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13-048 { a3a f, A6 447.5 400 fi ae �a k b X t � 1 f 513 A+ } 430 i z E , ..r I �,a3 Northampton, MA Property Detail 11/16/15, 5:47 PM City of Northampton, M1A: Residential Property Record Card New Search Property Type Classification Code Reference Card 1 of 1 IParcel - Location - Zoning -Assessment Map-Block-Lot: 13 -048-001 Zoning: Assessment: Location: 21 HATFIELD RD Neigborhood: 2 Land: 143,200 #Living Units: 1 Deed Book: 11142 Building: 8,300 Class: R-101 Deed Page: 237 Total: 151,500 Dwelling Information IBuilding Sketch Style: Cape Descriptor/Area Year Built: 1947 A:FAA Fr/B Story Height: 1 696 sgft B:OFP Attic: Full 29 132 sgft Finish C:EFP Basement: Full 36 sgft Total Rooms: 6 24 FA11 FF/B 24 Bedrooms: 2 11 sss Full Baths: 1 OFP Half Baths: 1 1 z C1 2 1 z Exterior Walls: Frame 11 29 Unfinished Area: 0 4 C 4 Ground Floor Area: 696 Total Living Area: 974 Finished Basement Living 0 X 0 Area: Basement Recreation Area: 0 X 0 Addition Information: Woodburning Fireplace Stacks/Openings: Metal Fireplace 0/0 Stacks/Openings: Heat/Central A/C: Basic Heating System: Electric Fuel Type: Electric Quality Grade: D Physical Condition: Average Lower 1 st Story 2nd Story 3rd Story Area Interior/Exterior: Same Basement One Story Frame IFinished Attic — 696 Condition/Desirability/Utility: UN F—Open Frame Porch �— F— 132 http://www.northamptonassessor.us/noho/propertydetai1.php?map_no=13%20-048-001&pagecard=1 Page 1 of 2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers Compensation InsuranceAffidavit: BuiIderslContractors lElectricians(Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): tk7=),t \I `J t�A :Kj,4C 1i�MDU� Address:l4coSk City/State/Zip: ate p 1 1 Phone#: Are you an employer? Check ihe appropriate box: Type of proiect(required): 1.❑ I am a employer with 4. i_] 1 am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. F-1 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 •,orking for me in any capacity. empl ogees and have workers' 9. Building addition [Noworkerg comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10. Electrical repairs or additions officers have exercised their H. Plumbing repairs or additions 3.❑ I am a homeowner doing all work g p myself. [No workers' comp. right of exemption per MGL 11 Roof repairs I C11 insurance required.] i 8.k'l Wu vw uav� 11V employees. [Noworkers� 13.F-1 Other comp. insurance required.] •Any applicantthat checks box#1 mist alsofiII out the sectionbeiowshc i rig their workerg cornpensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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. Ifthe sub-oontractors have empl oyem they must providetheir workers comp,policy number. I am an employer that is providing workerg compensation insurance for my employees. Below is the policy and job site information. A insurance Cuiinpany Naine. x /V V 1"\/ A-L— Policy#or Self-ins. Lie. #:�>�C — 31 S 3 J�_3 , _ S Expiration Date: D c Job Site Address:_[ �,y�Tt=\ t. 8 1 City/State/Zip: r �7 M -rVA , M A- 0 10 �7�. V Attach a copy of theworkers' compensation policy dedaration page(showingthe 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 estiga-m.of uhe Dr A for insurance cove.age.—ificat on. I do hereby certify under the pains andpenalties ofperjury that the information provided ab ve is tr a and correct r Si atur : Date: _3 S Phone#: ,�7L-1 g 4' 4 Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitlLicense# 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#: I� �I City otNorthampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Buildinq Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 'Z I � I a -71a NgjzTgA-.w\P V r� t� ►4 The debris will be transported by: (z S-1 i;zL)c,� IN) The debris will be received by: Building permit number: Name of Permit Applicant 4:E vi Date Signature of Permit Applicant SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor + r ' Not Applicable ! Name of License Holder:/Y I f+�� IfV -J F IZY ,( a S — D� q q t) y License Numb q6-K 1�ncl'6,r 0-�- 7e, Z, I L Address Expiration Da t-1 13 3 LI Signature Telephone 9.Reallstered Home Improvement Contractor: Not Applicable ! > 3 4- 3 Company Name Registration Numb yob i4eys AA 4- c t3 L \ ©�� 2 \ -z r' - Address Expiration Date Telephonegl 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....... ! X. 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 uv u�C.'3fi3iCiiCi vu Sspii:i$vr yv ur prCSC1iCC vli the J ....uC tv-."d—r,laid"Fv- 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 [7P ReplacementWindows Alteration(s) Roofing Or Doors ` Accessory Bldg. ❑ Demolition New Signs [O] Decks [CJ Siding ] Other[dl Brief Description of Proposed _ Work: � c.T ) t, � �r /4--Z)�D -`? a~ ' ��S o . 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 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? d. Proposed Square footage of new construction. Dimensions e. Number of stories? "Z- r IY�eth Vd VI heatlllg? \—(;)Zc 67 ,Ir� h/ Fireplaces or"Ill ood Stoves ` � � Nlurnber of ead, g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? — h. Type of construction 0 c C—)-,) 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 `L3 G k. Will building conform to the Building and Zoning regulations? X Yes No. I. Septic Tank '4_ City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �� � ` , .✓�os,��t� as Owner of the subject property hereby authorize to act on my behalf, in Talilatters relative to work authorized by this building permit application. Signature of Owner Date I, (�\ �'T�>✓\n3 �1Z�� 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. rint N e I Signature of Omer/Ageft Date I I I i I �' i '� I 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 Z 171 O D O rT 1 FrontaRe E L, Setbacks Fronts Side L:_` R: L: R: Rear S Building Height /6.-rj Z Z-- O Bldg.Square Footage f 7 LI % It-11,1,0 Open Space Footage 0,ot area minus bldg&paved #of Parking Spaces Fill: volume&Location A. Has a Special Perm it/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO () DONT KNOW i YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES Q 10 IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES,describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES i 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 0 NO IF YES,then a Northampton Storm Water Management ermit from the DPW is required. i i i i I i i I i 17 Department use only --- Cit of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit NOV 1 7 2015 212 Main Street Sewer/Septic Availability. Room 100 Water/Well Availability F& c - rth mpton, MA 01060 Two Sets of Structural Plans NO, ,;,r .� r:;a lU -1240 Fax 413-587-1272 Plot/Site Plans Other Specify 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 cqrnpleted by office Z I (-��T r i L'L Map — Lot '-fd Unit M, /4A AA I-r,�! ^°1 Zone Overlay District 0 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print Current Mailing Address: I elephone Signatur 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 com leted by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of �--� Construction from 6 3. Plumbing Building Permit Fee U YiJ 4. Mechanical(HVAC) r 5.Fire Protection b I C7 C3� 4� 6. Total=0 +2+3+4+5) S &-V"' Check Number This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date i '� I �,� i i I i i File#BP-2016-0672 APPLICANT/CONTACT PERSON MATTHEW J DERY ADDRESS/PHONE 408 HOOSAC RD CONWAY01341 (413)369-4447 PROPERTY LOCATION 21 HATFIELD RD MAP 13 PARCEL 048 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 4-44U At,959 Building Permit Filled out Fee Paid Typeof Construction: DEMO ROOF FRAMING&ADD 8 WALLS&TRUSS ROOF SYSTEM New Construction Non Structural interior renovations Addition to Existing AccessoU Structure Buildin Plans Included: Owner/Statement or License 64404 � 3 sets of Plans/Plot Plan �E�G�/� �C THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF MATION 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 m a Signat e of Buildin Of icial 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. �I i II i i, I I i i i I I I I I IIATFIELD RD BP-2016-0672 GIs li. COMMONWEALTH OF MASSACHUSETTS Map:Block: 13 -048 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) C,tegc�r _renovatign BUILDING PERMIT Permit# BP-2016-0672 Project# JS-2016-001145 Est. Cost: $54000.00 Fee: $351.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use GrOU : MATTHEW J DERY 64404 Lot Size(sq. 11): 87991.20 Owner: SZAWLO\k'SKI SHELLEY & D W HOOI{ LLC zoning: Applicant: MATTHEW J DERY AT. 21 HATFIELD RD Applicant Address: Phone: Insurance: 408 HOOSAC RD (413) 369-4447 WC CONWAYMA01341 ISSUED ON.121112015 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO ROOF FRAMING & ADD 8 WALLS & TRUSS ROOF SYSTEM 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: (,:Is: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: "PHIS 13EIZMIT 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 12/1/2015 0:00:00 $351.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner