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46-058 (11) p ��+ . � . ' , ..( l'+.A1, NI . i 0 Page 1 of 1 Glazewski, Mary From: Bill Nadeau [bill @thebarnyardstore.com] Sent: Wednesday, June 20, 2012 11:59 AM To: Glazewski, Mary Subject: Anchor Kit Attachments: Anchors.jpg Mary I do not have specs on the anchor kit. I did attach a picture of the kit. It gets driven into the ground then anchored to all 4 corners. If they give you a problem with they they can call me direct. Bill Nadeau Sales Representative The Barn Yard and Great Country Garages Cell: 860 - 280 -5777 Work: 860 - 896 -0636 Fax: 860 - 896 -3381 bill @greatcountrygarages.com 6/20/2012 90 -YR TAMKO SABLE VENTS ARCHITECTURAL 0/450TH ENDS 1/2' PLYWOOD SHINGLES 7 111111 O.G. \ 90 -YR 7AMKO 16" 6U886T PLATE8, ARCHITECTURAL SHINGLES 2x4 RAFTERS • WOG. 10 [STANDARD FEATURES) ALUMINUM DRIP 1x4 TOP PLATE EDGE - a Eyam;, 4.4 PRESSURE- TREATED TIMBERS FACIA L FLOOR ,OIST: 284 PRESSURE - TREATED JOIST, 12" O.C. _ FIN18 O fl O0*1140 5J8° PRESSURE TREATED PLYWOOD, OVER//At4G EXTERIOR-GRADE M 14ED SOFFITS 12' OVERHANG b: FRANINf.; PREMIUM 2x4 LUMBER, 16" O.C. WO' DURA FOR YEATER 2x4 KILN 0 �yp1NG KRA - TEMP Ti -I I 71 -11 SIDING T IGMTNE98 FINISHED DRIED STUD L *0 00140 AR T AMKO ARCHI SHINDIES SOFFITS Y4A4 L6 1 6' OC. p D.D A-DUTY, REI NFORCED AND PAINTED - � :8553:198-1C08";°D TH 4 x5 NiND0W S TO CHOO SE FROM MIRATEG TRIM p ��c. TO 11'x48' 2 X 4 SIL IW C OLOR 5: ORS TO CHOOSE FROM JACKS 4 HEADERS IN ALL DOOR PLATE FRAMING TO H4ECT ALL STATE ANp POPUI AR UPGRADE LOCH. BUILDING CODER , , _- , ° ° - ; VIN YL 5101NG CIJPOIA WIDTH GRADE WEATHER VANE WINDOW SORES S/8' PRE851JRE TREATED NAMES/ WIDTH LARGER WINDOWS METAL ROOF PLYWOOD FLOOR SECURED PRE88URE TREATED NARIEB) DUTCH DOOR WORKBENCHES ri1TH RING SHANK NAILS 4x4 IGUNDATION WIDER DOORS OVERHEAD DOOR BEAMS PRESSURE TREATED 4x4 244 F*66JJRE TREATED ADDITIONAL DOORS INTERIOR PARTITIONS PCVNDATION BEAMS 12' O.G. FLOOR JOISTS LOFT ELECTRICAL PACKAGE REINFORCED AZ. DL6 DOORS PAINTED ON BOTH SIDES SIZE 4 STYLE VARIES FRONT ELEVATION 1 GROSS SECTION GODES 4 NOTES " u THIS BUILDING 15 OE9GNED TO BE PLACED UPON A 4"- 6" DEEP 3/4" CRUSHED STONE BASE WINCH IS APPROPRIATE FOR AN UNOCCUPIED UTILITY BUILDING 90 -YR TAMK'O 1/2" GDX PLYYI00D • 40 PSF SNOW LOAD (ROOF) ARCHITECTURAL ROOF SHEATHING SHINGLES L 3- SECOND GUST OF 110 MPH _ 23(4 RAFTERS p FLOOR WILL SUPPORT 100 PSF LIVE LOAD • 16° O. 2x4 FLOOR JOISTS • 12' O.G. 2x4 PT SILLS 6 '-.--1„ I 4x4 PT _ � - WIDE 94 -1/4' 34 -I/4' T I SHANG P ]x4 KILN DRIED 7T ` I I / STUD YUU"LS 16° O.G. 111 0' wtJE "am ammo / by 54 -1/4" / , 3 Y I SEALED Bp" •,,, " I / R7 -5/4 94 -1/4" f -42 -9/4H VS \j\Y y„r �y �/r Ill -1/7" / � . 7, �`E 2 . '. Vtf. SO '..• � r � , ''� L L 2J v ; k p. "�. . $ ggg .- +++ _ -*i 1 /y w;..• LENGTH L ' v L C4 "'1 -SV�t ( f ,�.., 4` Y.3 + WINDOW STYLE - - - 8 612ES (VARIES) NAREB) * : ""i I � z V/' A 198 -0" , '4 . '4, SIDE ELEVATION 4i L FOUNDATION BEAM CONSTRUCTION > "0 ' Z . ' NA w . THE BARN YARD TYPI SHED INFORMATION CT LICENSE # 558916 FABRICATED BY : At GREAT COUNTRY GARAGES MA LICENSE # 127550 RI LICENSE # 23105 IIEADOUARTERS RTE. /5 WINDSOR LOCKS. Cr NY LICENSE # IWC 13083 - RTE. 85 120 WEST 0040 860- 623 -4654 R.O. BOX 89 VICTORIAN COTTAGE EVERETT SKINNER IV, E �7 uwSTON, CT RTE / BROOKFIELD. CT /gyp / P.E. / RD. N i \RL� 860-8V6 3636 xls /L0 /433 STYLE STORAGE BU IL DING P.E. CIVIL ENGINEER t�R; 120 WEST RD. fT Great Country Garages WEBSITE: WWW. THEBARNYARDSTORE. COM ELLINGTON, CT 06029 . 114 U 2 7"."°"'M'M 340 365 585 • 46 -05 • c 65 A c) \ 34 0 \4 Mary Glazewski 503 Mt. Tom Road Northampton, MA 01060 A = House B = Existing 20 x 40 garage/sheds C = Proposed 12 x 16 shed 9. ALL INFORMATION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This column to be filled in by the Building Department. Existing Proposed Required by Zoning Lot Size Frontage N/A N/A N/A Front: 1 D C } Th Setbacks: J Side: L: R: 5 L: R :5(9 Rear: Height % Open Space: (Lot area minus bldg and Paved parking) 10. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: (� l ► U I \2 APPLICANT'S SIGNATURE Lam, ` 1V NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Conservation Commission, Department of Public Works and other applicable permit granting authorities. Y AMP + City of North ampton 1 �T W - -- TO I - «a. te ti s - 0 S/ a Massachusetts ."' r oc � � G 142012 N DEP T OF BUILDING INSPECTIONS y , ',"4.6r.'","5.'"-. �' o ?'EG" � 1 2 Mai Street • Municipal Building ,t; 4 O b OCRTHA BU , 2�"forthampton, MA 01060 - � D � r 5A010E9 INSPECTOR `° "`- "---"---- _ ACCESSORY STRUCTURE PERMIT APPLICATION (For freestanding structures Tess than 200 sq. ft., at (east 5 feet from any other structure) Permit Fee: $25.00 Check #1/9 PLEA E YPE OR PRINT ALL INFORMATION 1. Name of Applicant: i QQ IZy Y /9 ZQ W S - ) Address: 0 A 4, ) Dm &,/ b� Telephone: N A ) 3 c '1) b e t Al 14 2. Owner of Property: ( 1" Z 1■0. Y.� ) Address: 5 D 3 6 )" . ) D rh Telephone: -\ l 3 57 \t - N4 3. Status of Applicant: / Owner Contractor 4. Structure Location: 5 D .; (J ►' 14-. " 1) m d b 61/0 aln n 1 Parcel ID: Zoning Map # Parcel # District(s) LLL (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Use of Property: Single or Two Family: Y Multifamily: Commercial: 6. Description of Proposed Structure: One Story Shed under 200 sq. ft.: Freestanding Deck under 200 sq. ft., less than 30" above grade: Other (describe): /4 Y/&' 7. Attached Plans: Sketch Plan 9 Site Plan Plot Plan 8. Does the site contain a brook, body of water or wetlands? NO 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 I (;\ ) 2., CONTINUED ON NEXT PAGE File # MP-2013-0022 N il6 IN co O tJ ,DERc1 EX151' (N APPLICANT /CONTACT PERSON GLAZEWSKI HELEN S & MARY ADDRESS/PHONE 503 MOUNT TOM RD (413) 584 -4109 O PROPERTY LOCATION 503 MOUNT TOM RD MAP 46 PARCEL 058 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out /777 4 Fee Paid Typeof Construction: ZPA - 12 X 16 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 INFQRMATION PRESENTED: i 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 Peinnt 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 C2Z— /OH/ "Z., 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 the Office of Planning & Development for more information. 503 MOUNT TOM RD MP- 2013 -0022 COMMONWEALTH OF MASSACHUSETTS GIS #: 8607 / � oa � " "AM T ory CITY OF NORTHAMPTON Map: 46 Block: 058 ZONING PERMIT Lot: 001 Permit: ZONING PERMIT APPLI f R�EN7ENP�� APPT �I PERMIT shed CATION P .KNIT Permit # MP- 2013 -0022 PERMISSION IS HEREBY GRANTED TO: Project # JS- 2013- 000281 Est. Cost: Contractor: License: Expires: 1 Fee Charged: $25.00 Homeowner as Contractor Balance Due: $.00 Owner: GLAZEWSKI HELEN S & MARY # of Fixtures: Applicant: GLAZEWSKI HELEN S & MARY DigSafe # AT: 503 MOUNT TOM RD UseGroup ConstClass ISSUED ON: 09 -Oct -2012 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: ZPA - 12 X 16 SHED THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fixtures: Floor: Type: # of Fixtures Floor: Type: # of Fixtures Fee Type: Receipt No: Date Paid: Check No: Amount: shed REC 2013 000629 14 Aug - 12 1128 $25.00 212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :lhasbrouck @northamptonma.gov GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc. City of Northampton s;�� Massachusetts t 11 A , DEPARTMENT OF BUILDING INSPECTIONS y a ' P'+r` 212 Main Street • Municipal Building Northampton, MA 01060 In accordance with Chapter 40, Section 54, Towns are required to issue a building permit for the new construction, demolition, renovation, rehabilitation or other alteration of a building or structure. This is to assure that the debris resulting the above will be disposed of in a properly licensed solid waste facility, as defined by Section 150 (A) of Chapter 111. The debris from construction work being performed at: _ 503 Mt. Tom Road (Please print house number and street name) Is to be disposed of at: 1 211 : 5 ems,,,, 7/,- -/757f (Please print name and location of facility Or will be disposed of in a dumpster onsite rented or leased from: /�d►'M �/f /S� l /v� G n 1 8 XJ /t/ 17/24/.144 /Olob (Company Name and Address) Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. t r? ifs 194; � �' PLANNIN G AND DEVELOPMENT • CITY OF NORTHAMPTON J � 6 j ( y ` 1 ' planning • conservation • zoning • northampton GIS • historic • community preservation • central busing architecture fj � 1 �` ti 11 Sarah I . La Valley, Conservation, Preservation, dr Land Use Planner • slavalley@NorthamptonMA.gov • 413 - 587-1263 August 21, 2012 Mary Glazewski 503 Mount Tom Road Northampton MA, 01060 RE: Determination of Applicability, shed placement, parcel 46-58 Dear Ms. Glazewski: Enclosed please find the original signed version of the above - referenced document for your files. This determination is valid for three years. As we discussed, this determination is valid for placement of the shed. Removal of the garage, moving the driveway, and construction of the deck were all permitted as described in the Order under Order of Conditions 246 -619, on August 11, 2008. While this Order was valid for only three years, recent state legislation has extended the life of most permits, including this one. The original Order permitting the additional work is now valid until August 11, 2015. Please feel free to contact me with any questions or concerns. Thank you, iii (1 Sarah LaValley Cc via email: MassDEP WERO City Hall • 210 Main Street, Room 11 • Northampton, MA 01060 • www.NorthamptonMa.gov • Fax 4133 -587 -1264 original printed on recycled paper 10/1/2012 10:31 AM FROM: Aquadro Insurance AQUADRO INSURANCE TO: 584 -4301 PAGE: 001 OF 002 AQUADRO INSURANCE FOR YOUR INFORMATION • To: <584-4301> Fax number: 584 -4301 From: Christina Barrett Fax number: 413 -584 -0859 Home phone: Business phone: 413 -586 -7373 Date & Time: 10/1/2012 10:31:00 AM Pages sent: 2 Re: INSURANCE Hello Eric, Please see certificate to follow. Thanks have a good day. Christina Barrett 355 BRIDGE STREET NORTHAMPTON, Ma 01060 10/1/2012 10:31 AM FROM: Aquadro Insurance AQUADRO INSURANCE TO: 584 -4301 PAGE: 002 OF 002 AC ° RO ® CERTIFICATE OF LIABILITY INSURANCE 10���2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. 11 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Christin Sullivan Aquadro & Associates r N,E F , (413) 586 -7373 fax . No1: (413)4e4 -0e50 (/UC 355 Bridge St., P. 0. Box 357 EAESS: INSURERS) AFFORDING COVERAGE NAIC s Northampton MA 01061 rams A :Travelers Casu & Sur of Illino 19046 INSURED INSURER B : ERIC MOOS DBA ERIC MOOS EXCAVATING INSURER C: 16 MARSHALL STREET INSURER D: INSURER E : NORTHAMPTON MA 01060 INSURER F: _ COVERAGES CERTIFICATE NUMBER:CL1 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. U LT SK R TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS Nmt Wyp POLICY NUMBER (MM/DD/YYYY1 NANDOM(YYI GENERAL LIABILITY EACH OCCURRENCE 3 500,000 X COMMERCIAL GENERAL uABLm PREMISES (E; orcurrencel s 300,000 A I CLAIMS-MADE a OCCUR I6804715N188ACJ12 4/20/2012 4/20/2013 M DEXP(Aryonep• ) 3 5,000 PERSONAL RADVINJURY S 500,000 GENERAL AGGREGATE 3 1,000,000 � GENL AGGREGATE UNIT APPLIES PER- PRODUCTS - COMP/OP AGG 5 1,000,000 x l POUCY n P 0 n LOC 3 AUTOMOBILE LIABILITY COMBINED SINGLE UFO' (Ea accident) ANY AUTO BODILY INJURY (Par parson) $ ALL OWNED SCHEDULED BODILY INJURY (Par incident) S AUTOS H R DSAUTOS SWNED ' ( P err a DAMAGE S S UMBRELLA MB — OCCUR EACH OCCURRENCE S EXCESSLUta CLAIAS -MADE AGGREGATE DED 1 1 RETENTIONS ( i S WORKERS COMPENSATION , I?DRYi - 1 1 P AND EMPLOYERS'UABIUTY Y/X ANY PROPRIETOR/PARTNER/EXECUTIVE (� N/A EL EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? I J (Mandatory (n NH) E.L DISEASE - EA EMPLOYEE 3 0 yea, ,, N O ttler DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIAIT i DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks SehsduN, Pinola space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN MARY GLAZEWSRZ ACCORDANCE WITH THE POLICY PROVISIONS. 503 MOUNT TOM RD NORTHAMPTON, MA 01060 T REPRESENTATIVE � � ( L 4 - v ACORD 25 (2010105) © 1988.2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD r The Commonwealth of Massachusetts — rra , Department of Industrial Accidents =.40.=----e' , Office of Investigations G Vigil _ i 600 Washington Street ' ='�= si Boston, MA 02111 N '" =fi www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information ,�/J Please Print Legibly Name ( Business /Organization/Individual): Y/ �G / / dO5 • ddress: /( waif I l� Sf ity /State /Zip: Aid /rI? p7"0/1 O /(O() Phone #: `7/3) 7 9 r 1el - 7 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction „ , . - - , . , , • . _ ' * have hired the sub - contractors 2.02 am a sole proprietor or partner- listed on the attached sheet. $ 7 ❑ Remodeling ship and have no employees These sub - contractors have 8. (`] Demolition working for me in any capacity. workers' comp. insurance. 9. ['Building addition y [No workers' comp. insurance lb • ❑ We are a corporation and its 10.0 Electrical repairs or additions re uir d. officers have exercised their 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §I (4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' 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. Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and their workers' comp. policy information. 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 # or Self -ins. Lic. #: Expiration Date: Job Site Address: ✓ O3 /"1 i ' Ro '( City/State /Zip: A/ ?r 11)4 d 10( 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 $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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and e pains enalties of perjury that the information provided abo e is true and correct. ---> 9 a 2 Signature: Date: / Phone #: 5//3 23 7 '7117 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit /License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: OCT -02 -12 09 :29AM FROM -MASS MUTUAL +413 744 5599 T -420 P.001 /001 F -342 OCT- 2 -2012 10:13 FROM :NORTHAMPTON HE%TH 0 4135871221 TO:914137447353 P.1 1 %/J - f 71- f,../-%, City of Northampton 010 W 4 Ma3aachtit$ ; _ , ,, I ."'=--'". - our $iaxcvuao .r.��ts TIONS 4, ,; , , a " . ", . -> : DRE Nar 212 a sesoet • . �{unicsipa. bui14zn� ��. s�as�ft3ors, aa►. 64 INSPECTOR Louis kashrauck Chuck Miller • Buildino Commissioner Assistant Commissioner ROME OWNE$..I: CEI�pi N ACKNQWLED The State of Massachusetts allows the homeowner the right under 7$OCMR 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 - arm structures. A person who constructs more than one home in a two- ' year period shalt 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 responsiblelorloomplianoe tate.buildi oodQSareiltegui ^- T�eaa specttop -- proc ssa requires that the building department be called to inspect work at various stages. which include foundatia s>g rtes ( be fore i dcfi ll) sonot4tbo holes (before sou r), a rou build i nsoo .tign befor, .4.� - ao . 2.t: •i Insular .n i _ !,,,...r."- if .0 -. s bu ld" _ - ns.. o - a The building department requires these inspections before the work is oonoeeled, failure to secure these i - 1-..�s ons can result i -'lure to o certifi - .. • , occupancy until the work can be t-p If the homeowner hires other trades to perform work Neotrical, 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,..add that they . irrequired inspections,Eailut' a- af..the.iadividuaai.trades to.secure-- - the permits inspections as uired can Dta the project until such time as the proper permits and in are made 1 _ i'� th undersdand a above. ( ow r debt's sign r equesting exemption) 1 will call to schedule I required building inspections necessary for the building permit issued to me. Date f}101/ Address of won( location & (1O.M1 fc ,rrt toed b_ ' rr•r�;► 'o.n ,A4A 4:9 6o PAGE 111' R YDAT 101212012 AM gaga DayightTivr SYR ISRFXFEiRO1R` :47363`CSC:4135 71221 1 !NATION OCT -02 -12 09:36AM FROM -MASS MUTUAL +413 744 5589 T -421 P.001/001 F -343 CCT -2 -2012 18:31 FROM:NORTHAMPTON HEALTH D 4135871221 TO:914137447353 P.1/1 - a r4/ //3 • 1 1 Pt —1 , SECTION if - COIF SERVICES 1.ww..w S.1 I..IOCrri4� Co nn:bOn Suoervesar: Not .''oplicable g— nome of Care* Feeler , - . 7Z-- ! % PJ Ore, ,e 0. License Number 4 i». /44 h- f / Sreisv ( " .j t9/2TGa Men= r 'ref .13 7 Vail Dote ire T dep tththe 9. _Fioena tmoro xairiehnt.Cvntraator: Not Awricable CI Patmpartv Name - Registration Number Address Expiration rate Telephone_ SECTION 10- WOT RS' COMPENSATION MISCHANCE AFFIDAVIT (NI.G.L c.162, S 2bC(6» wore Compensation Insurance eflidevit must be completed and submitted with this application. Failure to prom tfeia affidavit will result in the denial of the issuance of the buadu+g permit. — .. . -, - - - -- Signed Affidavit Attars YeS. II No_.... 0 11. - Home toner Exemption s 1 current exemption for "homeowners" . -o: - ded to indud o Owner eereueied Owslih es of one C1) or two(2) families and to - . .. L. alt individual till' hire who does not possess a limns% provided ti3tat tht owner acts ' As MUltefT "A Stgla . 1e.�,�.1. Ckflni pio of mcow+teir: Person (s) who own a parcel eland on which hdshe resides or httends to reside, on which there is, or is lot to be, a one or two family dwelling, attached or detached structures amess+ory to such use and/ or farm struonwes,... ...,..k.2, Rile ..., < .Ceti_. :. 1,4z... ' - A_ .7.1-2 � . hat be - _;. .1 2 . ti..4, _ r Such "homeowner" shall summit to the $uitding Official, on a foacceptable to the Building Official, that hehdte shall be - 441 .7 L. fnnr _. 1 , h 1_ t�11 Y, >_ L_LS . ;, !Lt L_ -Lt11 As acting rso :t heelen $nnerduos your presence on the job site viH be required from time to time, during and upon eompledion of the work for which this permit is issued. ALTO be advised that with reference to Chapter 1 S2 (Workers' Can) and Chapter 153 (Liability of LmploYers to Employees for injuries not resulting in Death) of he Massachusetts General Laws Annotated, von rsov fl a flable for person(s) you thine to perform work Ibr you under this pertniL The undersigned - homeowner" certifies • 1 1 aMswr.e5 • • � . • .. + for compliance with the State Building Code, City of zvartthatmprom Otdinartcea, state _7onimg taws ;C • afc renerst Laws wrtttosased. liom aowne r ill aatare uV —.,_. O PAGE 111 x RCVDAT 16121201218:40 :23Pra temDwightTime SVR:I$ XFEPRO21WW' ENIS:4T 3' CID:413271M 'DUPJTICN( : SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition 0 New Signs [0] Decks [Q Siding [0] Other [0] Brief Description of Proposed Work: Remove 800 square foot detached garage /shed. 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 OWN ERS AGENT OR CONTRACT , PPLIES FOR BUILDING PERMIT /( l `� , ) "W ) , as Owner of the subject property hereby a orize f /40 �S to a o y behalf, in all a er relative to wor uthorized by this building permit applicati n. k /Iner AA/ a A - �) v ) 2 Signat re of Date 1, as Owner /Authorized Agent hereby declare that the statements a n information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under t e pains and penalties of perjury. // L r f 00s Print Name C 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 Frontage Setbacks Front 20' Side L: ?4' R: 500' L: R: Rear 400' Building Height i2 Bldg. Square Footage 800 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 0 DONT KNOW O YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 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 ® DONT KNOW ® YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained Q , Date Issued: 8/9/12 C. Do any signs exist on the property? YES ® 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 ® NO 0 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 ® NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only f ECEIVED City of Northampton Status of Permit: uilding Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability n aT — 22012 Room 100 Water/Well Availability N rthampton, MA 01060 Two Sets of Structural Plans DEPT. OF BUILDING IN." ,;: 587 -1240 Fax 413- 587 -1272 Plot/Site Plans NORTHAMPTON, MA 01060 Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: 503 Mt. Tom Road, Northampton, MA This section to be completed by office Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: _Mary Glazewski 503 Mt. Tom Road, Northampton, MA Name (Print) ) Current Mailing Address: Telephone: 413 - 584 -4109 Signature 2.2 Authorized Agent: I l� c?oS r � / ail `I fi /'! /1/0/fhz," f -p /v ('o Name (Print) , 02 Current Mailing Address: �jC 8730 /9z/17 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $1,500.00 plus disposal fees (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) Check Number 02/1 _ App 0 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0376 APPLICANT /CONTACT PERSON GLAZEWSKI HELEN S & MARY ADDRESS/PHONE 503 MOUNT TOM RD NORTHAMPTON (413) 584 -4109 Q PROPERTY LOCATION 503 MOUNT TOM RD MAP 46 PARCEL 058 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ^ ` � Fee Paid Ga / A Tvpeof Construction: DEMOLISH 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 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 % i 7 .— Signa a 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. 503 MOUNT TOM RD BP- 2013 -0376 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 46 - 058 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit # BP- 2013 -0376 Project # JS- 2013- 000609 Est. Cost: $1500.00 Fee: $20.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq ft.): 117612.00 Owner: GLAZEWSKI HELEN S & MARY Zoning: Applicant: GLAZEWSKI HELEN S & MARY AT: 503 MOUNT TOM RD Applicant Address: Phone: Insurance: 503 MOUNT TOM RD (413) 584 -4109 0 NORTHAMPTONMA01060 ISSUED ON:10/9/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: DEMOLISH 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 10/9/2012 0:00:00 $20.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner