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36-323 '-)----"\-- ' ' k N. _ • - reo ......--. . _ ... ........• d t..... A -. .._ ILI _,............,i. • _ --- Al _____ • --- — – -P- - _ ' Mini All■ . ----2 ;1 ' , 4 4 ,-__,... , . ,. „.„.„ ____ ___ _ .„-- - - --- Ft=345.0tr 1 n L=78.94' \ EXISTING 30' r tATERLINE EASEMENT TO BE ABANDONE 0 1=13 SEE BOOK 1925 PAGE 28 Chd=N09*- ISOLATED \ R=345.09'- 1 78.77' \ WETLAND -0 b • \ L1 A-3:28 -- n ia---- •,,, \ R • \ > •I=23-47'---44" \ -47'-44" Z a \ / - --- El L I --‘,T Chd=N28'-08'-17" ' t-1 0 I / I. 142.25 Q. ISOLATED u C WETLAND WOODS • . 1 I . ,, •, i \ I 4 , i -0; 1 \ 11 7 v ' 1 ■ , 1 8 ' \ ,e .... 4 ‘ ) 1, 1; 334r S ti. FT.\i± \ , 0- BuiLpING / I :5' , 0.4 , C.±, ENVELOPE (TYP.) 782,E • .,w k., , .. „.xe - r, \ ._ . . I li s - - 1 f \ \ ('' Pi . 1 "c 700, (To ' B THE cirt • NOT le- dek, ' 1 SQ. FT‘± ..c... i.0.0e.......- Az., • . r < v 1-2 AC.± , ...., e / t N 4) • - • , „, ..- ,. • si. . co .^) N I cc, -,... i . ) _ • . „... .....--- • . ...„ . 1 210 ). • ....,..- / .2,e,1,-ic) dnex- -,. 1 i 1 -' /ixori" dif(k \ • ) • 1 ,...i. how 1\ co co - r ___ AnnFn FOR DESCRIPTION PURPOSES ll • 1 _ I I �-� in 1 A 100:Y r 2.(6 ' /, (t�' f/GC of -7 "%e I I snot <1kJt - CI - ''1'JT � I 1 i 1 i \ . 1 1 '‘... , ''. - .. 3 e oZk19 , 1 1- ri x ",..,,t,... -- _ ki '' H -4 a' , AY .0 A 4 _ 044 i I i A rsto5 ) i I 1 $ I , 1 ! i .. , , , • 1 1 \ ' . ‘. : . ,,/ .,,,' i s r 19 T- Vi , 1 1 I i 1 , .. 1 ,,,/ 1 , i i Ni / \ 1(.7;1 (? , a 4 . v 1 .6 # NA cotZ7 612-c, -aP qc` 6 - 0'45? -" 150- Oci- IZX -5A-/ /© HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 1 08.3.4 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 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 . ., The Commonwealth opfassachusetts „—......—..._. Department of Indushial Acidents , Office of Investigations . .":■ ........i iM .. t 600 Washington Street =74=.- # Boston, MA 02111 /dwww.mass.govia . . , . -Workers' Compensation Insurance Affidavit : Builders/Contractors/Electricians/Plumbers .- ... Applicant Information Please Print Legibly -----,-- ,--- Name Pusinesi/Orgardialionandividnap: ///■--( ,_,)/2 g/772/4C77X- - Address: I/ .. 3 e.i.,,,ary A;(,,J,--ffazpra.,1 City/State/Zip: o /0.2.5 - Phone.#: .1/ 3-6,2 b - r7) . Are you an employer? Check the appropriate box: ' Type of project (required): / 1. 0 I am a employer with 4. ',2, I am a general contractor and I 0 employees (full and/or part-time).* , f , I ' have hired the sub-contractors 6. New construction 2..D lam a Sole proprietor or partner- ,IF • ? listed on theattached sheet. 7. 0 Remodeling ship ancll -<° These sub-contractors have. .8. 0 Deraolition iave ri.o.iployees ?"^c. employee.s and workers' . - • . . - , • working for me in any capacity. 9.: 0 %Ming Odd [No workers" comp. iosurance required:1 - - 5. 0 We are a corporation its• 100 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have 4xercised their . 11.n Plumbing repairs or a .ritions 1 myself [No workers' comp. right of exemption per MGL I—I 12.0 ADM repairs . - insurance required.] t • c. 152, §1(4), and we have no employees. gio workers' 13.2] Other .PECK . . ' comp. insimance required:1 _ • • *Any applicant that checks box #1 must also fill out the section below showing their Timken' compensation policy information. ,.. t Homeownern who submit this affidaVit.infficating they are doing aD 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 subcontractors and state whether or not those entities have employees If the sub-contractors have employees they must provide their workers comp policy number. Jam an employer that is providing workers' compensation insurance for my employees. Below it the policy and job site information. • . , - Insurance Company Name: /clifeAte ,it-e/LY • i . Policy # or Self-MS. Lic. #: c ;?6,)Ci e rte_i 4 / V. • Expiration Date: Job Site Address -5Y .. ti.?e,q,, ..? ie.) . City/Stain/Zip :' /jgC.L.) c . 10 iv o:5 Attach a copy of the workers' compensation policy declaration page the policy number and expiration date). Failure to secure coverage as required under Seetiiiii'25K 152 can lead to the iiiiPiasiu of Critoinil penalties of a fine up to 51,500.00 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 ilk violator. Be a.dviSeci 'that a copy:of this stateinent may be forwarded to ilie OffiCe Thiniii of thi for insurance Coliiiiiivirifination. - _. - _ . „ _. ,.,... ..,,, -...., , • .., _.,. _ .1" do hereby_pertifil under the ' dpentiltlei ofperjinythat the inforntatiOnprovideiliibomislYue_cindr.Orrect - • Date: Sionatare: /..-...4-"er # , . _ Phone oi: H /3 /777 - - . - ' - • ...„,..., , . • Official use only. Do not write in this area, to be completed by city Or townOfficiaL . . 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 #: • - All111111111111111111111MENW • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder : l /tiC � Fz.�it Y (110 Ss Sz License Number /? Address Expiration Date q/3 6 -/17 Signatur Telephone SIglstereilf :lr�iilmtlroriienalcor's" ''" Not Applicable ❑ Ai /Ay Company Name Registration Number Address Expiration Date Telephone .'S'(Fz 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 QZI No ❑ id 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 buildine 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 . 4 . • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ED Roofing E Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [EZ1 Siding [D] Other [01 Brief Description of Proposed Work: 'LO I`I Y. ZZ i DIzC'- CFF 434- 1,Sit►JC- DR' ( i . Alteration of existing bedroom Yes >( No Adding new bedroom Yes V No Attached Narrative Renovating unfinished basement Yes >r No Plans Attached Roll - Sheet { tit ' ii ice. i ,Y _, >�` t� < rf�'�ll,�]ttl �,Gtl�S�ttq��tlD�rl�ir 311 I]f�'W� i S�: 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 Ta`- OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, f34, r✓ L Z: 1g, J?P,,.C_ , as Owner of the subject property 7) hereby authorize / /M Sir i "JAN l c -t 77t C TIAJG- to a on my behalf, ll a rs rim ive to work authorized by this building permit application. Signature of Owner Date I. 11.4 -CY , as Owne Aut o' 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 /1 y/ 4 ... If ....4„, Signature of Owner 41n9 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 ; /k 33 5a_r j 4 Frontage I /57' = 4 .:500-F Setbacks Front ' ? I -CAF R Side L:: 2 R:i a?`€ L:` l `R: r3 I Y ? ? A Rear 1 S�1 36 Building Height ; t [ A , 1..' } i Bldg. Square Footage 4 1 [Z] % WI I Open Space Footage % , r 7 (Lot area minus bldg & paved I 6 4 11 Z ( 4 �1 1 i j parking) ;5 2 Z 6 4" # of Parking Spaces ! Z 1 ` 2 1 r _. Fill: I i (volume & Location) NE ,i 1 A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO th DONT KNOW 0 YES 0 IF YES, date issued:; I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book 1 1 1 Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 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 {► IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO e 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 lr IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Zelle Building Department 212 Main Street Room 100 Nil() Northampton, MA 01060 M - 5 pit he 413- 587 -1240 Fax 413- 587 -1272 APPL ICATION 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 3co L ot, - { ' Unit Zone Overlay, Distric /°c.0:.', '. -'('C Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: &L/,�i../i✓ /S�> ^ lds9ftta> JZ Name rint) 9 Current Mailing Address: 4 cr2 Telephone Signa ure 2.2 Authorized Agent: / / "../o 77/1 , , c 4 /3 Ty /6 / / re.R.l Name (Print) ' Current Mailing Address: e)3o 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 _E( .20C 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection o � I 6. Total = (1 + 2 + 3 + 4 + 5) a O .e'' Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date • File # BP- 2010 -0982 APPLICANT /CONTACT PERSON TIMOTHY SENEY ADDRESS/PHONE 43 COUNTY RD HUNTINGTON (413) 667 -0230 PROPERTY LOCATION 243 CARDINAL WAY MAP 36 PARCEL 322 001 ZONE SR(100) /1WSP II THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Q L,/ Fee Paid ✓ / W" 4101.(e• Typeof Construction:_CONSTRUCT 14 X 22 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 061088 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: j,.*- proved 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 S 6 © 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. >fiAWAY BP- 2010 -0982 GIS #: COMMONWEALTH OF MASSACHUSETTS miimiada 36 422 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 -0982 Project # JS- 2010- 001450 Est. Cost: $8200.00 Fee: $61.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TIMOTHY SENEY 061088 Lot Size(sq. ft.): 18338.76 Owner: BOMBARDIER GLEN P Zoning: SR(l00) / /WSP II Applicant: TIMOTHY SENEY AT: 243 CARDINAL WAY Applicant Address: Phone: Insurance: 43 COUNTY RD (413) 667 -0230 HUNTINGTONMA01050 ISSUED ON:5/18/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 14 X 22 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 5/18/2010 0:00:00 $61.60 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo