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shed
BOOK 5278, PAGE 215
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10.3'
EXISTING DRIVEWAY TO LEFT
OF HOUSE TO BE REMOVED. proposed a
AREA TO BE LOAMED AND garage ¢
SEEDED.
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JAMES AVENUE 1.& 5.518/4-CK L.I
PLAN OF LAND IN
NORTHAMPTON, MASSACHUSETTS
PREPARED FOR
JAMES HAMMERSCHMITH
` SCALE: 1 " =20' NOVEMBER 17, 2011
RANDALL 1,‘
; HAROLD L. EATON AND ASSOCIATES, INC.
IZER " REGISTERED PROFESSIONAL LAND SURVEYORS
#35032 235 RUSSELL STREET — HADLEY — MASSACHUSETTS
,_ I
, mote- .:'
SURVE , 413 -584- 7599 413- 585 -5976 (fax)
email — hleaton@aol.com
0' 20' 40' 60'
um ma am Emma
z
OZ' 1P T t7
A � #1,-... ;i (rxi of , tart ntpt.hrt ► _ *= •
• $ :. 3JJ' y't; n a — _ � :
` � T =. i '` DEPARTMENT OP BUILDING I_NSPECTIONS 4 7-41=2„.111_--W.-.
212 Main Street~ • Municipal Building ,
. Northampton, Mass. 01060
WORKER'S COMPENSATION INSTTRANCE AIFIDAVT
I, //2 L..5 O ArEil / f/ = ii J l/ l /ie fL -% Pq /4-24 f, __Z-2/ L
i
(Iicensee!permittee)
with a principal place of business/residence at:
3,-to /2/12:45 i .b _ �i2li/` A.2-,2t AV (phone #) 9'8 /-7-2:2_-
(strt/city,'s,a:'zip) 41v
do hereby certify, under the pains and penal :es of perjury, that
() 1 am an employer providing the followin=g worker's compensation coverage for my
employees worming on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:. .
(Name of Contractor) (Lnsurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insuranc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) '
(attach additional sheet if necessary to include information p-imist to all contractors)
( ) 1 am a sole proprietor and have no one working for me.
( ) lam a home owner performing all the work myself.
NOTE: please be aware that vvhilo hosrove=rs who employ persons to do mr.n,tenemrY construction er reparrwork on a dwelling of
not mows than throe units in which thx homeowner resides or na the grounds appurtenant thereto are not gn e<aliy coaride ed to be
employes uruler tho worker's .. earePerisstren Act (GL152.ss 1(5)), application by a hameowns for a lice or permit may evidesac the
legal 'laths of an employer under the Worker's Camvew.atioa A.�.
I understand that a copy of this rtat- rr-,t may ba forwardef to the Dgeartme, of roil: stria Accidents' Oboe of lusrun.acs for the
coverage verification and that failure to secure coverage ue&r section 25A of NIGL 152 can lead to the imposition of aimittal penalties
consisting of a fire of up to 51,500.00 aud/cr aipri of lip 10 ono year and civil penalties in the form of a Stop Work Order and a
fns of S100.00 a day against six.
Signed this / day of 1624 For departmental usconly
� / Permit Number
7/ { "-/ Mapli Lot
Signature of L ermittee
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder : _ Steven Silverman _____ 077279
License N irnt:er
• 268 Forcer Roa., S • -. ■ on, _. - .MA 01 073__._ 6/21/12
Address / I Expiry o.t Date
584 - 7522 •
S ;Hato / Telephone
9, Registered Home Improvement Contractor: Not r''.pal cab e ❑
Steven S i lve rman_ 1319 4 5
Company Name Registration Number
268 FomerRoad 10/13//2
Address Expiration Date
Southampton, MA 01073 Telephone 584 -7522
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G,L. e. 152, § 25C(6))
1 Workers Compensation Insurance _affidavit must be completed and submitted with this application. Failure to provide this affidavit
1 wilt result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes...,... X No 0
•
- Hone Owtker Exelr. of on
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 helshe 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 orate 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 F,mploycrs to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated. yon may be finale to oersem(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 Zonint2, Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
nr OF noppl
N. At.dititin viiil,dcw!.. A t Rooficr,
AccE DiIitic Nev; 5gr Decks V Svrirg OthE! v
C4‘)C` A...71thiChve/C1 tiy-A(;..e.d
k: ' . 4 N/
Jt N eV," house aild or addition to existinghousine. cornplete the foliowins:
• r p/(C,
Papti5e1
46B SY
)4
N o t:
tt 40.— •
W-064 ekAn 2A.Y /6" 0 c.
CCT:CN 7z1 OWNER ALITUORIZAT - TO OE CON1PLETE'D WItC
OWNERS AOENT OR CONTRACTOR AP: FOP i3URMNG PERMIT
f
—Vit S yitifez_z,/ /7 7744- ...
teven Siiverman, Valley Home Improvement, Inc.
; .rr
/7 22 -20 //
• S teven_Si Ixerman,Valley_Honte___ Iraproventent „Inc . _ : :00
; ttte, r ,•r r: ,rdt t . f
• srv
Steven Salve an
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
le, Building Department
Lot Size (` , '176
N
Frontage 10, 36 /(/ f e
Setbacks Front in 1
Side L: [2 R: 30 / L: 12- R: � F n
Rear q5 V 6
_
Building Height
�� 2� / /
Bldg. Square Footage 12Sd % 1 lac 15
Open Space Footage
(Lot area minus bldg & paved ' l 5 13 ga iV a O !
parking)
# of Parking Spaces
Fill:
(volume & Location) _
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW YES _
W YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO / DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES 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:
RECEIVED Department use only
City of Northampton Status of Permit:
NOV 2 2 2011 Building Department . Cut /Drveway Permit
212 Main Street Sewer /Septic Availability_
Room 100 Water/Well Availability
DEPT OF BUILDING INSPECT1DNS Northampton
NOiRTHAMPTON, p , 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: �,r
2.5" _% tEs /4- U Map & Lot_ 00 -_Unit
0/06/0 Zone ._ _ _ Overlay District --
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: L j -' ` 4 . J S //` G
_J /iirlf% f l 5h 1 £ � / 45 c h `n , /I /I/0167/1 i /?/�.1/L-(
. e (Prl t) Current Mailing Address:
Sig ure
Authorized Agent: Steven Silverman
Valley Home Improvement, Inc P.O. Box 60627, Florence, MA 01062
Name (Print) � Current Mailing Address:
��� " 584 -7522 _ Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 2, DO O (a) Building Permit Fee
2. Electrical 1` /� (b) Estimated Total Cost of
1 VV Construction from (6)
3. Plumbing ---/ Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection 1 l .:)/ 93, 6. Total = (1 + 2 + 3 + 4 + 5) tt3 q ) Check Number d9/ a�
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature: _._ __.__ __—
Buildirg Commissioner /Inspector of Buildings , Date
File # BP- 2012 -0523
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC % *��,""
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413) 584 -7522 „� *O. r � l�
PROPERTY LOCATION 25 JAMES AVE ��, 4O ��
MAP 31A PARCEL 300 001 ZONE URB(100)/ l ' 1- � �` ld ,J VP-)
THIS SECTION FOR OFFICIAL USE ONLY: f ��( 5(?
PERMIT APPLICATION CHECKLIST ` AV A.
ENCLOSED REQUIRED DATE 01<,
ZONING FORM FILLED OUT
Fee Paid
Building Pemiit Filled out �/ c � r
Fee Paid
T"'I Y+''7 • tp U
Typeof Construction: CONSTRUCT 2 CAR ATT GARAGE ;AA %A S 11( w: ST (J\ VC b !CAL k,'\) e E `y
New Construction . 0\ 1- (;i PEA. i t d N
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 077279
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION 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
•
tgnature 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.