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16B-006 (3) 1 10 BRIDGE RD BP -2010 -0569 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Catei�oTy_ BUILDING PERMIT Permit # BP- 2010 -0569 Project # JS- 2010 - 000795 Est. Cost: $1800.00 1-ce: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEVIN NETTO CONSTRUCTION INC 001317 Lot Size(sq. ft.): 12980.88 Owner: KELLEY PHILLIP R & ALICE M Zo ning:URA(100) //RI Applicant: KEVIN NETTO CONSTRUCTION INC_ AT. 110 BRIDGE RD Applicant Address: Phone: Insurance: 90 Southampton Rd. (413) 527 -3168 Workers Compensation WESTHAMPTONMA01027 ISSUED ON :1211012009 0:00:00 TO PERFORM THE FOLLOWING WORK.- CONSTRUCT 10 X 14 DECK 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 12/10/2009 0:00:00 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo File N BP- 2010 -0569 APPLICANT /CONTACT PERSON KEVIN NETTO CONSTRUCTION INC ADDRESS /PHONE 90 Southampton Rd. WESTHAMPTON (413) 527 -3168 PROPERTY LOCATION 110 BRIDGE RD MAP 16B PARCEL 006 001 ZONE URA(100) / /RI 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: CONSTRUCT 10 X 14 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 001317 3 sets of Plans / Plot Plan THEXOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 74 Signature of Buildin Offic'al 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 This section to be completed by office 1.1 Property Address Map tot Unit Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Current Mailing d ss: Telephone Signatfire 2.2 Authorized Agent: Na m e (Print) Current Mailing Address: \Q a Si nature 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 (b) Estimated Total Cost of Construction from (6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. -Total = -O + 2 + - 5) _ Check Number (� Q -- - - This Section For Official Use Onl Date Building Permit Number. Issued: Signature: Building Commissioner /fnspecto o w mgs '-' Date Section 4. ZONING I 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 . . .... I Frontage Setbacks Front Side L: R: R: Rear Building Height Bldg. Square Footage % Open Space Footage % I _. Y _Y _._ (Lot area min I parking) 9 of Parking Spaces Fill: (volume & Location) A. Has a Special Permit/Variance/ Finding ever been issued for/on the site? f<7) NO VY DONT KNOW 0 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 wetlands? NO ,N, DONT KNOW 0 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 NO IF YES, describe size, type and location: E. Will the construction activity disturb (rIt-;;ring, grading, PyrAvation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO t0l 'ley IF YES, then' a Northampton Sforffi M Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing Or Doors M Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks 5' Siding [01 Other [CI] Brief Description of Propose Work: �tJXW W& Alteration of existing bedroom Yes �_ No Adding new bedroom Yes _I No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet Ga. If New house and or addition to existing housing, complete the follow 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? I 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. '1 6 - �N\ ar a� \NC �.� as Owner of the subject property f hereby authorize ?� to act on my behalf, i almafters r tive to work authori ed by thiVbuilding permit application. \ \ -3o-DR Signature of Owner Date 1. �(1e • N Q as Owner /Authorized Aqen hereby declare that the statements and information on the foregoing application are true and accurate, to the best o my knowedge and belief. Signed under the pains and penalties of perjury. v�r e. • I��e, Pi Name Signature of Owner /Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor {�\ Not Applicable ❑ Name of License Holder Y -- cL,4 �. ' y ,(o C�R)\_76N, License Number Address Expiration Date �.,► � �'l� � \3 513 \b8 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....... d No...... ❑ 11. - Home Owner Exemption 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 -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 Iiable 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 The CommonweaTZh of !Y_fassachuse s ^ Department of Indzrstria ccidents r 0 r — ice ofImesnga ions {c 600 Washington Street -��-- Boston, 31,4 02111 www massgov/dia Forgers' Compensation Insurance Aif1d2Njt: Builders / Contractors /EIeerricians/PIumbers A DDUC ant Information Please Print Lem 'bIv laMe (- usmess/Orzar>i m on/Individual j: YV — Ntr�, Address: Q� City /Statt'Zip: ire you an employer? Check the at) ? ropr.'ate box: Type of project (required): : . am a eral contractor and I I. I azrr a emn Ioyer with y ❑ I gen - 6. Cl -New construction employees (full and/or parr -tee). have Bred the sub- contractors I F - listed on the attached sheet 7- 1 m a a so.e proprietor or pare. �-' SL:—, a—i have no e=!Oo , ees These sorb - =onzi actor have g- D Lemo;iuon worlung- for me in guy capacity- employees and have workeers' 9. ❑ fiuD addition , [No wormers' c . h s ce comp. iu Jra ce.* rewired ] o- We are a corporation and its I0.❑ Electrical r pairs or additions =. ❑ I am a homeowner doing all work officers have exercised their I L❑ Plumb�g repairs or additions myself. [-N o workers' canm. ri� of exemption per MGL 12. [1 Roof repairs insurance rued.] ? c. 152, § 1(4), and we have no e=loyees. [No workers' 15 Other comp. iz=ranc reed ] — xnv can - = =J= oox F1 ago nil out tae s=on maw sttowmg ther wora'as' cor mromsadoa --- t Horr=wncrs who sumnir this affidavit mdxm=g they are doing all work and d= brie outside contractors must suhni t a new affidavit indimtiat such. *Conuaz:ats that cii=k this box tnuat.atmcited an ati on shear showme the name of the sub - contactors and state Whether ornot those ©lilies have ernpioyees. ff the sub—contractors-have caipioye -s, trey must provide their vmererss' corm. policy uu=6e . lam an employer that isproviding workers' conzpensazwn insurancefor my employee,5 Below is thepolicy andjob size tnformazion. Issai-ance Company Name: Policy # or Sellsins. Lrc. J�aSJ nt)t a1::?� ExpL*ation Date: 3 -Oa.- Job Site Addrss: p \Obi attach a copy of the workers' comp Lion 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 Lne up to S 1 -00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORD_R and a E--- of up to 5250.00 a day against the violator. Be advised that a copy of this statement sa y be forwarded to the Office of In,estTgadons of the DLA for insurance coverage very cation. I do hereby certify under the paths and penaldes ofperjury rkru the information provided above is true and correct Data Phone =: �►�� -5 c�`1 � \\�� _ _ LOrhr e oi'uv. uo rzor write to rats area, to be complete d by cu_v or town offzeiaL wn: thority (circle one): Health 2. Building Department 3_ City/Town CIerk 4. EIectrical Inspector 5. Plumbing Lisspector son: Phone -IVV I c- 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 65'f NOTE: PROPERTY LINES SHOWN ARE APPROXIMATE, A FULL FIELD SURVEY IS REQUIRED TO ACCURATELY DETERMINE THEIR LOCATION. BOOK 1153, PAGE 23 REFERENCE: - PLAN BK. 34, PG. 39 b o 0 0 I N N I NOTE: #110 SUBJECT TO EASEMENTS AND RIGHTS OF WAYS OF RECORD. 65'f BRIDGE ROAD TO: BERKSHIRE BANK & 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: arv 4 F -L. THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY jy � OF -MORTGAGE LOAN INSPECTION PLAT - s NORTHAMPTON, MASSACHUSETTS E. . RAN N PREPARED FOR IZER !35032 „ BLANCHE A. KING SCALE: 1 OCTOBER 22, 2009 ` � y Rv ° � HAROLD L. EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET - HADLEY - MASSACHUSETTS 12/03/2009 21:14. 4135273168 PAGE 03 � N w CL N .M, �— 4 w t17 Z W 1--- Lo wr co L O Q P3F"� ..._�. a.. N 00 's s ue, {4 wro L41 Cc d C) m �w W w 0 �,o C} w I N W W >�C w� fr �� LL! 0 m NMI- LU N w ° � � N F- F W 0 C.) 12/0312009 21:14 41 PAGE 02 b � C L rm -i i0 rJ) M m M ri Q n cz O � W O m m l M� 1 r o-;Wo � J1 oco v - `M> C� N qm N � m 4 Ir y F