17A-031 (2) BP-2010-0999
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 c.142A)
Cate BUILDING PERMIT
Permit # BP- 2010 -0999
Project # JS- 2010 - 001467
Est. Cost: $2000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 13677.84 Owner: MAY BONNIE S
zoning: URA(100) //RI /WSP Applicant. MAY BONNIE S
AT: 25 STERLING RD
Applicant Address: Phone: Insurance:
(413) 585 -0585 O
FLORENCEMA01062 ISSUED ON :511312010 0:00:00
TO PERFORM THE FOLLOWING WORK.- 8 X 10 SHED
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 5/13/2010 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
File # BP- 2010 -0999
APPLICANT /CONTACT PERSON MAY BONNIE S
ADDRESS /PHONE FLORENCE (413) 585 -0585 ()
PROPERTY LOCATION 25 STERLING RD
MAP 17A PARCEL 031 001 ZONE URA000 //RI /WSP
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: ERECT 8 X 10 SHED
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/ Statement or License
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 p
l b o
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.
WN
City of Northampton�r
�x
Building Department
212 Main Street
0 �Ur Room 100
?, Northampton, MA 01060
phone 413- 587 -1240 Fax 413- 587 -1272
�a
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
r� S.e J �� Map Lot Unit
� � �
M� �� Zane
���� OarerfayDistrict
EIm.SL CB District
SECTION -2 - PROPERTY: OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
rlo, Mfg 2-
Name (Print) Current Mailing Address:
13 -5g5-(25s'_5
1 L /� 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 ermit applicant
1. Building (a) Building Permit Fee
J,®i7D,
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) OC e • i7 /? Check Number �
:This Section Far Official Use Onl
"Date
Building Permit Number: issued:
Signature: -
Building Commissioner/Inspector. of Buildings Date
1 J
A �
TJ o 1' APPi -ic& b — FX IE-E sr Ai4bfk[C
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
Frontage
Setbacks Front i
Side L: ..m..' R _ ' L R :_._ mm
Rear. _.
Building Height
Bldg. Square Footage i F % C
Open Space Footage _ % _ -
f (Lot area minus bldg & pavedfi� .„
p arkin g)
# of Parking Spaces M- - -=
/ r
volume & Location —
AO Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO � DONT K NOW 0 YES 0
IF YES, date issued:
A.. .........
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 #
U Does the site contain a brook, body of water or wetlands? NO ,V DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued .
C .,1 Do any signs exist on the property? YES NO
IF YES, describe size, type and location
- g -.,.t - _ _- ._
v�_��` ��re � l�ere`any proposedTchanges o or a loons o slgns � iriten�ed for the property ? YES Q NO
IF YES, describe size, type and location: i
o f 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 Q NO Q
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 17
Accessory Bldg. Demolition ❑ New Signs [CJJ Decks [[] Siding [[] Other [El
Brief Description of Proposed f
Work: k,& — b o l o ( , aa 40 IC sl'e.'l I✓1 bc'a yow -
Alteration of existing bedroom Yes No Adding new bedroom Yes I— No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
If �t Cte lose aiid o � ftle t04 S In€E oasfi a omt to tT 'f [ owen+g:
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 o 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''. TQ BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLES FOR BUILDING PERMIT
h V% as Owner of the subject
property I
hereby authorize a Yo O L L,(- ✓ t
to act on my behalf, in all matters relative to work authorized by this building permit application.
I rD
Signature o Owner Date
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.
Print Name
Signature of Owner /Agent Date
4
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
... . _ ...... .
1: Retlib*re& Ek mi yiioyeiti n #Cot%tr tor ,., �. � � , � > . , . "... Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SE CTION 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...... ❑
_ _The-current-exemption for _ "homey -w -nets" was extended to include_ 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
. tts General- Laws - Annotated.
o ampton r manes;' a
Homeowner Signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.massgov /din
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumb.ers
Applicant Information Please Print Lez;ibiy
Name ( Business /Organization/Individual): .
Address:
City /State/Zip: Phone. #:
Are you an employer?. Check the appropriate boa: Type of project (required):.
1. ❑ I am a employer with 4.. I am a general contractor and I
employees (full and/or part time).* have hired the sub- contractors 6. ❑New construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no egployees These sub - contractors have. .8. ❑ Demolition
working for me in an capacity. employees and have workers'
g Y P tY• .. 9. Q Building addition
' ins nce $.'
[No workers comp. insurance c am`
required:] 5. F 10 . We are a corporation and its ❑ Electrical repairs or additions
3. E I am -a homeowner doing work- -- — _. _ -_ -- v .; — 11- �Iumbmg repairs or additions
myself [No workers' comp. right of exemption per MGL 12. F Roof repairs
insuran required.] t c. 152, § 1(4), and we have no
employees. (No workers' 13.❑ Other
comp. insurance required.}
*Any applicant -that checks box #1 nnist also fin out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit.indic sting they are doing an work and then hire outside contractors must submit a new affidavit indicating such_
=Contractors that check this box must-attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. .If the sub-conttactom have employees, they must.pnmde their workers' comp. policy number.
I am an employer that is providing workers compensation insurance for my employees; Below is the policy and job site
information. . -,
Insurance Company Name:
Policy # or Self-ins. Lic. #: Expiration Date:
Iob Site Address: City /State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to- secure coverage_ as required under Section 25A of 1tiIGL c. 152 can lead to the imposition of criminal penalties of a
fine tip to $1,500.00 and/or one =year imprisonment, as well as civil penalties is the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. - 19e advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties ofp. ei jury that the information provided_abov- &-true and-corrert___
Signature: Date:
Phone #:
F6Other e use only. Do not write in this area; to be comp etedby city or town orciaL
r Town: PermitUcense #
g Authority (circle one):
- rd of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Ins pector
_ . t Person: Phone #:
A
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends 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
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
re¢ai1_ations The inspe ction nro�P�ssr- quires that the building department be calle
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before hour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits- in- conjunction .to- thebuilding permitissued,_.and_that they get their required
inspections. Failure of the individual trades to secure. the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
.(Home owner /resident's signatur questing exemption)
I will call to schedule all required bu' ing inspections necessary for the building permit
issued to me.
Address of work
location
t
i
CJ ��
l'
J :
S� c
r
i
l
................
� _ .__
i
—
,.
',
r
� _..___
r�
��V��
__
__
__�.��_ _
i �
__ a
__
. _ _
. _.
�J' � � 1�1. ham" ,
.�
Northampton, MA property Detail Page 1 of 2
City of Northampton, MA: Residential Property Record
New Search Property Type Classification Code Reference Card 1 of 1
Parcel - Location - Zoning - Assessment
Map -Block -Lot: 17A- 031 -001 Zoning: Assessment:
Location: 25 STERLING RD Neigborhood 14 Land:
#Living Units: 1 Deed Book: 7735 Building: 1.
Class: R -101 Deed Page: 59 Total: 2.
Dwelling Information I Building Sketch
Style: Ranch
Year Built: 1958
Story Height: 1 20
Attic: None 20 Wood Deck
Basement: Full aoo F
Total Rooms: 6 10 31 20 1 12 14
Bedrooms: 3 38 t Fr
2°
Full Baths: 1 ( � s FG
zea
2� 7 FrlB
Half Baths: 0 1356 1 4
Exterior Walls: AlurnNinyl 33 � 2
Unfinished Area: 0 10 21
Ground Floor Area: 1356
Total Living Area: 1580 5 7- E-
Finished Basement Living 0 X 0
Area:
Basement Recreation Area: 0 X 425
Addition Information:
http: / /www.northamptonassessor.us/ noho /propertydetail.php ?map_no =17A- 031 -001 &page... 5/10/2010
Northamptofi, MA Property Detail Page 2 of 2
Woodburning Fireplace 1/2
Stacks /Openings:
Metal Fireplace 0/0
Stacks /Openings:
Heat /Central A /C: Basic
Heating System: Hot Water Lower 1 st Story 2nd Story 3rd Story
Fuel Type: Gas Basement One Story Frame I
Quality Grade: C+ 10pen Frame Porch
Physical Condition: Average 0 One Story Frame 0
Interior/Exterior: Same 0 Frame Garage
Condition/Desirability/Utility: GD 0 Frame Bay 0
Vacant/Dwell /Oby Status: Dwelling 0 Frame Utility 0
Additional Features [= Wo od Deck ]0
0 0
0 0
Brick Trim: 0 X 0 0
0 0 �-
0 0 �
Stone Trim: 0 X 0
Remodeling Data:
Year Remodeled: 2007
Kitchen Remodeled (Y/N):
Bath Remodeled (Y/N):
Land Data F Outbuilding Info
Square Foot Type
Utilities
Type Feet Value no
Prime information
Site 13,675 96,290 Type Qty Year Size 1 Size2 Grd Cond
000
RS2 � 1992 0 96 �C 0
Acreage Type Street/Road
Type Acres Value no
no information
information
Sales Info =F Permit Info
Date Type Price Validity Date Permit #Price I Purpose
03/29/2004 Land + Bldg 230,000 07/26/2007 91 4,000 1 20X20 W/D
06/15/2007 1225 6,735 NEW WINDOWS
http: / /www.northamptonassessor.us/ noho /propertydetail.php ?map_no =17A- 031 -001 &page... 5/10/2010