22D-120 (2) "0101114~—• BP-2002-0154
GIS#: COMMONWEALTH OF MASSACHUSETTS
414116000t.41init20 > CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:demolition BUILDING PERMIT
Permit# BP-2002-0154
Proiect# JS-2002-0245
Est.Cost:
Fee: $10.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN FERRARI 045108
Lot Size(sq. ft.): Owner: PIONEER VALLEY HABITAT FOR
Zoning:URA Applicant: STEPHEN FERRARI
AT: 109 RYAN RD
Applicant Address: Phone: Insurance:
103 RYAN RD (413) 586-1832
FLORENCEMA'01 062 ISSUED ON:8/10/01 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMOLISH BARN
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/10/01 0:00:00 2279 $10.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
•
File#BP-2002-0154
APPLICANT/CONTACT PERSON STEPHEN FERRARI
ADDRESS/PHONE 103 RYAN RD (413)586-1832
PROPERTY LOCATION 109 RYAN RD
MAP 22D PARCEL 120 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out oc�t9 #/O
Fee Paid i
Tvoeof Construction: DEMOLISH BARN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 045108
3 sets of Plans/Plot Plan
THE F(]1 LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION PRESENTED:
Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and 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 StreetwCommi : of
.t -, _as' /1e: el/J
Signature of:mlding 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.
r
Y re
partment tLpitigiii;
�V
-o0 1L P" FNV Ylab ""u
North. mph• �t„gge�g f •60
phone 413-68r-1246ENOAY'4121168iICe p Ep) S i,t° P: ' "8;'`. • „ .'
1'1 fitititif irrill:%–briDili2l22!frf":4itittiatlftillifliti ii
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
as section to tiom
e completed by office
1.1 Property Address:
Map f I1/} Lot .10Unit____—_
/ 0 et RYan #C pe 01 zone j'C4 #_,.Overlay District
'Elm St.District_ CB District_
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner 01 Record:
me
/once Voile✓ _ybice9i + lop, Curren� aili
�Qng Agqdr�ess.
Signatur—!-r GtitiFr4_______ _ Telephone06 — s-yso d. —el A-J
2.2 Authorized Anent:
_ .S- -FtFzrrrjr1-_. /o- v«A, blo4 c1*avreai,gegt 4
Name(P Intl Current Medina Address:
— Eterzyricr; — !3=Sith—18_ _r
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
I. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Are Protection
6. Total=(1 +2+3+4+5) Check Number Silo --
This Section For Official Use Only
Building Permit Number:____—_ Date
........_--_ _-- aed
Signature:
Building Commissioner/Inspector of Buildings 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
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
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 DONT 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 DONT 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
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:
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0
Or Doors 0
Accessory Bldg. 0 Demolition's New Signs [ ] Decks [ ] Siding( ] Other[
Brief Description of Proposed tx //
Work: Pe4410K5 eXISfrn, RCee sswy Sin/EA rc . °Corotj
Alteration of existing bedroom —Yes No Adding new bedroom Yes _No
Attached Narrative Renovating unfinished basement Yes _ No
Plans Attached Roll -Sheet
Ga.If New.house:afi "iictta'ddition to:th ritthot Pt• • •"'tedh • +` i$:
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. Mascheck Energy Compliance form attached?_
h. Type of construction
i. Is construction within 100 ftof 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
hereby authorize -
-- --yth_— -- — - — - -
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of
Owner Dale
I, 5 L rjeL1 &rt joy- Dn/ neer 14 fk / Q7L
_1G-/4,201/ es Owner/Authorized
Agent hereb 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.
S tciah e 154/4,4 r
Print Nam — — — -- – --
Signatu of Ow ,/Agent Date
SECTION 8-CONSTRUCTION SERVICES ��/
8.1 Licensed Construction Supervisor: JJJ���I� ,, Ferrer Not Applicable �Y /��/. �t-,/�
Name of License Holder: $t/9✓W.__( erre/ y O 1 " ) g
License Number
/0 3 4_ vo•vt- lkoed F%g 42 H 51O2
-;3 '
Address ------- �
Expiration Date
Signature Telephone
S86 - 1f3
9:Rdg1steredlHome lmptsententContractots661 <f_ ,, ,d':`. s.: Not Applicable 0
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 Omer-Exemption •
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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
roo-s lwrnroy
a t� IE.. Crrt� of Northampton 1 --
F _ f
W���r: Ej...=
�'. DEPARTMENT Cl' BUILDING INSPECTIONS
212 Main Street ' Mumclpal Dmldn,6 _ _
Northampton, Mass. 01060
\;'ORICSII'S COMPENSATION INSURANCE_ AFFIDAVIT
cFee „t Fere,
(Iiccnc^Npermince)
6.9115 a pl nc1p2J place of-business/residence at. H 4 p/ �ry
/0 j �"l_Zona__ RI. & a tC+2, (p.ioae;t) S.0( —/d 3 �
(soca/aty/s>uc(➢p)
do hereby certify, under the pans and penalties of perjury, tln;
( ) I :m an employer providing die following worker's colnncns=uon covempe for my
employees .vorhog on alis job.
(lmturm5c Comp=rv) (Paho Nu_ra'ocr) craapi moon Due)
I am a sore proonere , general contractor or homeowner(c cie one) and have hued
We colIn,,..ctos bstea below who� have the fQQtlOOLOOR workers nOrn e radon po'cles
)4vie/ >if 712-ow2-00 /ritte„vim"\ 411 -UM�-SoJ4- 9/) /Aocy
( n a^ o:Cor oaoq (I an.nnc Compan)i ouci re ami-r) bjj—t dd.—grown Dad)
(Nein( of Caoazclor) Qnnranc Company/Poly, Num-aa) (Exrb i ion Daae)
--
(Name of Conuanor) (Insurance Onrupan>ePnIen Namba) (E_cp;ru'uon Dale)
(Name of C000actor) (Iasuranc Comrzoy/Poticy Number) (Ea-prince Dare)
(mta e!3i c Jha:Juce=..a-m t,c✓d Wo-evioep`- min to.n mrysoz)
(Y 1 I ani a sole proprietor and have no one worfang For me
(\) I am a home owner performing all Mle work myself.
Noi : t<&Nrm 16e ytva Fcvo;avm tote cry loy peaoto w.boon-mess _,.c._ .d maz of
.may ex m,>,woc�m a co uti pt,/ n . 5A((=eye c�-s-ad yam
c.yloyct nee Ibe LtLa;o-.--.cm A I(eu S2P I(SU'ppuouoo by•n uommom In t Moot a{wan ony 05AL=ue
I cs,I%tvu of CP r lOye(ALGA dye Wohd.( - , .&boa Act.
I uodmt.od dna a caw atilt;m1 o eat),p.lm+.vo.bd to Wo Dgw.Lne of L.Av.od Amdeay Moo or Loon-woe toe W.
Aaicc ythigththea M thea E Axe to tart bp\nee reit mica 25A of MOL 151 on led to the irr o nice Mcnn,nil paugith
coons of tent o(upto(MOO 00.W(d mpriLLAscy or up to coo 5v ud aVJ(.-n.nio n t rpm of Sop Wort 0. - tack
Gm o(SI00.00•thy,Fpion cc
.iiNumu,W
uy _..
�Ic -
lif 1 ..� - Pawt l Number
Mali Lot
Sign. R 11Liccr FrlFtconuucc —Thar