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- -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
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{'laoPocED ZO , , - L_____
FRo
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t.
TO: WORONOCO SAVINGS BANK &
FIRST AMERICAN TITLE INSURNACE 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. 1 FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY # 250167
���, �RRnn T —NOTE —
SURVEYOR ����!'�4• THIS DOES NOT CONSTITUTE A PROPERTY SURVE
s.:sN , — MORTGAGE LOAN INSPECTION PLAT —
NORTHAMPTON, MASSACHUSETTS
� PREPARED FOR
E. 4
2 'S WILLIAM CUTLER & M. LEE Ma�cKINNON
S CALE: 1 " =30' AUGUST 16, 2.00
(1 ti..a''' HAROLD L. EATON AND ' ASSOCIATES, INC.
. REGISTERED PROFESSIONAL LAND SURVEYORS
• 235 RUSSELL STREET — HADLEY — MASSACHUSE
. •
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends 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
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, t0 act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation /footings (before backfill)
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
Permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to
Date
Address of work
location
• m
The Commonwealth of Massachusetts
== Department of Industrial Accidents
= r4g6- Office of Investigations
. _ o
t i 600 Washington Street
=ill— Z Boston, MA 02111
www.mass gov /ilia
•
-Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/PIumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individnat): 0 L.-ND Z___
Address: c --7 C'€ ',iv"( C.-5T
City /State/Zip: 4LO re -A4A- . Phone. #: if 2100
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 6. ❑New construction
employees (full and/or part-time).* have hired the sub- contractors
2 I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no loyees These sub - contractors have. 8. ❑Den olition
working for me in any capacity. employees and have workers' 9 �,� „, addition
jNo workers'. con insurance i ncrmanrr #._ -.. .. � `
re ��j 5. 0 We are a corporation and its 10 -r=1 Electrical repairs or adthtions
i
h
ffi
ocers have xercsed their . 11 Plumb' 3. 0 I am a homeowner doing all work ❑ 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.[] Other
comp, insurance required]. •
*Any applicant that chests box # must also fill out the section belotv showing their *mho=s' compensation h information.
�ti policy � •
t Homeowaers who submit this affidavit:mdicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
zCoatractors that check this box must attached an additional sheet showing the name of the sub=contractors and stair whether or not those entities have
employees. If the sub - ontractors have employees, they must pruvide their workers' comp. policy number.
l am an employer that is providing workers' compensation insur for my employees. Below is the policy and job site
information. • .
Insurance Company Name: •
Policy # or 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 wider .Section'25A ofMGL c. 152 can lead to the imposition `of crimm41 penalties of a
fine up to $1,500.00 and/or one- year imprisonment; as well as civil penalties in the form ofa STOP WORK ORDER and a tine
of up to $250.00 a day against the violator Be advised that a copy of this statement may forwarded to the Office of
Investisatioris of the DIA for ins ' .: e coverage vcrilication . _ .,
_ I do here_y b cerk u ,'.
p- 0 , d penalties ol` perjury that the ` information provided , �bave_tslrur_aadcvrr- ert� --
Signature: . � Date `7 -I3. ` I U .
A
Phone 4: . 93gszi _ I f • •
Official use only. Do not write in this area,10 be completed by cily 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 r .
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: `` '' D
(� Not Applicable ❑
�N D
Name of License Holder : li / V
License Number
CA CA V T �7 EC CE ' 3463
Address Expiration Date
,or )1111i
a. 4 (Lt1 504
Signature Telephone
■ Z- 3- 2OI•Zi
13x8 "fm#�iaementt4�tr"., = ;,„zazoNmningyzaaint Not Applicable ❑
Company Name Registration Number
t DL-AND 1 1 1 .6 /256
Address 1 R , �, Expiration Date
9 - 7 C H&71 f �� N V I 9r` PLO* Telephone LE L!TV 1 z-16, — 2(
-
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 '� .. - .
f �-
The current exemption for "homeowners" was extended to include Own iccupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire wh s s s es not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.
Definition of Homeowner: Person (s) who own a parc • f land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelli.. , attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more t one home in a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the B • ding Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work per med under the buildine permit.
As acting Construction Supe ' or your presence on the job site will be required from time to time, during and upon
completion of the work for ich this permit is issued.
Also be advised that reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for inju% - s not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to pe work for you under this permit.
The unders': ed "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northa .ton 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) [J Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [CI] Other [p]
Brief Description of Proposed
Work: Mt- `R '6 COVE -e P )W6'i 4 / (ZE -.6nl - //.1
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Renovating unfinished basement Yes No
Plans Attached Sheet
6l [ i s't is at tl offio.°Veiil t qh n cr�ln ie 1ie'followi q:
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. Dim- - ons
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 wi .' 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
I, ,,(.... /1/ (C +f` rrii'l , as Owner of the subject
property
hereby authorize
to act on m half, in all matters Live work authorized by this building permit application.
Air
Signature f Owner Date
I, el) DL 2 , 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. f .. Signed • :. - or , nd -en : - •f perjury. 4 - I3 -� X10
jib, Print Name
EP o144-1 4 LE
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 1 ‘ 0 2,7 T 10/ Z�7 -/ 5 i , - 07 _:
Frontage I 75 7 5 --~1 ! ' 1 5
Setbacks Front ` `=
7 Side L:' R: L:_._ R: �
Rear
1
Building Height .‘, E3E1 7-1
Bldg. Square Footage Nri FE % Za ; s,'
Open Space Footage
(Lot area minus bldg & paved 7 ' / RA W
parking)
# of Parking Spaces , . °-- _
Fill: 1 _
, i ....
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW ei YES Q
I
IF YES, date issued:1 4
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES Q
IF YES: enter Book j Pagel and /or Document # _ yN
B. Does the site contain a brook, body of water or wetlands? NO W DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 NO i►!4
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 1.:
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 cp
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
City of Northampton y
xi
Building Department
y .e
212 Main Street s
Room 100
ry \ 3 ���� Northampton, MA 01060 1 <"4
phone 413-587-1240 Fax 413 - 587 -1272 -
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1- SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map Lot Unit
1l r--)PI,f) 5 ( - F2 -
Zone Overlay Distract
T• 16/\..) M
, Elm St District ? CB District
SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
' , Q 1 f QC rl, 1 ch 3 / f /et �/`Ld -`t /V ` L C> / [ U
Name (Print) ' Current Mailing Address:
e 147 Telephone
Signatur
2.2 Authorized Agent:
0 ttekINI Lam- ` � 7 C i n1 tri ST" FLnPGi+
Name Current Mailing Address:
(3) 1-15S1+ - 2a 00
Signature Thone
SECTION 3 - •ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building i 000 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
/ Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection � � � �� ��
6. Total = (1 + 2 + 3 + 4 + 5) 0-Z101)0 Check Number y
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
•
File # BP- 2010 -0893
APPLICANT /CONTACT PERSON EDWIN OLANDER
ADDRESS/PHONE 97 CHESTNUT ST FLORENCE (413) 584 -2100 Q
PROPERTY LOCATION 31 DRYADS GREEN ST
MAP 31A PARCEL 270 001 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 47 /` u`� —
Typeof Construction: ENLARGE SCREEN PORCH (6 X 12)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 049348
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION PRESENTED:
V 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
o y //SIM
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.
31 DRYADS GREEN ST BP- 2010 -0893
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A- 270 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0893
Project # JS- 2010- 001323
Est. Cost: $22000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Conte Class: Contractor: License:
Use Group: EDWIN OLANDER 049348
Lot Size(sq. ft.): 10280.16 Owner: MACKINNON M LEE & WILLIAM S CUTLER
Zoning: URA(1001/ Applicant: EDWIN OLANDER
Al: 31 DRYADS GREEN ST
Applicant Address: Phone: Insurance:
97 CHESTNUT ST (413) 584 -2100 O
FLORENCEMA01062 ISSUED ON :4/16/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: ENLARGE SCREEN PORCH (6 X 12)
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Rough: Rough: Sa House # Foundation: `'"' 1 �
"' " Driveway Final:
Final: Final: c Hi° 31-4(5
fdS D ,l Rough Frame: D
�''� i�''►.S � � 4✓ l�
Gas: Fire Department Fireplace /Chimney: J 7
Rough: Oil: Insulation:
Final: Smoke: Final: ai< 7 —/3
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
,r Certificate of Occupanc ,f Signature: a 7:4 A.
FeeType: Date Paid: Amount:
Building 4/16/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo