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43-016 (2) DEMOLITION REVIEW APPLICATION' "J 1 2CC9 �i Activity Tracking Sheet Mn AiZIM ielceived in Building Department: Referred from Building Department: Action Taken/ Northampton Historical Commission Action Taken By : Entire Commission Sub - Committee of the Commission Commission Designee/ Staff Date Action Taken & X 0 Initial Determination Public Meeting held Public Hearing Held Determination Made Property has been determined not to be Significant according to Ordinance definition. pjc�� p No further action will be taken. Demolition Permit may be issued. Property has been determined to be Significant according to the Ordinance definition and a Public Hearing has been /will be scheduled. Demolition Permit may not be issued at this time. Public Hearing has been held, Property was determined Significant but not Preferably Preserved. No further action will be taken/ Demolition Permit may be issued. Photo documentation may be required. Public Hearing has been held. Property has been deemed to be Preferably Preserved. The demolition review period has been initiated. No demolition permit may be issued until the Historic Commission approves an alternative plan or the twelve month period concludes. Alternate plan has been approved/ delay terminated. Demolition may or may not be approved as part of plan. Twelve month time period has expired, demolition permit may be issued. /,, Referred by: ,,., Date `r File # BP- 2009 -0877 APPLICANT /CONTACT PERSON THEWS PETER A & REBECCA C CASTRO ADDRESS/PHONE 273 CRESCENT ST #2 NORTHAMPTON (413) 552 -6556 O PROPERTY LOCATION 248 PARK HILL RD MAP 43 PARCEL 016 001 ZONE SRO 00) //WSP II THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: DEMOLISH BARN 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 PIjKIENTED: 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 v Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management 1 Demolition Delay 1 200 9 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. k vi amity of Northampton i' 8uBding Department s d 2`1 Main Street Room 100 a. W70 , t�� r Nort nripton, MA 01060 phone 4'i3 57 -1 Fax 413 - 587 -1272 - 0�� u APPLI &AfiON TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address This'sedtion to.be completed by office 1(<6_ Map lot Unit Zane Overlay District Elm st flistrict CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record P61, U n Ca 2 S Nam Current Mailing Address: Telephone Signature 2.2 Authorized Agent �� &1A Name (Print) f Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUp noN COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermitapplicant 1. Building (a) Si�itdmg�smatt Fee: 2. Electrical (bj mated T�tali✓ost of ConstnidtionArem 3. Plumbing -Smiding Permit Fee.: 4. Mechanical (HVAC) 5. Flre Protecliuit 6. Total..= (1 - + 2 +3 + 4 + 5) heck Numbor ZG. a . _. TC�is .Sest�onForOffic�ia[Use:Onl Building Number. Date {' Issued. Signature: Building Commissionerlinspector of Buildings Date. r r Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This cohmtn to be filled ' by Building Department Lot Size Frontage Setbacks Front f Side L: R: L R.� Rear Building Height i Bldg. Square Footage Open Space Footage % (Lot area minus bldg & paved £ ¥ # of Parking Spaces 1 Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for7on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page I and /or Document # 1 B. Does the site contain a brook, body of water or wetlands? NO 0 DON KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 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 propert y ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, e xcavAtarf, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO is vice then ntnrth ;torrn Water Management Permit from the DPW is required_ SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors Ci Accessory Bldg. ❑ Demolition LJ New Signs [ED] Decks [p Siding [0] Other [p] Brief Description of Proposed Work: �c+�((/�Pf r >6 J �P✓ r`Y /'+ n.R Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll —Sheet Ga. If;Newbb use .:an . or dd air o eaasti a -#�o is�n�l c ri iife the � rag: 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 cons on. 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 L Is construction within 100 . f wetlands? Yes No. construction within 100 yr. fioodplain Yes No j. Depth of baseme r cellar floor below finished grade k. Will building, onform to the Building and Zoning regulations? Ye No. 1. Septic Tank City Sewer Private well City water Supply SECTION. 7a - OWNER AUT.HO.RIZATION TO...-BE.00NIPLETfD Wt{EN OWNERS AGENT OR CONTRACTOR APPLIES FOR B.IiILhINGPj =ftMiT I, as Owner of the subject propottY hereby authorize to act on my behalf, in all matters relative to work authorized by this building.permit application. S i ng_ature 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 Na Signature of Owner/ gent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction S J�� ^ Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone = S:l2e isterei Homein roarernesifCbr�traor �. Not Applicable El Company Name Registration Number Address iration Date Telephone SECTION 10- WORKERS'COMPENsAnoa INSURANCE AFFIDAI/)T (M G L c 15 § 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...... ❑ h - 1 21 M, , 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 - 10835.1. Definition of Homeowner Person (s) who own a parcel of land 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 oue'bome in a two -year period shall not'be considered a hom 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_nerformed 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 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, von 'mav be liable for persons)* you hire perform work for you under this permit. _ The undersigned "hnmtowner" certifies and assumes responsibility for compliance vv>th the State Building Code, City of - - - Northampton Ordinances, State and Local Zoning Laws an State of Massachusetts General Laws Annotated. Homeowner Signature The Corzznzonwealth of Massachusetts Department of Industrial Accidents Of Ice bf Investigations ! 600 Washington Street Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidairit: Build ers / Contractors /EIectrician SIP lumbers Applicant Information G �r Please_ Print Legibly Name ( Business /Organization/Individual): �rG i �F /_77 < J _ Address: 5 �� S"Cc N! s C - fa` City /State /Zip: 6 i?>if/, OfC� Phone 4 rr: Are you an employer? Check the appropriate boa: Type of project (required): 1. ❑ I am a employer with 4. E I am a general contractor and I 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors 2. 17 I am! a sole propri etor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub- contractors have g, emolition working for me in an capacity. employees and have workers' Y P . _ t 9. E] Buildin addition [No workers' comp. insuran comp. insurance. re ed j 5. ❑ 10. We are a corporation and its ❑ Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. ED Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insuran required.] t c. 152, § 1(4), and we have no 1� ❑Other 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. . t 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 nan>r 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 poiiey number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead:to the iniposrtion`of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance verification I do hereby ce d the pains an enalties of perjury that the information provided above is true and correct Sisnature: 1 Date: 2- Y © r Phone #: 5 " SS Official use only. Do not write in this area, to be completed by city or town officiaL Citv or Town: Permit License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact Person: Phone #: HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 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 tiu ding codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfiIl), sonotube holes (before your) —a rough building inspection (before wo is° conceaied) insulation inspection (if required) •and as f nal 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 occup . until the work can e'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 theirproper 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 _. 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 Northampton, MA Property Detail Page 1 of 2 City of Northampton, MA: Residential Property Record Card New Search Properly Tie Classification Code Reference Card I of 1 Parcel - Location - Zoning - Assessment Map -Block -Lot: 43-016-001 Zoning: Assessment: Location: 248 PARK HILL RD Neigborhood: 2 Land: 115,300 #Living Units: I Deed Book: 3895 Building: 100,500 Class R -101 Deed Page: — Total: 215,800 Dwelling Information Building Sketch Style: Conventional Year Built: 1720 Story Height: 1.5 Attic: None Descri °t, Basement: Full A:. 5M stl tW Total Rooms: 6 720 sgft B:1 Fr/8 Bedrooms 2 12 288 sgft Wood Deck C: Wood D Full Baths: 2 12 132sgft Half Baths: 0 �a4 D:Wood o . ' Exterior Walls: Brick 30 12 144 sgft Unfinished Area: 0 Ground Floor Area: 720 Wood Deck 24 . !5M s/1 Ms1B 24 1 FIB Total Living Area: 1548 y 3zza 2ss Finished Basement Living 0 X 0 Area: Basement Recreation Area: 0 X 0 Woodburning Fireplace 0/0 Stacks /Openings: Metal Fireplace 0/0 Stacks /Openings: Heat/Central A/C: Basic Heating System: Hot Water Fuel Type: Oil Addition Information: Quality Grade: C Physical Condition: Average Interior /Exterior: Better Condition/Desirability/Utility: FR Lower 1 st Story 2nd Story Story Area Vacant/Dwell /Oby Status: Dwelling One Story H Additional Features: en Masonary nary 720 Brick Trim: 0 X 0 Basement One Story Frame 288 Stone Trim: 0 X 0 lWood Deck I32 Remodeling Data: I I n http:// www. northamptonassessor. us/ noho /propertydetail.php ?m ap_no =43 - 016 - 001 &pagecard =l 4/27/2009 i Norehainpton, MA Property Detail Page 2 of 2 Year Remodeled: 86 (Wood Deck 144 Kitchen Remodeled (Y/N): Bath Remodeled (Y/N): Land Data Outbuilding Info Square Foot Type Utilities Type Feet Value no no information information ITypel Q ear ize 1 I Size2 Grd Cond AB2 1 1901 Acreage Type Street/Road Type Acres Value no information Home Site 1.00 115,250 Sales I nfo Permit Info Date I Type Price Validity I Date IlPermit #Price Purpose 11 no information E Ino information http: / /www.northamptonassessor noho /propertydetail.php ?map_io =43 - 016 - 001 &pagecard =l 4/27/2009