49-020 (2) 343 GLENDALE RD BP- 2010 -0980
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map :Block: 49 - 020 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- 2010 -0980
Project # JS- 2010- 001447
Est. Cost: $3200.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STACY BUILDERS & CONTRACTOR 060290
Lot Size(sq. ft.): 43560.00 Owner: BRAKEY SANDRA D
Zoning: SR(100) / /WSP n Applicant: STACY BUILDERS & CONTRACTOR
AT: 343 GLENDALE RD
Applicant Address: Phone: Insurance:
P O BOX 217 (413) 665 -6970
W HATELYMA01093 ISSUED ON :5/10/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REMOVE REAR PORCH & CONSTRUCT 8 X 10
SIDE PORCH
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 5/10/2010 0:00:00 $55.00
212 Main Street, Phone (413) M8/ - 1240, Fax: (413) S87 - 12% 2
Building Commissioner - Anthony Patillo
File # BP- 2010 -0980
APPLICANT /CONTACT PERSON STACY BUILDERS & CONTRACTOR
ADDRESS /PHONE P 0 BOX 217 WHATELY (413) 665 -6970
PROPERTY LOCATION 343 GLENDALE RD
MAP 49 PARCEL 020 001 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
Typeof Construction: REMOVE REAR PORCH & CONSTRUCT 8 X 10 SIDE PORCH _
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/ Statement or License 060290
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
VApproved 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.
City of Northampton
Building Department 'cs 1;. ,,-. .: ,,,, ...-i'.. - :, - ::"T.7:7-i7.7 - 'vT:77:7:'.::?.'-7.,:::r-tqcr„:eikcr --,
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Northarnpton, MA 01060
p h o n e 413- 58„7 - 1240 Fax 413-587-1272
066-65
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APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This sectiOteijo":be:-(0 ipPLOd-bY-PIfice
1.1 Property Address: • - -.. - , ',,' . - ,. -„,.: - -
ii ; --',;';.':-'''',-;:, - f.,z4V47 - „' -, 1= - --tinit-" , =„ 7 - - ","..'-:-
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SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1 _
2.1 Owner of Record:
) ,i7 ft, < i :1 1 i i ''''''' ' /
Name (Print) Current Mailing Address: „,
- . . ,
Telephone _ . , )
Signature .
2.2 Authorized Agent: -,,
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Name (Print)
Current Mailing Address:
/ .-''.4- : -,--, - -
Signature . Telephone
-
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building -) ' - (a) Building Permit Fee
2.
(b) r :timated Total Cost of
Elec.rical
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (riVi‘C)
5. Fire Protection
6. Total ---= (1 ± 2 + 3 ± 4 + 5) Check Number ,. , _
This Section For Official Use Only
Building Permit Number: Date Issued:
.
Signature: . .
Date
Building Commissioner/lnspector of BuildIngs
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 Department
Lot Size _
Frontage
Setbacks Front
Side L: R: L: R:
•
Rear
Building Height
Bldg. Square Footage
Open Space Footage % ^
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 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 r--' 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 L. ---
IF YES, describe size, type and location: — D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No L .
IF 'YES, describe size, type and location:
•
SECTION 5 DESCRIPTION'OF PROPOSE
D WORK (check all applicable) � --
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Siding [ ] Other [ ] 3
Brief Description of Proposed Work: 7 • ,
,111 I
Alteration of existing bedroom Yes No Adding new bedroom Yes t No t '
Attached Narrative 0 Renovating unfinished basement Yes -- -�-- No
Plans Attached Roll 0 - Sheet ❑
6a tfVNew h OUSel-andiOr..addi;tiOrf to,ezi - tin "li'ousin , comple e.`tYie"fotlowin
a. Use of building : One Family. -" Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms ',r
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. Mascheck 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
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 7,a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT APPLIES FOR BUILDING PERMIT
I -;t- , 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
�. w
I \ [ -{ "` r ) f 1 , as 0wner .Thor; zed 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
Signature of Owner /Agent Date
SECTIONt - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable O
Name o/ License Holder
�i
License Number
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Add . Expiration Date
1,f/ _ � � ~/
�-~_� ~_,/a_~��. ' ' `�y ��x, / �� / / �—
Signature Telephone
Not Applicable /O
CR / Regis Number
' �� � � /(}5 __ Expiration Date
Address SEcTioN 10- WORKERS' - COMPENSATION INSURANCE AFFIDAVIT (IVI.G.L. e. 152, § 25C(6)) "71-
Workers Compensation Insurance affidavit must be completed and submitted with this applica to provide this affidavit
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No 0
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. CIVID78O. 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 ronide, 011 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
resportsible for alt such work performed under the buildin 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 fir which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter |53 (Liability of Employers tu
Ernployees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned ^hornonwnnr' certifies and assumes responsibility for cornpliance with the State Building Code, City of
Northampton Ordinaoceo, State and Local Zoning Laws and State ofMassachusetts General Laws Annotated.
Homeowner Signature -- -
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L>EPAR OF /3 Lill....D17C; INSPECT] OMS
212 Main Street * Municipal Builciing A, .-,:__7'" •._-''
Northampton, an 01060 --,._,--
WORICER S CONITENSATIO INSURANCE kFF17).:AL..\%11'
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(Name of Ccmttmct.-„f) 11:1..eaTancta:. Ccto.:1'olitt ) . - Jittl - Pk-e - , - ) (7..:1. Date)
(i-IL.tme. of Cocr,t7, (1.2t CcrzottattylPel.:,t ;
(1';ainc: of Coatnctor) (1.P,tot.ratfIcatt Cerzte N-H„rit,i',1: , Fo. Date.)
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DEPARTMENT OF BUILDING INSPECTIONS '� ' / - ^
- - - E--1:..B.-= - X4'
INSPECTOR 212 Main Street • Municipal Buildin >
Northampton, MA 01060 ° ^~
e
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as Lis/her construction supL,: , :sor. 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 any 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 building codes
and regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour). a rough building inspection (before work is
concealed). insulation inspection (if required) and a final 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 occupancy
until the work can be 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 their proper
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
I, 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
DEBRIS AFFIDAVIT
As a result of the provisions of MGL c. 40, S 54, I acknowledge that as a condition of this
Building Permit, all debris resulting from the construction activity governed by this
Building Permit shall be disposed of in a properly licensed solid waste disposal facility,
as defined by MGL c. 111, S 150A.
I certify that I will notify the Building Commissioner of any change in the location of the
solid waste disposal facility to be used within 72 hours.
^,gyp ¢ _ jjjjjj
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a v
Date Signature of Permit Applicant '„
Print or type the following information:
Name of Peiiiiit Applicant
Firm name (if applicable)
// t.,, .,/
Address ,'
The debris will be disposed of:
Facility
Ad d ress
PLOT PLAN
Map Parcel
Sq/Ft
REAR LOT DIMENSION_
REAR YARD
SIDEYARD SIDEYARD
FRONT SETBACK
FRONTAGE DIMENSION STREE NAME:
• Indicate Location and Dimensions of House, Garage, Additions or Accessory Buildings.
• Locate Septic Design Area if applicable.
• Locate Well CAP if applicable.
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