24C-113 (5) •
U.S. Postal ServiceTM
QERTTIFIED MAILTM RECEIPT
• {Domestic Mail duly; No Insurance Coverage Provided)
ul For delivery information visit our website at www.usps.com®
ru SA,(P ,
ru
Postage $ M A
Certified Fee v, Q
trl
Posts, \
Return Receipt Fee
C (Endorsement Required) ' i<
2�
O Restricted Delivery Fee [
p (Endorsement Required) �■ /
r
rr" ▪ Total Postage & Fees $ L y '
- S t. Ag fig)) te) � '/ wh Jew
O Street, { A / pi. No.; a �
P- St PO Box No. �
i f -/
City, srare38,Zi /+,q 1 , 01 a 6' C
der
PS Form 38000. August 2006 See Reverse tor. Instructions
SEN : COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1, 2, and 3. Also complete A. Signature -
item 4 if Restricted Delivery is desired. ❑ Agent
• Print your name and address on the reverse X � �� retsee
so that we can return the card to you. B. Rec ved by Printed Name) , C. D to o Delivery •
• Attach this card to the back of tgi iecy
or on the front if space permits
D. Is delivery address different from item 1? Y s
1. Article Addressed to
Np� EN � 1 5e +' If YES, enter delivery address below: No
).4.-fh lee v - Fe.e4 ✓�
4Ve
y� a / / 3. Service Type
1 Ore-th �mplOA) / r ' �/ D/ 4C _ - Certified Mail 0
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(transfer from se 7006 2760 2205 2242 5680
PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540
NOTE -
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SUR \!EY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
,�
I 1
* \c ;: '.--c�� C
f o,
z �, 1
, --
I
i
i
( 1 - (j . -'
2
56 u r, `
, \ , 0 i L k _ ,?‘...
/
2 0 , l I i.
1
\ -
,, ----:-----,-- -- K. . \- 2/-- �`�„ tom_ - - '---`
TO: FLORENCE SAVINGS 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. 1 FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #
250167
—NOTE —
SURVEYOR : 1 \ • --1- -, THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
eee .
�,� of ;q -�. — MORTGAGE LOAN INSPECTION PLAT—
4,- S
NORTHAMPTON, MASSACHUSETTS
RQ�'OALL 1 PREPARED FOR
% I ,� ,
, '„ I N LINDA ENGHAGEN & KATHLEEN BECKER
135032 ! SCALE: 1"=20' JUNE 13, 2005
\ � °- •. HAROLD L. EATON AND ASSOCIATES, INC.
� , REGISTERED PROFESSIONAL LAD SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSEI1
,. n , . •
•
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 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 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 Sta of Massachusetts General Laws Annotated.
Homeowner Signature ., =r—
•
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors I]
Accessory Bldg. 0 Demolition ❑ New Signs [0] Decks [Q Siding [D] Other [0]
�
Brief Description of Proposed � r r 1,5 --
�
Work: shed on west side of lot
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
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
, 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.
•,` ■N. 4A i r
Print me
Signature of Owner /Agent .,; Date
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 5765 5765
Frontage
58'3" 58'3"
Setbacks Front 42'
Side L: R: L: R:
Rear 51'
Building Height 9'6"
Bldg. Square Footage % 33
Open Space Footage
(Lot area minus bldg & paved 3148 55 3115 54
parking)
# of Parking Spaces 4 4
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES Q
IF YES, date issued: 08/13/2010
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book 10295 Page 14 and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO O
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 Q NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Budding Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
Boom 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
5`- phone 413 - 58 - 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
■Tt-- Map Lot Unit
v..,���o u` Ns-- 1 ?v. Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Linda Enghagen and Kathleen Becker 5 -7 Fifth Ave Northampton, MA 01060
Name (Print) Current Mailing Address:
413
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 2,585 (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) 2,585 Check Number 7/�v
This Section For Official Use Only
Permit Number: Date
Building Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 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
ermits 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
\r, LA, ( � 42.. ^ understand the above.
(Home owner /resident's signat reque *ing exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to
Date — `fit — r
Address of work
location,
..
The Commonwealth opfassachusetts
Department of Indus Accidents .
Office of Investigations .
600 Washington Street
Boston, MA 02111
www.mass.gov/dia .
:...,
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly --
Name pusineseorganizationandividnaD .
: \—... , -_..:-_.. - a uN,
4 e '.. kr■ I .),. (_...
Add ress: `; — ----\ ---"'" ----,. - 3 - ,4,.._,-- N. :,--(..._.. ,. •
City/State/Zip: \, '`\,,,,,,-, .. Nt\-c\. Phone.#: '-> `--,_._,, C ?S - 1 4 - -- t (
Are you an employer? Cheek the appropriate box: • •Type Of project (required): /
• 1. 0 I am a employer with 4. 0 I am a general contractor and I
6. 0 New construction
hired the sub-contractors
employees (full and/or part-time).*
listed on the attached sheet 7. 0 Remodeling
2. 0 I ani a sole proprietor or partner-
• ship aaxl have no -.)loyees These S1-contractors have . 8. J Demolition
working for me m any capacity euvloyer,s- and have workers 9 -EjThilldiiii addition
# '
[No workers' comp. *Irian=
Ik requirecL] . . 5. 0 We are a corporation and 10.0 Electrical repairs or adations
its
3 I am a homeowner doing ill work officers haVet xerci..serl their . 11.0 Phinbing repairs or additions
.
1 .
myself [No woriers' comp. right of exemption per MGL
. 12.0 Roof repairs . •
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
•
con3P. =mance reqUired.j. -
*Any applicant-that checks box #.1- must also fill out the section below showing their worimrs' compensation policy information. 'I" •
t Homeownera who submit this affidivit imhcathig they are doing all work and then hire outside contraitors must submit anew affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether-or notMose ex Aides have
employees. If the sub-ccauractorsbaVe employee:a, they mustprovide their workers' comp policy number.
I am an employer that is providing workers' compensation insurance for my einplOyees. Below is the policy and:rob
information. •
Insurance Company Name:
Policy # 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 reqUited S e di 611 ' 2 5 A - 6 f NI GL ' d . 152 can lead to the iMPOSitiOn cifaiinoinil Penalties of a
fore up to 51,500.00 and/or one-year iraprisonme4 as well as civil penalties in the form of a STOP WOPX-ORDER.ancla fine
of up to S250.00 a day against the yiolator. Be advised:that a copy of this statement maybe forwarded to the Office of ,,..._
-: . --_ - J, 1:_ .:,,,.::
. _ IWO heraby ihe p auls an d 'en altiai oh; erjurithat the in:farMatiOnpro vitlid.aba;:iiiO4;;_and_Coprct _
,-- • ,,
si gnatm : e: )..._,,, ._ '.. : ..:_, . . Da: 0 _ ■.__ _ \, . ,
• .. ,
Phone #: 'g,.. ' - •`"7‹..-t , • - .• \ . ,,,.
- •
. - Official use only. Do not write in this are to be completed by chy Or townofficiaL
. • .
• .
City or Town: ' • Permit/License # •
•
Issuing Authority (circle one):
. 1. Board of Health 2. Building Department 3. City/Town Clerk . 4. Electrical, .1.npector 5. Plumbing Inspector
6. Other , g. •
Contact Person: Phone #:
September 14, 2010
5 -7 Fifth Ave.
Northampton, MA 01060
Building Inspector
City of Northampton
212 Main St., Room 100
Northampton, MA 01060
RE: Permit Application
Dear Building Inspector:
Enclosed is our building permit application and application fee. We are
submitting this to correct the problem with the shed we built.
Hopefully, we get it right this time. As soon as we get the permit, we will get it
the problem corrected and notify your office.
Thank you for your help in resolving this.
Sincerely,
Linda Enghagen
File # BP- 2011 -0226
APPLICANT /CONTACT PERSON ENGHAGEN LINDA K & KATHLEEN M BECKER
ADDRESS/PHONE 5 - 7 FIFTH AVE NORTHAMPTON (413) 586 -8746 Q
PROPERTY LOCATION 7 FIFTH AVE
MAP 24C PARCEL 113 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ye y
Fee Paid i
Typeof Construction: ERECT 7 X 5 SHED
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
INFOyRMATION 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
Signature of Building ficial Date 2/6 i(a
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.
n
7 FIF 1'H AVE BP- 2011 -0226
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C -113 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 -0226
Project # JS- 2011- 000388
Est. Cost: $2585.00
Fee: $285.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 5749.92 Owner: ENGHAGEN LINDA K & KATHLEEN M BECKER
Zoning: URB(100)/ Applicant: ENGHAGEN LINDA K & KATHLEEN M BECKER
AT: 7 FIFTH AVE
Applicant Address: Phone: Insurance:
5 - 7 FIFTH AVE (413) 586 - 8746 ()
N O RTHAM PTON MA01060 ISSUED ON :9/17/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: ERECT 7 X 5 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 9/17/2010 0:00:00 $285.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner