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V \D H I 4 - -- -—, \\ D.M. #4 l ) I II 11 1 --. -, / / / ' z, N \ P.T,#2` / N \ % N i r I �Ii ,�' - -_-./ / / 1 � 'v 11 0 J•FA. y 22 \ / / / �` Northampton, MA Property Detail Page 2 of 2 Interior /Exterior: Same Condition/Desirability /Utility: VG Vacant /Dwell /Oby Status: Dwelling Additional Features: Brick Trim: 0 X 0 Stone Trim: 0 X 0 Remodeling Data: Year Remodeled: 2004 Kitchen Remodeled (Y/N): Bath Remodeled (Y/N): Land Data Outbuilding Info Square Foot Type Utilities Type F Qt Value no no information information Type Qty Year Size 1 Size2 Grd Cond jovIA AB2 1 1977 1 640 C A Acreage Type RS1 1 2010 1 392 C A 44 Type Acres Value Street /Road no Home Site 1.50 104,300 information Undeveloped 5.90 30,090 ) g J Sales Info Permit Info Date Permit # Price Purpose 11/06/2009 483 7,984 14 X 28 SHED Date Type Price Validity 05/02/2005 1053 3,000 DORMER WORD 09/30/2002 Land + Bldg 385,000 G 11/29/2004 588 41,600 "36X15 DORMER 0 "BEDRM,NEW WI 0 SIDING http: / /www.northamptonassessor.us/ noho /propertydetail.php ?map_no =36 -199- 001 &pagec... 3/29/2011 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: 36 - 199 -001 Zoning: Assessment: Location: 348 WESTHAMPTON RD Neigborhood: 2 Land: #Living Units: 1 Deed Book: 9759 Building: Class: R -101 Deed Page: 16 Total: Dwelling Information Building Sketch Style: Contemporary Year Built: 1982 13 28 1 Story Height: 2 Wood Deck LIeLI Attic: None Basement: Full 36 2Fr /B `3i 13 Total Rooms: 7 1008 8 Bedrooms: 4 EFP, ie Full Baths: 2 28 1 ' Half Baths: 0 10 Exterior Walls: Alum/Vinyl 1 "EFP 2 Unfinished Area: 0 �� 24 Ground Floor Area: 1008 Total Living Area: 2052 FG 24 24 i ct ) Finished Basement Living 0 X 0 Area: 24 Basement Recreation Area: 0 X 234 Woodburning Fireplace 0 / 0 Addition Information: Stacks /Openings: Metal Fireplace Lower 1st Story 2nd Story Stacks /Openings: 0 / 0 Basement One Story Frame One Story Framc Heat /Central A /C: Basic Enclosed Frame Porch Heating System: Electric Frame Garage Fuel Type: Electric Enclosed Frame Porch Quality Grade: B+ Frame Overhang Physical Condition: Good Wood Deck http : / /www.northamptonassessor.us/ noho /propertydetail.php ?map_no =36 - 199 - 001 &pagec... 3/29/2011 City of Northampton Massachusetts �� . 'rt d ' AR DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �3 .. Northampton, MA 01060 474t;1 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3. 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 any 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 regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rouph 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 the building permit issued, end 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 insp - io - = m- • e t :. �,r 1, r understand the above. ( fffe o - r /resident's signature requesting exemption) I will 11 - schedule all required building inspections necessary for the building permit issued to me. Date 3/11 I Address of work location � ' 1 f � ,� v t O.,v v ? Vl V . Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." /y Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shale enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub- contractor(s) nan,e,(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liatility Partnerships (LLP) with no employees other than the members or•partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of • Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self- insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant • Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city`or town)." A copy pf the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le_a dog license or permit to bum leaves etc.) saidpersonis _NOT_required.to_complete affidavit '.___ ___ _ The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone -and fax number. The Commonwealth of Massachusetts • Department of Industrial Accidents Office of Investigations 600 Washington Street - Boston, MA 02111 Tel. # 617- 727 -4900 ext 406 or 1- 877- MASSAFE Fax # 617 -727 -7749 • . • Revised 11 -22 -06 Y www.mass.gov /dia . , • The Commonwealth of Massachusetts ' Department of Industrial Accidents, m---7,10,-- t Office of Investigations ' W_ t ' ii . . E � y 600 Washington Street f Boston, MA 02111 • . , , www mass gov /dia -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information • Please Print Legibly Name ( Business /Organization/Individual)): J� Address: ( 7"D t,aN aL- . • City /State/Zip: Phone. #: • Are you an employer? Check the appropriate box: • Type of project (requied): / r 1.0 I am a employer with 4.. 0 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 These sub - contractors have. • ship and have. no. e�loyees 8. ❑ Demolition working for me in any capacity. employees and have workers' P # . 9. 0 Building addition [No workers' comp. insurance comp. insurance. 10.0 Electrical repairs or additions required] 5. 0 We are a corporation and its eP 3'44 I am a homeowner doing all work officers haveexercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exem per MGL 12.0 Roof repairs • insurance required.] t c. 152, §1(4), and we have no • employees. [No workers' 13.0 Other comp. insurance required} *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. • t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1 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 - contractors have employees, they must provide 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: - Job 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 MGL c. 152 can lead to the imposition of criminal penalties of a -- foxe to $1:500:00 antl/orone =year imprisonment, as well as civil "penalties in the form of a STOPWWORKORDER andi fire of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance covera • e erification. I do hereby ' ' under th ' . ' and pen c ]o , e 'ury that the information provided above is true and correct. , / VA Signature: i, 1 • Date: _ Phone #: f Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other r • Contact Person: Phone #: • 4 # I Ai L • SECTION 8 -- CONSTRUCTION SERVICES 7' 8.1 Licensed Construction Supervisor: Not Applicable` Name of License Holder : License Number i Address Expiration Date I I Signature Telephone $,;' RBQ1SteF1idOatlelfigrtIYlL1Y eiat&tslat(1r go Ta V " )Ei_ .. 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 ❑ 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 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, 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 Northampton Ordinances, State and Local Zonin Laws and State of Massachusetts General Laws Annotated. 7/ l � Homeowner Signature ! %% � % , SECTION 5 - DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ,® Demolition ❑ New Signs [D] Decks [C7 Siding [D] Other [0] Wo ief Description of Proposed i d rk: t I ,/ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes }ct No Plans Attached Roll - Sheet lfill llif Wit EWO - & awn a. Use of building : One Family Two Family Other b. Number of room's family unit: Number of Bathrooms c. Is there a garage attached?, d. Proposed Square footage of new construction. Dimension's e. Number of stories? - f. Method of heating? \ `-., T �,Fifeplaces or Woodstoves Number of each g. Energy Conservation Compliance. ,. - -->c " Masscheck Energy Compliance form attached? h. Type of construction `� i. Is construction within 100 ft. of w ds? Yes No. Is constru�tioon within 100 yr. floodplain Yes No j. Depth of basement or r floor below finished grade k. Will building. nform 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, , 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 1- 0Seprl T r� k,' , 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 3 /1 / II Signature of Owner /Agent Date At SE f PI P R Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete nformatic ' . Existing Proposed Required by n in S ; This column to fil lecin by Building Depa ent �° ' i i x.', Lot Size i ! g .... , •.,..„ ' Frontage { , , e Setbacks Front"" [ i Side L:1 —i R: . leg � R:1 _. i Rear 1 / E-1 Lmi Building Height 1 ' 1 i t f' Bldg. Square Footage - r ---- 1 % F-`\ I' Open Space Footage % (Lot area minus bldg & paved , 1 = f 1_ ' parking) # of Parking Spaces ---- . ' Fill: F (volume & Location) I A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES IF YES, date issued: 9 j'3, i J 0 1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book I 04/ Page Q (`j I and /or Document # B. Does the sip contain a brook, body qf water or wetlands? O Q 1 DONT KNO YES F YES, has a permit been or need to be obtained 'from the Conservation p dmmission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO G IF YES, describe size, type and location: E. 1Niill 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 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 1 ** R C City of Northampton a ; 7 ,t Building Department , , leg ' � 212 Main Street , • = Room 100 E� B „�o► orthampton, MA 01060 phone . ' 413- 587 -1240 Fax 413- 587 -1272 a te, , ,j,!,1,,, , c'° L, 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: I ,� WQ J Y ' ©`''Y � � Map Lot Unit Zone -_ Overlay District Elm: St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: VI rrA ckyl& g el Le +— ' G(0 1?- RIrd 1c Name (Print) Current Mailing Address '� — / } fi r? f 1 �P � L� - 2 - Telephone Signature 2.2 Authorized Agent: Name (Print) Current Mailing Address: 4 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 r— Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection / � 6. Total = (1 + 2 + 3 + 4 + 5) ) Q (9 Check Number j ° This Sect For Offic Use Only ` ita5 Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2011 -0782 APPLICANT /CONTACT PERSON JEWETT JOSEPH & KIRA ADDRESS/PHONE 126 BLACK BIRCH TRAIL FLORENCE (413) 582 -0346 Q PROPERTY LOCATION ,34 WESTHAMPTON RD // MAP 36 PARCEL 001 ZONE SR(100)1/WP /WSP II SI / — 3 (O THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out f� . � Fee Paid /fe p` 6 Typeof Construction: CONSTRUCT 10 X 15 SHED New Construction Non Structural interior renovations Addition to Existing 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 INFO ATION 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 3/31/1i i nature of Building Official Date Signature g 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. WESTHAMPTON RD BP-2011-0782 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 408 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: shed BUILDING PERMIT Permit # BP- 2011 -0782 Project # JS- 2011- 001286 Est. Cost: $5000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): Owner: JEWETT JOSEPH & KIRA Zoning: SR/WP /WSPII Applicant: JEWETT JOSEPH & KIRA AT: WESTHAMPTON RD Applicant Address: Phone: Insurance: 126 BLACK BIRCH TRAIL (413) 582 -0346 () FLORENCEMA01062 ISSUED ON:3/31/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 10 X 15 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 3/31/2011 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner