49-040 (2) 99rr
EN::RGY CONSE VAT ION APPLICAMN$0 FOP,
LOW-RISE kESI ENTIA, L NEW CON' 1` UCTIC 3' .and . DITIQNS
700 CNM 4ppend x+I(t6active 3/1)§18) .IIM'�rerr
y A PP licant Nate: 9001 00 AA& •
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Applicant Address:,
Address: r
t �� .A Use Group,
Dait of Applic#6h
Applicant prone: � . ''L. APP I=t Sip�rtat�re
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s PackagT(A t3unugh T€lo fro 'l"ale J5 , 1:c,.1: Hearing Degree ta) +( IDI m'If� fff r
(For items d.through i , fill in all values*t apply from Table 15."...I b:)
a. Gross Wa11 At ea ;s�.ft f. w all R ti i�We
b. Glazing
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Application Approved ( L7eitted [I Dame ofApprovallNnial
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DE?AR..VENT OF BI:ILDrl\rG INSPECTIONS Aff��
212 Main Street ' Municipal Building
INSPECTOR Northampton, ,Mass. 01060 �
Square Footage Amount
Basement @ .10
1st _lcor @ .40 �tr*400 A`
2nd ?lcor @ .20
1/2 Floors, Attic, Garage .10
Deck, Porches .10
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JOB
rr�r/ SHEET NO. ✓.{ ✓`
DATE
14tehaei J.Behrens CALCULATED BY
699 park K�il Rd CALCULATED
— DATE
Northampton.
., CHECKED 8Y i
SCALE
o�(t1AM PLO
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9 :� �:asRrfinsrtta'
Q DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building 'a
Northampton, Mass. 01060 '
WORKER'S C&POTENSATION INSURANCE AFFIDAVIT
•
(Iiceas.°�1pe:mitler)
v.,ith a principal place of business/residence at:
��� �I�� ��� IC d. � �1"]�I�phone r) ���• 0/t��'
do hereby certify, under the pains and penalties of pe71ry, that:
( ) I ant an employer providing the following workerjs compensation coverage for my
employees working an this job:
(Insurance Company) (Policy Number) (Expiration Date)
(�am a sole proprietor, general contractor or homeowner (oracle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Cony actor) (Insurance Compazy/Policy Number) (E.�iradon Date)
(Name of contmc:or) (Insuran(-- Co=arry/Policy Number) (Expiradon Date)
(Name of Contractor) Gnsuranc-- Compaay/PoUgf Number) (E.\-piradon Daze)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addition1 xboet if nooeauy to include informs ioa pex wining to all coatrj o )
( ) I am a sole proprietor and have no one work ng for me.
( ) I am a home owner performing all the work myself.
NOTE:plisse be aware th3i while hocseownera who employ pe-.om to do=.iz1ca•kcr.corL=%=oa cr n-,air work on a dwelling of
not axone than thrm umu is which the bomeowncr reside cc oa the grounds appiutensnt thereto arc not Sencr y co=dered to be
eaxploym under the workces a=pe=satica Act(GL152,a 1(5)),application by a homeowner for a liccuse or permit may cvideaoc the
legal rudw of an employer under tho Workers Corzpanaaiion Act_
I underusnd that a copy of this may bo forwntdod to rho Departasm2 of Indauui al Accideal OfSoe of Iaarnaoe for tbs
coverage vctifiatioa and that failure to seatre cove�under soctioa 25A of MOL 152 an I=d to tho inxposid-of sic m peaart es
000siuing of a fine of up to S 1,500,00 and!« of up to one y=and civil pcm Mcs is the form of a Stop Work Order and a
film of S 100.00 a day apiast me.
For deg�—only
• ���` /j//� i Permit Number
{ Ut
Si Qf Lic=L JPcrmittce e
SECTION 8 -CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : *#wymdr;
License Number
Address Expiration Date
Signature Telephone
9:Regisered Home fmnravemen 'Cotrtractor. 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...... ❑
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 �'
7CTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition 30000 Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
•
Brief Description of Proposed Work: ftvdl r �� ✓��� �� •
Alteration of existing bedroom Yes eNo Adding new bedroom Yes �� No ��rr
Attached Narrative 0 Renovating unfinished basement Yes �C_No
Plans Attached Roll�001heet 0
sa°° lf'N'ew�fiouse an�,:o�=addition= o ex"��'housing compCethe"forCOwt`n�:
a. Use of building : One Family 1000* Two Family Other
b. Number of rooms in each family unit: 4 Number of Bathrooms_
c. Is there a garage attached? CIO /
d. Proposed Square footage of new construction. �� Dimensions �� X '� 41
e. Number of stories? 411111'
f. Method of heating? 4OV49S 4044 Fireplaces or Woodstoves Number of each
._*
g. Energy Conservation Compliance. Mascheck Enerq Compliance form attached?
Type of construction Ir0"4 4fIy'I~4e ss
i. Is construction within 100 ft. of wetlands? Yes �No. Is construction within 100 yr. floodplain Yes V00No
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 %0##v 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 to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
•
#c*f.Jr( • Aft4ftejvr , 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.
/Y/c4.4opop +� ��p�c�•
Print N C^ t f/
Signature of Ow r/Agent Date
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
Lot Size �/
y7t �r
Frontage f ,
Setbacks Front
Side L: �® R:J ' L: R:
_ yT,
Rear
Building Height ��►
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved q� 'r
-parking)
#of Parking Spaces do
Fill: '0^000 Ap
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 DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO "000 DON'T 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 — 40000
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:
Carty of Northampton y
`k l�� l _.�
L�, � ---��II`ding Department _
212 Main Street
DEC - oom 100
Northampton, MA 01060
i>
p hc�p€i,4413y887. 240 Fax 413-587.1272
�7
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 ProRerty Address: x s s a
C ���� ,��� �� • Map ,,Lot'-' " Unit
Zone Overlay District
EIm SL Dts#rict > CB Distriet
r
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: #440 A� ��: ��•
Name(Print) Current Mailing Address:
`~�'• • Telephone 40004040
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 few*** (a) Building Permit Fee
2. Electrical ! (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) • ! 0
5. Fire Protection
6. Total =(1 + 2 + 3 +4 + 5) ' 0 t0 Check Number sol
This Section For Official Use Only
Building Permit Number. /& � Date Issued:
Signature: _,"=
Date
Building Commissioner/Inspector of Bulldmgs
File#BP-2003-0554
APPLICANT/CONTACT PERSON BEHRENS MICHAEL&PAMELA
ADDRESS/PHONE 699 PARK HILL RD (413)586-0138 Q
PROPERTY LOCATION 699 PARK HILL RD
MAP 49 PARCEL 040 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out JJ
Fee Paid
T peof Construction: CONSTRUCT 22 X 18 FAMILY ROOM ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accessoly Structure
Buildine Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FO LOWING 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 Co ion
�Z z cz �-
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.
699 PARK HILL RD BP-2003-0554
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:49-040 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2003-0554
Project# JS-2003-000908
Est.Cost: $27000.00
Fee: $158.40 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 84506.40 Owner: BEHRENS MICHAEL&PAMELA
Zoning: Applicant: BEHRENS MICHAEL & PAMELA
AT. 699 PARK HILL RD
Applicant Address: Phone: Insurance:
699 PARK HILL RD (413) 586-0138 (1
FLORENCEMA01062 ISSUED ON:1211812002 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 22 X 18 FAMILY ROOM ADDITION
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 12/18/2002 0:00:00 $158.40
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner