49-024 (2) 676 PARK HILL RD BP- 2010 -0515
GIS /;: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 49 - 024 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateor : BUILDING PERMIT
Permit # BP- 2010 -0515
Project # JS- 2010 - 000725
Est. Cost: $4800.00
Fee: 538.40 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
u se Group: Homeowner as Contractor
Lot Size(sq. ft.): 79976.16 Owner: MASON PHILIP M & ALEXANDRA
Zoning: SR(100) / /WSP II Applicant: MASON PHILIP M & ALEXANDRA
AT: 676 PARK HILL RD
Applicant Address: Phone: Insurance:
676 PARK HILL RD (413) 587 -9516 O
FLORENCEMA01062 ISSUED ON:11/16/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: ERECT 12 X 16 SHED
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumping 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 11/16/2009 0:00:00 $38.40
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
File /I BP- 2010 -0515
APPLICANT /CONTACT PERSON MASON PHILIP M & ALEXANDRA
ADDRESS /PHONE 676 PARK HILL RD FLORENCE (413) 587 -9516 0
PROPERTY LOCATION 676 PARK HILL RD
MAP 49 PARCEL 024 001 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 < _
l vpeof Construction:_ ERECT 12 X 16 SHED
New Construction
Non Structural interior renovations_
m
_ Addition to Existing
Accessor Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION 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
/ to.„
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.
Departmentjise only
City of Northampton Status of Permit:
Building Department CurbCut/Driveway Permit
212 Main Street Sewer /Septic Avallabi[ity "
Room 100 Water/Well Availability
Northampton, MA 01060 Two sets "of structural plans
phone 413 -587 -1240 Fax 413- 587 -1272 Piet/Site Plans
Other Specify
A PP ICATIl1N TO CONSTRUCT, !AI TER REPAIR RENOVATE OR DEMO! ISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address:
' 1 t Map Lot Unit
r- ! Zone Overlay District
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
i I
2.1 Owner of Record: t j j
i k" P/1/14 e ri` 1 z j r h'
Name (Print) Current Mailing Address:
/ 1 /
Telephone
Signature
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building ; F (a) Building Permit Fee
r
2. Electrical (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)____ Check Number j Y r t
This Section For. Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building- Commissioner /Inspector of Buildings 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 "
I- 6
Frontage
Setbacks Front
Side L: ..5(; R:
Rear J.
Building Height
:›te
Bldg. Square Footage t %
Open Space Footage
(Lot area minus bldg & paved - 41.: 3i cib-70r),, fiJ 1
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit/Variance/Findin ver been issued for/on the site?
NO Q DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wet 0 lands? NO (P) DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained
0 Obtained
, Date Issued:
C. Do any signs exist on the property? YES 0 NO
t 1/419
IF YES, describe size, type and location:
D. Are there any proposed to orad intended nor the property ? YES 0 NO C)
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excoVation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO (r)
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) ri Roofing I I
Or Doors El
Accessory Bldg. Demolition f 1 New Signs [p] Decks [L=] Siding [D] Other [0]
Brief Description of Proposed
Work: ? ; 441- 1 a a ✓ .. 'X �.. N ;, g ?t b 3J :c
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the foliowinq:
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 DUILDINC PERMIT
, 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
I, I rt w j a � +' , 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 pains and penalties of perjury.
Phl
Print Name t 1
Signature ofOr /Ageyf ✓ Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
' te -..
1-
SECTION 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 buling permit.
Signed Affidavit Attached Yes No
11. = Hone Owner. Exemptions
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 Icense, provided that the owner acts
as supervisor. CMR 780, Sixth Edition 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, ut is intended to be, a one or two family dwelling, attached or detached strictures accessory to siinh n.se and/ or farm
structures. A person who constructs more than one home in a two -vear 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 Urchnan Stat d-L al 5m Laws State of Ma°sset,husetts- General Laws Annotated.
Homeowner Signature _ -- ' 6
1
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