44-123 1123 FLORENCE RD BP 2010 -1065
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map.-Bloc 44 - 123 C ITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -1065
Proiect # JS- 2010- 001566
Est. Cost: $37100.00
Fee: $222.60 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor. License:
Use Group: STEPHEN D ROSS 079160
Lot Size(sq. ft.): 59677.20 Owner. SIRACO SANDRA J & DEBORAH A BLUME
Zoning: SR(100, ) //WSP II Applicant: STEPHEN D ROSS
AT: 1123 FLORENCE RD
Applicant Address: Phone: - - -- Insurance:
3.6 SERVICE CENTER RD (413) 584 -1224 O WC
NORTHAMPTON MA01 060 ISSUED ON :61112010 0 :00:00
TO PERFORM THE FOLLOWING WORK.-CONVERT DECK TO 3 SEASON ROOM
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: I
Footings: s-'° OK
Rough: Rough: _ �l W House # Foundation:
d �� Driveway Final:
Final: Final: ? //S — A U/J�'�
Rough Frame:
i
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: diro
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULA IONS. j
/7 arA
Certificate of Occupancy re:
FeeType: Date Paid: Amount:
Building 6/1/2010 0:00:00 $222.60
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
�a►t /2jZ�c7
File # BP- 2010 -1065
APPLICANT /CONTACT PERSON STEPHEN D ROSS
ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413)584-1224()
PROPERTY LOCATION 1123 FLORENCE RD
MAP 44 PARCEL 123 001 ZONE SR(100, )//WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid i
Typeof Construction: CONVERT DECK TO 3 SEASON ROOM
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/ Statement or License 079160
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO RMATION PRESENTED:
_JZApproved 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
slze
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.
C?epartrnOnt use d'oly
- -Cifjr of Northampton Status,of Permit
Building Department Curb_Out %Drive+pyrPeiti � ;
212 Main Street sav+rrlSeptcAuaiJablliy
MAY 2 5 2010 Room 10o Wter/uttelvaitabiltty ";��
Northampton, MA 01060 Two Seth Of;structural Pa
L_- phone 413 ° 87 -1 40 Fax 413 - 587 -1272 PJot/Site lslans
, Other Specify
APFCICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address This section to be completed by office
Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (p� t Curre Mailing Address:
Telephone
Sign re y� -' ' 71
2.2 Authorized Agent: /
am rint) Current Mailing Address:
atu G Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building 3 J (a) Building Permit Fee
2. Electrical 99 (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) 7 6 vp . Check Number
This Section For Official Use Onl
Building Permit Number: Date
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 4 ? 7 S9 G oc)
Frontage
Setbacks Front S'
Side L: Z,5 R: L: 2 5 — R: Z Y
Rear y ,
Building Height Zv 2U
Bldg. Square Footage 16 5 y 2 % I 3
Open Space Footage % a ,�
(Lot area minus bldg & paved Z73 Y � / 0 5 Y p
p arkin g)
# of Parking Spaces
Fill: �U.� 1 /�'`
volume &Location /f/
A. Has a Spec' ermit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW 0 YES Q
IF YES, date issued:
IF YES: Was th ermit recorded at the Registry of Deeds?
NO DONT KNOW 0 YES Q
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW @
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO Q
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:
E. Will the construction activity disturb (clearing, grading, ex vation, 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.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors E]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] Other [CI]
Brief Descriptio of Proposed
Work: 7 & / ��� /
Alteration of existing bedroom Yes T/ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If Now Wouse and or addition to existing housing, complete the following
a. f g : 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
I, ul. &2 as Owner of the subject
property
hereby authorize T COZ--e
to act my behalf, in all ma rs relative to work authorized by this building permit application.
�L ,
nature of Owner Date Z p
as Owner /Authorized
r
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.
D
Print Na
a ur f Owner /Agent Date
8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder H �- �� 67!9z& 0
License Number
34 5'-wv, e-L �� 1..1 r2 /j/ - ,z -1.c a 1,06 o
Address tion Date
Si ire _ / Telephone
v �
Not Applicable ❑
om Name Registration Number
A dd"/ ,r �G Expir tion D to
�v
9 A-A4 Telephone
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 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 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
IE�Gw� CERTIFICATE OF LIABILITY INSURANCE OP ID SF DATE(MMIOOIYYYY)
ROSSS50 1 07/15/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IRK Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Barry M. Stephens, CPCU HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
75 North Main St. -P O Box 564 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
East Longmeadow MA 01028
Phone: 413 -759 -0010 Fax: 413 -759 -0017 INSURERS AFFORDING COVERAGE NAIL S
INSURED INSURER A: central Inw=ance Companies 20230
INSURERS:
$Reuben Ross INSURER C:
3 3 6 6 B SelYla® CAII r R d INSURER D:
Northampt MA 106
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM.
mom P"n
LTR INM TYPE OF INSURANCE POLICY NUMBER DA . LIMITS
GENERAL LJAerJrY EACHOCCURRENcE $1000000
A X COMMERcAL GENERAL LIABILITY CLPS123544 07/01/09 07/01/10 PREMISES aoca..rws s300000
CLAIM MADE X] OCCUR MED EXP (Arty one Pinson) s5000
PERSONAL &AM INJURY $1000000
GENERALAGGREGATE s2000000
GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - cOMPIOPAGG s2000000
X POLICY ,J� 7 LOC
AUTOMOBILE LIABILITY
ANY AUTO ( COMac SINGLE LIMIT $
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per Person)
HIRED AUTOS
BODILY INJURY S
NON-OWNED AUTOS (Pw Solent)
PROPERTY DAMAGE $
(Per aoddent)
GARAGE LIABLI Y AUTO ONLY - EA ACCIDENT S
ANY AUTO EA ACC S
OTHER THAN
AUTO ONLY: AGG $
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR 7 CLAIMS MADE AGGREGATE $
s
DEDUCTIBLE $
RETENTION $ $
AND E PLAYERS' LIABILITY X TORY LIMITS ER
A U NER� cunv WC812355915 07/01/09 07/01/10 E.L. EACH ACCIDENT $100000
yyaenq U E.L DISEASE - EAEMPLOYE 5100000
SPECIALPROXW below E.LDISEASE - POLICY LIMIT s500000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY BdDORS .T / SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CONS001 DATE THEREOF, THE ISSUING INSURER WILL, ENDEAVOR To MALI- 10 DAYS WRITTEN
NOTICE TO THE CERTWICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL
Construct Associates IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
36 Service Center Road REPRESENTATIVES,
Northampton MA 01060 AUTHORIZEDi0i r ATIVE
IRM Insurance Agency Inc.
ACORD 25 (2009101) ®1988 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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