35-155 (3) Quick Open Space Calculations Coverages
existing 180
Lot area existing proposed existing 780
21070 2104 2764 existing 64
existing 1080
Open Space 18966 18306 existing 0
total 2104
Open % 90.0% 86.9%
new 660
new
new
total 2764
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Board of Building Regulations and Standards
Construction Supervisor License
Fi License: CS 722
Birthdate: 820/1982
Expfiration: 8202009 Ti# 2488
_ Restriction: 00
THEODORE D TOWNE JR
21 LOUDVILLE RD
EASTHAMPTON,MA 01027 Commissioner
AoartT nP Auil%fing itegOntiohs'atad 5tandariis
Construction Supervisor License
License: CS 724
Birthdate: 9/24/1938
Expiration: 9/24/2009 Tr# 3192
Restriction: 00
THEODORE D TOWNE
23 LOUDViLLE RD
EASTHAMPTON,MA 01027 Commissioner
FAX N0. P. 03
SEP-15-2008 MON 09:06 AM w U tINS O"M
r wowx—u U:KTIFICATE OF LIABILITY INSURANCE 09/15/z003
N (411)586-4111 FAX (413)S46-5441 THE CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Webber & Grinnell Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
8 March King Street HOLDER.THIS CERTFICATE NOES NOT AMENQ,P.XTEND OR
n9 R N Pa B
Morthawton, MA 01060
INSURERS AFFORDING COVERAGE NAIL 8
Rff111 re ovme, r. EN9w"k NGIN Insurance Cow ny 14798
21 loudville Road N ME"& MICR- Savers_Property Casualty
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MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
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23 Leadvi l l e Road OF AMY 9W UPON TIN POUNK fls~1100 RWROSENTATTr M
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13anna Rodriouse CTS 7911
U=25(2001=) FAX: (413)S27-9060 ' CACORD CORPORATION i"I
FAX NO. F.
SEP-15-2008 MON 09:05 AM GATEpwWOr"'m
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i North King Street "OLDER.THIS CERTIFICATE DOES NOT AMEND, TENgD OR
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INSURERS AFFORDING COVERAGE NAIL 9
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23 Laudvil l e Road RRWM& is M- Travelers
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Theodore i Evelyn Towne BUT EAILute To GAIL SIGN NOTICE SHALL M E NO Oft"TIGR ON LMUW.RTC
23 Lmudvi l l to Rt1ad Of ANY Iolro eNPotl THE HIRIRtER.ITS AOISIIT!)OR RQReiEIATATIVEs
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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
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, 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.
Date
Address of work
location
•_. The Commonwealth of Massachusetts
Department of Industrial Accidents
Office bf Investigations
• , 600 K ashington Street
Boston, MA 02111
yT www,m ass.a ov/dia
NIVorkers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): T h a6(,re, k 0 Lei)e-, c _
Address: 13 )-60 �! �
City/State/Zip: ,.- Phone#: �J / - 7 —
Are you an employer?Check the app opriate box: Type of project(required):
1.❑ I am a employer with 4. z I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp. insurance.$ "
required.] 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions
myself. No workers' comp. right of exemption per MGL 12.7 Roof repairs
insurance required.] c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other w �
comp. insurance required.]
*Any applicant that checks box 11 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 contactors 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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. ## _
Insurance Company Name: Iv M l h5 U rQ fv(?,
Policy#or Self-ins.Lic.#: j��1 G 1.9 C Cl Expiration Date::
Job Site Address: ¢6 2 1� ick r) - 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$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 under the pains and penalties of perjury that the information provided above is truce and correct.
Signature: �c�-c�rr�( Date: 3l> 1 ®9
Phone#• Ll 13 - 17 ((Q 6 U
Official use only. Do not write in this area,to be completed by city or town official
Citv 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#:
A
SECTION 8-CONSTRUCTION SERVICES N.
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number ff
Address v M Ex ion to
,n L,y�CL
Signature Telephone
-557 C�
9.Re istered Home lim r vement Contractor: Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(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: x" mption
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-vear 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) ❑ Roofing
Or Doors Q
Accessory Bldg.IN Demolition ❑ New Signs [[3] Decks [71 Siding[O] Other[C)]
Brief Description of Proposed ,c
Work:
Alteration of existing bedroom Yes _No Adding new bedroom Yes _ No
Attached Narrative Renovating unfinished basement Yes X
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? A c
d. Proposed Square footage of new construction._ 410 D A*Zt Dimensions
Ir
e. Number of stories? aTtlZ.
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. /VZA Masscheck Energy Compliance form attached? X
h. Type of construction - C114
i. Is construction within 100 ft. of wetlands? Yes —A—No. Is construction within 100 yr. floodplain Yes-,X—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 P y behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
l 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 s�
�S C�
Signature of Owner/Agent Date
A
Section 4. ZONING Alt 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 p p
Frontage
Setbacks Front
Side L..... ....,.,' R ,_ .....` L !P R
Rear
Building Height 20/
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 DONT KNOW 0 YES
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO � DONT KNOW 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 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 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use onfy
City of Northampton Status of Permit:: .
Building Department Curb`CuttDr#vervay Permit
212 Main Street Server/SpficAvaziabiiity
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets ofStructural Plans
c �Ione 413-�87-1240 Fax 413-587-1272 Plot/Site Mans ==
Other Specify
APPLICATION TO CONSTAUCT,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
8 Address,
Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
63
Name(Print) Current Mailing Address:
CIA—, 4 ��4�� Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address: S 7- O L U
off, X94
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 700 (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
a-� Construction from 6
3. Plumbing /V/x Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection Al j7
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2009-0898
APPLICANT/CONTACT PERSON THEODORE D TOWNE
ADDRESS/PHONE 23 LOUDVILLE RD EASTHAMPTON (413) 527-9060
PROPERTY LOCATION 802 RYAN RD
MAP 35 PARCEL 155 001 ZONE SR(100)//WSP 11
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid WE
Tyyeof Construction• CONSTRUCT 22 X 30 DET GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 000724
3 sets of Plans/Plot Plan
THE FOL OWING 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 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.
c +
> ,� BP-2009-0898
GIs#: COMMONWEALTH OF MASSACHUSETTS
r CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: GARAGE BUILDING PERMIT
Permit# BP-2009-0898
Project# JS-2009-001313
Est.Cost: $15900.00
Fee: $142.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THEODORE D TOWNE 000724
Lot Size(sq. ft.): 21083.04 Owner: BATES LEELAND T&MARGARET T&M QUATTLEBAUM&T BATES
zonin : SR100)//WSP II Applicant: THEODORE D TOWNE
AT. 802 RYAN RD
Applicant Address: Phone: Insurance:
75 PARSONS ST APT V (413)527-9060 WC
EASTHAMPTONMA01027 ISSUED ON.51812009 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 22 X 30 DET 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 5/8/2009 0:00:00 $142.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
vip er
802 RYAN RD BP-2009-0898
GIs #: COMM(. :HEALTH OF MASSACHUSETTS
Map:Biock: 35 - 155 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: GARAGE BUILDING PERMIT
Permit# BP-2009-0898
Proiect# JS-2009-001313
Est. Cost: $15900.00
Fee: $142.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THEODORE D TOWNE 000724
Lot Size(sq. ft.): 21083.04 Owner: BATES LEELAND T&MARGARET T&M OUATTLEBAUM&T BATES
Zoning: SR(100)//WSP 1I Applicant: THEODORE D TOWNE
AT: 802 RYAN RD
Applicant Address: Phone: Insurance:
75 PARSONS ST APT V (413) 527-9060 WC
EASTHAMPTONMA01027 ISSUED ON.51812009 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 22 X 30 DET 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: t�'��z��z 'j House# Foundation:
/`L yam. Driveway Final:
Final: Final:�r�
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: 6r, 6 -3
g
THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGUL NS.
Certificate of Occupancy / Si nature:
FeeType: Date Paid: Amount:
Building 5/8/2009 0:00:00 $142.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo