10B-017 Rt3 BP- 2010 -0904
GIs #: COMMONWEALTH OF MASSACHUSETTS
10B - 611 V CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinci DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate BUILDING PERMIT
Permit # BP- 2010 -0904
Project # JS- 2010- 001339
Est. Cost: $10000.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: LOUIS MONTGOMERY 013471
Lot Size(sq. ft.): 17075.52 Owner: BARRETT MICHAEL
Zoning: URA(100)/ Applicant: LOUIS MONTGOMERY
AT: 48 RIVER RD
Applicant Address: Phone: Insurance:
PO BOX 951 (413) 268 -2028 O
WILLIAMSBURGMA01096 ISSUED ON :411612010 0:00:00
TO PERFORM THE FOLLOWING WORK.- CONSTRUCT 8 X 16 DECK, REMODEL
KITCHEN & INSTALL 1ST FLR REPLACEMENT WINDOWS- MUST SUPPLY DECK PLANS PRIOR
TO SONOTUBE INSPECTION
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 4/16/2010 0:00:00 $60.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
File # BP- 2010 -0904
APPLICANT /CONTACT PERSON LOUIS MONTGOMERY
ADDRESS/PHONE PO BOX 951 WILLIAMSBURG (413) 268 -2028 Q
PROPERTY LOCATION 48 RIVER RD
MAP l OB PARCEL 017 001 ZONE URA(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
Tvpeof Construction: CONSTRUCT 8 X 16 DECK, REMODEL KITCHEN & INSTALL 1 ST FLR
REPLACEMENT WINDOWS
New Construction
Non Structural interior renovations
Addition to Existin
AccessorV Structure
Buildinc Plans Included:
Owner/ Statement or License 013471
3 sets of Plans / Plot Plan AA to S T S Lk e PLy b EG K PL A r1.S P 2 14 Ty S (, ),) n TN � -6- WI PKYt
TH QLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I F ATION 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
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
Building Department
212 Main Street
q Room 100
Northampton, MA 01060
phone 413 - 587 -1240 Fax 413 - 587 -1272
n
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address
e",sz6��p Map Lot Unit
Overlay District
Etm =St _ CB District
SECTION ;2 - PROPERTY OWNERSHIPIAVTHORIZED AGENT
2.1 Owner of Record:
Name (Print) �iurrent Mailins�dr� s: r 3 �O 2—
1_ �( / r jTelephone
Signature `
2.2 Authorized Accent:
Name (Print) Current Mailing Address:
Y . , 3 ?. (.► a -- - Z
Signat_ 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 o (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) , �'�� v✓ Check Number
This Section Far i 17 UsW Onl
Date
Building Permit Number "'Issued:
Signature:
Building Commissionerllnspector.of Buildings _.. Date
r
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 C c.��( `. �...
Frontage L e i 5 t ,
Setbacks Front _.
Side L: 'JL I _1 R: L/ s j L: � R j.,.,:_I.,,_
Rear _.
Building Height 5 ILI BLD4
Bldg. Square Footage 1/0 �o C R� U><'J A
Open Space Footage % I �
(Lot area minus bldg & paved�`��� 1 U �`( ✓V I '
p arkin g)
# of Parking Spaces
Fill: i
volume & Location)- — ----- -- — A. Has a Special Permit/ Variance/ Findin ver been issued for /on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Reg,Wry of Deeds?
NO DONT KNOW YES 0
IF YES: enter Book i Page! Document #
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES 0
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:e — tire any proposes c angel o or a rtlon� ssignsntened 1 or - tTie property ? YES Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exc ation, 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.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement�dows Alterations) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0J Decks [SK Siding [O] Other [C)
Brief Description of Proposed 1 ( - L, - )Cel- - 4 1 4 -, -.��.Y
Work: p�•v /QO $' / Cr Dec 4 _ Con a4�yr TC.�/ 4 /V'� � i W:roO� S f fil Ov
Alteration of existing bedroom Yes V No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a I f E 1.O1�S@ It OI' flE It kti , *7f[ EFIiT�tOt1st1Cf 4t11 Y b llw Q:
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 yell City water Supply
SECTION 7a.- OWNER AUTHORIZATION:.- TO BE! COMPLETED WREN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject
property
hereby authorize
to act on my Peh If in all matters r lative to work authorizbd by this building permit applica on.
Q- tilt � �
Signature of Qwher Date
I ,�vv�� fiCa• -� T �+d �-�+ 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 r pa i ns and penalties of pe
Print Nam
Ll
Signature of wner /Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor ,° Not Applicable ❑
Name of License Holder L Q ,l /_ 7 Af 0,- r y V d 04.*2 , Y -71
License Number
Address //
Dat
Signatur Telephone
- Itegfstr+rrl htdt
Not Applicable ❑
j ne p �� rayetirnetelaiiittat+or . ;
Company Name Registration Number
� Address E
piration Date
f U '5 J l W/ 1611- f /S - "" Telephone �i� $ r Z ��• z �' /��� f/
S ECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (N .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...... ❑
�-
-The-current-exemption for_ "homeowners" was ex 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
o amp on r mantes; a e s General _Laws- Annotated.
Homeowner Signature
B
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.massgov/dsa
- Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual):
Address:
City /State/Zip: Phone -M
Are you an employer?. Check the appropriate box: Type of project (required):. /�
1. ❑ I am a employer with 4.. ❑ I am a general contractor and I
/employees (full and/or part time).
* have hired the sub- contractors 6. ❑New construction
2. (� I ani a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no. employees These sub - contractors have. .8. ❑ Detriolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insurance comp...ins ance ...
required:] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
officers veeTSised
3- ❑ 1 ani - a - homeowner- doing all
-- - ever- lr - - - -- _ _ ha .; -their — 1- 1- . ❑- P1umbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.
c. 152 4 ❑ Roof repairs
insuran required] t ' § 1 O' and we have no
employees. [No workers' 13TJ Other
comp. insurance required].
'Any applicant that checks box #1= must also fill out the section beiowshowing their workers' compensation policy information.
t Homeowners who submit this affrdavit.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 sbect showing the name of the sub - contractors and state whether or not those entities have
employees. if the sub - contracts 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 joh she
in ormaiwn.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
J 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 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 is the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. 13e advised that a copy of this statement maybe forwarded to the Office of
Investisations of the DIA for insurance coverage verification
I do hereb cen under the ains enaldes o .. a that the in ormation rovided� hove usrue_aridcorr ct --
-- - - - - -- -y. fy p. }p-rjuy f p
Si
D
Phone #: -
Official use only. Do not write rn this area, to be comp died by city or town bridaC
City or Town: Permit/License #
Issuing Authority (circle one):
- I. -Beard of Health 2. Buil ding Department 3. City/Town Clerk .4. Electrica Inspector 5. Plumbing Ins ector
6. Other
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 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
xegul atinns The inspection proc�s�re� s that the building de be call to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour), 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
secure these inspections can result in failure to obtain a certificate of occupants
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
— - - - - - -- pests- in- con}unction.to_the_bu n rmit imed,- _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
L understand the above.
.(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Address of work
location
-NOTE-
' THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
79. 72 f
i�
o Parcel 2
o REFERENCE:
00 BOOK 10028, PAGE 155
µ PLAN BK. 45, PG. 2
\ Parcel 1 NOTE:
SUBJECT TO EASEMENTS AND
G RIGHTS OF WAYS OF RECORD.
o y cA
co
c ( 4
99.92'±
RIVER ROAD
TO: FLORENCE SAVINGS BANK AND
CONNECTICUT ATTORNEYS TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION. KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY /250167
—NOTE—
SURVEYOR: �h c. l� THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
�H C 'us — MORTGAGE LOAN INSPECTION PLAT —
NORTHAMPTON, MASSACHUSETTS
RAN ALL PREPARED FOR
JOHN MICHAEL BARRETT
SCALE: 1 " =30' FEBRUARY 24, 2010
~0 S�; HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS