30C-052 -NOTE -
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
NOTE:
PROPERTY LINES SHOWN ARE APPROXIMATE,
A FULL FIELD SURVEY IS REQUIRED TO
ACCURATELY DETERMINE THEIR LOCATION.
NOTE:
SUBJECT TO EASEMENTS AND
RIGHTS OF WAYS OF RECORD.
REFERENCE:
PLAN BK. 179, PG. 89
108.50'± Plan
110'(Deed)
Elj shed
0
BOOK 10564, PAGE 25
PLAN BK. 3, PG. 81
PORTIONS OF
LOTS #15 & 16
PLAN BK. 110, PG. 61
w {, REFERENCE:
n: cn PLAN BK. 47, PG. 8
H-
o ° gar. � 10' r
rn
CD , to
// /I / ///
/ /
j #105 /
! / / /7 //X
100'±
I p 5 CLEMENT STREET
TO: BERKSHIRE BANK AND
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
—NOTE —
SURVEYOR ?(5 \ A A P �. 1 THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
SN °F — MORTGAGE LOAN INSPECTION PLAT —
NORTHAMPTON, MASSACHUSETTS
RANDALL %; PREPARED FOR
Iz R N I CYNTHIA S. SCHAEDIG & BONNIE S. COOPER
#35032 SCALE: 1 " =30' APRIL 13, 2012
suRvc4 �'h� ' HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
The Commonwealth of Massachusetts
Department of Industrial Accidents
S T= � Office of Investigations
t = 600 Washington Street
Boston, MA 02111
www.nrass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information j Please Print LcEiblv
• Name ( Business /Orgy izarion/Individual): 2f)1. k 9 Pe i h os c_d ' : / ol /k l
Address: /D 7 5
City /State/Zip: p r k ' 0 1I Phone. #: y/ 3 u8O -
Are you an employer? Check the appropriate box:
4. I am a general contractor and 1 Type of project (required);
I . ❑ I am a employer with ❑ 8 6. (] New construction
employees (full and/or part - time).* have hired the subcontractors
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These subcontractors have 8. ❑ Demolition
working for me in sec c ity. employees and have workers'
Y insurance.:
9. ❑ Building addition
[No women s' comp. insurance Amp.
ed.] 5. are a corporation and its LOU Electrical repairs or additions
3. ❑ I am a homeowner doing all work °Mc= have exercised truth 11.0 Plumbing repairs or additions
m o workers ight Of exem p MGL
yselt � co. m 12.0 Roof repairs
insurance required] t c. 1.52, 11(4), and we have no I3.Q Other
employees. ( workers
comp. insurance required.]
*Any apptiame dint: +ec s box al e a stabo fin out the ueetion below showing anisswans' onnoseraoon policy mfaentatiat
t Homoovniess wrho submit this affidavit mdiotug they ere doing an work and then hire outside cents ctos mast submit a new affidavit indicating such
5 ConNUtots that check this boa wont attached m additional sheet showing the nuns of die subseetraogas sod tyre wbeflrer or not those entities have
. =playas. if the subeonttaeters have anploroes, they must provide their notions' comp. policy>>mober. •
lam as employer that is: providing workers' compensation Insurance for my employees. Below is the policy and job rile
information.
Insurance Company Name: ?e f I /
5
Policy # or Self -ins. Lic. tit: a? g I/ 'S 7 Expiration Date: OB f06 /aO
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 an lead to the imposition of criminal penalties of a
fine up to $ 1,50000 and/or one-year imprisonment, as well as civil penalties in the foam of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copyof this statement 'may be forwarded to the Office of
Iavestiestiens of the DIA for insurance coverage verification.
I do km ky ewer - the palns.md penalties afpedary that the lafor eden provided above is bare and correa.
?pone a: V/5 — g �d
•
rcta use only. Do ,ot write bt this area, t t arp dry or tow OS9ciaL
City or Town: • Permit/Memel
j Issuing Authority (circle one):
:1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: Phone #:
SECTION 8 - CONSTIWCTIONSERVJoES
8.1 Licensed Construction Supervisor: J Not Applicable ❑
Name of License Holder: 5 k , L„01' j (5 93950
1 l / ( f / 1 n AA /
License Number
� Expi 4 q 0 -4 4 - f 1 6" 5) klar J �,. ,,G � Vim /'�4 . d iga /71, 4/ y
Address
Yf -,4 Yr 904
Signet Telephone
Not Applicable ❑
l3 1 .. e /51 /® 3
Company Name Registration Number
/Q � l et1U,— C,... 51 er › cPo /y
Address // Expiration Date
1001• 4 d /Op / l/ Telephone
SECTION10- WORKERS' MPENSATION*SURANCE AFFIDAVIT (M.G G.L. c 152; § ?SC(*)
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 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
L040 5 ' 1 1 \ 4 . k 5 0 - I
SECTION 5- DESCRIPTION OP PROPOSED`WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [[ Siding [n] Other [a
Brief Description of Proposed r r II rr )) // /
Work: p e . 0,5`�r c c /0 / Jer of /xt �f )o ' iNykir( )1'1. ht.' (-
Alteration of existing bedroom Yes -"No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes , lNo
Plans Attached Roll - Sheet / / )
�� / / /l // 11"ei11
€
a. Use of building : One Family Two Family Other J f -2 to 6
b. Number of rooms in each family unit: Numby- f Bathrooms ;�
c. Is there a garage attached? �� � � 5 -,2x/o ir
d. Proposed Square footage of new construction. / Dimensions
e. Number of stories? f /
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,of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement oycellar floor below finished grade
/
k. Will building corkrm to the Building and Zoning regulations? Yes No .
I. Septic Tank/ / City Sewer Private well City water Supply
SECTION 7a OWNER AUTHORIZATION - TOB COMPLETED WHEN
OWNERS AGENT OR CONT ACTOR - APPLIES FOR BUILDING PERMIT ". .
I, L' no y SC1.4,. i 7 , as Owner of the subject
property
hereby authorize 3e1...k C_.b t v t cJ C
to act o my behalf, in. Il.tnatters relative to work auri ed by this building permit application.
Signature Owner Date
I, Sdk 'S. I- .O ry , as Owner /Authorized
Agent hereby declare that the statement 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 Owne gent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning l' A S . s
This column to be filled in by
Building Department
Lot Size L i ___ ... ___
i
Frontage # w _ _ . _. .. , t
Setbacks Front ? ( }
r Side L:= R: -`' L:i 1 R:i . ._. I ._. J
I
Rear _ ....,__ ,.
Building Height `� - 3
Bldg. Square Footage 1 1 I % t ;
Open Space Footage _. % I
(Lot area minus bldg &paved € --I
parking)
r _ ___ . ,
- -_
# of Parking Spaces = }
Fill: 1 ;
(volume & Location) €
A. Has a Sp l Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book I Pagel ( and/or Document #� __ __9
B. Does the site contain a brook, body of water or wetlands? NO DONT 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: 1
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location: 1
D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO 0
IF YES, describe size, type and location: r _ __..___.
E. Will the construction activity disturb (clearing, grading, ex tion, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
t m : :,
City of Northampton .„ J
Building Department --1
K
2 212 Main Street ° , - ` � , „, �,
Room 100
tis� "� Northampton MA 01060 .
pEp pR
o MP phone 413 - 587 -1240 Fax 413 - 587 -12
APPLICATION TO CONSTRUCT, A LTER, REPAIR, RENOVATE OR DEMOLISH A ONE O TWO FA MILY DWELLING
SEGT1ON 1 -SITE INFORMATION
1.1 Property Address: �'Y
I r e C., lt'?V�C. r1,� / `�z' '� r c F.�.s , s 4.kl,r ,- � .. '1' e � tu k.
x @ : r","F, ; _ 'k°�' z '•fie "i `�`* ^Z` �,t
.-
SECTION 2 - PROPERTY OWNERSHIP /AUTHORISED AGENT
2.1 Owner of Record:
C�dy s �P� q /3 � - 2 k NA 06
Name
Print) Cunent Mailing Address:
1,,,- gig-.
"
Signat e
2.2 Autho rized Agent: 2 Z l �G �f-E! . _ Telephone �� 3 5,3?),, S y
6
vvv
Name (Print) 4 / Mailing Address:
Signature / Telephone
SECTION 3 - ESTIMA ED CONSTRU `COS
Item Estimated C ost (Dollars) t o be ti y
comp leted by pe rmit appl
1. Building 4c%G (a) Building, ermit
2. Electrical (b) Esttrriated Cost of
Constru from S "
3. Plumbing Building Permit Fee
es
4. Mechanical (HVAC) ,, - / 4. 7 1 ' ' eg ,
5. Fire Protection
6. Total= (1 +2 +3 +4 +5) jfi( y�i Chec Number
Thi Se ctia� For Offici Use O r t`
Building Permit Number. Date
.. � Issued:
Signature:
Buikiing Gom missioner/Inspector of Buildings
File # BP- 2012 -1034
Q
APPLICANT /CONTACT PERSON JOHN LANDRY -,00e1
ADDRESS/PHONE 104 NORTH ELM ST NORTHAMPTON (413) 204 -9880 �p n (!
11-
PROPERTY LOCATION 105 CHESTNUT ST
MAP 17C PARCEL 303 001 ZONE URB(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 1070 r� 0 A 5a
Typeof Construction: CONSTRUCT 10 X 12 DECK & INSTALL PATIO DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 093450
3 sets of Plans / Plot Plan I TOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I SRMATION 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
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.
105 CLEMENT ST BP- 2012 -1034
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30C - 052 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 -1034
Project # JS- 2012- 001774
Est. Cost: $8000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN LANDRY 093450
Lot Size(sq. ft.): 14505.48 Owner: SCHAEDIG CYNTHIA
Zoning: SR(100)/ Applicant: JOHN LANDRY
AT: 105 CLEMENT ST
Applicant Address: Phone: Insurance:
104 NORTH ELM ST (413) 204 -9880 WC
NORTHAMPTONMA01060 ISSUED ON:5/25/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 10 X 12 DECK & INSTALL PATIO
DOOR
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 5/25/2012 0:00:00 $50.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner