23D-175 (2) 28 BAKER HILL RD BP-2002-0363
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D- 175 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:ADDITION BUILDING PERMIT
Permit# BP-2002-0363
Project# JS-2002-0553
Est.Cost: $24000.00
Fee: $132.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 15986.52 Owner: SWIFT BRIAN M&SUSAN H W SWIFT
Zoning:URB Applicant: SWIFT BRIAN M& SUSAN H W SWIFT
AT: 28 BAKER HILL RD
Applicant Address: Phone: Insurance:
28 BAKER HILL RD
FLORENCEMA01 062 ISSUED ON:10/5/01 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMO 14 X 13 PORCH & CONSTRUCT 22 X
15 FAMILY RM ADDITION
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: 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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/5/01 0:00:00 3712 $132.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2002-0363
APPLICANT/CONTACT PERSON SWIFT BRIAN M&SUSAN H W SWIFT
ADDRESS/PHONE 28 BAKER HILL RD
PROPERTY LOCATION 28 BAKER HILL RD
MAP 23D PARCEL 175 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 11
Fee Paid 3I/? l3c
Typeof Construction: DEMO 14 X 13 PORCH&CONSTRUCT 22 X 15 FAMILY RM ADDITION
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
INFO ATION PRESENTED:
pproved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and 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
/00
Permit from Elm Street C C. ssion
. ,_-461 "-GL:A1--- ____.4 ii&—e _IC:70
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.
• a 0
C-----k
i =° ` ?De'part e—rt set rrrm-
, Ci orthampton Status of hermit
1 0' OCT — 3 2001 B i :: Department Curb Cut/Driveway Permit
t"`i L -- -- 12 ain Street Sewer/Septic Availability_ _
• �� ,, ,�IpINGINSPECTIONS Ro.m 100 Water/Well Availability
.,.,ON,MA link; . .. .... : on, MA 01060 i wD ScAs of Structural Plans___.
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans_____
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property
Address: �� /
�" �/�>64 � A ,4 / Map 3 Lot f Unit
Zone ald Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
sr ; a cssw , ag AcI /ci/ 0J f1,nee ,)c, n;
Name(Print) Curr nt M ling A s:
r2i yr s� _yes
/ ( (tif---
,
- / � Telephone
ignature
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 1 / 0 (a) Building Permit Fee
2. Electrical 5f (b) Estimated Total Cost of
i )S 0 O • 0 s3 Construction from (6)
3. Plumbing 5 J S a • O v Building Permit Fee
i
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) S a vi 0 O • V Check Number ?7/ ;1 3a
This Section For Official Use Only
Building'Permit Number: rye'-da---,.63 Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
r
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
Building Departmentar�
f
Lot Size / 6, /6,60 0 g,J r=
Frontage / S O 7 ° l v
Setbacks Front 3 0 3 O 020
Side L: S R: a S L:5 R: S /�
Rear LS� / / 1O
Building Height / Q/
SS-
Bldg. Square Footage /3 so p % 1 6 60 / 0 OlQ ado
` do
Open Space Footage f.3 g 7 Q % l S6J
�
(Lot area minus bldg&paved 0
Cat C1J f
parking) _
#of Parking Spaces 3 .3
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO N 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 y 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
IF YES, describe size, type and location:
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition )4 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 0
Accessory Bldg. 0 Demolitior)i New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: ,as A", 4.• ,[ rCI o m 8c4'. ,-k , ,, 4 0,1.S `
A p ,f� ®r
Alteration of existing bedroom Yes A No Adding new bedroom Yes No (�_
Attached Narrative❑ Renovating unfinished basement Yes X No
Plans Attached Roll ❑- Sheet❑
OFIfirsleVhlidtefitiroTaaddition to existing housing, completfe,t_he following:
a. Use of building : One Family X Two Family Other, ctY-}/')'t,'i y rO CIill 90 C/C411',,,-•
b. Number of rooms in each family unit: I Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. 3 36 Se Dimensions / S x
e. Number of stories? I
f. Method of heating? /1 7 Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. yf Mascheck Energy Compliance form attached?
h. Type of constructionki0 Od mN
i. Is construction within 100 ft. of wetlands? Yes K No./ Is construction within 100 yr. floodplain Yes i i
j. Depth of basement or cellar floor below finished grade (I ct' t/- n %rV
k. Will building conform to the Building and Zoning regulations? ,Q Yes No .
I. Septic Tank City Sewer ,k Private well City water Supply r
SECTION 7a -OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I , as Owner of the subject proper-
hereby authorize to act
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I , 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 ' ftj\- 1. 1�- 6c-`o e `S a 6 6 f
Signature o Owner/Agent Date
•
SEC iON.B tCONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable D
Name of License Holder : _3-1 0 a/I, IA i !de oS
License Number
Address r Expiration Date
Zc� y0Z,
Signature Telephone
�n
/i 4/VVI/►
Re r—e. ni < rn• ., et a ''' a . , ¢ " ....... Not Applicable ❑
Company Name Registration Number
9a%wt,e # O c, o q t 5-
Address Expiration Date
Telephone 2 O Z
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 affida
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes........ ❑ No ❑
u Dniet. .P O , f 7a n
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)familie
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(:
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�Locall`Zoniing Laws and State of Massachusetts General Laws Annotated.
ej ' �
Homeowner Signature I Y ç1A11 /
i , , , r
g a74.,0 r .i of NoriIJantpthr __
9 qYa%,,+^•i ?t 6 lassachasctts' _" '.-:
—
'�'W} DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 rr'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I,
(licenseeJpermiuee)
with a principal place of business/residence at:
. • (phone#)
•
(btic t/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
- (Insurance Company) (Policy Number) (Expiration Date)
I am a sole proprietor, general contractor or ••meo• s' (circle one) and have hired
contractors listed below who have the following wor.er's compensation policies:
i < _
d '11 ..I _ I i.
/ tune of Contra r) (Insurance Company/Policy Number) (Expiration Date)
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additio ui shoot if ne .sry to include infonnaaon pertaining to all contractors)
I am a sole proprietor and have no one working for me.
( ) I am a home owner performingall the work myself.
y
•
NOTE:please be aware that while homeowners who employ persons to do trr.inr.o,r rr construction or repair work on a dwelling of
not morn than throe units in which the homeowner reside or on the grounds appurtenant thereto arc Dot generally considered to be
employers under the worker's rev:ye-DI sr ion Act(GL152,ss l(5)),application by a homeowner for a license or permit may evidence the
legal status of an employee under the Worker's Compensation Act.
•
I understand that a copy of this statement may be forwarded to the Department of Industrial Accidents'Otf oo of Insurance for the
coverage verification and that failure to aecure covet-ago under section 25A of MCOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S 1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S 100.00 a day against me.
•
For departmental use only
64111/1-.. CLil
(� Permit Number
� Mapil Lot#
.._... Signature of T.irrn cn,/Pr rm item Date - .
• .
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DEPT OF BUILDING INSPECCNrit R°ltcQ
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06-20-00 14 :03 DEPT OF PUBLIC SAFETY ID`14134431053 P01 'G1
._. ��.�w r-'„t i91
RE C E U E I, : 'GY CONSERVATION APPUCATIGN FORM FOR
2W••• RESIDENTIAL NEW CONSTRUCTION AND ADDITIONS •
i OCT 3 • 780 pMR Appendix J*effective 3/1/98)
S ri c 8- .6 ,I. Qii ,2
DE. f i 11 :� hJ Site Address:
. 14 i licanf'11 dlr� .D• g- : A. 4. . , . ; /1 City/Town: ci-I p ✓c ri C_A
-Pe.-,- e/ : Use Group: -
pate of Application: _ 13 aj O
•Applicant Phone: 41 1 3 —SX 6 "— 4/ Application Signature:
COrtepitai Pith(check on
O Prescriptive Package(Limited to 1- or-2-family wood frame buildings heated with fossil fuels only)
Package (A through KK from Table J5.2. lb): Heating Degree Days (HDD6s)from Table J5.2 la:
(For items d. through i., fill in all values that apply from Table J5.2)
1. G o~z Vail A:ea b b sq. ft f. -Wa I l f?Vahra- R-
b. Glazing Areal /1 O sp. ft g. Floor R-Value R-
c. Glazing%(100 x b- a) _ % h. Basement wall R-
d, Glazing tj-va{_'e U, i, Slab Perimeter R-
. e. Ceiling R-value R- I. HeatingAFUE
❑ Component Performance: 'Manual Trade Off` (Limited to wood or metal framed buildings only)
Climate Zone(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14
Attach Trarle•Off Ilbrksheet from Appendix J,[and HVAC Trade-Off Worksheet, if applicable)
Q MAScheck Software
Attach Compliance Report and inspection Checklist printouts.
❑ Systems Analysis OR ❑ Renewable Energy Sources "
Attach Mass Registered Architect or Engineer Analysis
•
ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wall + Ceiling Area`Y3U sq. ft. b. Glazing Areal /f D sq.ft. c.Glazing%(100 x b+a) 'jf,
❑ ADDITION with Glaring% (c.)up to 40%may use 780 CMR Table J1.1.2.3.1 below:
MAXIMUM U-value O, 3 5 Minimum RA/Wiles `Z
I I
Fenestration . Ct+ilirg Wall ` r� -Icx r - Basement Wall Slab Perimeter, Dept
Lc„,,_ R-37 _R-I3 I R-19 i R-10 ' R•10,4 ft.
❑ "SUNROOM"addition (greater than 40%glazing-to-wall and ceiling gross area)
Attach `Consumer information Form"fromm 780 C► f Appendix B. ,�,e�
Ofn sau f Name: 4/ 5�� �/1TC - Official's Signature: 43 ,..e J
Application- Approved W[ [enied ❑ Date of Approval:Denial:
Rvaw,i(j)for Denial: (provide additional details as needed on back side)
L G'� a Ivory be debts-Rough Opening ar Unit niimenticies.
06-26-00 14 :01 TO:DEPT OF PUBLIC SAFETY FRO11:413 4999444 P01