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35-272 87.23 135.07 251.71 132.75 20 35 —273 235.03 149.67 150 150 150 50.00 E13.82 �„ 42 -157 42 —022 815 42 —023 805 42 —024 • 35 — 2 72 73 80C xh�,= . , a , r.n����� ��, �•�.�ex, � _ 3 _42•x= 159��, ��m� ���.�r� � _ u 3527 � n��3, .���Px ��a ���. r ,. ,� � g 1 74.77 345.94 R45 nR coning Overlays Northampt n' FFR Farms, Forests and Rivers 0 of plANN,it, RI Rural Incentive �°���oi`i"A""pra9 "o 4 ' � L o f WP Watershed Protection �� ) Y, st WSP Water Supply Protection i. _l. = 4" 1.; "' ping overlays are superimposed over the ' districts shown on the Zoning Map. Jus,ri� ; ulations for an overlay district supersede t AM $ lations for the underlying district when there 'onflicts. w , s...., r. x .r. r �� z^. ., �.� Y ..,,. a3�x x._, ».: u,�x��r:aa ..�, .......�.t�r - - .- �- �- «,,.,.,. , .. •;:... r „„ v,...:r? A, �,� °k�as;� ay:a, _�W -` .... , , 194.00 -153 7 . 4.77 345.94 845.03 N 123.96 300.19 t2 -152 147.742 -154 60 2.63 1 00.00 42 -159 170.00 95.49 91.23 64.10 42 -143 42 -022 190.46 35 -272 242.92 -151 280.00 42-158 3 181.60 1.3.57 815 168.17 249.83 266.24 145.44 1 142.81 450.00 108.13 ! -016 42 -021 516.52 35 100.00 42-160 151.34 100 380.83 ' 4.30 42 1 1 - 55 O 0 193.82 196.41 \ C.1 132.18 j 300 99.99 Z 1..42 -020 156.38 Q 196.0 150 42 -017 42 -018 Q 74.93 75.54 --- -- 132.18 til 300 150 283.05 42 -147 183 160 " - --T 172.14 42 -146 :- I 180 •+.48 179 100 ' 3 -145 35 : - 300 10 99 Qa ..... - ......3 no1AQ PQ 42 -0 V iv - - , .-! r " . - r - C ') • • 421' „ - - - r - ' / • 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" i s p ction aroc 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- conjunctionlo t * e buii ..permit issued,.. 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 C`(`(O 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. Address of work location f The Commonwealth of Massachusetts Department of Industrial Accidents --i "',t..= f Office of Investigations • °- r 600 Washington Street - .11 " Boston, MA 02111 s� . www.massgov /dia -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): Address: • City /State/Zip: Phone. #: 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 have hired the sub - contractors 6. ❑ New construction employees (full and/or part-time).* 2. El I am a sole proprietor or,partner- listed on the attached sheet 7. ❑ Remodeling ship and have . no emTloyees These sub - contractors have 8. ❑ Demolition for mein any capacity employees and have workers' working Y P ty 9 ❑ Budding addition [No workers' comp. insurance _ comp- snsnra # required:] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. N, I am- a-Iiemeewner dtieing_ a� �verlt- ofacers_hay_ ses xerci their - 11_- 0- Plumbing repairs or additions right of exemption per MGL myself [No workers comp. 12.0 Roof repairs insurance required:] c. 152, § 1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance required] *Any applicant that checks box #I roust also fill out the section below showing their workers' compensation policy inforimtion. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_ 1 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 # 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 $1500.00 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. 15e advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance coverage verification I do hereb certi under the pains and penalties o : e 'u that the information provided is true.andco sect -- - .... .Y .T' P P fP r1 �T f P -- Signatuire :(..., Date: . Phone #: C 3 S )is f - O f f i c i a l u s e o n l y . D o n o t w r i t e i n t h i s a r e a , t o be completed by city or toiiii - City or Town: Permit/License # Issuing Authority (circle one): I: -Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical I • ector 5. Plumbin! Ins. ector _ __ _ _ 6. Other r Contact Person: Phone #: • ., , SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : _ License Number Address Expiration Date Signature Telephone g: Recestered. HomeAliin [irovement:Gon , . s.. p „ €. i;... .. :i z Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT (RI-G.1 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 ❑ The_current_exemption for "homeowners” was extended to include Owner 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 x o ampton *romances; a e . I . . ` • - . -- ,• s ' . tts- General-- Laws- Annotated. Homeowner Signature C(—■ s SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [] Addition 0 Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors l] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[I Siding [0] Other [I:D] / Brief Description of Proposed nn '9(1) Work: P1/4‘04■14e Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a ; 1f,New hoiise'and._or addit on,to`'existiht housing. corniMe the-following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN , OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , 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, , 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. Print Name r $ Signature of Owner /Agent Date , iy 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 m , Side L: :_ _. R L_._...__ L . R. ? Rear .. ._. .� AO Building Height TI Bldg. Square Footage l , % r i____` Open Space Footage % (Lot area minus bldg & paved - 0, parking) # of Parking Spaces 11 ' _ Fill: (volume & Location) — _.,..._.h. __ __i ..._..___ _. A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 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' 1 and /or Document # ' B. Does the site contain a brook, body of water or wetlands? NO 0 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 0 NO 0 IF YES, describe size, type and location: — 13: S re Isere any proposed changes to eir a loons o signs lnt�eniTed or"tie ? YES 0 NO 0 IF YES, describe size, type and location; E. WIII 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Citypf Northampton Stater= of Pant ..,. _ Ir , 'nI i �c' It ng Department Cti r t '�° _ � o r x 1. 1 -N- -- -- — -, , 2 Main Street s e' 0"c: tits+ , Room 100 AUG - 20 09 North 'm MA 01060 � � ' . m <, �. � �, , w' °�� ± 1,: hone 4 87 - 2 40 F ax 413 - 5 87 -1272 la �, 4��� ' if ��`�+ 3 , ,p, '3 _Z. � y C 3. " -2 Yw,, gam. _ r u r. 3 , n1_c ?1'in f� ..CTIC'i$ l Ar PA4 6 A O CCL S TRU ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION 71.1 Property Address: This section to be completed by office 3 n Map Lot Unit • �' `n ... Zane Overlay District ` o � o c o a EtmSt District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: , • Name Print) Current Mailing Address: ;3y Woc 10. ' C - 3 �_ Telephone /Signature ,S S 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone . _ _.. SECTION 3 - ESTIMATED'CONSTRUCT COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant /I. Building , ��� 46 (a) Building Permit Fee ✓ —1 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 /1 This Section For ftficial Use Only Date Building Permit Number, Issued: Signature: Building Commissioner /Inspector of Buildings - Date File # BP- 2010 -0126 APPLICANT /CONTACT PERSON RIVERA - BERRIOS DAMARIS & JORGE L BERRIOS - TORRES ADDRESS/PHONE 34 WOODLAND DR FLORENCE (413) 584 -7554 Q PROPERTY LOCATION 34 WOODLAND DR MAP 35 PARCEL 272 001 ZONE SR(100) //WSP II THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid /93 9 3i Typeof Construction: INSTALL 24' ABOVE GROUND POOL 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 INti F(MATION 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 ` < 9/4 Signature of Building Official Dat 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. VD DR *` BP- 2010 -0126 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: BUILDING PERMIT Permit # BP-2010-0126 Project # JS- 2010- 000149 Est. Cost: $4000.00 Fee: $30.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 106896.24 Owner: RIVERA- BERRIOS DAMARIS & JORGE L BERRIOS - TORRES Zoning: SR(100) //WSP II Applicant: RIVERA - BERRIOS DAMARIS & JORGE L BERRIOS- TORRES AT: 34 WOODLAND DR Applicant Address: Phone: Insurance: 34 WOODLAND DR (413) 584 -7554 O FLORENCEMA01062 ISSUED ON:8/7/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 24' ABOVE GROUND POOL 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 8/7/2009 0:00:00 $30.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo