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10. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO X
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling)�r 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
This column reserved
for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear
Building Height
Building Square Footage
% Open Space: (lot area
minus building & paved
parking
# of Parking Spaces
# of Loading Docks •
Fill:
(volume & location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: Apr( 9010- Applicant's Signature r airar
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning
requirements and obtain all required permits from the Board of Health, Conservation Commission,
Historic and Architectural Boards, Department of Public Works and other applicable permit granting
authorities.
W: Documents \FORMS? original \Building- InspectonZoning- Permit- Application- passive.doc 8/4/2004
File No.
_
,ZONINczREMITTAPPLICit TIO
Please type or print all information and return this form to the Building' •
Inspector's Office with the $15 filing fee (check or money order) payable tv the
City of Northampton
1. Name of Applicant: (Ahl{IA - v1 eq -of( D84 kiii /s' nest t L -'J ?A
Address: 2 64-1,30. O 0 1 C3(O(r?0 Telephone: (Lt,'S Y 4 8 SZc1S
2. Owner of Property: ( '1 4 ( L t 4 A V t 9 (p2 t rat rt-f
Address: 19 ("-)00D ,c11)-e- . j to•linearioLAi °1166 Telephone: elephone: ( 3) -) S yo crq
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) (10\11►r4.c
4. Job Location: :7'1 1N DI4 ter 1 1 , / i k ii A ) , J' A 0/6 �j Z
Parcel {d Zoning<Map P arcel# Districts)
h i Elm Street District hi Centrat Business District
(�O�BE FItLEQ.l N, B`< TNE�,,B / C�fL A QI(�tE�D�'AREIt�Tf
5. Existing Use of Structure /Property: f d�•V
- 7k1
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
140L E e") S i J
7. Attached Plans: Sketch Plan )( Site Plan Engineered /Surveyed Plans
8. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW x YES IF 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 #
9.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:
(Form Continues On Other Side)
3 4,2004
W:A Documents \FORNIS`.original `Building - Inspector Zoning- App lication - passive.doc
Will's Residential COASSACSETTS
NSTRUCTION
SUPERVISOR
CS 97317
Repair & Remodeling EPA Lead Remodeler
32 Terrace Lane, Northampton, MA. 01060 413.348.8245
7543044 PROPOSAL
FOR: AT:
Maria and David Pritchard 31 Indian Hill
123 Woodside Drive Florence, MA. 01062
Longmeadow, MA. 01106
We hereby propose to perform all applicable tasks for the completion of:
DECK CONSTRUCTION
1. Install 3— 6" Sonotubes @ 1', 6.5', and 13'
2. Construct deck in addition to the existing deck to 10' x 14'
3. Remove existing decking
4. Add framing to existing deck
5. Remove existing posts and ceiling beam, remove vinyl soffit
6. Replace ceiling beam to obtain open concept
7. Replace vinyl soffit
8. Install new decking, railings and stairs (exit to the front)
9. Permit included, paperwork will be filed after deposit is received 4firL. l 3.0-3
10. Remove and disposal of debris
Payments as follows: $ 800.00 Deposit, $800.00 to be applied to owed balance of Rent, ($800.00 balance)
on 31 Indian Hill.
All material is guaranteed to be as specific, and the work completed in accordance with the specifications for the above work and completed in a professional manner
for the sum of:
ONE THOUSAND SIX HUNDRED DOLLARS DOLLARS $ 1600.00
With payments to be as follows upon signing: $ 800.00 Respectfully submitted by William Patenaude
All material will be paid for at the time of signing unless otherwise documented and/or if material is supplied by you, then 50% of
the labor will be due at signing. Half Balance or partial payments due upon request when determined, by me, based on job and
good faith. Balance due on completion or existing payment arrangements. Balances after 30 days will accrue interest at 1.5% per
month. Purchaser (s) will pay for all costs, expenses, and reasonable attorney's fees incurred in collecting this contract If the
balance is defaulted upon the material used in the job can be removed as collateral. We reserve the right to use subs, to complete a
job to a standard code and any alterations or deviations from the above scope during the performance of the work will only be
executed by written scope change. These changes can be verbal and will be entered into the contract, these changes will become
an extra charge above the amount of the proposal, additional deposit may be required for additional materials. Proposals are valid
for 14 days, some materials or services pricing may fluctuate, and so will the proposal, contact with intentions as soon as possible.
Proposals are placed in an inactive file after 60 days. Jobs are scheduled based on first come first serve when deposit is received.
Exterior jobs during inclimate weather may be postponed determined by me based on the current weather forecast. (initial)
I also consent to placement of advertisement (lawn sign...etc) for Wills Residential during, and after the job has been completed .
ACCEPTANCE The above prices, specifications and co satisfactory and is hereby accepted. You are authorized to do the
work specified. Payments will be stated "above. Any cancellations f ork to be performed by appointment will be charged a daily rate of
$ 75.00 per day, unless given 24 hours notice, circumstances dictate po 'cy.
Signature of acceptance: v DATE: 2 I Z •
The Commonwealth of Massachusetts
_= - _ Department of Industrial Accidents
is v :__ r
ilPM
1 ' ` Office of Investigations
600 Washington Street
. t 7 Boston, MA 02111
Uw www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business /Organization /Individual): IA)) II Am_ FR- i��lX- d 'INA ) V0. C P J.Q 11/4i7/4 I
Address: <3 2 IL> CA i•X---
00100
City/State/Zip: t`- 0 av Zia Ma, Phone #: LI'13 I V? F 1 1 S
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or part- time).* have hired the sub - contractors
2. I am a sole proprietor or partner- listed on the attached sheet. $ 7• Remodelin
/ \ ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs
insurance required.] t employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box #1 must also till 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.
$Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: IV A_
Policy # or Self -ins. Lic. #: J Expiration Date:
Job Site Address: 81 ,TAJD 1 Ai 414 Cr Oft N[.P ( M4 City /State /Zip: o l C) ( p n
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
fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
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
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and I ' allies of perjury that the information provided above is true and correct.
Signature: Date:
Phone #: ((l3' ,(--tv 8Z JS
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
Contact Person: Phone #:
i
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : (Au r I i,/4M PA CS R - 23 17
License Number
39 - `t e j u t , , e L. , M o a. pi?) 4 ) IAA . (MO& 0 l ee / 90 I Q
Address Expiration Date
413 7'1E EV't S
ignature Telephone
9. Registered Home Improvement Contractor Not Applicable El
w ill .S 'DTI dLAJT ( lam! 9a
Company Name Registration Number
'. a. T c-2i- - q C) 00 En Jv19 re io MA 010!7 6 j . / 1 94 I Q
Address Expiration Date
Telephon f 1 3) 31t8 2 tlS
—
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (MG.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 X 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 - 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 L cal Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature f�/ A
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House n Addition ❑ Replacement Windows Alteration(s) F2( Roofing n
r-1 Or Doors E
Accessory Bldg. ❑ Demolition I 1 New Signs [0] Decks [Q Siding [El] Other [p]
Brief Description of Proposed
W L
ork: L 0*Di
Alteration of existing bedroom Yes x No Adding new bedroom Yes K No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
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 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
1 ' 1 ?Q ITC,.(T , as Owner of the subject
property
hereby authorize 1°4 ' • L D Q L.1 t 1 1 5 S i ai.JT1 A t
act on my bekraff, in all matters relative •• work authorized by this building permit application.
Signature of Owner Date
I,
/ 1h -( V rL(. re)A, �-L , 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 DitiFferfAgeof ��� Date
^.
ir,
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information ' ' ~l
� ,
Existing Proposed Required Zoning i
This column to be filled in by \
Building Department, ��� � .
.^�w� ' `
r ------------- — ------ �----~— -------
Lot Size _ ____. ________ `___________ .
Frontage
Setbacks Front ---- ---- --
'---^ ---
�----� _ -- ---- ----/
Side
� --- L___
Rear _ _ ^ __-
Building Height . -- -- .
__ _�
Bldg. Square Footage !��-�-- F °A [--- F--- _---
� ��� ��� � ��
Open Space Footage �W � ___,
(Lot area minus bldg &nmou
parking)
# of Parking Spaces __ ____
'-------------- - -
Fill:
(volume & Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
0 ��� �~\
. NO \~� DONTKNOYV ,�� YES \^�
r ---------- l
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
��
NO �J DONT KNOW 0 YES
r ------ ----- i
IF YES: enter Book ___�_ � Page | and/or Document #
�� ��
B. Does the site contain a brook, body of water or wetlands? NO �&J D0NTKNOYY ��' YES �~/
��
^
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained �-\ Obtained y-� Date|ssued'
*�� \~� , '___--__-
C. Do any signs exist on the propert �� y� YES \~� NO ��)
��
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the pnoperty? YES 0 NO d)
IF YES, describe size, type and location:
E. Will the construction activity disturb ( ring, grading ovation, or filling) over 1 acre orisit part ofa common plan
that will disturb over 1 acre? YE8K ) NO
��
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
,
•
- — _ Department use only
•
• .f Northampton Status of Permit
ECEIVE0 Build ng Department • Curb Cut/Driveway Permit
21' Main Street Sewer/Septic Availability
3 2012 Room 100 Water/Well Availability
North. mpton, MA 01060 Two Sets of Structural Plans
DEPT. of BUILDI - v= ' ' ' ' - 58 '-1240 Fax 413- 587 -1272 Plot/Site Plans
NORTHAMproN MAOtaeo 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
3 1 . J ) p 4 WI 11 Map - Lot Unit
f ►-! 4 Zone Overlay District
C f ° iV i 0 ` 6 — Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: 0/104?
MA(14_ A A p ,I)1 - r C-Mik
le. Lrin) ,� teci4 j , m
Name (Prin Current M ng liess
L l3� dr `7
S� 36
Telephon
Signature
2.2 Authorized Agent:
WI 14 4.4/VA ?AT�- au,D ` Z I P �A1 Nfi� i'ari p h4 .010100
Name (Print) / Current Mailing Address:
4f Current ( ed c S
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building I (yap. (,o (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 W 6. Total = (1 + 2 + 3 + 4 + 5) � Q . '° ( 9,3 Check Number / 0(5°
This Section For Official Use Only
Building Permit Number: Date
r:
Issued:
Signature: ,_ J
1 2
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0857 elf:A44K/"- -e
APPLICANT /CONTACT PERSON WILLIAM PATENAUDE A l 9 ' S Ci L' ""
ADDRESS /PHONE 32 TERRACE LANE NORTHAMPTON (413) 348 -8245
PROPERTY LOCATION 31 INDIAN HILL ! v m'
MAP 29 PARCEL 546 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUI'. D DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out / ij ,0/6'
Fee Paid O 7 SpV �
Tvpeof Construction:_EXTEND DECK .
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 97317
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9R1VIATION 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
o � R- Pot
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.
31 INDIAN HILL BP- 2012 -0857
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 546 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Deck BUILDING PERMIT
Permit # BP- 2012 -0857
Project # JS- 2012 - 001503
Est. Cost: $1600.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WILLIAM PATENAUDE 97317
Lot Size(sq. ft.): 15289.56 Owner: PRITCHARD DAVID W & MARIA C
Zoning: Applicant: WILLIAM PATENAUDE
AT: 31 INDIAN HILL
Applicant Address: Phone: Insurance:
32 TERRACE LANE (413) 348 -8245
NORTHAMPTONMA01060 ISSUED ON:4/9/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: EXTEND DECK - RAILINGS,GUARDS TO MEET
CURRENT CODE
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 4/9/2012 0:00:00 $50.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner