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43-166 20 GREENLEAF DR BP- 2011 -0262 GIS #: COMMONWEALTH OF MASSACHUSETTS Ma - Bloc k: 43 166 ... CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0262 Project # JS- 2011- 000435 Est. Cost: $6770.00 Fee: $48.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor. License: Use Group: HOMETOWN STRUCTURES 98186 Lot Size(sq. ft.): 62726.40 Owner: DRYSDALE BLAINE & KIM PEDIGO Zoning: SR(l00) //WP/WSP II Applicant. HOMETOWN STRUCTURES AT. 20 GREENLEAF DR Applicant Address: Phone: Insurance: 627 SOUTHAMPTON RD (413) 562 -7171 WC WESTFIELDMA01085 ISSUED ON. 912312010 0:00:00 TO PERFORM THE FOLLOWING WORK.- 12 X 20 SHED 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: FeeType: Date Paid: Amount: Building 9/23/2010 0:00:00 $48.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # BP- 2011 -0262 APPLICANT /CONTACT PERSON HOMETOWN STRUCTURES ADDRESS/PHONE 627 SOUTHAMPTON RD WESTFIELD (413) 562 -7171 PROPERTY LOCATION 20 GREENLEAF DR MAP 43 PARCEL 166 001 ZONE SR(100) //WP/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: ERECT 12 X 20 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 98186 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I RMATION PRESENTED: 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 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. The Commonwealth of Massachusetts $oard �f Building Regulations and Standards FOR y ` Massachusetts State Building Code, 780 CMR, 7 edition MUNI Building Permit - Application To Construct, Repair, Renovate Or Demolish a Revised January Otte- or Two - Family Dwelling 1, 2008 This Section For Official Use Only Building Permit Number: Date Applied: Signature: Building Commissioner/ Inspector of Buildings Date SECTION 1: SITE INFORMATION 1.1 Pro ep rty A Q C 1.2 Assessors Map & Parcel Numbers �� I.la Is this an accepted street? yes _ x _ no M Map Number Parcel Number 1.3 Zoning Information: 1.4 Pro erty Dimensions: I ,fly C, c - � 1 1 6 r y .a3 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 I) ° Sb' l.: r0' R: to L' Sa' R �' /0` I Su' 1.6 Water Supply: (M.G.I. c. 40. §54) 1.7 F ood Zone Information: 1.8 Sewage Disposal System: Public Private ❑ Zone: Outside Flood Zone? y Municipal ❑ On site disposal system L7 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 O er of eco •d: G, .. S J 1 c; <« a© 6re- D ,ivt F /o r-eA ce, M Name (Pr Address for Service: Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction ❑ Existing Building ❑ Owner- Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. 10 Number of Units Other ❑ Specify: Brief Description of Proposed Work 2 : I re ,J I. CV" 6tod ) X do ct ee e.5 6'. rd � SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑ Total Project Cost (Item 6) x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees: $ Check NoArA6a—Check Amount: Cash Amount: 6. Total Project Cost: S �r 1 ❑ Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUC'T'ION SERVICES 5.1 Licensed Construction Supervisor (CSL) cS - 2 / 8 to -- _i License Number Expiration Date Name of CSL- Holder Q List CSL Type (see below) _ U Address v1V 5-0 T e Description U Unrestricted (up to 35,000 Cu. Ft.) Signature R Restricted 1 &2 Family Dwellin II M Masonry Onl - 1- -, - - RC Residential Roofing Coverin Telephone WS Residential Window and Sidin SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor (HIC) HIC Company Name or HIC Registrant Name Registration Number MA Address n G 1 o? S `� _ - 7- - VA. vvt / ! �tzo s ( _ 7�� Expiration Date - _ Signature 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 Issuance of the building permit. Signed Affidavit Attached? Yes .......... X No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, m c --kcu a, oly as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to w r authoriz by this ilding permit application. q Signature O er Date SECTI N 7b: OWNEW OR AUTHORIZED AGENT DECLARATION / cw'i • 0 , as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. M C kn n Print Name Signature of Owner o Authori A gent Date (Signed under the pains and penalties of perjury) NOTES: 1. 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 and Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations I IO.R6 and I IO.R5, respectively. 2. When substantial work is planned, provide the information below: Total floors area (Sq. Ft.) '/0 s { (including garage, finished basement/attics, decks or porch) Gross living area (Sq. Ft.) — Habitable room count — Number of fireplaces Number of bedrooms -- Number of bathroontis -- 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' -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 10' Wide Utility Easement H 240 00 /4 + fA / 5 C: � LOT #22 %120 5 h Lt 0 r I "\ N N T O 1.y �. 9� \ REFERENCE: Q BOOK 9268, PAGE 317 PLAN BK. 166, PG. 73 \ !s N O N � o NOTE: A PORTION OF THE PREMISES IS LOCATED tt WITHIN A 100 YEAR FLOOD ZONE (ZONE A), ` THE STRUCTURE IS NOT LOCATED WITHIN THIS FLOOD ZONE. i NOTE: � SUBJECT TO EASEMENTS AND N o RIGHTS OF WAYS OF RECORD. 1+ PARK HILL ROAD TO: EASTHAMPTON SAVINGS BANK AND FIRST AMERICAN TITLE INSURANCE COMPANY TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF 1 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 LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY #250167 -NOTE - Q'✓. -�.�� J- THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY SURVEYOR AND DOES NOT CONSTITUTE A PROPERTY SURVEY J� ESN �"SS - MORTGAGE I OAN INSPECTION PLAT- NORTHAMPTON, MASSACHUSETTS RANDALL PREPARED FOR Ijt ER LINDA E. BORNSTEIN /350332 SCALE: 1"=80' JUNE 29, 2010 +N� HAROLD L. EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET - HADLEY - MASSACHUSETTS HOMETOWN STRUCTURES K Mki I r= 627 SOUTHAMPTON ROAD WESTFIELD, MA 01085 -1329 Order Date 9 -ao 10 413- 562 -7171 Estimated Delivery Date 3 %a wee ks BILL TO: K t d_ 3 1Q f' t Q- O r yS� NOTES: ADDRESS: Dr . FJorw► % M,a IN 0 to ' ) PHONE # -5 1 CELL PHONE # email address �I DuraTemp T1 -11 El Instock Display Shed F] To To Be Custom Built Body Color: 9 Y ow in" Body Color: Corner & Fascia Co /1'. M 0' Corner Color: El Delivered Fully Assembled poor Color. Pe Door Color: El Built on - site SOFFIT CHOICE: (For New England Sheds Only) Solid T1 -11 ❑ Body color SOFFIT CHOICE: (For New England Sheds Only) Size: x Exposed rafter tails ❑ Body color Style: Aluminum Strip vent X wh to O Brown Perforated vinyl 11 White ❑ Brown Perforated vinyl White Brown Beaded vinyl ❑ White only ❑ Gambrel Beaded vinyl ❑ White only ❑ Cape ❑ NE Cape ❑ Ranch ❑ NE Ranch Single Door Double Door ❑ Quaker ❑ NE Quaker L/ /0 El Villa El NE Villa Width &Type: 3 1 0 - T- Q -A Base Price — 4 6 6 �Q ❑ Dutch Colonial ❑ NE Dutch Colonial tr o -- 3 U v ❑ NE Chalet Transom Frame ❑ W El B W r-1 g Win Price $ ll dow ❑ NE Victorian Door Price $ XNE Sugar Shack Hinges ❑ Std Strap ❑ Std X1 Strap Soffit Price $ ❑ NE Swiss Chalet p with dormer Ramp: I C IS x4 ❑ with upper level ❑ 5 x4 1 00 ❑ NE Homesteader ❑ 54 x4 ❑ Other x Loft: ❑ 4 x8 Shingles: Window Type ❑ 4 x 10 El Dual Black — F 18 x 36 ❑ 6 x 12 El Other x O $ ❑ Earthtone Cedar — 024 x 36 Flower boxes: )I Wood ❑ 18 ❑ Dual Gray ® 36 x 36 El Brown El Vinyl 024 ` ,� ❑ Weatherwood — E] ventilator Color 36 y $ ❑ Harvard Slate Shutters: XlWood ❑ Charcoal Gray . s � Color ❑ Vinyl ye-S $ Y� CIJ4 /"90 -1 goof b.^unze y Drip Edge: ❑W ❑B Frames: XW ❑e $ 1gd Site Preparation - pad size _x 3 $ $(o S NT subject to site evaluation Overwidth road permit fee $ 1 /0 AT Sub Total $ - -= Load Door Towards: Sales tax: $ ❑ Front ❑ Driver s Side TOTAL: $ .737 $tJl3. 3 3' E Back El Passengers side Deposit: $ 200L) BALANCE:$ (OUI�I N L O s- 0 N >i N `+ • O 7� . N > Z3 Q U Q} � cn 41 • cv o0 Ln L � a V • V1 �i $7 n * ` O 4 � O i U N ca - O lD N • � X N O cto N -0 _ L Q) O 4 - _ O O z L O U Q) > L L O X aj 6 m Q The Commonwealth of Massachusetts Department of Industrial Accidents a Office of Investigations =' 600 Washington Street Boston, MA 02111 f. www. mass gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): H 'r, Address: ( ,� S e ����, �, RBI City /State /Zip: W e f 4 0 / 69' 5 - phone #: )-7/ Are you an employer? Check the appropriate box: Type of project (required): rl " 1. p I am a employer with _ _ 4. E] I am a general contractor and I employees (full and /or part-time).* have hired the sub - contractors 6. E] New construction 2. ❑ t am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship nd have no employees These sub - contractors have P 8. ❑Demolition working for me in any capacity. employees and have workers' INo workers' comp, insurance comp. insurance. $ 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13. Other A ('�es employees. [No workers' comp. insurance required.] *Any applicant that checks box #I must also till out the section below showing their workers' compensation policy information. I I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new at�idavit 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: ' _ -e.r k S A; T n S u fy,n o Policy # or Self -ins. Lic. #: W L b 0 U - y - y U � Expiration Date: 3 - ,g — / - d q o Job Site Address: a O � 1ec< j' O r,'vr Ci ty /State /Zi p: R"".) W , / U /U L, Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition 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 coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: _ d 9 - ,-20 Date: / U Phone #: I S -- S`Z., d 21 ` 7 I 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. Citv /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector