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10. Do any signs exist on the property? YES NO
O,,, 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) over 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO X
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
�s97b 2 EVES _2 t -
Frontage 12'1' ) 21
Setbacks Front I 7'
Side L: 2c R: L: D R: 5 L: R:
Rear Z_I2 - 2
Building Height
l o !b
Building Square Footage
11-1$ hp0E 371 m 3 + 31'4
low
% Open Space: (lot area (3/0 %
minus building It paved g� gy c
parking
# of Parking Spaces
# of Loading Docks
u /A N/A
( Fill:
(volume >t location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: J V 1 Q 1 20/0 Applicant's Signature p� 1e.
2a;P�82t
NOTE: Issuance of a zoning permit does not relieve an p scan s burden to comply with all zoning
Amk 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 - Inspector\Zoning - Permit- Application- passive.doc 8/4/2004
File No.
1' d
! ZONING PERMIT APPLICATION (i o.2)
Please type or print all information and return this form to the Building
Inspector's Office with the $15 filing fee (check or money order) payable to the
City of Northampton
1. Name of Applicant: DUES' F1'`S' t.0N32R. .sxJS elo N isgPol 14T5 U.13DOv�t -tKb- 11.44_
Address: tOc. TAN -• \ 047 01610 Telephone: SO$ • 7 S2...• 7 3S(0
2. Owner of Property: Pt4tLtP t C i L- �fitl - lI�SK _
Address: Z1 441LLS1 NdtZTR,4- ri'y'Z v" Telephone: 41 5 (o 76,12
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
G• C•
4. Job Location: 21 -
Parcel Id: Zoning Map# Parcel# District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure /Property: C=am f '1U2
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
G5nwET S (NW E r't'I c* `p Y 1,t•G 12=SI D4CF Man
-P\ 1 112:4 Rl 1PUJI.n0O & ( ICE &O
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 X DON'T KNOW 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 x 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)
W:\ Documents \FORMS \original\Building - Inspector\ Zoning - Permit - Application- passive.doc 8/4/2004
1tOL .— I4€ iNfo aJ
File # MP- 2011 -0005
A(4 0 f 47 616 CA
APPLICANT /CONTACT PERSON EVERETT ANDREWS
ADDRESS/PHONE 100 TAINTER ST (508) 328 -0693 CHUCC,-- gi76 V IS IT 7
PROPERTY LOCATION 27 HILLSIDE RD 1 9 , 0 t ;i 19 6l0 ,5
MAP 24D PARCEL 300 001 ZONE URA(100)/ ra
tilr�t i, Ft��
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FO ILLED OUT ,
Th iaid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - CONVERT ATT GARAGE TO LIBRARY
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
INFQ tMATION 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
I N
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 the Office of
Planning & Development for more information.
1
INSURER'S AFFIDAVIT AS TO WORKERS' COMPENSATION INSURANCE
I. � � 1`1n A" 11 2)C k k.-\ Y\Q .i. [Name. Address] am:
❑ an authorized representative of insurance Company
(Company Name l
(a producer' in the voluntary market)t
›f an authorized agent of 5-'- 6V.Cc..'( , Insu rance Company (an went
(Company Name'
in the voluntary market. authorized to sign on behalf of a producer)
O an authorized sitrnatory of the . the Prime Contractor
(Company Name]
(an insured of a producer in the iitvolt market pool)'
o an authorized signatory of the Sub - Contractor (an insured of
[Company Name'
a producer in the involuntary market pool, group, or otherwise insured)`
and do hereby aver that effective �1 - \ \ 1 [Date]. 1N' n e ` r + \t■iQi n
J
. , the Prime or Sub - Contractor, is insured for Workers' Compensation insurance with
O4c C r (% insurance Company under Policy No[s]. t. C— k T3,
pursuant to the attached Certificate of Insurance. and in accordance with Massachusetts General Laws.
Chapter 152 and Subsection 7.05A of the Standard Specifications for Highways and Bridges of the
Highway Division of the Massachusetts Department of Transportation.
Sinnaturc
)c.'vOsr h* t=C' k GHQ
Title
COMMONWf ALTI -1 OF MASSACHUSE
On thisl2 o f July 2010, before mc, the undersigned notary public. personally
appeared Kimberly Balthazar [document signer]. proved to me through satisfactory evidence of
identification, which was /were MA Driver's License to be the person who signed the preceding or
attached document in my presence, and who swore or affirmed to me that tilt, ntents of the document
are truthful and accurate to the best of their knowledge and belief.
( a, EILMN M. RYAN �/ . Notary
Notary publ / /
1 COMMO of MASSACHUSETTS Eileen M. Ryan/ _ [Printed Name]
My Commission Expires
September 7, 2012
A producer is an insurance company that provides insurance policies directly, not an insurance agent.
` For Prime or Sub - Contractor companies insured through the voluntary market, this Affidavit must be completed by the insurer
or an authorized agent of the insurer.
If the Prime or Sub - Contractor is insured through the involuntary insurance market, a pool. such as the Worker's Compensation
oillik Inspection and Rating Bureau, or is otherwise insured they tnayprovide a Certificate of insurance and this Affidavit which may
be signed by an authorized signatory (company officer) of the Prime or the Sub - Contractor.
Effective lo- May -10
•
•
ENERGY • CONSERVATION APPLICATION FORM FOR ENERGY EF +'ICYCIENCY FOR
ONE- AND TWO- FAMILY DETACHED RESIDENTIAL CONSTRUCTION (750 cma. 61.03
Applicant Name: -TT bpx Site Address: 21 ( u.Stic� �a
• print Town: tycrorttlowl ►v
Applicant Phone: So$ 37.2 CAI
Applicant Signature: 5.
Date of Application; 2.12 '12
1.1siEW CONSTRUCTION Srboose ONE th e follo,v n .t, o o itious '
780 C'MIR TABLE 6107.1
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR
NEW ONE- AND TWO- FAMLLY BUILDINGS
MAXIMUM MINIMUM
Ceiling or Basement
1
Oi3IOn 1: Fenestration exposed 'Vall Floor Perimeter
U-factor floors R• Value R-Value R Value R Value
R Valuc and Depth 1
C� 30 R - 10, Nam p 2=4,
.35 R -38 I. R-- R =1U o �s $�}
• Fs y t'r ie
0R- 1C(' .
Note: This form is not required if you choose either of the two versions of REScheck as i s
Option 2: REScheck Version 4-12 or later variant software analysis must be completed
(780 OAR 6107.3.2)
REScheck—Web which can be accessed at httD:/ /www.enerzycocies.govtresehecki
D O . Orrin t?ATI4N =T ,tag7` Y BUILEiirT0:0#x13: 131
'"Buildings under 5 years old must use option #1 or #2 in IN ew Construction section above.
Complete the following formula to determine the % of glazing:
(a) Gross Wall & Ceiling Area equals Formula: (100 x b = a) _ �~
SF 100x _ • _ C i'm � ~gis.,
(b) Glazing area equals SF b . a
v] glazurig; rs. t#01e;.;use the chaitbeiti ;'° `. Yf' laztrig is" ,40`%o;piuceed;to'` UN . i c
780 ChM TABLE 6101.3
PRESCRIPTIVE ENVELOPE. COMPONENT CRITERIA ADDITIONS TO EX!_STING
LOW-RISE RESIDENTIAL BUILDINGS
MAXIMUM MINIMUM
0 . Fenestration • Ceiling and Wail Floor Besrmcrd Wall 4 :: 1 -b pe:2 ete
U- factor Exposed floors R -Value R -value R -Volt c -V -1
R Value and Depth
39 R -37 a • R -13 R I9 R -1O 1 R -1€ o 4 feet
a R -30 ceiling insulation may be used in place of R-37 it the insulation achieves the full R -value over the entira ceiling
area (.e. not compressed over extetior walls, and including any access openings).
SUNROOM — An addition or alte - apton to an existing building/dwelling tint where the rota;
0 glazing area of said addition excei'ds 40% of the combined gross wall and ceilir g area of the
addition_
Note: Owner to fill out Consumer Information Form (found in Appendix 120.P)
I00I gLgiL9SCT11 IV OT:g0 0T0g /9T /i0
Adli SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction - Supervisor: Not Applicable ❑
G
Name of License Holder : l r "AIAD `D 5 SS 0 9
License Number
aroC° VE e N truto6 VMS (3 IS344 2-/i4 -/ kt
Address Expiration Date
SOS ' 3 n 'Ckft3
Signature Telephone
9. Registered Home Improvement Contractor Not Applicable ❑
0 "7003 (p)
Company Name Registration Number
TINE P.:)(14-rs orsci IA «l6 INC- g•2. 2012
Address Expiration Date
JkH1�R ST �c c rR
1 TD
Telephon �'� � 3 S� O 20 1 294
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 p No ❑
OW
11. — Home Owner Exempt
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
ow
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) IT Roofing I I
Or Doors El
Accessory Bldg. IS Demolition ❑ New Signs [El] Decks [p Siding [El] Other [0]
Brief Description of Proposed
Work: Proposed„ 1:^^y. \5T11.16, C P/ INTO `4 5) BP. R4
Alteration of existing bedroom Yes )-- No Adding new bedroom Yes X 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: I Number of Bathrooms
c. Is there a garage attached? X
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? 1
f. Method of heating? Etec.R.Mipturbrur itchrl'U) Fireplaces or Woodstoves T Number of each
g. Energy Conservation Compliance. __ Masscheck Energy Compliance form attached ? t/
h. Type of construction U%o Frvte ?�o &LCC RE -t
O ink
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes k No
j. Depth of basement or cellar floor below finished grade 5e, oli ODE
k. Will building conform to the Building and Zoning regulations? X Yes No .
I. Septic Tank City Sewer X Private well City water Supply X
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 71', ‘ j c 2 le c., VA , as Owner of the subject
property
hereby authorize
to act on m behalf, in all matters relative to work authorized by this building permit application.
Ai' 7 - ; K �- gf la/ 1r
Signature of Owne Date
MIIIIIIIIIIMIIIIMMIIIII
1, Ft/E1 —At •kD izel (M( { t xt.Ir tzcscrol�` Kb.�( )1ZL , as Owner /Authorized
Agent hereby declare that the statements nd 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.
rr E-E1�Er - ^ S
Print Name
Ems— E . l a-. P
Signature of Owner /Agent Date
•
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........,, g (O._...
Frontage
12`1 127
Setbacks Front 17
..W
Side L: _._.. R... L. w 21 0 __... R:
Rear Z Ci
Building Height
Bldg. Square Footage
Open Space Footage
O
(Lot area minus bldg & paved g
parking)
# of Parking Spaces
Fill:
(volume & Location)...... _....
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO e DON'T KNOW 0 YES
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 DON'T KNOW 0 YES 0
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 0 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.
.
1
Depart
City of Northampton es "Of Pit:
,
212 Main Street
Building Department Curb DufeDnvew,ay 3
Pe i,ty ,
S Avaliablllty
Room 100 WaterrWeiiAvaiab ty�e:.
Northampton, TwGSets of Ria s
phone 413- 587 -1240 Fax 413- 587 -1272 01060 Plot/Sitet Pla Other Specif P rik Gi ";, , it(i
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
Z7 f tILLS 1 U.Ejt). Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
NIL r CAL ' -FS kl 27 it l 1- -L4toc 1ZD, l
Na li! C Current Mailing Address:
yI 3. 526 7(12
�v Telephone
Signature
#14* 2.2 Authorized Agent: / /Or) { t -t 5T 016 fot
Name (Print) Current Mailing ddress:
751 73s ,
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 6 (a) Building Permit Fee cp
2. Electrical I (b) Estimated Total Cost of
COP= Construction from (6)
3. Plumbing 5 dp` Building Permit Fee
4. Mechanical (HVAC) y ;fo
5. Fire Protection ��'/ lY 3°L
6. Total = (1 + 2 + 3 + 4 + 5) _ 5 1.011. Check Number (
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
•
File # BP- 2011 -0123
APPLICANT /CONTACT PERSON EVERETT ANDREWS
ADDRESS/PHONE 100 TAINTER ST WORCESTER (508) 752 -7356 Q
PROPERTY LOCATION 27 HILLSIDE RD
MAP 24D PARCEL 300 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out / / /
Fee Paid A (a XD 3 C
Typeof Construction: CONVERT ATT GARAGE TO HOME LIBRARY
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 55809
3 sets of Plans / Plot Plan
THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I F 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
• • • o i f ei
Sig . s e of Building Officia 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.
Ft,
I ILLSMAD PIQk 0 N BP- 2011 -0123
GIS #: COMMONWEALTH OF MASSACHUSETTS
,: I: 241)- 300 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP- 2011 -0123
Project # JS- 2011- 000088
Est. Cost: $51074.00
Fee: $306.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: EVERETT ANDREWS 55809
Lot Size(sq. ft.): 8973.36 Owner: ZALESKI PHILIP T & CAROL G
Zoning: URA(100)/ Applicant: EVERETT ANDREWS
AT: 27 HILLSIDE RD
Applicant Address: Phone: Insurance:
100 TAINTER ST (508) 752 - 7356 () WC
WORCESTERMA01610 ISSUED ON:8/20/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:CONVERT ATT GARAGE TO HOME LIBRARY
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 8/20/2010 0:00:00 $306.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner