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35-191 (3) d N v� 'P°r Clb • • i 1 Iy 4 J 1 I ;. L .» 7 MORTGAGE LOAN INSPECTION THIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SUM x B U RTS PIT ROAD 102.38'± I 34.55± I BIT. DRIVE Z HOUSE GAR. ii 0 Z N F� xt 0 D ___�, �s v Q LOT-2t ,6 r 109.2 ' TO THE FLORENCE SAVINGS BANK AM tw LAWYERS TITLE INSURANCE CORPORATION - ONLY M Ass RC11 its cIts DEPARTMENT OF BUILDI]TG 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 !Js/her construction sup,,:-,,:sor. T lie state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dfvelling, 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 1, 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 N1%, of 01" DUJIDP C; 1)LTARTME N'l 212 Main Street * Alunidpid Buddiq; Northampton, AWR 010(30 W01-,',,KT,R'S COMi -PE, 1"i'SATION INSURANCY AFFIDAVIT %vith a [):-iiicipai place of bulnesdrOdence at 0 F �oCe ��Xen C 00C.) do hewhy COHN, WOU: the lxnaltif ; I cjn an �iiiployci provAng the fillomy vnYWA con .t.<. wvcn"� cinployccs ""'m klli'i'T' ull t,'.Ii's job� L X, j eA (IIISUT-ance col-npaiiy) I a'm -Ci �ulc proul-ic-ol, g(mt al '-"F the contractors Red bdoo"vho ha%!-, the, (N I C )1,t c Da,C) (Naw of Connaumm (Namc of Conaictai) DaLc) ;1:1"1 have 110 On", c aws of wirp 5 yx under ti,c W i 'i Comj oration Ac'L di.!.copy of(h:, I ,"y L-for"—I d to tln LYtxirL.rcu of --I A,,, "f liL,", for Um mvanb'c VQjf1 C-al i CKI r-:A t i•(Court to :auc C'3 vc-rz e ur3 r zcc'i,-n 25A d G 1,152 can iced to t')1,i Cq', C-1 Cmns!bg of a i b y of up to S I (Y),CK) i evil 1cr,I ti C I m CC S I W.00 SECTION 8 -;CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ 1 Name of License Holder : e P�, e —, i� -X1 -.1 — nn License Number Address (� Expiration Date Signature Telephone Ci '1 Not Applicable ❑ Company Name Registration Number Address 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...... ❑ 11�= O ner �emption' The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2) farlilies 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 wider 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 f(r-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 ivlassachusetts General Laws Annotated. Homeowner Signature SECTION 5=DESCRIPTIONW PROPOSED WORK.(check,all applicable) ate. New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ n New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: 5keck Ro GC3►'�C R�` �_ Alteration of existing bedroom Yes_X_ No Adding new bedroom Yes _ No Attached Narrative ❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet 0 s_a _If`New'l'ouse.'and=or'ad°ditfon to'ezistiny,"hdtising -complete jh0"followink 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? I � s� d. Proposed Square footage of new construction. � _ Dimensions It X / 9 e. Number of stories? J f. Method of heating? AIO t e,4T Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction Woo i. Is construction within 100 ft. of wetlands? Yes _X_ 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? ___X_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 — _ ��� _ as Owner of the subject property hereby authorize Pkc,, C� _ __ to ac; of my behal , all m ters relative to ork autho ed�by�thuilding permit application. Signatur of 0 ner _ Date 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 Na le Date Signature of 0 ner/Agent Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department oLot Size �7 Frontage -3 15- Setbacks Front 30 "r, T T — -3,-) T 3 Side L: D.�5—R: Z- p�- L: 30 R: 35 T 07 O Rear yS F7' * — I-T qC) Building Height 13 A=T 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 X DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # 13. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a pert pit 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 No IF YES, describe size, type and location: City of Northampton S atus�of Per- Building Department dur Uf�/C7xve 212 Main Street Sa a ttc Room 100 1Naerl.Wel>/�vat a !f Northampton, MA 01060 TwoSeso€ tr e u aJ> ai phone 413-587-1240 Fax 413-537-1272 Plot/Site P ans Iry APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DE4IW" A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: }� This section.to be completed by office �C R` 5 �`\ li�C Map Lot/q it Zone Q Overlay',District `cam ve e v. c (�'► r►Ss O i Ca A-�L— EimSt. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 7-S At2 Name(Print) Current M n�Addres 'aephone - Signature ---- .- --1_ -'- 2.2 Auth zed Agent: V3 I-_© e - - - a o _ Flo, c Name(Print) Current Yailing Address: Signature Telepneo - - -- SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only ccnlpleted by permit applicant 1. BLIliding � � C70 (-a) 'Building Permit Fee 2 EI � -_ --- --- i �F�` ir~n?ted Total Cost of onstruction from §)-- 3. Plumbing Building Permit Fee i 5. Fire Protection _ 6. Total =(1 + ?_ + + 4 5) --.--_-_--_— _— Check Number This Section For Official Use Only_ Building Permit Number: A& 94 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2003-0909 APPLICANT/CONTACT PERSON STEPHEN BROIDE ADDRESS/PHONE 820 FLORENCE RD (413)585-8000 PROPERTY LOCATION 1214 BURTS PIT RD MAP 35 PARCEL 191 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Ao gon,_ Fee Paid Typeof Construction: CONSTRUCT 18 X 16 ROOF OVER PATIO New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included: Owner/Statement or License 039880 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFPFRMATION 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 Co ssion 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. 1214 BURTS PIT RD BP-2003-0909 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 - 191 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category BUILDING PERMIT Permit# BP-2003-0909 Project# IS-2003-1451 Est. Cost: $5750.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STEPHEN BROIDE 039880 Lot Size(sa. ft.): 12196.80 Owner: REILLY JOHN V&VIRGINIA L Zoning: SR Applicant: STEPHEN BROIDE AT: 1214 BURTS PIT RD Applicant Address: Phone: Insurance: 820 FLORENCE RD (413) 585-8000 FLORENCEMA01062 ISSUED ON.4125103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 18 X 16 ROOF OVER PATIO 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 Sienature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 4/25/03 0:00:00 799 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo BP-2003-0909 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0909 Project# IS-2003-1451 Est. Cost: $5750.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STEPHEN BROIDE 039880 Lot Size(sq.ft.): 12196.80 Owner: REILLY JOHN V&VIRGINIA L Zoning`SR Applicant STEPHEN BROIDE AT. 1214 BURTS PIT RD Applicant Address: Phone: Insurance: 820 FLORENCE RD (413) 585-8000 FLORENCEMA01062 ISSUED ON.4125103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 18 X 16 ROOF OVER PATIO 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 Si2nature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 4/25/03 0:00:00 799 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo