06-013 493 HAYiLLI`'' BP- 2010 -0618
GIs 4: COMMONWEALTH OF MASSACHUSETTS
`' � , :0 Q13 CITY OF NORTHAMPTON
Lot: -001
Permit BUk[a
Category BUILDING PERMIT
Permit # BP- 2010 -0618
Project # JS- 2010 - 000900
Est. Cost: $0.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RONALD HODGES 003042
Lot Size(sq. ft.): 4213994.40 Owner: MCLOUGHLIN WILLIAM H & JAMES WATSON & DANA CULVER &
BRUCE CULVER & H CULVER
Zoning: RR(38 /SR(62)//WP/WSP Applicant: RONALD HODGES
AT. 493 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 Si
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
File # BP- 2010 -0618
APPLICANT/CONTACT PERSON RONALD HODGES
ADDRESS /PHONE 60 NORTH MAPLE ST FLORENCE (413) 586 -1150
PROPERTY LOCATION 493 HAYDENVILLE RD
MAP 06 PARCEL 013 001 ZONE RR(38) /SR(62) / /WP /WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp Permit Filled out
Fee Paid
Typeof Construction: DEMOLISH HOUSE
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Buildin., Plans included:
Owner/ Statement or License 003042
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
1NF RMATION 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
C
—�-� n —
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.
City of Northampton 5tt�s af�er� f 3
Building Department C CtCDr►vewaer� a
212 Main Street Seuurri�dAirabtl►i _rr
Room 100��fiev�fa.
y
- Northampton, MA 01060 xr ,#
phone 413 -567 -1240 Fax 413 - 587 -1272 tae?Iarr��
;vA �, p�
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE O EMOLISH ONE OR TWO FAMILY DWELLING
.SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
✓ Lot Unit
Fi U 1
w�.J� ®
Map_
/ Zone Overlay District
��G�`'�= j /� Ehn'St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
r� me (Print)( Clirrent Npiling Addres :
Telephone C _ 1
Si nature
2.2`A4horized 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 / (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction: from 6
3. Plumbing Building Permit Fcc
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number 0
This Section For Official Use 0nF
Date
Building Permit Number: 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
Frontage _...__. _. _"
Setbacks Front µ `"
Side L: _. R _ ._.. L _._- _...__. R. __` _...........
Rear
Building Height
Bldg. Square Footage _ %
Open Space Footage % _
(Lot area minus bldg & paved
p arkin g )
# of Parking Spaces
Fill:
(volume & Location) - --
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO �DONT KNOW 0 YES
IF YES, date issued:•.;
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON KNOW 0 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
Jo
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 0 NO
IF YES, describe size, type and location: '.
. .. �. .. . ........... .. -_.. .. _.._. ... . .... _...._..
"` D_ — t ere`an rn nsPii "�han Ps to nr "a > >nnc n s ns intan ri fi:F_f P NO
rn ort z YFS 0
S� (� P Y
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, cavation, 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 Permit from the DPW is required.
r
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition Replacement Windows Alterations) ❑ Roofing ❑
Or boors
Accessory Bldg. ❑ Demolition New Signs [E3] Decks [p Siding [E:3] Other [ [3]
Brief Description of Proposed
Work: 'TC� �CL7` ✓�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa. It, Nevlr hawse .and or addition to exis "ting k ousfng, complete the #oiFou�rin :
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 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: - T4 BE COMPLETED ! WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING;11 T
as Owner of the subject
j property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
J Signature of Owner Date
as Owner /Authorized
Ag6Whereby de re 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.
oa
Prin Name
igna of Opferlkgint Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable
Name of License Holder POP Y , n CGS
License Number
ST
Address Expiration Date
Signature Telephone
Not Applicable g
Company Name Registration Number
` Address Expiration Date
Telephone
S ECTION 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...... ❑
T_he_current_exemption for_ "homeo- w-niers" 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 consid 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 Suuervism yuui presence on the job site will be roquired from time to time, during and nrnn
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 an4 assumes responsibility for compliance with the State Building Code, City of
ttsGeneral L -aws- Annotated.
o amp oti r mantes; a
Homeowner Signa L
a
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.massgov /din
- Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/ Organization /Individual): _ c �' �° /7 �(.1, ; y ,= J� cv w
Address:
City /State /Zip: f iy lVbi U r-, 067 > Phone. #: ' / /,Y �26 k . elS
Are you an employer? Check the appropriate box:
❑ I am a g '
4. general contractor and I Type of project (required):
I am a homeewaer�iein
1.X I am a employer with
employees (full and/or part-time).* have hired the sub- contractors 6. ❑New construction
2. El am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have. a: to jeer These sub - contractors have. g. Demoli'
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insuran _ comp: insurance_#
required-] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
g am c�rlC -- - -- _ e v
ofdaczs�aa xem kes3._tthei� LI ❑�'Imnb in g or additions
— -- r
myself [No workers' comp. right of exemption per MGL 12. Roof repairs
insuran required] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.].
'Any applicant that checks box #1 must also fiIl out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doinga1l 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- contcaciors have employees, they must provide their workers' comp..poficy number.
lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
__�ormalion.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: 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 Seciaon"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. lye advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verific
I do_hereb �_certi un
y fy � thep ' and aloes ofp that the a :formation provided above_ittrue_aridcvrrect____ .
Si tur ` ate .�
Official use only: Do not write in this area; io be completed y eity or town offu iaL
City or T o wn: Permit/License #
Issuing Authority (circle one):
Board of Health 2. BuiMinb Department 3. City/Town Clerk 4. Electr Insp 5. Plumbing Inspect _
6. Other .
Contact Per son: Phone #-
�r
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 Northampton wants 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
regulatio The inspecti -p-mEesi il� res that the building department be calle to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before your) a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspectio The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupa
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 hired secure their proper
conjunctionto _theaau gTernit issued,_and-that 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
J understand the above.
cme ow r /resi n '` signature requesting exemption)
11 o schedule all required building inspections necessary for the building permit
issued to me.
.T =a Z�2���_
Address of work
locatio
PLANNING AND DEVELOPMENT • CITY OF NORTHAMPTON
planning - conservation - zoning - northampton GIS - historic - community preservation - central business architecture
■ Wayne Feiden, FAICP, Director of Planning and Development - Wfeiden @NorthamptonMA.gov • 413 -587 -1265
„
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 Hall - 210 Main Street, Room 11 - Northampton, MA 01060 - www.NorthamptoriMa.gov o , Fax 413 - 587 -1264
original printed on recycled paper