOOK 236, PAGE 265
60't
x
x
LOT #9
x
x
NOTE:
SUBJECT TO EASEMENTS AND x
RIGHTS OF WAYS OF RECORD. j/+i shed kl_H
gar.
//_ \
1 x �_
X X
#14
/ /
___I
J 60±J
STODDARD STREET
TO: FLORENCE SAVINGS BANK &
CONNECTICUT ATTORNEYS TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
—NOTE—
SURVEYOR�C✓ U ___L-, THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEYP��N OF mass�y —MORTGAGE LOAN INSPECTION PLAT—
NORTHAMPTON, MASSACHUSETTS
o2�AN E. G� PREPARED FOR
� E.
c�i IZER N DEIRDRE CABRAL
503� SCALE: 1"=30' JUNE 24, 2013
90 suRvO°� HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS