24A-225 (3) ' I '
1
i I I
; , h
. ,
,
, .
3 , ,
, I
1
l i
,
,
,
,
_ .
. .
. ., .
. ,
....,,
,
!(' \
, ..
1 ; i
/ / \ \
/
, 1
// •
/ /
I !,/
/ .
\ !
, ! I
9 .------
/
I 1 ! 1
1 !
! I
! I i
! ,
■ ! i i
4G1 /I P ' " 14 -"7°- ) Al erins.
i I
p-J a 1 ., 1 s i ■.) +.5 u 1 + : AA y?4.0 ,9 ), A
i 0 ...,, Gild i
$
' $ 7, “ 4 $ $$$$$
1 71
' •
•
I .
I . •
•
. ; .
-
; , , „ • • • -
A
q /
.1
t $ ‘V.
,
, 25
1
.. .
\-\\: ,..
\'‘
. 1
; .
.-:
I
I
i .
...:
t . , ..,....... ...
... , :..
, .
N .
...-:
. .
. .
. . ,
-.. ,
, .
, . ..
. \
. ,
. . .
,..
1 I 4,---____, .
. . ,
N
! . 1
...."
,
. t .
1 1
'... i--."1,
,
.s .-----',.
..
,
9 ,
. •
. .
,
/
.,
\ . t ..., .
\ - • .,
....
.
"1
\ ..,..
,•'' 7 .
, , k _.,_
... ,.,,
N., .....„
.._
,,,
--,
Id 60 1 , .P FAL= ,,/ \ , ‘
- \.,...,
\\ ---
. 1
i ' t
tiP T._
- "1 -
3 ! .
■
[
\ \...
, .
. ,
\:\ ,
. .
f,
Yj Li 01
\ , 1
. I
1 "
.V 'j .D IT
(...1 -
1 !
! ,
8 Y [ 0 b p, ri 5/ Ai i VV.c, D c A
5 "
1 ,
f pe ck :,../ c,
1 !
! i !
, omci s a halt
/
t ' _
. -44-7 / ,
i-
,..,, 1
1 ; c
I
1.
1
1 i .• _
r 1
I
1 1 } 1
I ,
, -
..,
i 7 ,
1 I ,
1 1 I
1
1 t
I ,
1 ,
t
_ _ 1
I ,
. I
1 1
1 ' 1
I
1 1
1 i
1 ! i
1
I I 1
I I I ■
1 1 I
t
1 I / \
i l A.
I 1 .
— 1
4 ...... , ' /
.10'
51 pilgrim Drive, Northam ton �Vl , ; _ ; ;
Accessory Apartment (Secondfoor)
- • Proposed 6' x 4' deck
{ I I } i a _ _. 1 ± i and fire escape _
t n I RIG
1 r
i ' O •
T t STOVE F i up
T cn w i_
a z ;:7 z a f
(7 m
� Z
U
, . . r f c Z kitchen/living room i Jg C) -----:- -,-
z
I ■ ' I
P roposed 8' x 10' deck
t �,i bedroom
4 and fire escape . 1,
----f,' : � C � 1 1 {_r ' i _ _ -- I _ 4- 1l -1
+ }
r , ' r -I +� ril - i •
!I i f
C) - ._..._ i_ ++
v) 1 11
i
O i
_ " r-
- - - -- - t__ r
1 7 ' kneewall space
kneewall space --
1
Symbols: Door Window Electrical Washer
(" Outlet Dryer
Scale: 1 square equals 8" :
51 Piriin Drive , Northampton ' W.,4
Primary Residence (first Efoor)
1 L
,
I I;
.
,..r... 0 1
,
, I 1
, '
- bedroom t '
, kitchen
,
i
, 1
_ 1 .
T- ,;-•", , t 7 .-- i :
1
■ I 1 --------- - ,
1 ■ ---- I '
0
bedroom
,
living room
1 ....,__, f t
1 ---- ---i r – -- - i
r• — i i
, .
F ---- i
IIII4 Symbols: Door Window Electrical Stairs
Outlet
1 1=2 Scale: 1 square equals 8"
Addendum to plans/brief description of work
Conversion of home to home with accessory apartment including as follows:
2 second floor egresses leading to grade as marked on floor plan
Fire proofing of stairway with addition of 5/8 firerock to walls and underside of stairway,
1 hour fire doors at base of stairs and relocation of closet out of stairway /landing area
Fire proofing in mechanical chases as applicable
Installation of smoke detectors as per code, locations marked on floor plans
Second floor kitchen to be inspected and approved or made compliant
Separation of electrical service to dwelling units
Install of laundry hookups in bettracnn
Install of through the wall ac unit in bedroom
The Commonwealth of Massachusetts
D epartment of Industrial Accidents
i.,. r a ---� Office of Investigations
1 2 1 4 600 Washington Street
a ki Boston, MA 02111
v:' www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): Na -!-ha 4 ,4 e / 4-1 v e /," 4 JPh
Address: ‘ G C 1 dr 4. S�
City /State /Zip: 5 4- yi,,, 1"1/l' o Lor? Phone #: `l ( a. So - 30.0 7
Are you an employer? Check the appropriate box: Type of project (required):
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. glitemodeling
ship and have no employees These sub - contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers'
g Y P h 9. 0 Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption 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.]
*My 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.
tContractors 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
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 certi under the pains and penalties of perjury that the information provided above
� t
is true and correc
Signature: Date: 7/ 7 //O
Phone #: l t 3 d fv - 3 Ov7
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 #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: �i Not Applicable ❑
Name of License Holder : I u d/T�'t d pro e i 41 me ic i k axle 3-- to a a 7 7
License Number
4 C f or k S4- re / , v r ,i 14 O 1 01)7 S151/101 /101 ot
Address J Expirati n Date
6 /1 T so- 300-7
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
ilicrtho4i p,[ 4/me. CY! q 6fr
Company Name Registration Number
'G GI 4 I: of Cl') 4/ ./Cc(ll
Address Expir i on a te
Telephone 4 1/3 - 250 - 3tn
—
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 ❑
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 Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) 1E, Roofing
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [[S- Siding [0] Other [j
Brief Description of Proposed oO k
Work: n G� SC ��_ 6- 1/6-c_ % 11(0 -4- I (vc)
Alteration of existing bedroom Yes No Adding new bedroom Yes No
aced Narrativ) Renovating unfinished basement Yes No
Plans AttachedRoll - 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 , i� c C ��� L�~ o V c i E , as Owner of the subject
property /I
hereby authorize Na +fit e 1 4 I vx, C' rr
to act on my behalf, in all matters relative to work authorized by this building permit application.
�, tL ( v,C r� (. 2 � Lo ID
E 'L '�' .,.�
Signature of Owner Date
I, 1/a -4-11,1 hd Pi'[ At r. eilh -d e►• , 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.
NCH a e 4(
Print Name
— 7/upo
nature of Owner /Agent Date
_ as<
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 eLCi- lY lac t - c
Frontage
Setbacks Front 1 -1 )5 1
i
Side L: R: zt L: 3 R 2 Y
Rear
Building Height
Bldg. Square Footage f � c L I S. Z % 1 47 3 ? S. ? %j,
Open Space Footage c,.
(Lot area minus bldg & paved f i 7c s' 7 ?. 3 5 . 7`i / (c.
parking)
# of Parking Spaces .3
Fill:
(volume & Location) Yl ��� ��
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO t21 DONT 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:
E. 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 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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
Ngampton, MA 01060 Two Sets of Structural Plans
phone 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE +R D OLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
01 # /
1.1 Property Address: This section to be completed by office
Ca I Pc' I , V✓. fJ if . V c -- Map Lot Unit
Key -V t, r. ' � s L Cft / M (* > C) Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Curren Mailing Address:
Current fa \ 5 T-1 7 �� 7
C ✓l -�E��� �'C . CI 'YU:LA Telephone
Signature
2.2 Authorized Agent:
ijn+l1 r , he e I A - / hi e k t of e C l (ir l c S Et75, 4 110 sft fai-oh t 14 c QY7
Name (Pri t) Current Mailing Address:
q/ 3 - aso -- 30 0 , 7
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 I (b) Estimated Total Cost of
{�
8 60 Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) /3 Oct f _ Check Number (� 1 • 0
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
•
File # BP- 2010 -1208
APPLICANT /CONTACT PERSON NATHANAEL ALMEKINDER
ADDRESS /PHONE 66 CLARK ST EASTHAMPTON (413) 250 -3007
PROPERTY LOCATION 51 PILGRIM DR
MAP 24A PARCEL 225 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT , s�, / p
Fee Paid �V d W G y O
Building Permit Filled out /
Fee Paid / ZE/3 o� `III
Typeof Construction: CONSTRUCT ACCESSORY APT, 8 X 10 DECK & 6 X 4 DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 102079
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN_ F 9MATION 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 /
/1-0 7/30/0
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.
yttr;.PR BP- 2010 -1208
GIS #: COMMONWEALTH OF MASSACHUSETTS
ro k.: 24A = 45 .f° CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ACCESSORY APARTMENT BUILDING PERMIT
Permit # BP- 2010 -1208
Project # JS- 2010 - 001518
Est. Cost: $13045.00
Fee: $64.80 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NATHANAEL ALMEKINDER 102079
Lot Size(sq. ft.): 10846.44 Owner: GARDNER DARIEN A
Zoning: URA(100)/ Applicant: NATHANAEL ALMEKINDER
AT: 51 PILGRIM DR
Applicant Address: Phone: Insurance:
66 CLARK ST (413) 250 -3007
EASTHAMPTONMA01027 ISSUED ON: 7/30/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT ACCESSORY APT, 8 X 10 DECK
& 6 X 4 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 7/30/2010 0:00:00 $64.80
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner