49-055 981 PARK HILL RD BP- 2010 -1012
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 49 - 055 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pern,it: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Non structural interior renovations BUILDING PERMIT
Permit # BP- 2010 -1012
Project •# JS- 2010 - 001491
Est. Cost: $1100.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID VELETA 61352
Lot Size(sq. ft.): 104718.24 Owner: City of Northampton
Zoning: SR(100) //WSP II Applicant: City of Northampton DPW
AT: 981 PARK HILL RD
Applicant Address: Phone: Insurance:
125 Locust St (413) 587 -1570 0
NORTHAMPTONMAO1060 ISSUED ON:5/17/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL RADON MITIGATION SYS
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: 6 Y
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REG: ON .,�
Certificate of Occupancy /, Signature:
FeeType: Date Paid: Amount: t.<}
Building 5/17/2010 0:00:00 $0.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
981 PARK HILL RD BP- 2010 -1012
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 49 - 055 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Non structural interior renovations BUILDING PERMIT
Permit # BP- 2010 -1012
Project # JS- 2010 - 001491
Est. Cost: $1100.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID VELETA 61352
Lot Size(sq. ft.): 104718.24 Owner: City of Northampton
Zoning: SR(100) / /WSP 11 Applicant: City of Northampton DPW
AT: 981 PARK HILL RD
Applicant Address: Phone: Insurance:
125 Locust St (413) 587 -1570 O
NORTHAMPTONMA01060 ISSUED ON:5/17/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL RADON MITIGATION SYS
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 5/17/2010 0:00:00 $0.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
File # BP- 2010 -1012
APPLICANT /CONTACT PERSON City of Northampton DPW
ADDRESS /PHONE 125 Locust St NORTHAMPTON (413) 587 -1570 0
PROPERTY LOCATION 981 PARK HILL RD
MAP 49 PARCEL 055 001 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: INSTALL RADON MITIGATION SYS
New Construction
Non Structural interior renovations
Addition to Existint
Accessory Structure
Building Plans Included:
Owner/ Statement or License 61352
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
t-/ 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.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site _ Plans
Other Specify
APPLICATION 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
a
f ',K, �`-; ., f '3 ,- . )-- • . Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
r °; 0 tr !Jr F NA c- -f' () ,/ 0 . A ) f. ,i5:71
Name (Pri ' Current Mailing Address: .> _ e . ""7 , ,
' . ...Add_ Telephone
Signature
2.2 Authorized Agent:
Narn,e(Tln ) -- - �-- Current Mailing Address: fi .
Signature Telephone
(
'''--„SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1 Building (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 S s 1P3
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
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
l';xisting Proposed Required by Zoning
This column to he tilled in by
lluilding Department
A/75 c- - HP 1iE
I,o1.. Size ,
? ,
1 ,
1- i
-...)
Frontage /
Setback , -
s F ront ;2.,.. (.1 ° -
./ , ...-tj i
6.1 ' t/
Side I
,
C i Id - ft*
, 1
Rear
,..;:, „.„:,C i"-- •1~-, A 7-+ ;
(1 ' /-
Building Height -) <.---/-- "73.4-- /
, -
Bldg. Square Footage ,,„:3„ , , --.2 % 9) ir —)
:,,),i—c / ,... ,..7..)-
Open Space Footage
04, „ .,......
(T.ot area minus bldg & paved . 30t , ' i .-.)
2 ) (
parking) )
,-,
# of Parking
Fill.
A-4'k
( , o N/ hm. & Location) . , .
A. Has a Spec ',I, Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW Q YES Q
IF YES: enter Book Page and/or Document 11
B. Does the site contain a brook, body of water or wetlands? NO a DON'T KNOW Q YES 0
(
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained
0 Obtained
0 , Date Issued:
C. Do any signs exist on the property? YES Q NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO a
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excayation, 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 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : 7
c C "T 1 ; � 1 r'� t' r'' L ^, .:` frtb, ft� P-7NA,A... r �jf✓.J License r
Access CJ r ) Expiration Date
f
t ,
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable
Company Name Registration Number
Address Expiration Date
Telephone
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 building permit.
Signed Affidavit Attached Yes ❑ No ❑
11. - Home Owner Exemption
1 he current exemption for "homeowners " as extended to include Owner- occupied Dwellings of One (1) or tvwu(2) (amit
and to allow such homeowner to engage an individual for hire \ ho 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 faun
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 01'ficial, 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 joh site will he required from time 10 time. during and upon
completion of the work for which this permit is issued.
Also he advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 155 (Liability of I ritplovers to
I , mplovices fur injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may he liable Ia person(si
you hire to perform work for you under this permit.
The undersigned 'homeowner' certifies and assumes responsibility for compliance v - vith the State 1uilding Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
~--~--~--- - -- -
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House [ Addition El Replacement Windows Alteration(s) F r Roofing 1
Or Doors CI
Accessory Bldg / . �� Demolition �� �_� New Signs [[]] Decks [[] Siding [0] Other[[]
Brief De Y»s*d F-- i��[`(�y�7)0 �i 7� ��rv\ -1 ��� � �Jv r��' ��
/4% III c
Alteration of existing bedroom Yes :--- Adding new bedroom Yes / ~~ -- No ~� ‘^ � A[/�~
Attached N ti ^
Narrative Renovating Yes � No
Plans Attached RoU Sheet a it{T /�4:75 1-
6a. If New ho and |o addition ~~~ existing housin complete the following
�
a. Use nr building : One Family Two Family Other
b Number of rooms in each family unit: Number of Bathrooms
o s there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e Number of stories?
f Method of heabng? Fireplaces or Woodstoves Number of each
g. Energy Conservation Campliance. Masscheck Energy Compliance form attached?
h. Type of constrLlct!on
i
Is construction within 100 ft. afwetlands? Yes No. Is construction within 100 yr. Mnodplain Yes No
j. Depth of basement or cellar floor beow finshed grade -
k. Will building conform to the Building and Zoning regulations? Yes No
i Septic Tank City Sewer Private well Cty water Supply
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
| . 4 , : " I i ' A /» t 5; A, i.4 »\�7('ff.: V as Owner of the subject
property '
hnm�a�ho����A�\1� 1' k
to act on ey behalf ina'attora relative to work authorized b9 this building permit application.
^ ~� _
X ` '�~��,w� - ----' ��
- ��/ '°/ '~
�gn�o�orowno �� Date
-�`~ �/ �~ l��
1, *-�/* " �� p- - �� a� 7/6 »A as Ownor/4uthnhzed
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.
l l V '4A /< �f
"
/ - - ~ ` � ' ` ('L � ^� ~~� '~ / / °
��natumorf*°m�/xgent Date /