37-102 (2) 4
67 ICE POND DR BP-2016-1285
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37- 102 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit# BP-2016-1285
Project# JS-2016-002210
Est. Cost: $22000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JDR BUILDERS 074105
Lot Size(sq. ft.): 15333.12 Owner: ZUCHOWSKI EDWARD S JR&DEBORAH M ZUCHOWSKI
Zoninp-: Applicant: JDR BUILDERS
AT: 67 ICE POND DR
Applicant Address: Phone: Insurance:
P O BOX 4 (413) 665-7587 WC
NORTH HATFIELDMA01066 ISSUED ON:5/9/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.•CONTRUCT 14 X16 PORCH
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 5/9/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1285
APPLICANT/CONTACT PERSON JDR BUILDERS
P�
ADDRESS/PHONE P O BOX 4 NORTH HATFIELD01066(413)665-7587 f
PROPERTY LOCATION 67 ICE POND DR J
MAP 37 PARCEL 102 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid t
Building Permit Filled out
Fee Paid
Typeof Construction: CONTRUCT 14 X 16 PORCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine Plans Included:
Owner/Statement or License 074105
3 sets of Plans/Plot Plan
THE FOLLOWING 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
Demolition Delay
Sig ure of ffu-igimfOfficial 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.
Department use only
t ity of Northampton Status of Permit:
wilding Department Curb Cut/Driveway Permit
fJ 1. +212 Main Street Sewer/Septic Availability
} Room 100 Water/Well Availability
c. 1ONS NO 'hampton, MA 01060 Two Sets of Structural Plans
one -587-1240 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 completed by office
Map Lot Unit
Zone Overlay District
i
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Pri Current Mailing Address:
q13 - _s -7 St- 7t2 433.
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building � � loo (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) i.'GCr Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings 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 /5-/ 3-1 / l S-, 3 2-J
Frontage Y '
Setbacks Front
Side L: q D R: q q L: L10 R:
L
Rear 7S�
Building Height 5 7'eQ'7
Bldg. Square Footage % Lw
Open Space Footage j % s
(Lot area minus bldg&paved /ZZ 3 (� 7; °7,�
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO (,?r DONT KNOW O YES O
IF YES, date issued: �h' ' � " �` I''"'s r`,
IF YES: Was the permit recorded at the Registry of Deeds? 12, tvc:L P Fie '�°�
NO 0 DONT KNOW ® YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO (Del', DON'T KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained O , Date Issued:
C. Do any signs exist on the property? YES0 k27
NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, excavoAft,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs (tom] Decks [Q Sidng0] Other[o
Brief Description of Proposed r {�
Work:
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?
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
as Owner of the subject
property _ -7 (�
hereby authorize �'�� 1 �5 i`Ye-.4jj ti`s f 6 / 4���i�� IA.-<
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner 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 andel penalties of perjury.
Print Name
Signature of O er/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Y►� 5
Name of License Holder: r G1/0
License Number
Addr s Expiration Date
t � / 7 .Sj
Sign Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
J lX iRba-6 En--- //L* 1 S 7 �
Company Name Registration Number
,��, AS£x ( � ,l'�%J7�r Cl�I� sl G �c, 3 )c, j
Address r Expiration Date
Telephone ak - -7
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
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
W Office of Investigations
d 1 Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): F - I d 1..,E WC _
—7>
Address: "r, E � Y
City/State/Zip: i\)6),, liY +F/C-'IZ n,4.-a0K Phone #: Lt/ - Til
Are you an employer? Check the appropriate box: Type of project(required):
1.[tl am a employer with 4. ❑ I am a general contractor and I 6. ❑
New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• 9. E] Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.0 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
employees. [No workers' 131-1 Other
comp. insurance required.]
*Any applicant that checks box#1 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 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: �,e c. �'V 5 - � �✓
Policy#or Self-ins. Lic. #: W C �] � ��L� / Expiration Date:
Job Site Address: 6'.7 16f: 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 t IA for insurance coverage verification.
1 do hereby certif un ler t e pain d penalties o er'ury that the information provided above is true and correct.
Signa 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#:
City of Northampton 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 Building 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: 6 -7 iCet I ,Q .v o jv oz:
The debris will be transported by:
The debris will be received by: V itd(t-1
Building permit number:
Name of Permit Applicant
Date sl
gnature of Permit Applicant
5/4/2016 Northampton,MA:Residential Property Record Card
Building Sketch /
34 Descriptor/Area
A:2Fr/B
11 670 sgft
7 B:1 Fr/B
1 Fr/B 800 sgft
8 28 C:FG
6 800 F� 330 sgft
D:OFP
10 1234 sgft
5 16 54 6 �W E:Wood Deck
9 E 8 54 sgft
5 16 6 �,—
y(,� 15 5 \�
2Fr/B 32
FG
22 330 22 22 670
6
8
15 25 14
6 25 D
31
5z
Notice
The information delivered through this on-fine database is provided in the spirit of open access to government information and is
intended as an enhanced service and convenience for citizens of Northampton, MA.
The providers of this database: CLT, Big Room Studios, and Northampton, MA assume no liability for any error or omission in the
information provided here.
Currently All Values Are Finalized For Fiscal Yr 2016.
Comments regarding this service should be directed to: isarafin@northamptonassessor.us
http://www.northam pton.univers-clt.com/view_property_R.php?account_nO=37+-102-001&series card=1 2/2
„GTE=:
1.SDEUNE Q ROCRY Ixl ROM HAS BEEN WD OUT PER MONUMENTS FOUND MDV 192+
COY ACEPTMICE PVN AS S10FM 011 PIAN BY CTD'VN EER DATED MARCH&1954,EAST
OF TME TMiNG.THE TEN(0)TWT WIDE TA OF PARCEL 40.15-18-C M SIOFIN W PLVI .
BOON 90 PACES 69-70 CANNOT BE E1,C,REPROIXICED ON THE GROUND.ANO THEREFORE
1MS RE EN SHOWN HEREON BECINI6NG ADJACFM TO TME M AY I—iD FDItlMJ 011 ME
NORM SDE OF TME ROAD MIO RUNI6NG WESTERLY RASED UPON TME 195!PVN.SIOV ME N
WEST OF ME TA4MG HM BEEN LAID OUT PER M EIFTS FOUND, RAYMOND H.BLU$
2.THE ENTIRE SUBJECT PARCEL AND M.,CEM ROAD ARE LOCATED VNIN FLWO ZONE'C” 8004 3458 PAGE 1.
(AREA Of MIN—PLDDEINC)PER FEL,FLDW MSURANCE RATE MM PMEL 250187-0002-A
EFTECTNE MRR 3,1978.
J.COORDINATES A ELEVATION$WIPE BEEN ESTABLISHED FROM G.P.S.CONTROL POIMS PA-01
AHD RA-25 AS PROVIDED W THE CRY OF NORMANAPTON ENGMEERMO DEPARTMENT,
YASSACHUSETiS MA9 0 COOROIUTE SYSTEM NAp83.
4 LOTS 9A, 1A BA I3 IM I17A MD 21A 26A ARE TO SE DEDICATED TO TIE CM OF
NORTHAM
LEGEND PTON LOTS 9,11,13,14,16,17.21 AAD 26 ARE RE ED AREA LOTS PER --
NORT1WiPT014 ZONING ORDDI CE SECRON 6.3.3.SEE TABI£OF L DONATIONS. "
'51.1w PROPERTY UNE 5.FRONTAGE FOR LOTS 10-15 IS REDUCED PER THE PFO,SgNS Of NDRTMMPTOM ZONING
OR—CE SECTION 6.3.1.
Ot'38'43 7_EASEMENT LINE B.LOTS 21,28 AND 29 AAE NOT RUIDINC LOTS. EAST NOAH_SB39e6.54
101.81'(E) /M59.COORO w 6YSi
WATER UNE ).ABLGHEAlAF AA ELEVATIONS FOR SEER ED CONTROL PpNiS t ANO 2 ME TO BE
ESTMLSHED ALTER THE BWNOS HAVE BEEN SET.
• WIRE FENCE PATHWAYS COHWSING'MC.
BOOR 5743 PAGE BB
Q UNMONUMENTED PROPERTY CORNER eHO 00N.TIONS PFR c CTINI 6a a PLM BOOK 85 PACES 152-154
O IP.FOUND
TOTAL LOT TOTAL AREA PORTON DONATED MM.SZE REMINDER ACTUAL SIZE RETIA MR
6 BOUND FOUND LOT1 9+9A 60.932 S.F. LOT 9A 24.000 S.F. LOT 9:32.979 S.F.
• I.P.TO SE SET LOTS 11+IRA 65.262 S.F. LOT 11A 24,000 S.F. LOT 11:27.792 S.F. ISI
LOT$13+IJA I"_S.F. LOT to 4,000 S.f. LOT 13:11220 S.F.
• BWND TO 0E SET LOTS 14+IM 60,0♦$S.F. LOT tM 24,000 S.F. LOT 11:35.b]S.f.
LOTS
18+i8A 84,120 S.F. LOT 1. 24,000 S.F. IT 18:34.432 S.F.
LOTS 17+17A 80.]27 SY LOT 17A 21,000 SF. LOT 17:49,487 S.F.
LOTS 21+21A 82,631 S.F. LOT 21A 21,000 S.F. LOT 21:39,602 S.F,
LOTS 2612M 3G.7D1 S.F. LOT 28A 12.000 S.F. LOT 28:22.9 S.F. �� \ HH.95'FROM �AB•
EASEMEIF°
4939669.M
DOORDMNTEDRWE.Q1
MASS SYSTEM
\ \
APPROVED BY THE NDRTMAMPiON APPROVED SUBJECT TO REPORT i T THIS PLW ANO SURVEY'CONFORM TO MC \
e
f
PUJMINO BOAHO, CbrENMrt CONATIONS E%FLUTED BY TECHMCA AND PRCCEO ME OIRADNDS FOR THE PRACTKE
n Of LAUD SURVEYING IN TIE COMMONNEµTI OF WSSICIN/$Ei15 �
TLE W.s rLw Wli I Of'
FlQP REC 6Y S01 DEED WRH /�
TMC AR �11pI5 OFdS1ERS OF DEEDS OF \ "°� \ OPEN
DATED ANO RECORDED M
SO-DAR, SPACE
HAIJPSHME CWMY REGISTRY OF DEEDS. STOWED: /NJ,��Y->�1+�-%L \ Z7. 9"A
BOON_PAGE DAlE: _�%T/a L[20 2 "�'�j1 y0 4 Q ^ \
y N7'+ v J• h y •A \\
h �,�:r 100•BUFFER ZONE
37.470 N.
EAST
NORTH-29393D.32 q. �4�, .�•
-34aers.0 �9^ ,, 'fb vH. \
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LOCUS REFERENCE: PER$IECTp!R
COMMONWEALTH OF MASSACHUSETTS Ne
(DEPARTMENT OF MENTAL DISEASES) T.S°6 27.794 q.M1
PORTION OF BOOK 926 PAGE 426 /.q,`
PLAN 90OK 1B3 PAGE 4 (PARCEL E) h' I R� YA
TOTAL AREA = 36.7912 ACRES / 9
PJF 13A SBTSJ•D4'E J2Y19 M1
ET 2 SHEET 5 DO T PORITS 5-21-03 I AREA 2749•0.M1 00.34' �p 0 ���
0 20 40 80 120
FT. DEFINITAIE SUBOMSION PLAN e.
h' 7O sro4u GRAN +25
•0.M1 FASEMENT-MEA L b1
METERS 10M 20M 301A 40M ND h / u• 13.321 yI 18,016 q.M1 m•� WnraN LOT q `8
E HLYA 7iY d ASSOpOES RTNAMPTr7AI swAw Aid JB9z S.F. °�Ys LLQ -� Detention
LAND SURVEYORS PREPARED FOR �•a �g iN4 0 b/r h 1e� :6.664 q M1
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WTCN LME SIEET 2 OF 5 / q ?�j •41 —————— ,L6� ,t603%pk VSE LOT Fa —— 2
SCALE. I' 40' JOB NO.
2002-013-DJ DECEMBER f 00 SHEET 3 OF 5 3 R`6p /51D I .2571 S.F. TCH uNE SHEET 5 OF 5
City of Northampton
Building Department
r Plan Review
j ( 212 Main Street
Northampton, MA 01060
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