18C-071 (3) Tc
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\ -h -� ' FLOORPLAN
Borrower: Rosser O'Brien & Alice Crawley O'Brien File No 1291125
Property Address:7 Francis Street Case No Loan # 2002015522
Cdy: Northampton State MA Zip: 01060
Lender: Florence Savings Bank
480'
n Bath
Master Bedroom $ V Bedroom
Bedroom
24.a 0.0' V
o rG
Master
Bath
b Closet
I`nd
2 Car Mud
Garage Room Kit hen Living Room
as
as Foyer
a
Open Pond,
24.5' 348
Sketch by Apex IV VVIndows'~
AREA CALCULATIONS SUMMARY 1 LNING AREA BREAKDOWN
•
Code Daalpgon She Totals Crackdown SobraWde
Mal First Floor 1560.00 1560.00 • First Floor
0/0 Open Front Porch 160.00 160.00 - CO x 16.0 120.00
CAR Garage 500.00 500.00 = 30.0 x 40.0 2440.00
TOTAL UNABLE (rounded) 1568 ;. 2 Areas Total (rounded) 1568
2 Lexington Drive, Easthampton, MA 01027 (413) 527-0231, Fax (413) 527 -7272
SA THIS PLAT NOT FOR RECORDING PURPOSES 5K.4095 P6.191
pt..81‹.
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I HEREBY REPORT THAT I 11AVE EXAMINED THE PREMISES, AND BASED ON COSTING MONUMENTATION. ALL EASEMENTS. ENCROACHMENTS
D BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT UNES. 1 FURTHER
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The Commonwealth of Massachusetts
Department of Industrial Accidents
:_� =1 Office s Office of Investigations
e = _41_
_ y 600 Washington Street
=.015:-..--. „- Boston, MA 02111
- „ p . www.mass.sov /dia •
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Nance ( Business/Orgaa;zaaonflndividnal): SI k v S to.t Acc . e, (,,c .
Address: 1I k, . t(1/4-0 •
City/State/Zip: 1 S ...,_,,, (`' L , ) k Phone. #: Ll L - 7.s 4 - L r; 4 0
Are you an employer? Check the appropriate box:
Type of project (required): •
110 I am a employer with j, 0 4.. ❑ I am a general contractor and I 6. Q New construction
employees (full and/or part - time).* have hired the soli- contractors
2.0 I am a sole proprietor or partner- listed on the attached sheet 7. Q Remodeling
ship• and have no
employees These sub- contractors have. S. 0 Demolition
working forme in any capacity. employees and have wormers'
t • 9. 0 Building addition
(No worker's' comp, insurance comp. iastuaace. .
required.] 5. 0 We are a carpotion and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have Sitereised their 1 I. ❑ Plumbing repairs or additions
myself. o workers' co right of exemption per MGL
Ys [No comp. 12.0 Roof repairs .
insurance required.] t c. 152, §1(4), and we have no
employees. (No workers' 13V OtherSk c.e(ly
comp. insurance required.] °
Any applicant that checks box #1 roust also fill out the section below showing their woticers' 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. .
ZContractors 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 subcontractors 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. C ' , -
Insurance Company Name: . \ � e c kk.�-'� . � ` 5-� „� —Z •
Policy # or Self-ins. Lic. #: \-...1c... I
((.'”: Expiration Date: _ Cp 1 A (
Iob Site Address: k r'^ & j S S C' /State/ 4 iv- - 1 el c=: 4.
ny z:ip:'I,�vi
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage. as requited under Sectiod 25A Of MGL c. 152 cat 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 f• .' : . ce cov ' e verification
I do hereby certify 11 g r I " , ii ,r 1 , 11r Ld penalties of; a:jury that the infortnation pro vuded.ab
. ove islrue_and_eorreej_. _ .. .
6. ` 1i � ate l� _
Phone ii: `•1 tS° - 7 MA! V`r - .
O use only. D6 not write lii this area, tb be co " 7eted b . ._+
Official y rnp y City or town official
City or Town.: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other t
Contact Person: Phone #:
•
S' 686098L - N716 :01 I22TL8S £tib d0 O21u08 NOldWdHidON :W0dJ 80 :0T OT02- 9I -nON
,.
.
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
9. Regl>atere'd Homo .Imprpvemant'COptraCtoll Not Applicable ❑
CompanvNemo Registration Number
(2' IO 1 3i /
Address Expiration Date
k
/ft Telephone L CC-Ca
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 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 ❑
11. -- Home Owner exemption;
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 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. Aperson who constructs more than one home in a two - vear 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(s)
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 Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
t d 686098LETt7T6:01 TZZTLBS £Sb JO Oeld08 NO1dWUH1i'iON :W0eIA 80 :0T OT02- 9T -rON
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House E] Addition [] Replacement Windows Alteration(s) El Roofing D
Or Doors ❑
Accessory Bldg. '1;`"' Demolition ❑ New Signs (Cl] Decks (0 Siding (O] Other [0]
Brief Description of P pose
Work: SI.i � l,w- � A.,
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached RoII - 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
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, f411 . A !',, , ,t IA O 4 E K (' 0 ' 6f . ]'Q , k? , as Owner of the subject
prop - y ct
- 1
hereby authorize `' � ' S ) ��
to act my behalf, t all mattxs relative to work authorize.. this building permit application.
Signature Date
1, � R ' s \ , as Owner /Authorized
Agent hereby declare that the scents and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains ,! • = a is of ry.
/N ( 4 - \ \ - .i
Print Name ff�jN�
Signature of Owner /Agee" Date
2'd 686098L2TVE6 :01 ti221L8S Lit' AO Gek108 NOldWdHINON:WOHA 80 :01 0Z02- 9Z -nON
.
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage i L .
Setbacks Front
Side L. R L:' _.._.. R
Rear i_.........
Building Height
Bldg. Square Footage t ...._._ i % r
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces `.:,...-
Fill:
5 y
(volwne & Location) ° ...... ....- ........_ _
A. Has a Special Permit /Variance /Finding r been issued for /on the site?
NO 0 DONT KNOW YES Q
IF YES, date issued:?
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book l Page . and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO IGK DON'T KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained O , Date Issued:
C. Do any signs exist on the property? YES AT. NO Q
•
, type and location: r�
IF YES, describe size, S�J F� 51 ,�Y� CJ fin� � � � �`".9
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 125
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exc lion, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
2 'd 686098L2TtT6 :01 T2ETL8S £Zb JO Ozlid08 NOldNUHlhhON :NOeIJ BO :13T OTO2- 9I -(lON
pe partrnettt use: only
City of Northampton Status- of 'Permit
Building Department Curb,Cut/Driveway Permit
2010 212 Main Street Sewer /Septic Availability
Room 100 Water/ ellAvailab I,Iy
Northampton, MA 01060 Two Sets; of Strdctufaf Plans
phone 413 -587 -1240 Fax 413 -587 -1272 piof/Sit F •
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot Unit
Zone Overlay District
Cr la
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
' A+2A \ c s 0'C C1r1 7 r``'.,L S N .�� f ,�( �. �h cwt..
Na '? 3 v _ Current Mailing Address:
-\k3., S(
✓ ✓ / L " / ) u _ /� Telephone
Sign tune /.:
2.2 Authorized Agent:
• A- A,
Name (P Current Mailing Address:
dAL/113
Signature N 1 Telephone
SECTION 3 - ESTIMATED. CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building \ 5 - 3 (3 (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 J Check Number
This Section For Official Use Only
Building Permit Number Issu
ed:
Signature:
Building Commissioner /Inspector of Buildings Date
T • d 686098LSTt'i6 :01 T22TL8S £titt. JO Od1:108 NOldI4 HThON7NOZId LO :0T 0202- 9T -(ON
. .
File # BP- 2011 -0519 (P
APPLICANT /CONTACT PERSON SKIP'S OUTDOOR ACCENTS INC / L O N
ADDRESS/PHONE 1265 SUFFIELD ST AGAWAM (413) 786 -0990
PROPERTY LOCATION 7 FRANCIS ST LO
MAP 18C PARCEL 071 001 ZONE URB(100)/
Al CAt
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED
ZONING FORM FILLED OUT ati& S t 86 ( . f -
Fee Paid
Building Permit Filled out �� .� `
Fee Paid d %Z c#5//
Tvpeof Construction: ERECT 12 X 24 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 131955
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRIVIATION 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 Storm Water Management
Demolition Delay
/2/40
Signa e 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.
•
BP- 2011 -0519
GIS #: COMMONWEALTH OF MASSACHUSETTS
tt }�1 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 -0519
Project # JS- 2011- 000849
Est. Cost: $7150.00
Fee: $57.60 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SKIP'S OUTDOOR ACCENTS INC 131955
Lot Size(sq. ft.): 16988.40 Owner: O'BRIEN ROSE & ALICE
Zoning: URB(100)/ Applicant: SKIP'S OUTDOOR ACCENTS INC
AT: 7 FRANCIS ST
Applicant Address: Phone: Insurance:
1265 SUFFIELD ST (413) 786 -0990 WC
AGAWAMMA01001 ISSUED ON:12/13/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: ERECT 12 X 24 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 12/13/2010 0:00:00 $57.60
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner