42-009 305 WEST FARMS RD BP- 2011 -0914
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Bloc 42 - 009 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: demolition B UILDING PERMIT
Permit # BP-2011-0914
Project # JS- 2011- 001494
Est. Cost: $5000.00
Fee: $20.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KENNETH LYNDS 013668
Lot Size(sa. 1): 25613.28 Owner: NUNNELLY JAMES M & ANNE M
Zoning: SR(iiiyi /A�% Agpl f;ernt. KENvAv " ', ", JD f3
AT: 305 WEST FARMS RD
Applicant Address: ' Phone: Insurance:
P O BOX 448 X413 584 -9282
LEEDSMA01053 ISSUED ON. 5112120110.00.00
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. 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 RE
Certificate of Occu an y Si nature:
FeeType: Date Paid: Amount
Building 5/12/20110:00:00 $20.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
File # BP- 2011 -0914
APPLICANT /CONTACT PERSON KENNETH LYNDS
ADDRESS /PHONE P O BOX 448 LEEDS (413) 584 -9282
PROPERTY LOCATION 305 WEST FARMS RD
MAP 42 PARCEL 009 001 ZONE SR(100) //WSP II
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 BARN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 013668
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 Vii' tia F I'c �( �Q : o = coLt,A, jTC, or,DC. j) pepo '
�/ — IP. 11
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
x
Building Department
, REQUYED 212 Main Street
Room 100
OW
_ 6 �!� Northampton, MA 01060
hone 13- 587 -1240 Fax 413- 587 -1272°
STRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Protaertv Address /M fi d A` This section to be completed by office
Tom"' Map Lot Unit
Zone, Verlay Ads, Gt
'Etn1, Si District CB District
SECTION ,2 - PROPERTY' OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
Tim* 1juat 96S LAV40 f - ",$ LoAD
Nam (Print) Current Mailing Address:
G�,f6
Telephone
igna re
2.2 uthorized Anent:
Name ( Current Mailing Address: Q
Si ure Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed b' permit a licant 1. Building , er (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 = 0 +2+3+4+5) Check Number Q J
This Section For Official Use Onl
Date
Building Permit Number. Issued:
Signature
Building CommissionerAnspector_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 lied in by
Building Depanm t
3 5
Lot Size
t
Frontag
Setbacks Front
Side L: s__.__.- R: L 1 --- J Q i R: F
Rear `•,. i „.
Building Height1
Bldg. Square Footage % ---
Open Space Footage %
(Lot area minus bldg & paved
p arkin g)
# of Parking Spaces I —•• - --
y
Fill:
volume & Location
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT,KNOW YES
IF YES, date issued: -�
IF YES: Was the permit recorded . at the'Rggistry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book Page and /or Document #[
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0
. f.
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. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO
IF YES, describe size, type and location: i
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTIONS- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows ' Alteration(s) ❑ •Roofing ❑
Or Doors
Accessory Bldg. Demolition New Signs [E3] Decks [M Siding M `'' Other [CQ
Brief Description of Proposed $+-_ A Q� �� �,_l�� ��\` 4 9 i - 6ff
Work: f�PV" (l�r"' 1 DV�N
A & w- #
Alteration of existing bedroom Yes No Adding new bedroom Yes No •
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
0
sa fern►iis�.ii iisnaosl �a�+ni�re>oilWi�
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"
1 �; �•.(/►/1if JIJ G as Owner of the subject
property
hereby authorize �'L �� -,4 7- 9L
to a IA n my behalf, in all matters relativ to work authorized by this building permit application.
Signatu of Ofvner Date :;
�•r► ` L yM �j '/� • ./ �' as AwWWAuthorized
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 un r the pains and penalties of perjury.
e *n W N�
Print Name
• -f t
Sign re Qpar /Agent ate
SECTION 8 - CONSTRUCTION'SERVICES
8.1 Licensed Construction Supervisor Not Applicable ❑
if
Name of License Holder 4 N'w"L N J; a s 134
License Number
^x Pf l z y • Z (f
1 "
Address Expiration Date
,.,, c .. — f 6re phonei
Not Applicable ❑
Company Name Registration Number
Addre wJ Expiration Date
Telephone afi'S Z
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M -G.L. c. 152, § 25C(S));
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...... ❑
r °.
k 9 '
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 p ss a license, provided that the owner acts
as supervisor. CMR 780 Sixth Edition Section 108.3.5.1.
Definition of Homeowner Person ( who own a parcel of land on whi be /she resides or intends to reside, on which there
is, or is intended to be, a one or two fam' dwelling, attached or deta ed structures accessory to such use and/ or farm
structures. A who constructs mor an one home in a tw ear eriod shall not be considered a homeowner.
Such "homeowner" shall submit to the Buildin Official, on a fo acceptable to the Building Official that he /she shall be
responsible for all such work erformed under the buildi ermit. `. .
As acting Construction Supervisor your presence on e ' site will be required from time to time, during and upon
completion of the work for which this permit isissued.
Also be advised that with reference to Chapter 152 ' orkers ompensation) and Chapter T53'(Liability of Employers to
Employees for injuries not resulting in Death) of a Massachuse General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this pe it. •.
The undersigned "homeowner" certifies an toning stAnes responsibility for compliance with the St Building Code, City� of
ate
Northampton Ordinances, State and Loc Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
a
CITY OF NORTHAMPTON
Construction Debris Affidavit
In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work
covered by a Building Permit shall be disposed of in a properly licensed disposal facility,
as defined by M.G.L. c. 111 § 150A.
Address of Work: 3 6S' l M w
- -- -
The debris will be transported by: OK A W 4 "
The debris will be received at: G?o,r'?'c it - r t w o ~-
Signature of Permit plicant -G� �f✓
Date IV
�f
Building Permit Number:
' T
The Commonwealth of Massachusetts
Department of Industrial Accidents "
Office oflnvesdgadang
600 Washington Street
Boston, MA 02111
www.massgov/dia
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumb.ers
Applicant Information Please Print Legibly
Name (B 'vidnal): .0 •... L�. �, LJ
Address: 7 [ ! 4✓00 4 ✓i /'L
City /State.(Zip: 4.&Cj�o o.!) Phone. #: Y/ S - S8
Are you an employer ?.Check the appropriate'box.- T e of io'(required):
• .- tn a eneral contractor and I ..� ect p 1
1. ❑ I am a employer with 4 ❑ 1 a g 6. ❑ NOW construction
Ioyees (full and/or part time).' have hired the sub- contractors
2- 1 am a sole proprietor or partner- listed onthe;:ax#acheii sheet. 7. ❑.Remodeling
ship and have. na e�loyem These sub - contractors .have. .8. Q Den iolition
wo for Me is any e�Io,_yxs and`bave wogs'
y cap�ty l arfdnon
�_. �.:.
r ecL 5. 0. We are a corpoiatron and' 10-FT Electacal repairs or additions
officers xercismb'
3. El am a hom offi have ed their 1 L ❑ .
eowner doing aII work •� . Plu ?ng r epairs or additions •
myself [No workers' comp. right 6f exemptsari per MGL 12 Roof ans
t c. 152, § 1(4) and 'we have no
insurance required.] 13.❑ Other
� -
con p
• msMranc C Mpiired }
'Any applicant Shat checla box #1 =mwt also fin out the section below Aowmg theswodoers•..compeasation policy idermatiaa_
f Homeowners who submit this affidavit.indimem they ate doingalt work and then. hire outside contractm must submit anew sTRIavit indicating such -
=Co==tms that check this box tmat.att whed = additional sheet siwwi g the time of the sub-cont acxots and statcwhellier- ornov&ose-entides bave
employees. 1f the sub- caakacW bave employees, they mustprovide dins workers' comp._policymmmber.
I am an employer that &providing workers' compensadon insurance for my employees Below is thepo&7 andjob
information.
Insurance Company Name:
Policy # of Self-ins. Lic. # E tpitation Date: .
Jo S ite Addre
-Attach a copy of the workers' compensation policy declaration page the p9licy number and irat<on date).
P� - - .. .
Failire. to secure coverage* required 1636 .g eahvn - 25A ofMGLC ` 15Z can lead to the iuiposrttori ofcnmuit;I penarhes of a
fine up to $1,500.00 and/or one.- year sonment, as well_ as civil. penalties in the fours of.a STOP WC and a fine
of up to $250.00 a day against the vioL3tor. Be advised lint a copy of dais statement may be forwarded to the O$ice:of
RLft ofthc bIA for Msurancec0V&axRFi erffic tion
ldo hereby_ Gertz under the and �alt<es ofperfury:fltaf the information provuledlrbav is e _aadearr
Phone #
Oieial use only. Do not write in this area, to be comp by ctty or tow n official
City or Town: NrmftUcense. #
Issuing Authority (circle one):
J. Board of Health 2. Building Department 3. City/Town Clerk .4. Electrical Inspector 5. PIumbing Inspector
6. Other
Contact Person: Phone #: