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DPPF �T2.fc "iVT OF BUILD INSPECTIONS � =_
INSPECTC�
212 Main Street a Municipal Euildin� c
"
Northampton, MA 01060 - c�
1
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3 -4 to
act as his/her construction sup -.: is or. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or tsvo 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 ihe 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 backiill).
so- notube holes (before pour). a rough building inspection (before work is
concealed). insulation inspection (if rea.uired) and final bu 1dina.insnecti.on. 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..
Lithe 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, �� lc,/ Lc- Li - ./ 6 ,_ 4 understand •
the above
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building - ections necessary for the building. permit
issued to me- y
Date 7 / --------
Address of wor / ��
location V G le. th,
1 eeek A (r) /6 r ?
,.-...z.2.,\ The Commonwealth oPlassachuserrts
Department of Industrial Accidents
c i Office of Investigations
`.i-� # 600 Washin Street
�� Boston, .ALA 02111
www.mass gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Aoolicant Information f Please Print Lesibly
•
Name (Bu sines /Organization/IndividnnI): r ' e /-7, G
Address: y‘ c f f.? ��
City /State /Zip: L---� /4 0/0:7Phone.# : ...5 - j - f •`-
Are you an employer? Check the appropriate box: Type of project (required)
1 _ El I am a employer with El I am a general contractor and I
employees (foil and/or part-time).* have hired the sub-contractors
, e attached sheet 6•lvew construction
listed on *hed sh r. ❑ Remodelu:g
I i 2. ❑ � am a sole proprietor or partner- !
ship pneI have no e. loyees
These sub - contractors have 8. ❑ Demolition
working for mein any capacity. employees and have workers' I _
Y9. El Building addition
[No workers' Co :..�SI.a comp. insurance.: l ^ We EleCtr. cal r. airs or additions I
re q uired_J 5. LJ vve are a corporation and its I ( 1 V_ LJ I-1
fiii am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
m, elf o workers comp. ri-it of exemption per MGL
�' ' 12.0 Roof repairs
ins„ once re e31 t c. 152, §I (4), and we have no
• employees. [No workers' 13.0 Other
comp. insurance required.]
-- -- -- =Xty applicant niat caecl6 Pox rI must a:so MI out me secaon oetaw showing their workers' compensation policy information.
I 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 mustarr led an additional sheet showias the name ache sub - contractors and s'ate wheel= or not those entities have
emnployees. If the sub - contractors have ernpIoyee , they must provide their workers' corm. 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 n or Self -ins. Lic. #: Expiration Date:
Job Site Address: City; State /Zip: •
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 crimmai pera Ities of a
fine up to 315 00.00 and/or one -year imprisonment, as well as civil pens ?Ties in the fora of a STOP WORK ORDER and a one
of up to 3250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DLA for insurance coverage verification.
p do hereby cerd der the pains and penalties of perjury that the information provided ove is true and correct
-- — -- -- - - -- - --- - 11 d' >
�gIIafnre: _ Date: _
Phone T- Sir --- );)-6) 4 7 ,t ✓
I r
fl
i Official' use only. Do not write in this area, to be camvlered by city or towns official
City, or Town:
Issuing Authority (circle one):
1. Board of Health Z. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact P er son: Phone ,-:
ti
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor " Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
i —
SECTION 10- 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 ❑ 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. A person 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 an Deal Z ning Laws and State of Massachusetts General Laws Annotated.
Homeowner Si g nature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House fl Addition 0 Replacement Windows Alteration(s) 0 Roofing I I
Or Doors 0
Accessory Bldg. 21 Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0]
Brief Description of Pro sed (, �,( ) /
Work: ,f' Y I, f 17J �'�?� 7. Gi� C.
Alteration of existing bedroom Yes ,A—No Adding new bedroom bedroom Yes o
Attached Narrative Renovating unfinished basement Yes' No
Plans Attached Roll - Sheet
6a. If= -New house and-or-addition to-existing housing,- complete the fallowing:
. 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, • / ' r r , 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
pi-i-- /� e /.--), /"� 4- J , as Owner /Authorized
Agent herelare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under he pains and pe aities of perjury.
1 ---Z /, /'
Print Name
/ ' b?
Signature '6 er /A.- •:te
• w
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 , 3y
Frontage
Setbacks Front
Side L: R: L: R:.
Rear
Duilding IIcight
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
narking)
# of Parking Spaces
Fill:
(volume & Location) . , ......._. .,_..
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 'Tel DONT KNOW 0 YES 0
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 Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO , DONT KNOW 0 YES 0
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
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO ,
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from theDPW is required.
w
Department use only ,
p o f Northampton st of P ermit
o
�-� ;
\', � ' B , Department Curb CutlD u Permit
;, � AI
,:.,3 ' S treet Seraer/Se c aE ility
Room 1 00 Water i c e pt tAvailability lab
, ,10, Li ton, p MA 01060 Two Sets o f Stru Plans "
t-'-' �� p 4 1 -587- 240 Fax 413 -5$7 -12 72 Plot/S iSpecify tePlans
y , Other
AP}k ATION TO•CON3 RClET,�TER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TW FA MILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address: r' -
I�: / / � Map Lot Unit
Zone Overlay District
Lee d •� c :sHipiAuTtioRIZED /t? j Elm St District CB Distri
SECTION 2 - PROPERTY OW NE AGENT
2 .1 Owner of Rec ord:
Na me (Print) Curr nt Mailing A d dr ess:
Telephone
Sig - -
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - E CONSTRUCTION COSTS
•
Item Estimate Cost (Dollars) to be O fficial
_Use Only
co mpleted by permit applicant
1. Building (a)''Building Permit Fee
(J r]
2. Electrical / (b) Estimated
Constructio T otal r Cos o
l / , 0 /..) n fro (6)
3. Plumbing _ Building Perm Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number ��9 �j c
This Section Fo Official Use Only
Date
Building Permit Number: Issued:
Sig nature:
Build /lns dfButldm Date
File # BP- 2008 -0486
APPLICANT /CONTACT PERSON MELNIK PATRICK J
ADDRESS/PHONE 110 KING ST NORTHAMPTON (413) 584 -6750 0
PROPERTY LOCATION 46 CHESTNUT AVE
MAP 11A PARCEL 005 001 ZONE URA
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: CONSTRUCT 24 X 24 DET GARAGE
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 F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ATION 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 •ssion Permit DPW Storm Water anagement
/ 2 O
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.
^ fi BP- 2008 -0486
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: GARAGE BUILDING PERMIT
Permit # BP- 2008 -0486
Proiect # JS- 2008 - 000163
Est. Cost: $10000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 22041 .36 Owner: MELNIK PATRICK J
Zoning: URA Applicant: MELNIK PATRICK J
AT: 46 CHESTNUT AVE
Applicant Address: Phone: Insurance:
110 KING ST (413) 584 -6750 ()
NORTHAMPTONMA01060 ISSUED ON:11/13/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 24 X 24 DET GARAGE
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 11/13/2007 0:00:00 $50.00399
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
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MELNIK LAW OFFICES I '07
Attorneys At Law
110 King Street — �
Northampton, Ma. 01060 , -
Telephone (413) 584 -6750 5
Fax(413)584 -6789
Patrick J. Melnik, Esq. email: pmelnik @verizon.net
Patrick J. Melnik Jr., Esq. patmelnikjr @verizon.net
August 7, 2007
Building Department of the
City of Northampton
210 Main Street
Northampton, Ma 01060
Dear Mr. Patillo:
Enclosed please find Revised Site Plan and Plan for 46 Chestnut Avenue,
Leeds permit to construct a Detached Garage (foundation only). As you can see,
the new plans show the foundation is going to be 23 feet x 25 feet and is going to
be 15 feet off the property line. I believe that these changes still conform with all
zoning requirements.
If you have any questions please feel free to call.
Sincerely,
j .trick J. Melnik, Jr.
PJM/j 1p
08071et(22)
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DEPARTMENT OF BUILDING INSPECTIONS Ka' .__ _ • !l
INSPECTOR 212 Main Street • Municipal Building
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 sup: . 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_ inalbuilding 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
O MpT
ti
�� *?,, : � (City of Nortirampten - --- = -- - 41— = -.1 - 4----- - - = – _-= ,/.
� -__ .
`�"` DEPARTMENT OF BUILDING INSPECTIONS /%
INSPECTOR 212 Main Street • Municipal Building ' o
Northampton, MA 01060 ,~ 5 �`
1'
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his /her construction sup ::Hsor. 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.buildinz 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, Pte : G� 7- e /,:, 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. /
i
Date /02 i
O
Address of work
location q' C 4 /7.- ±-- 70-e_
i- 1 7z it
SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10- 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 ❑ 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. 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
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 a • oc. Zoning Laws and State of Massachusetts General Laws Annotated.
o r Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. NI Demolition ❑ New Signs [D] Decks [p Siding [D] Other [D]
Brief Description of Proposed
,i„`�`,.r /,�G
Work: single story freestanding garage � tl✓�'L y� !� FF �
�! l
Alteration of existing bedroom Yes °O No Adding new bedroom Yes °O No
Attached Narrative Renovating unfinished basement Yes n° 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
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
, 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
1, , L■ /9e4 - Z , 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. Tn
iAD `L 4 - ✓ ' `
Print Name
• owner /All/ Date
/ 01.1
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 22532.5 sq. ft same
Frontage 165 same
Setbacks Front 80
Side L: R: L: R: 80 ... / $
Rear 10 2�0
Building Height 20
Bldg. Square Footage % 576
Open Space Footage
(Lot area minus bldg & paved 210a
parking)
# of Parking Spaces 2 2
Fill: _. .... _.
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained t Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
T om _ a ( Department use only
w.- City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit,
212 Main Street Sewer /Septic Availability
/ ! — 1 2C07 Room 100 Water/Weir Availability
Northampton, MA 01060 Two Sets of Structural Plans
G-
photl 4131587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
;, `, 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
q / �e ��� �J�L �_ Map Lot Unit
e-eFff /114( j� Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Patrick J. Melnik Jr 46 Chestnut Ave., Leeds Ma 01060
Name (P Current Mailing Address:
(413)584-6750
Telephone
Sife
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 12,000 (a) Building Permit Fee
2. Electrical 1,500 (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) 13,500 Check Number ! % 0t
This Section For Official Use Only ///
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2008 -0101
APPLICANT /CONTACT PERSON MELNIK PATRICK J JR
ADDRESS /PHONE 46 CHESTNUT AVE LEEDS (413) 584 -6750 0
PROPERTY LOCATION 46 CHESTNUT AVE
MAP 11A PARCEL 005 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ,,,��
Fee Paid g�' .0
Typeof Construction: CONSTRUCT 24 X 24 DET GARAGE (FOUNDATION ONLY)
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 F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ATION PRESENTED:
A pproved 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
Pe 't from El /trreet Commission
I V ;:
Signature of Building • fficial 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.
46 CHESTNUT AVE BP- 2008 -0101
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 1 IA - 005 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- 2008 -0101
Project # JS- 2008 - 000163
Est. Cost: $13500.00
Fee: $86.40 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 22041.36 Owner: MELNIK PATRICK J
Zoning: URA ! Applicant: MELNIK PATRICK J JR
AT: 46 r!-- !EST\n IT ,4VE
Applicant Address: Phone: Insurance:
46 CHESTNUT AVE (413) 584 -6750 0
LEEDSMA01053 ISSUED ON :8/3/2007 0 :00 :00
TO PERFORM THE FOLLOWING WORK CONSTRUCT 24 X 24 DET GARAGE
(FOUNDATION ONLY)
POST THIS CARD SO IT 1S 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 8/3/2007 0:00:00 $86.40381
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo