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SUBJECT PROPERTY PHOTO ADDENDUM
Borrower: John Aubrey File No.: 09 -1614
Property Address:47 Forest Glen Drive Case No.: 1012015257
City: Northampton State: MA Zip: 01062
Lender Florence Savings Bank
a 'S
. FRONT VIEW OF
'. SUBJECT PROPERTY
•� 3 Appraised Date: September 22, 2009
�'- Appraised Value: $ 230,000
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GARAGE EXISING HOUSE
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G ARAGE EXISING HOUSE
47 FOREST GLEN
1 M1/2009 12:20 1 413 - 584 -1670 DOHERTY WALLACE NH PAGE 06
• Exhibit A
The land, with the buildings thereon, known and. designated as Lot No. 11 on a plan
entitled "KV Street and Lot Layout of Forest Glen, Northampton, Mass. Owned by Kay
Vee Realty Company, Inc." by Smith. & Wallen Engineering Company, Inc., dated
September, 1958, recorded in the Hampshire County Registry of Deeds in. Plan Book 56,
Pages 24 and 25, bounded and described as follows:
WESTERLY along Forest Glen Drive eighty (80) feet;
NORTHERLY 175.0 feet along land designated as Lot No. 12 on said plan;
EASTERLY eighty (80) feet along land now or formerly of Romeo and Marietta
Lapointe; and
SOUTHERLY 175.0 feet along land designated as Lot No. 10 on. said plan.
GRANTING also the right of ingress and egress over said Forest Glen Drive as shown on
said plan., and the right to use the same for all purposes for which a public way may be
used.
The described premises arc conveyed SUBJECT to an casement granted to Northampton
Electric Lighting Co. and New England Tel. & Tel. Co., dated October 9, 1958, recorded
in. said Registry in Book 1285, Page 214, and SUBJECT ALSO to restrictions described
in a document dated January 13, 1959 and recorded in said Registry in Book 1292, Page
113.
Being the same premises described in deed of Shirley A. Kimball to Shirley A. Kimball
and Deanne R. Kimball, dated September 13, 1994 and recorded in the Hampshire
County Registry of Deeds in Book 4556, Page 190.
ter..
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, 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
iermits 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 me.
Date
Address of work
location
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
c_�
600 Washington Street
Boston, MA 02111
www.massgov /dia
•
-Workers' Compensation Insurance Affidavit Builders/ Contractors /Electricians/PIumbers
Applicant Information Please Print Legibly
Name ( Busines / Organization/Individnsl): ► e j: , 1 e 1 CL X1 f R )
Address: 2/3 ` )A4-A-;`, r •
4 3 City /State/Zip: iti-Uk t" .PTZ NA ) A Phone .#: ci -= ?_, 1 (�
Are yo,u an employer? Check the appropriate box: Type of project (required): f
1. I am a employer with ( 4. 0 I am a general contractor and I
employees (full and/or part- time).* have hired the sub- contractors 6. ❑New coiistruction
listed on the attached sheet 7. ❑ Remodelir,
2.0 I aai a sole proprietor or partner-
ship and have no. a loyees These sub - contractors have. . 8. 0 Demolition
for me in as employees and have workers'
working
y capacity 9. ID Bu�lding'tAdition
[No workers' comp. insurance Comp.IIISI #_.
required. 5. We are a corporation and its 10.0 Electrical repairs or additions
" ) ffi h
officers aveZxercsed ter 11. - Pluinb' - 3.0 I am a homeowner doing all work i hi ❑ mg repairs or additions
myself [No workers' comp. right of exemption per MGL 12:o Roof repairs
insurance required.) t c. 152, § 1(4), and we have no
employees. [No workers' 13.[1O$iei.EC:
comp. insuranc req�gd,),
Any applicant that checks box #1 must also fin out the section bellow showing the wwokkers' compensation policy information.. •
t Homeowners who submit this affrdavit:indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whethernr not those entities have
employees. lithe sub - contractors have employees, they must provide their workers' comp. policy number.
I um an employer that is providing workers' compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name: 11 F b ViN t _
Policy # or Self-ins. Lic. #: t 1 4 1 "6 7.7 •? Expiration Date j - t _j. 1
Job Site Address: 4 1 ' f3`� C; c:; i City/State/Zip f :�4.4 1- a I n . -
Attach a copy of the workers' compensation policy declaration page (showing the policy number and`exj iration date). • Failure to secure coverage as required under. Section 25A'ofMGL•c: 152 can lead to the imposrtion`of crin al penalties of a
tine up to $1500.00 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
Indesti attons'of the DIA for insurance coverage verification
I do hereby certify under the pains and enaltres ofperjury that the info rm n provided :above_is�rur_andcorrect. _
Signature: ate; L A — la k (
Phone #: L. i 1 3 . 5 ?q
: Official use only. Do not write in this acacia, 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
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : �� �> r (al , 1
License Number
Address � y '3 ) Expiration Date
d PTD3 CA S 5 3J � 4 52A
Signature Telephone
9: R cNSte► d,#lc�rne lmp`ro r t>ipttt 0arilfra t lr:` , 5 kN _, NIMMIPTLANZ Not Applicable ❑
rl
jo L.) F` (� C c K, 43 9
Company Name Registration umber
Address ( 13) Expiration Date
1 b1/41-AP 1.1 H Q. Telephone 03c -6 (521
—
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 LY No ❑
1.. :1011,040 et' YrenintiOn
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
r
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) J Roofing J
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [Er Siding [D] Other [Ci]
Brief Description of Proposed ' t
Work: 1 lr, 1( 1 L - 17' � .FAe— (ty --- .Firloe 4 c >)E >., r
Alteration of existing bedroom Yes ' , r o Adding new bedroom Yes 17 No
Attached Narrative Renovating unfinished basement Yes ✓No
Plans Attached Roll - Sheet
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. Dimensions
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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/ I, y
F 9 SJ . n1? //G 7 , as Owner of the subject
prop
hereby authorize ii 4.?_. M
4140 my behalf, in all m rs r ive to wo authorized by this building permit - , plicatio .
Signa ure of Owner Date
I , t--A 1e)( f-A -N , 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
Signa of er /Agent Date
.'l•
z y 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 i 19 i OC' 4'b 4 1' I C?G � 7 'L
Frontage [ VT H i* z 1 71 -----
.
Setbacks Front _ i 4 771 1 7 '
Side L:;_ :5,..j R:I 1 .5 ! L:Ladl R:!3L?
Rear , 121, 111141 _ Vii 7
Building Height a'
Bldg. Square Footage I z % ;1 7,,Jki _..._....- ? ..
Open Space Footage % ;°
(Lot area minus bldg & paved ! l 2.Y ., .... ___j 1(� . 44 ' J (0 ,).,„i 0
parking)
# of Parking Spaces 1 C` i ° _
Fill: _ ._w r _ .... . �. .�.,.� ... - {
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 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 I Pager ' and /or Document # T
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q - YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q ,, , Date Issued:
C. Do any signs exist on the property? YES 0 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 a
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
r
City of Northampton
4f Y
Building Department t _ `.
212 Main Street
0 Room 100 g
A 2 1 Northampton, MA 01060
phone 413 -587 -1240 Fax 413- 587 -1272
s + 414,0A
F» 8n.rv5 - Fes- w(t .•�: eZ
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
Map Lot Unit
X 11
Zone Overlay District
1.-ur .. C-
Elm St District CB. District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Nam (Print) f Current Mailing Address: 1 —
V Telephone3
Signature
2.2 Authorized Agent:
l\rZ.K c*4 p fc= "W S 7A e '3
Name (Print) Current Mailing Address:
� 'Y 2 -C�29
�
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
ID�
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection C c}O
6. Total = (1 + 2 + 3 + 4 + 5) ) C I j Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -0907
APPLICANT /CONTACT PERSON MARK BONDE
ADDRESS/PHONE 205 PARK ST EASTHAMPTON (413) 535 -9529 0
PROPERTY LOCATION 47 FOREST GLEN DR
MAP 36 PARCEL 014 001 ZONE URA(100) //WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out rt! 6L✓
Fee Paid (h V `J
Typeof Construction:_CONSTRUCT 16 X14 DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 67758
3 sets of Plans / Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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
Demolition Delay
1 0 Li i (-17)
S ature 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.
47 FOREST GLEN DR BP -2010 -0907
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 014 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- 0907
Project # JS- 2010- 001343
Est. Cost: $10000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK BONDE 67758
Lot Size(sq. ft.): 13982.76 Owner: KIMBALL SHIRLEY A & DEANNE R
Zoning: URA(100)//WSP II Applicant: MARK BONDE
Al: 47 FOREST G EN nR
Applicant Address: Phone: Insurance:
205 PARK ST (413) 535 -9529 O WC
EASTHAMPTONMAO1027 ISSUED ON:4 /16/2010 :00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 16 X14 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: O
Footings: II i „,,, I�
Rough: Rough: House # Foundation ii 16 �� I' Y
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 5 I / Ler'^^" Signature:
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
nY