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46-049 Lt . I \ I 00/0 94 V° 1-4 a rt/ )9y r4' LOI I rorxf. /,:sr )( k . • _ 800Z - OflV • 3-LS lh QA(yo mogo 171 if4i12\s1 -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 NOTE: THE PREMISES TO INCLUDE THE STRUCTURE IS LOCATED WITHIN A 100 YEAR FLOOD ZONE (ZONE A). 89.50' gar. BOOK 1455, PAGE 36 n o � o #109 #107 J87.00' 3 O ISLAND ROAD TO: NORTHAMPTON COOPERATIVE BANK & FIRST AMERICAN TITLE INSURANCE COMPANY TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF I 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 - SURVEYOR:CUmA,-4„,QQ z i THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY - MORTGAGE LOAN INSPECTION PLAT - :c; OF SS ti NORTHAMPTON, MASSACHUSETTS RANDALL � PREPARED FOR IZER y STELLA M. ROGALESKI & CYNTHIA FURTEK #35032 SCALE: 1"=30' MAY 29, 2008 <': svo� SURVE HAROLD L. EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET - HADLEY - MASSACHUSETTS - T HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 7800 108.3.4 to act as his/her construction supervisor. 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 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 o er /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 1IS1 Address of work t_ Q location (O - (SItt& 5 NI 44 4tctoit Mt at040 The Commonwealth of Massachusetts =. 7 -_- Department of Industrial _A ccidenrs O of Investigations _ 600 Washington Street Boston, MA 02111 www.mass.gor/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /EIectricians /Plumbers Applicant Information Please Print Leo Warne (Business /Organ: zanonIndividual): _ Address: City /State /Zip: Phone r'�=: Are you an employer? Check the appropriate box: Type of project (required): I 6 ❑ New constiction 1. ❑ I am a employer with ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or pa per 4. listed on the attached sheet. 7. � ► J Remodelin_ These sub - contractors have g_ ❑ Demolition ship and have no employees working for me in any capacity. e employees and have workers' a 9. ❑ BuilriinQ addition [No workers' comp. insurance comp. insurance.$ ` d 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions ,� �r quire ] 3. ✓� I am a homeowner doing all work officers have exercised their 11.7 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 1 ❑Roof repairs insurance required.] c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other i comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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 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: _ Policy 1 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 criminal penalties of a fine up to S1,500.00 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 DLz for insurance coverage verification. I do hereby certify tender ze pains and penalties of perjury that the information provided above is true, and correct. Signature: Date: Phone. • Official use only. Do not write in this area, to be completed by city or town official • ' City or Town: Permit /License r . I ssu i ng Authority (circle one): i 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other I Contact Person: Phone ,, 1 a a SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: I Not Applicable ❑ Name of License Holder : ". ' License Number acress - Expiration Date signature Telephone I. R'edistered"Home lrr<nrovernent'Contiactor Not Applicable ❑ :omoanv Name Registration Number .ddress Expiration Date Telephone ECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G L. c. 152„.§-,25C(6)) I 'orkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result the denial of the issuance of the building permit. • gned Affidavit Attached Yes ❑ No ❑ . <. 6•".O i. r.E 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. CiVIR 780. Sixth Edition Section 1083.5.1. 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 OEcial, 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) y u hire to perform work for you under this permit e under signed "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of 'orthampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 4. .• SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) i _ New House ❑ Addition r f Replacement endows / Alteration(s) g i Roofing I Or Doors Accessory Bldg. ❑ Demolition ❑ I New Signs [D1 Decks [)J Siding rpi Other [g Brief Description of Proposed � � r7 Work: �e�rn r Fil n1 t Sim Pa.'zik �fii 1osJ l4 -.,-. ade( IA/ , Sf'h cc.. i \ 40 �A ce-- t'bcr, 5 J Alteration of existing bedroom Yes No Adding new bedroom Yes X No Attached Narrative ( Renovating unfinished basement Yes y No Plans Attached Roll - Sheet 6a. If Never Rous and o r a d d iti O n=to e xi s ting housin Com i t he f 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. cf wetlands? Yes No. Is construction within 100 yr. floodpiain 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 • SE COMPLETED WHEN "" OWNERS- AGENt OR C ONTRACTOR 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 I 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 periury. '/i of Name V S of Owner/Anent :ate 1 i I Section 4. ZONING I 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 ...____..... _ ;.__ w_. F __ _., I , __ .. _ _____ Setbacks Front Sr 5 - i, Side L: _�_ ._: R: _ L t ��7 © R _7� Rear �. C1�W Building Height I t % _..� ,z + .. 1 _ Bldg. Square Footage � ,. I _ . Open Space Footage ... • , , , ., s. - % __ -- (Lot area minus bldg & paved nar s r idne) # of Parkine Spaces - Fill: 0 (volume & Location) - -- — - -- - — A. Has a Special Permit /Variance /Findi g ever 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 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 CD Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO p 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 j } IF YES, describe size, type and location: E. Will the construction activity disturb (cleating, grading, excavation, or filling) over 1 acre or is it part of a con 1 nwnl plan that will disturb over 1 acre? YES (9 NO IF YES, then a Northampton Storm Water Manageme fPetrnif from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street SeweriSepticAvaiiability Room 100 tlilaterANeil.Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413- 587 -1240 Fax 413 -537 -1272 PloVSite Mans QttletpEiGify APPLICATION TO CONSTRUCT, ALTER, REPAIR, R OR A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 3 1 2008 1.1 Property Address: This 4ectiorl to be completed by office i I /01 tS 6.# 4)t, & Map Lot Unit r9 tilt 4, 4- 4& Ot c - Zone Overlay District IV Elm St District C8 District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT I 2.1 Owner of Record: • ; � , . d; \ - S k " Name (Print) �� _ . - -•— Current Mailing Address: ' g q i c Telephone l Sin ure 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS 1 Item I Estimated Cost (Dollars) to be Official Use Only completed by permit aoolicant 1. Building �,. , ��v (a) Building 'Permit Fee • 2. Electrical / ©p(� (b) Estimated Total Cost of '( Construction from (6) 3. Plumbing j2 Building Permit Fee • j 4. Mechanical (HVAC) A Ce0 5. Fire Protection /} I f 6. Total = (1 + 2 + 3 + 4 + 5) (/( 000 Check Number pi 0 7CO ( This Section For Official Use Only Date Building Permit Number Issued: Signature: Budding, Commissioner /Inspector oibuddrngs Date File # BP -2009 -0112 ��/ j4 77 S — ) `-•— ! 3z APPLICANT /CONTACT PERSON ELIA TALA ADDRESS /PHONE 20 FRUIT ST NORTHAMPTON (413) 575 -8415 () PROPERTY LOCATION 107 ISLAND RD MAP 46 PARCEL 049 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ��/ �Q Fee Paid d Typeof Construction: REPAIR FRONT /SIDE PORCH,ADD INSULATION,ATTIC LIVING SPACE,REPLACE ROOF & SIDING 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION PRESENTED: 1 /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 Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolition Delay C: fir/ 4(/4� Signature of Building Official Date 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. 4 _'A BP- 2009 -0112 GIS #: COMMONWEALTH OF MASSACHUSETTS 3 14401iitk: ' 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- 2009 -0112 Project # JS- 2009 - 000147 Est. Cost: $46000.00 Fee: $276.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 6621.12 Owner: ELIA TALA Zoning: SC(100)/ Applicant: ELIA TALA AT: 107 ISLAND RD Applicant Address: Phone: Insurance: 20 FRUIT ST (413) 575 -8415 () NORTHAMPTONMA01060 ISSUED ON:1/6/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: REPAIR FRONT /SIDE PORCH,ADD INSULATION,ATTIC LIVING SPACE,REPLACE ROOF & SIDING 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 1/6/2009 0:00:00 $276.00921 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo