06-012 509 HAY6�WILI �* : BP- 2010 -0617
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map;B1 CITY OF NORTHAMPTON
Lot: -001
Permit: BuNing
Category: BUILDING PERMIT
Permit # BP- 2010 -0617
111-0 iect # JS- 2010 - 000899
Est. Cost.
Lee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RONALD HODGES 003042
Lot Size(sq. ft.): 26397.36 Owner: MCLOUGHLIN WILLIAM H & JAMES WATSON & DANA CULVER &
BRUCE CULVER & H CULVER
Zoning: SR(100) Applicant: RONALD HODGES
AT. 509 HAYDENVILLE RD
Applicant Address: Phone: Insurance:
60 NORTH MAPLE ST (413) 586 -1150
FLORENCEMA01062 ISSUED ON:1212312009 0:00:00
TO PERFORM THE FOLLOWING WORK.- DEMOLISH HOUSE
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 12/23/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
He # BP- 2010 -0617
APPLICANT /CONTACT PERSON RONALD HODGES
ADDRESS /PHONE 60 NORTH MAPLE ST FLORENCE (413) 586 -1150
PROPERTY LOCATION 509 HAYDENVILLE RD
MAP 06 PARCEL 01 t 001 ZONE SR(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: DEMOLISH HOUSE
N ew Construction
Non Structural interior renovations
Addition to Existing
__` A ccessory Stn�chrre
Building Plans Included:
Owner/ Statement or License 003042
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
Jam, Z 2 3 L�
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.
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e 40 ar#rrleAt fise
City of Northampton std yr
Building Departmentriur�vewr
212 Main Street 1SeficAvarla)ul
Room 100` ellAvar�abTit h
Northaf:pton, -MA 01 -060. �io�ai�rrt
phone 41'87 1240 Fax 413 -587 -1272
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APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE O DEMOLI A ONE OR TWO FAMILY DWELLING
SECTION 1. Sll`E 1NFRJfIfATfON
1.1 Property Address This section to be completed by office
Lot 1 7 Unit
s
�f vne -
QuerfajrDrsttfiei
rn CB District
M El S�is#rleY
SECTION 2 -PROP ERTY. 0WN_ERSHIPL4. HOt�4�ED T::
2.1 Owner of Record:
NamePrint Current Mail dress:
t C�Z/ ��rn -- 6
f Telephone C/
ngna _
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
701 3 E iNFAT1= ON5T13U COi+11 .t)STS
Item Estimated Cost (Dollars) to be µ Official Use Only
completed by ermit applicant
1. Buildinga }t3uifding'eFrirt Fee
2. Electrical _ «ifs) Esttriaat�d Festal Ccys€:of
nstruclior from:.:6
3. Plumbing f d'Ing Peniait Fce
4. Mechanical (HVAC)
5. Fire Protection =
6. Total = (1 + 2 + 3 + 4 + 5) Cf J 0
Date
Buildirrg:Permit Numbe Is sued:
Signature:
Bnrli*v Col rnissioridrlCnsp.ectcr ef$ari l ngs Date
Section 4. ZONING Alt 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 t
Side L: R: L: R: t #
e t
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(L.ot area minus bldg & pavedV'
# of Parking Spaces --i `- - -
Fill: f
volume & Location
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW ® YES 0
IF YES, date issued: ^ `
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW _0 YES 0
IF YES: enter Book i Page - - -r 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 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES ® NO
IF YES, describe size, type and location:
rw : ere any props .. r_ antg s n nr at , t nF n gns m r?n nr P j Mj Wir 7 YFS 0 NO
XV
IF YES, describe size, type and location:
E. VA the construction activity disturb (dearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that MR disturb over 1 acre? YES � NO M
IF YES, then a Northampton Storm Wate fMnagement Permit from the DPW Is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Re placement Windows Alteration(sj ❑ Roofing ❑
Or Doors 0
Accessory Bldg. 0 Demolition 0 New Signs [0] Decks [Q Siding [Oj Other [E3]
Brief Description of Proposed
Work: /�r'9,�i d���r✓�✓ /p/l1s? �d�/c�G�G` r�� �i'hl�C��� �Jcfc/!5E'a
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
. :octse ar>d _or afd'itloc.o e>QStrg housing.- complete "tA� f fug:
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 o f stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Complianoe 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: i'a OtA1MC -E€ #t1TtiORIZATION �O BE COWIFLETE[s(=
OWNERS AGEHtF" Ok*kAGTORAPPUESFOR BtAbW[ =PE 1118 t'
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
as.Owner /Authorized.
Agent hereby declate 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.
Cif '
Pnn Name
� .
at r /Agent Date
ti
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Super Not Applicable J$
Nam o,2f Ucense Holder : /� I 6 L� �i -S
License Number
Address Expiration Date
Signature Telephone
Not Applicable
Comoam Name Registration Number
r
Address Expiration Date
Telephone
SEC TIO . 0 - ' WORDS' CQ PERSA f10lII t1i +iC E A lik4 L -c.. . ib2, § ( &)j
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...... ❑
exemption.far_`-%o was extended to in clude Owner - occupied DweUinas 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 snnersisor..CMR 780. Sixth Ediflon Section 1083.5.1.
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 `Uoineosrrxe� -shall submpt to #he gvi1irig Dtliciai, on a form acceptable to the Building OfTrcia that he/she shall be
responsible Loran such work performed wader the buildine permit.
As acting Conanraction 3uuervhcur yuui presence on the job site will be roquired from time to time, during and 11pnn
completion of the work for which this permit is issued.
Also be advised that with referencelo Chapter 152 (Workers' Compensation) and Chapter 153 (Liabilit3;4Employers 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 undersd igned "homeowner'' certifies and assumes responsibility for compliance with the State Building Code, City of
- e - - - --
o _
Homeowner Signatu
i
r
The Commonwealth of Massachusetts
Department of Industri& Accidents • .
Office of Investigations
1 600 Washington Street
Boston, MA 02111
wives- massgov /dra
- Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ApPlUcant Information Please Print Legibly
Name ( 3usiness /organii2don/fn&vidual): % a!
Address:
.City /State,(Zip: Phone. #: xvIzF -
Ar you an employer ?.Check the appropriate - box: Type of P ( require project ro
. q� 4_. E] I am a general contractor and I � .
I , 1 I am a employer with 6. 0 New constcnetion
employees (full and/or part tirne).* have hired the sub - contractors
2.0 I am a sole proprietor or:pintncr-
listed on the sheet. 7. 0 Remodeling
ship =d• have as , These sub - contractors have •8. De�io;ti`ion
working for me in any capacity. employees andhave workers' 9. Bull addition
(Ne w0deep comp. insurance 10.0 Electrical repairs or additions
required:] - •
S. El We are a corpoiation and its
1Immbsag repairs or additions
v V " myself- [No workers' comp. right ofexeniptioii per MGL 12.E03 repairs
insurance required.) T c: 152, X1(4), and we have no 13.0 Other
employees. [No workers'
c0MV- insurance } .
'Any applimw -that ehecla -box #l: oust also fin oat the section bdow showing th* wod=s boa policy iaformatign
t Homeowners who-sW= this affidmdtm&catmgAhty aze damgal work amd dmhue ouWde-contcac Wts mast submh anew affidavit b&caling such
tcomwtws that check this box must .a an additional sheet showing the name of the sub-coM = tats a� tat
se wbea= arnot dx se uddes have
ernployem rf Hie sub- =kaconts nave employees, they motproridt flub woti = comp. policy number.
tam an employer that is providing workers' compensation insurance for my employees: Befow is the policy and joh - site
ixforraati -. - .. - ••
V Insurance Company Name: .
Policy # or Self-ins. Lic. #: Expiration Date: -
Job Site Address: Cit3dStatmaip:
Attach a copy of the workers' compensation pol cy-declam#on (showinn the policy number and'eapiratian date
Failure to- secure coverageas requit tut9er $ectty -'25A of MGL' c. 1.52 can lead to the iatposztton of cal pesalhes of a
fine Up to SI,500.00 and/or one= year as well as civil penalties is the foam Qfa STOP WORK ORDER, and fine
of up to $250.00 a day against *violator -- fie advised gt a copf of-d3is stanement maybe forwarded to the.Oglre - of
by gations of the MA for insmance coverage verification
I do hereby certify der the pains erraltces a'Pa!!Q9. tlu i�rfarmmYean�rroxulednbstve� ,tsrtienadcorr� _
D aft
Si
D ial use only. o not write v1 area, to_ a camp y .Zi ar town a '
__City or Town: P nL*t_R•icenc #
Issuing Authority (circle one):
}:
Board of Health Z. B Department 3. City/Town clerk . 4. Electrica Inspector 5. PIumbing luspector - -- 6. Other --
z
Contact Person: Phone #:
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 Northa.mptoiLwants 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 ink _ ion �5 r :that the b i ding department be calm t
inspect work at various stages, which include foundation/footings (before bacM},
sonotube holes (before your), 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
securethese.inspections,can_r _ esult in n- failuire 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 hived secure their proper
p erm s k conn,ncti - = dAhat they get their required
inspections. Failure of the individual trades to secure: the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
understand the above.
M o / esic entls signature requesting exemption)
I will o_schedide all required building inspections necessary for the building permit
issued to me. -- - -
Address - of work '
location
a
PLANNING AND DEVELOPMENT • CITY OF NORTHAMPTON
4
C�
planning • conservation • zoning • northampton CIS • historic • community preservation • central business architecture
f
Wayne Feiden, FA1CP, Director of Planning and Development • WfeidenO%NorthamptonMA.gov • 413 -587 -7265
December 18, 2009
Louis Hasbrouck and Anthony Patillo
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
RE: Map ID: 6 -11, 6 -12, and 6 -13
493 and 509 Haydenville Road
Dear Mr. Hasbrouck and Mr. Patillo:
At their meeting on November 23, 2009, the Northampton Historical Commission reviewed the
structures at 493 Haydenville Road and at 509 Haydenville Road. They determined that these
structures are NOT historically significant and that the Historical Commission will NOT impose
any demolition delay when the owner applies for a permit to demolish the structures.
Please feel free to contact me if you have any questions.
Sincerely,
Wayne Feiden, FAICP
Director of Planning and Development
City Iiall • 210 Main Street, Room 11 • Northampton, MA 01060 • www.NorthamptonMa.gov P Fax 413 - 587 -1264
original printed on recycled paper