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Job Name 5V v f vt �A S+ - Pc '`zll` `y Job Number ROSEBURG
Location 3y U f'idran 5 {' Sheet of FOREST PRODUCTS
} 10599 Old Hwy 99 South Dillard Oregon 9 -432
Technical Representative ,JO G;,.Ac / c y - ,, 9 5 �7� tel 800-347-7260 I fax 541-6
web wwwrfpco.com 1 email ewpsales @rfpco.com
By Date ‘ V ` f 2_
'38
MORTGAGE INSPECTION PLAN
BOUNDARY 1NFORMA1ON AND EASEMENTS SHOWN HEREON HAVE BEEN COMPILED FROM DEEDS AND PLANS
OF RECORD. NOT AN ACCURATE FIELD SURVEY. TO BE USED FOR MORTGAGE PURPOSES ONLY.
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No.32 -34
H
Q Jewett St.
< 191' L =57'
�tMor
o Vernon Street i 4- AS .
/y
L No. 28518
�� rla�
L.L. `6'441_
Owner: Sharon, John, & Patricia To Norwest Mortgage, Inc.
Z Deal and First American Title Insurance Co.
Location: 32 -34 Vemon Street I report that l have examined the
Q Northampton premises shown, and that to the best
MA of my knowledge and belief, all visible
a_ References: H.C.R.D. easements, buildings, and encroachments
Deed Bk. 4510 Pg. 217 by buildings on this and adjoining
Plan Bk. 029 Pg. 013 premises, are located as shown, or
otherwise noted hereon. I further report
that the structure shown is NOT located
Scale: 1 "x30' in the established flood hazard area ay.:.
Date: 09/12/97 % ,.\.,t)—c--,_ 6 . (-3'.,
Thomas B. Wilson P.L.S. 28516
Thomas Wilson & Associates
professional land surveyors
99 East Circle Dr., E.Longmeadow, MA 01028
Mar 30 10 10:38a p.3
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
17.-fir— .,, .�-= 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): Zd t' 4, R65,\:7" nw / ..,� / 'Fir 1 I I vq . _
Address: 0 N0rf(N elv, 51 ice .f lUd fI ty �6 - OfadD
City /State /Zip: Phone #: Y/3 - 5 - 050
Are you an employer? Check the appropriate box: Type of project (required):
1. E I am a employer with r 4. ❑ I am a general contractor and I
employees (full and/or part- time).* have hired the sub - contractors construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ®Remodeling
ship and have no employees These sub - contractors have ; [1] Demolitio
working for me in any capacity. employees and have workers'
9. El Building addition
[No workers' comp. insurance comp. insurance.}
required.] 5_ El We are a corporation and its 10.1=1 Electrical repairs or additio
3. ❑ I am a horneowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp, right of exemption per MGL Roof
insurance required.] f c. 152, §1(4), and we have no
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box #1 must also 011 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
etnployees. 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: l h )'Pr e. rot 1 - _
Policy # or Self -ins. Lic. #: goo,- c2 ff 1 / 7 Expiration Date: g /^/ 2
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 certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date: d- 3-/ 2-
Phone #: 7 / • 3 — 58 /6 / 3GS0
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 #:
d1 1/�
e
SECTION 5- DESCRIPTION OP PROPOSED WORK (checkatl applicable) 6kC�.re.Si S i'
New House [l Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Er
[ Siding [0] Other [o]
Brief Description of Proposed )J ( ( T J
Work: /n5l a 13x 50 dfcr t 6c�� of 10 J ) /c6 -.
Alteration of existing bedroom Yes 'L/No Adding new bedroom Yes '-''.-- No
Attached Narrative Renovating unfinished basement Yes '' -No
Plans Attached Roll - Sheet
a. Use of building : One Family Two Family Other / ; ` I
12 , 1 i ir Sr- 0= ------..
b. Number of rooms in each family unit: Number of Bathrooms ? 3G
c. Is there a garage attached? ''c,. { ;
attached? /6 `/ �5 a X /U /1
d. Proposed Square footage of new construction. Dimensions `.3 - 3°G•w S
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 ORGONTRACTORAPPLUES P BUILDING PERMIT " , '
1
I, - " i
a - j' _ _ _ � ��a. .�. � 110Cr v\ .'a , as Owner of the subject
property T /
hereb authorize (- 4 y
to - • my behalf, in all mafters relat to viork authorized by this building permit application.
Signature of Owner Date
I, :JU I /Ge•.v r , as Owner /Authorized
Agent hereby declare that the state rr nts 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.
1,.. L ,d7
Print Name
/
Signature of f* er/Age/ 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 L _.._ ___._____ .i 1... m. „_ __ ,
Frontage 1 „. �.. _
Setbacks Front 1
; , __ t
Side L:1 1 R:l I L :; ...,_i R
f
Rear .- L
Building Height 1 ,
Bldg. Square Footage �'" 1 % 1" 1 r 1
Open Space Footage _ _. % t -- ---- -,
(Lot area minus bldg &paved E .1 1 , 1
parking)
# of Parking Spaces
Fill: ....... �. __...�,.�. ....- ._�. I
;.
(volume & Location) L --- 1
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW er YES 0
IF YES, date issued:; 1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book 1 Page and /or Document # _ _ i
B. Does the site contain a brook, body of water or wetlands? NO e( 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
0 f Date Issued: ' 1
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location: i
D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO
IF YES, describe size, type and location: ' 1
E. Will the construction activity disturb (clearing, grading, excav tion, 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.
%
City of No rtha m to � '
Building Department « �� `'
;: ��, oeo
212 Main Street � ` � �
Room 100
Northam ,
phone 413- 587 -124 0 Fax MA 413- 587 -1272
Gw r } mil v .. ^ , :wr r .w.»,
APPLICATION TO CONSTRUCT, ALTER, REPAIR 0 RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
Property Address ��. : W `
{� p . - 3 3 u ; , "a � , , eta °
3 L. VLr ,r
Y - SRµ F
s � ` e
SECTION 2 - PROPERTY OWNER HIPIAU FHORI ED AGENT
2.1 Owner of Record; /
��'� f ' f' I �i j V �hc 54
Y �7✓\ T
Name (Print) / / Current Mailing Add ress:
/y� n/ ��1 1 ' y/3 _ ?30— 6/v9
r� f / W ► Teleph
Sig ture
2.2 Authorized Age / nt:
Ja 41 l ti � �d it1� w . ,q1 /LP` �a
Name (Print) / :
Telephone
Address
SECTION 3 - ESTIMATED CONS T RU CTION COSTS
Signature
Item Estimated Cost ( Dollars) to be
completed by permit ap plicant
1. Building (a) Beddts , Foe
2. Electrical (b) Estimate Cost Of .'
Construc from' (6)
_ 3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) I 00 0 C heck Number /
This Section For Official Ice O
Building Permit Number Date
I • =
Signature
Building Gommissioner/inspector of Buildings Da
File # BP- 2012 -1071
APPLICANT /CONTACT PERSON JOHN LANDRY EF / ���
ADDRESS/PHONE 104 NORTH ELM ST NORTHAMPTON (413) 204 -9880 C , 5 1
PROPERTY LOCATION 34 VERNON ST 3�
MAP 31A PARCEL 117 001 ZONE URB(100)/ s 2 " �l P
THIS SECTION FOR OFFICIAL USE ONLY: pl Aj5 ? � ( . ,k
PERMIT APPLICATION CHECKLIST (,�
ENCLOSED REQUIRED DATE V ZONING FORM FILLED OUT (045€ C-
Fee Paid , N S 1
Building Permit Filled out WL.
Fee Paid /0 7/ C°
Typeof Construction: CONSTRUCT 12 X 30 2ND FLR DECK J ■ fir—
New Construction
Non Structural interior renovations I C) (h+ ��q, U Wt
Addition to Existing pA
Accessory Structure 1 S
Building Plans Included:
Owner/ Statement or License 093450
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION 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
De,j elay
G I 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.
34 VERNON ST BP- 2012 -1071
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A - 117 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 -1071
Project # JS- 2012- 001850
Est. Cost: $17000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN LANDRY 093450
Lot Size(sQ ft.): 7274.52 Owner: DEAL SHARON H
Zoning: URB(100)/ Applicant: JOHN LANDRY
AT: 34 VERNON ST
Applicant Address: Phone: Insurance:
104 NORTH ELM ST (413) 204 -9880 WC
NORTHAMPTONMA01060 ISSUED ON :6/11/2012 0:00:00
TO PERFORM THE FOLLOWING WORK :CONSTRUCT 12 X 30 2ND FLR 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 6/11/2012 0:00:00 $50.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner