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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
' 44't
NOTE: GARAGE
SUBJECT TO EASEMENTS AND
RIGHTS OF WAYS OF RECORD.
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1 I BOOK 2629, PAGE 191
1 Q I PLAN BK. 26, PG. 77
I
I
52't
CRESCENT STREET
TO: APPLIED MORTGAGE SERVICES CORPORATION &
LAWYERS TITLE INSURANCE CORPORATION
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 -
c EYOR:
T . 7 L
SURV lh THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
,�, OF
-MORTGAGE LOAN INSPECTION PLAT -
,` 5i, NORTHAMPTON, MASSACHUSETTS
4. RANDALL G IP
E \f PREPARED FOR
IZER 0 ; ! CHRISTOPHER R. CHAPUT
135032 SCALE: 1"=20' SEPTEMBER 1, 2006
' �
� HAROLD L. EATON AND ASSOCIATES, INC.
SURVE /�
_% REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS
Registry of Deeds Page 1 of 1
t Z 1 ►1i
Plan Oook 26 Page 77
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http: / /masslandrecords. com/malr/ controller? commandflag= searchByNamelD &optflag= lmageSearchCommand &county= ma015... 6/5/2009
City of Northampton •
Massachusetts re
b . DEPARTMENT OF BUILDING INSPECTIONS
a "' = 212 Main Street • Municipal Building �6s
Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
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 any person(s) who seek to use the home
owner exemption, to 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 made
understand the above.
(Ho 'miner /re •'gent's signatu re�iesti exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date � � 2 0 /
Address of work location /5 CPV 5 4
/44/'A v /&o
•
The Commonwealth of Massachusetts
t` , Department of Industrial Accidents
4 .,, f " Office of Investigations
.4 """ 600 Washington Street ,
B oston, MA 02111
www. mass.gov/dia
7' P c ns Insurance rance Affidl vit: Builders/Contractors/Electricians/Plumbers
�o � ��D?n�e_... S1. a
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual):
Address:
City /State /Zip: Phone #:
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑ I am a employer with 4. n I am a general contractor and I
employees (full and/or part-time).* have hired the sub - contractors 6. ❑New construction
listed on the attached sheet. 7. ❑ Remodeling
2. El I am a sole proprietor or partner-
ship and have no employees These sub - contractors have 8. ❑ Demolition
for in any capacity. employees and have workers'
working Y P Y• 9. p Building addition
[No workers' comp. insurance comp. msurance.$
required.] 5. n We are a corporation and its 10.0 Electrical repairs or additions
3. n I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.n Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13. r— Other
comp. insurance required.]
*Any applicant that checks box #1 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.
tContractors 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:
Policy # or Self -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 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:
Phone #:
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 #:
SECTION 8 - CONSTRUCTION SERVICES I
b '
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
9:'Recjistered
finrne'ttn'nrOVettinnttnittridiaii:ggjcKq;;lt:41;.g.Z22rraZgig y ,.. Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
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 ❑ No ❑
11. = -Home ,.Owner Exemption
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 workperformed 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 ..d State of M .c • etts General Laws Annotated.
Homeowner Signature j
•
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) �,
6 .
New House I I Addition Replacement Windows Alteration(s) I I Roofing
Or Doors D
Accessory Bldg. I I Demolition I I New Signs [O] Decks [[] Siding [DI Other [D]
Brief Description of Proposed '
Work: a 1'1 I i ( 0, , 41 d<� LlykAp I ( >3 X I z(� tt ra (...Sd
Alteration of existing bedroom Yes ✓( No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement es No
Plans Attached Roll - Sheet
sa IfNew house and or ad iTion / to existing housini , corrnplete.the following:
a. Use of building : One Family / Two Family Other
b. Number of rooms in each family unit: �/ Number of Bathrooms 7• _S
c. Is there a garage attached?
d. Proposed Square footage of new construction. 2 Y ' 3 (0 .5/" Dimensions > 3 f X I Z
e. Number of stories?
f. Method of heating? 7J f c is t Fireplaces or Woodstoves 0 Number of each '
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction U /
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
r
j. Depth of basement or cellar floor below finished grade '.SS Wall
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
, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
•
, 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.
Signed under the pains and penalties of perjury.
Print Name
Z /Z
ow
Sig lure . Ow - � Date
I i
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Parcel I D Existing Proposed Required by 'i l
This column to be filled in by
Q 1- 2/ 2. - I - Building Department
Lot Size 7 �� % . ,___- ��fztv� �- --- ::_ ..
Frontage _. _ J
Setbacks Front T`
Side _
L:: R: L:L R:
Rear
Building Height , 5 �,�
Bldg. Square Footage 7 O % /t ire
Open Space Footage ° o —
(Lot area minus bldg & paved _�_ i
paig)
# of Parking Spaces 4
Fill:
(volume & Location) - —° -- _,
A. Has a Special Permit /Variance /Finding ever been issued for /on the site? 6 ,2 ec 0
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued: I Z, Zait
IF YES: Was the permit recorded at the Registry of Deeds?
NO (3 DON'T KNOW (3 YES 'I;,
IF YES: enter Book a( Page, and /or Document #
T Z ri O ) -
B. Does the site contain a broo YC , body of water or wetlanis. NO ' I 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 0 Obtained ( , Date Issued:
C. Do any signs exist on the property? YES CD NO 410
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 g/►
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exc.vation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES (0 NO
O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
Department use only
- ° R k" City of Northampton Status of Permit
Building Department Curb Gut/Drtveway Perrntt` s
VOI t° Z�
212 Main Street Sewer/Septic Flvaila411ity
Room 100 Water(WellAvailabillty `' �
�
oFeu M p 0 0� rthampton, MA 01060 Two Set aft trucfiural Plans : r
one 413- 587 -1240 Fax 413 -587 -1272 PiotlSlte Plans A
Othe S pecify Y
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
15-"Z � Map Lot Unit
(r 1L 5 r `
zone Overlay District
Elm St. District '° CB District -. --
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
e I 1 15PlP►f e �Z CU NP i is 2- c—v e-5 Sf 1 ump ilivc vt UU 01066
Name (Print) JZ Current Mailing Address:
/ r / Telephone // �/.3 ,- �3‘, 2_0 t-f J
// /r1 .%�. / 7 _ e/ / - 0 t,/
gna �/ J (L !
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
6,000
2. Electrical (b) Estimated Total Cost of
/( 0 (20 Construction from (6)
3. Plumbing Building Permit Fee
—C9-.-
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) '7 Od C) Check Number 1 /
y'
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
•
File # BP- 2012 -1041 p��{�3
APPLICANT /CONTACT PERSON CHAPUT CHRISTOPHER R
ADDRESS/PHONE 152 CRESCENT ST NORTHAMPTON (413) 341 -3620 Q
0it
PROPERTY LOCATION 152 CRESCENT ST l
MAP 24D PARCEL 292 001 ZONE URB(100)/ p
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �/Q� / '
Fee Paid /T 7 < LJ5
Typeof Construction: CONSTRUCT 3 X 12 DINING RM BUMPOUT
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
INF9RMATION 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
e , lition Dela
/—/
_ ' - • re o Buil ± ing fficial 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.
152 CRESCENT ST BP- 2012 -1041
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D - 292 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit # BP- 2012 -1041
Project # JS- 2012- 001794
Est. Cost: $7000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 4965.84 Owner: CHAPUT CHRISTOPHER R
Zoning: URB(100)/ Applicant: CHAPUT CHRISTOPHER R
AT: 152 CRESCENT ST
Applicant Address: Phone: Insurance:
152 CRESCENT ST (413) 341 -3620 ()
NORTHAMPTONMA01060 ISSUED ON: 7/6/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 3 X 12 DINING RM BUMPOUT
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 7/6/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner