49-024 676 PARK HILL RD BP- 2010 -0515
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 49 - 024 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
S_ Lor BUILDING PERMIT
Permit # BP- 2010 -0515
Project i+ JS- 2010 - 000725
Est. Cost: $4800.00
Fee: $38.40 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 79976.16 Owner: MASON PHILIP M & ALEXANDRA
Zoning: SR(100) / /WSP II Applicant: MASON PHILIP M & ALEXANDRA
AT: 676 PARK HILL RD
Applicant Address: Phone: Insurance:
676 PARK HILL RD (413) 587 -9516 0
F L O R E N C E M A 010 6 2 ISSUED ON:11/16/2 0 09 0:00:00
TO PERFORM THE FOLLOWING WORK: ERECT 12 X 16 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 11/16/2009 0:00:00 $38.40
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
File 4 BP -2010 -0515
APPLICANT /CONTACT PERSON MASON PHILIP M & ALEXANDRA
ADDRESS PHONE 676 PARK HILL RD FLORENCE (413) 587 -9516 0
PROPERTY LOCATION 676 PARK HILL RD
MAP 49 PARCEL 024 001 ZONE SR(100) / /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
pcof Construction _LRI CT 12 X 16 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildin_ Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 2MATION PRESENTED:
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 Commission Permit DPW Stoma Water Management
Demolition Delay
•! / /.ter 00 _ _ _ _ _ _ � � 4e CI
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 jase only
City of Northampton Status of Permit:
Building Department 13y Perm
212 Main Street sewe /Sep it
Room 100 WaterJWelt A
Northampton, MA 01060 Tw i Sets of Structural Plans
phone 413- 587 -1240 Fax 413 -587 -1272 P ot:Site.Plans
Other Specify
n noo 1,-.A1-Intl TO CONSTR iCT ei TFR REPAIR? RENOVATE nR rDEMOt_ISH A ONE OR TWO FAMILY DWELLING
SECTION 1 —SITE INFORMATION
This section to be completed by office
1.1 Property Address:
6 '76 t s §; o a s.:r Map Lot Unit
t Zone Overlay District
Elm' St. District CB District
SECTION 2 - PROPERTY'OWNERSHIPJAUTHOFRIZED AGENT I
2.1 Owner of Record:
_ _ _ , " » /ir (`'. ' fl 3 - y " 4- 4.1 Q.. -r' va.' C P t 1 `,1 , b" 6 .4
Name (Print) Current Mailing Address:
t
e` Telephone
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 4 1 . (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) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
.,
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ] Replacement Windows Alteration(s) ri Roofing
Or Doors
Accessory Bldg. LE Demolition 1 1 New Signs [0] Decks [E] Siding [O] Other [DJ
Brief Description of Proposed
Work: �° 1 rs_'� P s ` p', ' s� _ �, �' . /'
i � a a;�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
1 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
I, , 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
t ,. p ] $ , ''' 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 3
! P
Signature of Oer /Agex1i PJ
vin Date
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