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Know All Men By These Presents
Bk: 11333Pg: 109 Page: 1 of 1 y
Recorded: 05/31/2013 12:34 PM
That Cheryl &Scott King hereby Covenant &Agree that basement space at 95 Pioneer Knolls,
Hampshire County, Northampton, Massachusetts 01062 recorded at the Hampshire County
Rregistry of Deeds in Deed Book 7040 Page 157 & 16 will be used as recreation &office space.
It will not be used as sleeping space without first obtaining a building permit and meeting all
the requirements of the Massachusetts State Building& Health Codes for a newly created
bedroom.
Executed as a sealed instrument this date: f(9/ 13
4C C ` �, / On this;;/ day of I7_a" ,20 )
before mc. the undersi`ned notary public,
personally appeared ""`
S`"
Scott King T �`
C�tt� } k���� _-(na:nc of
doei!;'.i:-ni smmar ri-o ed to me through
satisia::toi� et idenc:c of identification,
'ant, II v hick v,ere K '1vLt
�Li to be the person whose name is siened
on the preceding ox attached document ,,,,,,,,,,
in m� presence. ., P" BR
O----
Kin: -- .�' pti.. .....•O
$ . cLnu Id) 6-4;'... 1
_•__4, 1,00
MARY GO L B ER Dr ATTEST: HAMPSHIRE, Dr-)1/-e-6/1,-(084,40 '
REGISTER
114° CLixt serf Narfflainpton
e
= et d xsaschnsclta' =_ 111
DEPARTMENT OP BUILDING INSPECTIONS �1_!-
3-
212 Main Street • Municipal Building
Northampton, Mass. 01060 r''•
WORKER'S COMPENSATION INSURANCE A.1t'F DAVTT
Pioneer Contractors
(license Jpennittee)
with a principal place of business/residence at:
•
P.O. . Box 1145 Northampton, MA D1-061 _(phone#) 586 5491
(sii .t/city/stateJzip)
do hereby certify, under the pains and penalties of perjury, chat:
(V I am an employer providing the following worker's compensation coverage for my
employees working on This job:
•
• Wcc 500595701 20012-
• _
nsurance- Co
(Insurance: Company) (Policy Number) --y (Expiration Date.)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Ex�piralion Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(anadr additional si ect ifnecxisary to include information pertaining to sll contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plc=be aware that while homeowners who ca ploy persons to do maint o• a construction ar I- an work on a dwelling of
not more thin thtno units in which the homeowner resided or on the gowns appurtenant thereto arc not filly oomidcmd to be
employers under tho worker's.eempcusntioa Act(GL152,1s 1(5)),application by n homeowner for a license cc permit may cvidcaLco the
legal crania of an employs(under tho Wociceet Compovsatioa Act.
[understand that a copy of this ctatemcm may be forwarded to the Depertmoot of Industrial Accidents'Ot£ioo of lmauznce for tha
coverage vcrifiestion and that failure to aceurc covet-ago under section 25A of Mal,152 can lead to the imposition of criminal penalties
consisting of a fine'of up to S1,500.00 andlor imprisonment of up to one year and civil penalties in list form of a Stop Work Order and a
fine;of 5100.00 a day against tt c-
For dcguuntt i use only
/ I Permit Number _
4411 /,' J/Y /3 lvfap, -Lot# _
Si�a lure of Liccnsee/Permi,- 1° e
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: 4(-- Not Applicable ❑
•
Name of License Holder: �]V k \ x`1W GS 0 k--( 490
License Number
Q•U '�J` 1 t�4 S' kAo�- 4h- I APAf oia( t( tof 1 4.
Address Expiration Date
4(3- _S—S/
Signature Teelllephon
9.Registered Home Improvement`Contractor Not Applicable ❑
21T)1 eP r Cu�.��c c: v � i 31-Yff(J
Company Name Registration Number
' Jx t �k-i;) ,. q t 0-11/3
Address Expiration iration Date
Telephone S �l
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 buil g 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 and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) 151 Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding[D] Other[D]
Brief Description of Proposed eiet v""1/���`, 'Q�,re,�� !
Work: Finish Existing Basement
t ( ,1 �7W"
Alteration of existing bedroom X Yes No Adding new bedroom X Yes No
Attached Narrative Renovating unfinished basement X 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
A.L' L A , as Owner of the subject
property ' ,
hereby authorize P 1 t- C I"v,�Yt' C) il{S
to act on my behalf, in all matters relative to work authorized by this building permit application.
/,;/,3
Signature of Owner Date
I 1Tha V k cS (1 Av-— / 'pll.;l-c0.‘24-` Cirv:I , as OwntF/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 / y icfrhg
Signature of Owner/A ent 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
Side L: R:
Rear
Building Height
Bldg. Square Footage
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 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 C 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
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
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 Q
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.
rB CEIVED peparlme Luse only rys
z� r r
. [ City of Northampton StatueofPermit� rr ,r
A°( 2 3 2013 Building Department curb CuttanvewayPermit xr - ,,,�t
212 Main Street Sewer/Septic Araiiabriity
Room 100 U tailed A�ratiabtti �
DEP1:CiF bUI�DWG INSPECTIONS
�/i a�i s i
NORTHAMPTON, Northampton, MA 01060 Two es of tructura Plans t � �`f�'�� -"i�
phone 413-587-1240 Fax 413-587-1272 Pfotf it PlaPs
Other.S eci t� � i yr rf j/'tr/rk ti' r
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
�_,►, r,�\ ' c,� , Map Lot Unit
CI L'�n��r ��fy�� " Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Cheryl& Scott King 95 Pioneer Knolls, Northampton,MA. 01062
Na (P int) Current Mailing Address: 413.584.5610
Telephone
Signature
2.2 Authorize Agent: l
7�V1^ e- C v,r�C rr�C�4oc�s ?- U • l l 4J( \` r ' 1 tn, . AA11
Name(Print) � Current Mailing Address:ii)\_,iyo/te,
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated (Dollars)to Official Use Only
completed by Cost permit applicanbe t
1. Building �„ (a) Building Permit Fee
obi 1�{a
2. Electrical 2,555 (b) Estimated Total Cost of
Construction from(6)
3. Plumbing 4,800 Building Permit Fee
4. Mechanical(HVAC) 31 PP
5. Fire Protection ,�
6. Total=(1 +2+3+4+5) Z ` 1 fj Check Number I��KJ I��
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2013-1135 ci 1
ovje
APPLICANT/CONTACT PERSON PIONEER CONTRACTORS
ADDRESS/PHONE PO Box 1145 NORTHAMPTON (413) 586-5491 A /O`a J
PROPERTY LOCATION 95 PIONEER KNLS 'v
MAP 29 PARCEL 565 001 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 /‘o33 33 13 p-
Typeof Construction: FINISH BASEMENT(OFFICE/STUDYBATHROOM//t�sBI�Q(SPi)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 017890
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 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.
95 PIONEER KNLS BP-2013-1135
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-565 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2013-1135
Project# JS-2013-001864
Est. Cost: $21400.00
Fee: $132.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PIONEER CONTRACTORS 017890
Lot Size(sq.ft.): 166399.20 Owner: KING SCOTT A&CHERYL A
Zoning: Applicant: PIONEER CONTRACTORS
AT: 95 PIONEER KNLS
Applicant Address: Phone: Insurance:
PO Box 1145 (413) 586-5491 Workers Compensation
NORTHAMPTONMA01061 ISSUED ON:5/24/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:FINISH BASEMENT
(OFFICE/STUDY/BATHROOM)
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 5/24/2013 0:00:00 $132.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner