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29-030 (4) 2 2, S„ _.. . rl 4" Neigh � Table J Ramp anding 6' long p in epth 36" '7 Pedicure 12" Total 11' chair long 36" 7' 11" OS door Open space 14' O 'a 7 ' 6" inside .08" ^ c Deer y N n Exists Slide Sink Toilet Sink door to the house fe No 8003341 Page#111 Subject Photo Page Borrower/Client ROEUN&SOVANNARY CHEA Property Address 284 RYAN ROAD city FLORENCE County HAMPSHIRE State MA ZI Code 01062 Lender FLORENCE SAVINGS BANK Subject Front 284 RYAN ROAD Sales Price 237,000 w.� Gross Living Area 1,236 Total Rooms 6 Total Bedrooms 3 . Total Bathrooms 1 Location AVERAGE View NHOOD _ Site 0.31 ACRE Duality AVERAGE Age 56 ,r Subject Rear ALL— L).• Subject Street Form PIC3z5.SR—'W riTOTAL'appralsal software by,a la mode,inc.—1-800•ALAMODE �.ry r 'rau� fi� Tst k3��c� ��W�q✓yJ rro �. ca ..'. YY �r h 41 C 5 �` O �9 10 ; RZFU {� a , f J 3 'A�lzw . K Ll -'` F .xi ,r ('l File No._8003341 Paoe#121 Building Sketch BorrowedCllent ROEUN&SOVANNARY CHEA Prc Address 284 RYAN ROAD w., City FLORENCE County D HAMPSHIRE Slate MA Code 01062 *' Lender FLORENCE SAVINGS BANK NOT TO SCALE f'I r,""" LAYOUT APPROXIMATE l DIMENSIONS ROUNDED r'12.0'I Patio Family Rao. 1 17.0' 36.0' KitU>en Hednwm 22.0' 24.0' Garage Living Room / 5=:� Bedroom Bedroom 12.0' . 40.0' •Imeriur Dlrnensions Not To Scads �z Comments: ;�,•/. ,. J AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN Code Description Sire Net Totals Breakdown Subtotals GLAl rust rloor 1236.00 1236.00 First Floor P/P Patio 192.00 192.00 24.0 r 40.0 960.00 GAR Garage 264.00 264.00 12.0 r 23.0 276.00 TOTAL LIVABLE (rounded) 1236 2 Calculations Total(rounded) 1236 Form SKT.BldSkl—"NinTOTW appraisal software by a la mode,inc.—1.800-ALAMOCE City of Northampton Massachusetts t' 1 DEPARTMENT OF BUILDING INSPECTIONS �= x� 212 Main Street • Municipal Building �.� Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 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 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 /thn 'er mits and inspections as required can DELAY the project until such time as the proper permits nspections are made understand the above. 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 r ! Department of Industrial Accidents Office of Investigations - F 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibly 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 employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. employees and have workers' [No workers' comp. insurance comp. msurance.1 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.Ek"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.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors 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. 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. Lie. #: 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 $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 her certify under the pains and penalties of perjury that the information provided aho a is ue and correct. S' atu - 4 Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder License Number Address Expiration Date Signature Telephone 9'"Registered Home Imp"rovement Contractor �; __ ,. ; 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. 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 orthampton Ordinances,S to 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 Alterations) Roofing ❑ Or Doors M Accessory Bldg. ❑ Demolition ❑ w Si ] Deck [C] Siding [0] Other[0] Xe'r Desc" tion of Propos d Alteration of existing bedroom Yes No Adding new bedroom Yes i No r- e &•+., , Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa lf.New house and"Or addition to exlsfiing.housirig,cornpf4 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 I, 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 underthe pains and penalties of perjury. Print Na ig5f 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 Lot Size Frontage Setbacks Front Rear Building Height Bldg.Square Footage 010 Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has a Special Permit/Variarce/Finding ever been issued for/on the site? x~� �~� � NO «�~\ Y/ «�� DONTKNO YES �~� IF YES, date issued:/ / IF YES: Was the permit recorded at the Registry nfDeeds? NO � DON7 KN0Y 0 Y[5 IF YES: enter Book Page and/or Document# �� B. Does the site contain a brook, body of water orwed ��/wetlands? NO DON7 KNOW �~�� YES �~�� IF YES, has a permit been nr need tobe obtained from the Conservation Commission? Needs to be obtained �-� Obtained x-� Date |ssued'. �_� �_� ' C. Du 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 0 IF YES, describe size type and location: ' ' . E. Will the construction activity disturb(clearing, gradingexcavation,or filling)over 1 acre orioit part ofa common plan ' that will disturb over 1acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. I I City of Northampton Status ofPermtt "'' �" ' Building Department Curb Gut/Driyeway Permt# z� FO 2014 V 212 Main Street Sewer/SepflcAyailabilrt Room 100 WaterfU�CeilA�atla6ihty Electri , Plumbing$Gas InspeWOns Northampton, MA 01060 Twa Sets otS#ructural Plaffs't orthampton, MA 01 OW e 413-587-1240 Fax 413-587-1272 Plof/Site Pians :.: Other_Spec�fy_ ,� � 3 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address:C,��'/� Thts sect►orr to be completed byoffrce 4 �'' / Zone ' ' Overlay Dtst�[ct ;Elm Distnct CB District SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: ✓ Telephone - ig Katuref 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone CTION 3 -ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �,` (a) Building Permit Fee 2. Electrical /Qd (b)Estimated Total Cost of Construction from 3. Plumbing Building Permit Fee ^/ 4. Mechanical(HVAC) d �� 1.5. Fire Protection 6. tal=(1 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Comm issioner/Inspector'of Buildings Date