24B-005 (2) 10. Do any signs exist on the property? YES NO
i$1!";.
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) over 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 REQEDBY
ZONING
Lot Size
�G nt I cc..
Frontage
Setbacks Front ,2<)
Side L• 14- R: 15 L 1 4 R: l5 L R:
Rear
Building Height
Building Square Footage s ter
% Open Space: (lot area
minus building & paved 3 r 3Civ E. 3 l \
parking
# of Parking Spaces
kOA
# of Loading Docks
Fill:
(volume & location) ,J/4\ A.0
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: IS 3- " Applicant's Signature
NOTE: Issuance of a zoning permit does not re 'eve 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: \Docunients\FORMS \original\Buil ding - Inspector\Zoning - Permit- Application- passive.doc 8/4/2004
RECEIVED
,l File No.
Ple. `Y:>< + • ,, ' s''ormation and return this form to the Building
Inspector's Office with the $15 filing fee (check or money order) payable to the
City ofNorthampton
1. Name of Applicant: E
Address: barrcj t) NLE Telephone: f % 51f4 " s!7 7.).
2. - Owner of Property: Z. ti 4 1 V v L-
Address: ge- rr - Si ,, JL „ NIA Telephone: ill 3 ' S - 4 D-
3. Status of licant: Owner
App X Contract Purchaser Lessee Other (explain)
4. Job Location: IC 6o,tr- {t St . e r r.nl�n�, MA D i U
ct lm s I n .;� -. H' x k�t✓4 ���-� - -tw�°` �' t '",, -.y �� shF' a w-w
q u a
are
t,�r -T 3an•�» cKV.la. p .5 �§vr � _
5. Existing Use of Structure /Property: lie 4; Aan u
6. Description of Proposed Use/Work/Project /Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan x Site Plan Engineered /Surveyed Plans
8. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW X YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and /or Document #
9.Does the site contain a brook, body of water or wetlands? NO / 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:
(Form Continues On Other Side)
8/4/2004
W:\ Documents\ FORMS \originahBuilding - Inspector\ Zoning - Permit - Application- passive.doc
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HOMETOWN I N V O I C E
STRUCTURES • -
627 Southampton Road Order Date �7 1 - ?0 I
n ` Westfield, MA 01085 1329 Estimated Completion Date ? c �L.s 1tI--- """` (413)562 -7171
►`
(-ex, .1 /low
Bill To 2 ► F 14 C • f • lr aor ktss Notes .
Address - 7 -r is a , r re 4 t S 'trek 4
A a r'f �bn PIP 0/0(4 u _
Phone # Ship- 5 7 c Cell Phone # V 13- 9ae - S 2 95
E -mail Address ,219- 05 ('3u6
f , In -stock Display Shed DuraTemp T1 -11 U ❑ Vinyl
U To Be Custom Built Body Color r Body Color
U Delivered Fully Assembled Trim Color (....) A ' - k Corner Color
Al Modular Door Color I lack Door Color
U Built On site SOFFIT CHOICE (For New England Style Only) SOFFIT CHOICE (For New England Style Only)
' X •�� Solid T1 -11 U Body Color Perforated Vinyl ❑ White CI Brown
Size Exposed Rafter Tails U Body Color Beaded Vinyl U White Only
Ai New England Series Aluminum Strip Vent U White U Brown q 1
U Keystone Series Base Price $ 1. 3 4 0
Style Abew E 61. a,t 3-4 , rru (1;1-o — o ?, ) 3o
Code Door Adjustment $ + 'S S°
Shingles Windows Window Adjustment $ 4 do
)! Dual Black U 18"x 36" Ramp 6' x 4' ❑ 5' x 4' ❑ 54" x 4' ❑ $ tk A(!v
U Earthtone Cedar ❑ 24" x 36"
U Dual Gray 36" x 36"
U Dual Brown ❑ 36" x 40" Loft ❑ 4' x 8' ❑ 4' x 10' ❑ 6' x 12' ❑ $
U Weatherwood
U Harvard Slate Window Boxes ❑ Wood ❑ 18" Color $
U Charcoal Gray ❑ Vinyl ❑ 24"
U !OA 3S ❑ 36" -
Drip Edge: ON U B Grids: VW U B e //���� Shutters ❑ Wood Color 1 $ — 1 ( O
Single Door Double Door ❑ Vinyl —/
Width Width (c cv r *c� $ 7 1 6 Type Type
Transom Transom 5+r4.. r Ca ,s t $ + 3 0 U
Grids: U W U B Grids: U W U B
Hinges: iJ Std. U Strap Hinges: U Std. U Strap
IS Site Preparation — pad size IS x a 3 (subject to site evaluation) $ b (c. S' N r
A Overwidth Road Permit Fee $ S/ j. '/T
•
Loading Illustration Subtotal $ 1 . Ljfo..S"
— $
Sales Tax i S
TOTAL $ 1 a, 00v
_ T — — -- — -- —. Trailer 00. Truck
� ` ' Deposit $ y J
,\
Balance $ 611) 611) '3 ' 3 , . `� 7
•
1 L • Customer Si g \
.„,,,,,,,,,,:: 30 -year architectural f 2 x 6 rafters ridge 16" vent on i shingles over 1/2" CDX with collar
plywood roof sheeting ties 4' on center
v: a
n d
y • A.' �
exclusive detailing, �g $ q
a
with large roof overhang = ss ,, 1 ,,,, , i
' It w .
--,„ „,,,,,, , , i
1
, ii ,
1‘ ,
, , ,,
.,,,,,,,,..,..,11,, , ...,„„,,,,, ,..., I
_.,-,,.--;.,,,,-.,,,, * I „. ., ,,, , ,. , I
�t 3 S
double 2 x 6 header n. `��'
over windows and doors ; , pressure treated floor
� system, 4 x 4 rails, joists 12
on center, 5/8" plywood
vinyl over 1/2 CDX plywood
The Commonwealth of Massachusetts
Department of Industrial Accidents
I, 4 I Office of Investigations
11=
.._ 600 Washington Street • =� Boston, MA 02111
�' www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): /40,1,-,c_4 J /6t..- a '1-k. ; -rt
Address: l c ,7 S,_,..4 ket r+ • j�J .
City /State /Zip: LO e s +- " /4, in' A C /(. ihone #: t ) 7 / —7 J
Are you an employer? Check the appropriate box:
4. I am a general contractor and I Type of project (required):
1 .X I am a employer with ) ❑ g 6. ❑ New construction
employees (full and /or part-time).* have hired the sub - contractors
listed on the attached sheet. 7. ['Remodeling
2. ❑ I am a sole proprietor or partner-
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9. 111 Building addition
[No workers' comp. insurance comp. insurance.
5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, § 1(4), and we have no 13.Q Other ct -sc. �d
employees. [No workers 7 l
comp. insurance required.]
*Any applicant that checks box # l 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.
: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: 1 k 5 ; �e 1 ,1 5,) ,-, - tie
Policy # or Self -ins. Lic. #: 781 - Lu C- c )L 1 Expiration Date: 3 - 7 - dby ;]
Job Site Address: 1 5 gc 'tN, *f S' e_ City /State /Zip: /V ,--11c, , 9 ; , idi 0 /0(,0
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 cert fy under the pains and penalties of perjury that the information provided above is true and correct.
Signature: ✓ ` �� °�� �� � "�`' Date: 7 / 6 - )c i )
Phone #: 5 is - 7/7/
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
rnntart PPrcnn• PhnnP ft•
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSL)
A nd ,f Z License Number Expiration Date
Name of CSL- Holder (J
` 5- � � 7 f 4 i 4 , i �, Mi l List CSL Type (see below)
Addres / I V N 010 .Sti Type Description
/5 / � U Unrestricted (up to 35,000 Cu. Ft.)
`c a R Restricted l &2 Family Dwelling
Signature M Masonry Only
5 �O 1/7/ RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Regi eyed Home Improvement Contractor (HIC) c
0 ,�e-Iv,.,., n 5-1-n., c it, re s / .S 1 ' 7 c7
HIC om any Name or HIC Registrant Name, Registration Number
rz d'7 Ste, I ., �a i,.� a 1 - 0 e , t /) ) y 4
Address „ d ru,�. S _ a — 7- ' 0 I D
f 1, , „,,, 471,.,L. 5 b a- J /' 7 / Expiration Date
Signature Telephone
SECTION 6: 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 00 No ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 2 Atk . Vic) r AC s S , as Owner of the subject property hereby
ze AWL. v Na n 1li c 1 f`e s to act on my behalf, in all matters
relative to , .• s -d by this building permit application.
Sign. a of b \ ' 44- OF Date
,--/I " \SECTION 7b: OWNER OR AUTHORIZED AGENT DECLARATION
I, i+ r ° w () 5 ' f 'ry ( ku-c f , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf. /� ki i i.,
Print Name
G 1 ) k4-- _ -/(t, 2 i
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor (HIC) Program), will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations 110.R6 and 110.R5, respectively.
2. When substantial work is planned, provide the information below:
Total floors area (Sq. Ft.) c VO (including garage, finished basement/attics, decks or porch)
Gross living area (Sq. Ft.) Habitable room count —
Number of fireplaces Number of bedrooms
Number of bathrooms - -- Number of half/baths
Type of heating system Number of decks/ porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage” may be substituted for "Total Project Cost”
The Commonwealth of Massachusetts
W , .; • : . _ • ing Regulations and Standards FOR
a Building Code, 780 CMR, 7 th edition MUNICIPALITY
USE
ildil P rmit A lic • To Construct, Repair, Renovate Or Demolish a Revised January
''.�'°' • �� o► or Two - Family Dwelling 1, 2008
is Section For Official Use Only
• ILDING I'
BuildinL ' - III . tom: �; ,.f a; ,,�? vs Date Applied:
Signature:
Building Commissioner/ Inspector of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Pro ertx Address: 1.2 Assessors Map & Parcel Numbers
1 iScert Si-. ,)(-- fitclio, 07/9
1.1a Is this an accepted street? yes - no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dime sions: ,
5 b ti -I,. i Y3, 5t,,o i/— /00
Zoning District Proposed Use Lot Area (sq ft) Frontage (ft)
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Flood Zone?
Public Private ❑ 1) Check if yes❑ Municipal On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Qwne to ' ecor • _
�,-,� P. V- r�esS "7 5 (3,4z,- l- Sit - „'�'ke, -�M-A
+me (Print) - Am Address for Service:
S $10- 5 -17 g
Signaa'', qill Telephone
CTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building ❑ Owner - Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. Number of Units Other ❑ Specify:
Brief Description of Proposed Work a 1 i ter- O 4 Ire -" s S tfsA t d l, x ?o
rtt cc_SSu✓ -1 i '-'• 1 ds1
•'
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ F S (0 0 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑ Total Project Cost (Item 6) x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 5 6 0 fl Pairs in Thill f Ontstanrlinn Balance Tine.
File # BP- 2012 -0054 (1,1 f C K
APPLICANT /CONTACT PERSON HOMETOWN STRUCTURES ,------- \ /� (j
ADDRESS /PHONE 627 SOUTHAMPTON RD WESTFIELD (413) 562- 7171�V6� J
PROPERTY LOCATION 75 BARRETT ST
MAP 24B PARCEL 005 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
ee Paid
L'B 'lding Permit Filled out !
ee Paid � 'f(� (2.�
Typeof Construction: 12 x 20 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 FO LOWING 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
7/9,1/ I
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.
75 BARRETT ST BP- 2012 -0054
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24B - 005 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- 2012 -0054
Project # JS- 2012- 000083
Est. Cost:
Fee: $48.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOMETOWN STRUCTURES_
Lot Size(sq. ft.): 43560.00 Owner: VOORHEES ZILLA G
Zoning: URB(100)/ Applicant: HOMETOWN STRUCTURES
AT: 75 BARRETT ST
Applicant Address: Phone: Insurance:
627 SOUTHAMPTON RD (413) 562 -7171
WESTFIELDMA01085 ISSUED ON:7/26/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: ERECT 12 x 20 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 7/26/2011 0:00:00 $48.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner