35-027 (2) MORTGAGE LOAN INSPECTION
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_ LOCUS REFERENCE
BOOK 2036.PAGE 85
PLAN BOOK 108 PAGE 35
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RYAN ROAD
TO: Source One Mortgage Corporation
OWNER: Eugene T. Vanasse
AND: First ^m°r;^ Title ins Go.—
I hareby art that dw X mism shown on this plan ago LOCATION: 1040 Ryan Road
not located within s Flood hazard Area ss shown on the
FoderdEmagcncyMansa mantAgency'sFiood Northampton, Massachusetts
Inaatmoe Rate Map,
E. B. HOLMBERG &Associates
¢•t►iAM p�,
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Cztp of Narfhamptan
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� j�ilassacf�icsettn
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building '
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as i:is/her construction super,'isor. 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 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 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, �� i C' �C, i i-� understand the above.
(Home owner/resident's signatur requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
J0
Address of work
location
Cris of �rlrfllalll}�tol)
.Q DEPARTMENT OP 5UILDf1\G INSPPC ot.S —
212 Main Street Municipal Building a
Northampton, Afass. 01060
WOMCER'S C01YIPENSATTON MSURA.NCE A1=1 AVI
(I7 CCDS:X'JnCTrT]7 ttcc)
with a plb,-tcipal plat- of business/residencc at:
(phone:')
do hereby certify, under die.pa-ins and penalties of perjury:; hat
( ) I an an employer providing the folloWine worker's comoc isaoo, cove age for my
etnplovccs woriong on t-iiis job:
(IanLr-an= Conr ) (Policy Nu-nab-cr) (E:•pirzt or,D21--)
O I am a sole proprietor, general contramor or homeow-Der (ci c:e one) and have hired
the contractors listed below wbo hLave the 'LoDo V19Q worker's policies:
(Nam-, Oi Contnaor) CoInp3'I)'/hoUci NILLMh---) (E.\.)7idtl^R Datc)
-
(Name of Contractor) (Ins-aranc: Comoan-vI?oIje" Ntlncrr) (i.%D-Lf.bon Date)
(Name of Connactti:) (Insuranc: Compan)/Pol,e} Nttsbu) (Expirrlon Date)
(Name of Contractor) (=raac-- COIDCany/Pobcy Numb•:r) (Expt-,doo Date) ,
(aaAch:.d:iitoc=7 ecd,if no.-•to incucvc iafortna_^ioc P,1jnia
( ) I am.a solc prop,iCtul and have no one wor4dDg for me.
--� I am..a home owner performing all the work myself,
NOTE:plesc lx ewue t%,w{ }e lxmroµvcra wbo ploy pe�oei to do o , 'oo=rcpa r-ork oa a d-. U-,-z of
tux mote than Uxor unr.,is ta'.]it�the botnoawn=rt=de or on the p-ound3 xppu Lc==tb= w c.-r oox -,..><:_1ty oeceiderod w bc
azrploy=i uac,=the.vr'd O—P von Aa(GLI SZn 1(5)1 pptinaoo by a bomcoavc fcr_b=x-a p=mh=y er+d—the
Iept e- of as¢ployer under ct o workora Comp.ocnat-ion AxZ
I uadcst•^A that>oopy of thi.mtcmcrat may bo foc--d-d to the poportmco¢of IoduSricl A.&..&Offi-or In—for tho
o0veXc reiGalioa and thai L•.iltat to sca=borcrase tradcr soetioa 25A of).141-152 tan 1.�d to the impoziiion of aimiaa.l penAWc:
ooaais.ixtg of a riot orup to S 1•SOO.00 and/or of up to ooc yr3 e.od cNi1 pcm-ttia in tx form of a Stop WorV.Ord=and a
rtn of 5100.00 t dxy Lpiast tnc
dc�u-oaty
Pcrm7t Numbcr --
hdap"—_ Lot
Stpy7uurc of LiO=IscrJPCrrriUC=C
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address \\ Expiration Date
Signature Telephone
9.Re`istered WOMO IEn r V merit `n ra I Not Applicable ❑
Company Name Registration Number
Address f 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...... ❑
. Home Owner Exemotion
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 Lawn and State of assachusetts General Laws Annotated.
--� Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors C]
Accessory Bldg.•pKr Demolition ❑ New Signs [0] Decks [0 Siding[0] Other[0]
Brief Des c�'Ption Pro sed // Y16
Work: (, ocG O ' c:- c� `�P
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 o[addition to exiStinq houSincl,COMPlete the!followind:
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
1, ,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
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 t
Lot Size /05,60 s 74 /0.5 4 0. N
'[0
Frontage ..........
Setbacks Front
SAVAi
Side L: (Q._ R: L. R: 1 to
Rear
SHED 1
9vQ
Building Height
Bldg. Square Footage % Me �---�
1392' '78,2 7a ?oho I,✓s P
Open Space Footage .. % ��Q
(Lot area minus bldg&paved
parking) '?o
#of Parking Spaces
Fill:
1
(volume&Location) . ..
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DON'T KNOW YES
IF YES, date issued:.'.
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES
IF YES: enter Book Page; and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 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
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
.--N NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
C�parfxnent t t�rl)y
City of Northampton Btatuslaf Perrtt
Building Department Curb Cuttfityeray Permlt
212 Main Street Sarleptit Availability
Room 100 tlatea6�Vell Avatialarli�r'
Northampton, MA 01060 T�trti bets tSftu la.ta
phone 413-587-1240 Fax 413-587-1272 1'Icfiftwllrt
C�tl��r apecify''
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
/O V6 fir n 2Cl Map �� Lot Q2'1 Unit
tab t^e m C el j A ff 0 (06 '7- Zone 0,verlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Ci ct P
Name(Print) ? Current Ma ili Address,
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 ermit applicant
1. Building L1 (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 = 0 +2+3+4+5) A 7 Q 0 Check Number
This Section For Official Use Only
Building Permit Number: Date Issued.
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2007-0210
APPLICANT/CONTACT PERSON KLATSKY MICHAEL
ADDRESS/PHONE 1040 RYAN RD FLORENCE (413)586-1486 Q
PROPERTY LOCATION 1040 RYAN RD
MAP 35 PARCEL 027 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid fav Amu
T_ypeof Construction: ERECT 8 X 10 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
INFO ATION 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 S t Commission
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.
� BP-2007-0210
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0210
Project# JS-2007-000320
Est.Cost: $2700.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 10890.00 Owner: KLATSKY MICHAEL
Zoning: SR Applicant: KLATSKY MICHAEL
AT. 1040 RYAN RD
Applicant Address: Phone: Insurance:
1040 RYAN RD (413) 586-1486 O
FLORENCEMA01062 ISSUED ON:812512006 0:00:00
TO PERFORM THE FOLLOWING WORK.-ERECT 8 X 10 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 8/25/2006 0:00:00 $25.00MO
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo