32A-227 (2) •
Zoning Board of Appeals - Decision City of Northampton
Hearing No.: ZBA -2011 -0003 Date: October 8, 2010
I certify that a copy of this decision has been mailed to the Owner and Applicant.
f Al ( 'P
NOTICE OF APPEAL
An appeal from the decision of the Zoning Board may be made by any person aggrieved and pursuant to MGL Chapt 40A, Section 17 as
amended, within (20) days (30 days for a residential Finding) after the date of the filing of this decision with the City Clerk. The date of
filing is listed above. Such appeal maybe made to the Hampshire Superior Court with a certified copy of the appeal sent to the City Clerk
of Northampton.
ECEDVE
OCT -82010 11
CITY CLERKS OFFICE
NORTHAMPTON, MA 01060
October 29, 2010
I, Wendy Mazza, City Clerk of the City of Northampton, hereby certify that the above Decision
of the Northampton Zoning Board of Appeals was filed in the Office of the City Clerk on
October 8, 2010, that twenty days have elapsed since such iling and that no appeal has been
filed in this matter.
r
Attest:
City Clerk
City of Northampton
ATTEST: HAMPSHIRE,Alcuttoftifilt °C • algokit.,REGISTER
MARIANNE L. DONOHUE
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10. Do any signs exist on the property? YES NO
IF YES, describe size, type and location: !� ' l -fir ' b
Are there any proposed changes to or additions of signs intended for the property? YES ✓ NO
IF YES, describe size, type and location: . i1 / _ = L _•• .L
tAAL F1 6 tv'‘ .�'C s )
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CM BE DENIED DUE TO
LACK OF INFORMATION.
Thus cobs= to ba filled is
by the aai— ' "'� Department
Required
Existing Proposed By Zoning.
•
Lot size
Frontage
Setbacks - front
- side L R: L: R
- rear
•
Building height
Bldg Square footage v20
7 S'6� /00 _CA PT
%Open Space:
(Lot area minus bldg
&pared parking)
# of Parking Spaces
it of Loading Docks
Fill:
{volume--& location)
13. Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: -/ o o f . l � APPLICANT's SIGNATURE ,%
NOTE: lsss.ea a`zoning permit does not relieve an eepplioanrs burden to ranpty with all
coning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
Fil No.
ZONING PERMIT APPLICATION ( §10.2)
PLEASE EA S'E TYPE OR PRINT ALL INFORMATION
1. Name of APP p licant: ( V [eCife- � r �- r
Address: Y g t- 5 e&'flLVot 17/4/1— ahTelephone:
2. Owner of Property: CPU P ,e d
g /
Address: Telephone: g .h - O D 5
3. Status of Applicant: Owner Contract Purchaser Lessee
V Other (explain): SI �1v �'�► v'►'� I���c�C_
4. Job Location: YJ ' :��:06/ ' 2 I
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property ,1.21.
6. Description of Proposed UsefWork/ProjectlOccupation: (Use additional sheets if necessary):
a..�_.• � W d :>I , . 4 3 A26 At,
i —
a /
7. Attached Plans: Sketch Plan Site Plan . Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for /on the site? f
NO DONT KNOW ✓ YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document #
9. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , date issued:
(FORM CONTINUES ON OTHER SIDE)
o boy � // ee
• `'F Erection (N)
i Alteration ( )
l� 2'� fi r_ i
--�- ._ Repair ( )
Plans must be filed with the Building Inspector, Repainting ( )
before a permit will be granted, - JUL — 1 2010 Removal_
( )
Qt it o - nrt a tpt n &z+ '
Application for a Permit to Place or Maintain a Sign
or other Advertising Device
(Application to be filled out in ink or typewritten)
FEE � -7 P l AGE.......... PLOT.
Northampton, Mass., // 0 o
To the Building Commissioner:
Application for a permit to place or maintain a s• or othe advertising device, or marquee.
BUSINESS NAME -1 1/Nee-- .. .. liuk-er '
1. LOCATION, STREET and No. • • , ‘214- - - - —
2.. Owner's name r, _ • .
3. Owner's address
4. Maker's name Fs -k) SI 6-QS
5. Maker's addre L.* .r31 IV m 01 o35 __. $$% - TYG1
6. Erector's ---
7. Erector's address --•
SIGN KIND OF SIGN
1. Sign will be (check one) illuminated.__non -ill ated. V (Designate)
Marquee____
2. Will sign obstruct a fire escape, window or door ?
0 g
3. Lower edge will be Wit. / mg above the public way. Projecting
Roof
4. Upper ed a will be .ft. ins above the public way- __..
Temporary
5. Height 'V ins. Width_.,lt ing
Wall._
6. Face area... q. ft. ay SQ Fr
7. Inner edge will be from the building or pole.
8. Outer edge will be ins. from he building or pole. Other ___
9. Face of building or pole i k from the street line.
10. Sign will project 0 ins beyond the street line.
11. Sign will extend 0 ft..._ ins. above the building or pole.
12. Of what material will sign be constructed ? F
13. Estimate cost,..700_
The undersigned certifies that the above statements are true to the
best of his knowledge and belief.
(Signatur of O,j er or Agent)
_ _ _- NOTE: 1n order that this application may be accepted; the data called for above must be set forth maws ,
CLEARLY and FULLY.
File # BP- 2011 -0006
APPLICANT /CONTACT PERSON FERGUSON SIGNS
ADDRESS/PHONE 3 RAILROAD ST HADLEY (413) 586 -8462
PROP A „0 ATION 58 POMEROY TER
r -
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 4S
Typeof Construction: INSTALL NON -ILLUM GROUND SIGN - COLLEGE CHURCH
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 SE t A� t Q
INFORMATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER: § 6
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
7//6/16
Signature of Building 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.
Zoning Board of Appeals - Decision City of Northampton
Hearing No.: ZBA -2011 -0003 Date: October 8, 2010 11111111111111111111111#1 00 400
APPLICATION TYPE: SUBMISSION DATE: Bk: 10352Pg: 106 Page: 1 of 2
Commercial Finding 9/8/2010 Recorded: 10/29/2010 11:16 AM
Applicant's Name: Owner's Name:
NAME: NAME:
College Church COLLEGE CHURCH INC THE
ADDRESS: ADDRESS:
58 Pomeroy Terrace 58 POMEROY TERR
TOWN: STATE ZIP CODE: TOWN: STATE ZIP CODE
NORTHAMPTON MA 01062 NORTHAMPTON MA 01060 1
PHONE NO.: FAX NO.: ` PHONE NO.: FAX NO.: 0 OCT C LU
(413) 586 -0057 (413) 584 -4760 0
EMAIL ADDRESS: EMAIL ADDRESS:
Site Information: - Surveyor's Name:
STREET NO.: SITE ZONING: COMPANY NAME:
58 POMEROY TER SC(1)/URC(99)/
TOWN: ACTION TAKEN: ADDRESS:
NORTHAMPTON MA 01060 Grant
MAP: BLOCK: LOT: MAP DATE: SECTION OF BYLAW:
32A 227 001 Chpt. 350- 7.2: General Sign Regulation TOWN: STATE ZIP CODE
Book: Page:
644 65 PHONE NO.: FAX NO.:
EMAIL ADDRESS:
NATURE OF PROPOSED WORK:
INSTALL NON -ILLUM GROUND SIGN - COLLEGE CHURCH
HARDSHIP:
CONDITION OF APPROVAL
FINDINGS:
The Zoning Board granted the Finding to alter a pre - exisitng non - conforming ground sign In a residential district based on the
information submitted with the application.
The Board found that the change will bring the sign closer to conforming because it will be further setback from the road than the
existing sign. The sign will not be as large as a by -right ground signs for churches are allowed to be.
COULD NOT DEROGATE BECAUSE:
FILING DEADLINE: MAILING DATE: HEARING CONTINUED DATE DECISION DRAFT BY: APPEAL DATE:
8/24/2010 9/18/2010 10/7/2010
REFERRALS IN DATE: HEARING DEADUNE DATE HEARING CLOSE DATE: FINAL SIGNING BY: APPEAL DEADLINE
9/11/2010 11/12/2010 9/23/2010 10/7/2010 10/28/2010
FIRST ADVERTISING DATE HEARING DATE VOTING DATE DECISION DATE
9/9/2010 9/23/2010 9/23/2010 10/8/2010
SECOND ADVERTISING DATE: HEARING TIME: VOTING DEADLINE: DECISION DEADUNE:
9/16/2010 5:35 PM 10/7/2010 12/17/2010
MEMBERS PRESENT: VOTE
Malcolm B.E. Smith votes to Grant
Sara Northrup votes to Grant
Bob Riddle votes to Grant
MOTION MADE BY: SECONDED BY: VOTE COUNT: DECISION:
Bob Riddle Sara Northrup 3 Approved
MINUTES OF MEETING:
Available In the Office of Planning & Development.
I, Carolyn Misch, as agent to the Zoning Board of Appeals, certify that this is a true and accurate decision made by the Zoning Board and
certify that a copy of this and all plans have been filed with the Board and the City Clerk on the date above.
GeoTMS® 2010 Des Lauriers Municipal Solutions, Inc.
File # BP- 2011 -0006
APPLICANT /CONTACT PERSON FERGUSON SIGNS
ADDRESS/PHONE 3 RAILROAD ST HADLEY (413) 586 -8462
PROPERTY LOCATION 58 POMEROY TER
MAP 32A PARCEL 227 001 ZONE SC(1)/URC(99)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out #36
Fee Paid � Q
Typeof Construction: INSTALL NON -ILLUM GROUND SIGN - COLLEGE CHURCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THEOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 V
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
ni (0
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.
City of Northampton :r, 32Atot227 Zone
SC(1) /URC(99)/
Massachusetts Date issued
Inspector of Buildings Permit # BP- 2011 -0006
Permit Fee$30.00
SIGN PERMIT
Business COLLEG CHURCH
Add , _ $n OY TER
Applicant Installer FERGUSON SIGNS
Applicant Installer Address 3 RAILROAD ST
Work Description INSTALL NON -ILLUM GROUND SIGN -
COLLEGE CHURCH
Estimated Cost $700.00
Building Department
Approval by:
•
.
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
jermits 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
TM �
Ty�
, #
. ,
' - , .,
.# .
The Commonwealth of Massachusetts
Department of Industrial Accidents
z melirsr.:.=-7. ,F Office of Investigations •
600 Washington Street
•,,,'" '=-." Rif_ /-1, Boston, MA 02111
www.mass gov/duz
• -5
-Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
,
Name (Business/Organization/Inclivirinn1): elc),2,-A ril. yr- c r
n
Address: I le bel vi A Set • 0 AL .ifiron 144a
City/State/Zip: . Phone.#: C" 3 j Sat 7
Are you an employer? Check the appropriate box: •Type of project (required): 1
1.0 I am a employer with • 0 I am a general contractor and I
0 'construction
1 oyees (full and/or part-time).* have hired the sub-contractors 6. New
listed on the attached sheet 7. 0 Remodeling
2. W.1 am a sole proprietor or partner-
These sub-contractors have
ship and have no employees .8. 0 Demolition
working for me in any capacity. emigoyees and have workers '
9 0 Building additiOn
[No workars/ eorop. insurance _ comp.in.surance.; '
10.0 Electrical repairs or additions
5. 0 We are a corporation and its
3.0 I am a homeowner doing all work officers bave4xercised their
t 11.0 Plumbing repairs or additions
myself, [No workers' comp. nab+ of exemption per MGL
.0--- 12.0 Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
• employees. [No workers' 13.0 Other
.
comp- In =lance recluirecq
*Any applicant that checks box #1 must also fill out the section below showing theirworlcers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
:Contractors that rlu'4 this box must attached an additional sheet showing the name of the sub-contractors and state whetheror 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/Stair/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 Ctiminql 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 $25000 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Efestizations Of DIA for insurance coverage Verification
I do hereby cc un :.# the pains and penalties of perjury that the itzformationprovidediabovg_isinie_and_correct. _
,
.... <-
Signature: ... - r)... 1- 13ate: 2 .-- E 0 ,
, -
Phone #: ,5 7 - 0333. ,
.
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 Contact Person: Phone #:
4....mummummonmiony
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑0
Name of License Holder : e-OLeit rift r-o-- t •p r 7 / 6
License Number
os 54 vt-ba. co) 9
Addr Expiration Date
5;2 -v 33
Sig ature Telephone
9.ReQitttered- lialiielrrikfro4emeirit'06itrador: ri Bg Not Applicable ❑
Company Name Registration Number
rv`t V - � L Lt `a /,.).
Address 4_54. J Expiration Date
� G bt N c ,v - 0108 Telephone ra 7° 03 -i
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.GL. 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 ❑
1if,giC1Ii1
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
i
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House D Addition ❑ Replacement Wjnd' ows Alteration(s) 0 Roofing 0
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [O]
W o r Descr tion of Propos 1 - l 11A1.01 l , �pp /�
W � 4CCe. a-3a tit, a
>ckt33 � Rc:� �, c � /�7L- �.R.+t 5 I�- ecie 0 r hOJ.ie
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
el if Neiiii a d.or a diti i t0 Is iiiiii .ibis iiii eiiiiii ii t thr`e aii n ' :
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, jr?..6 Ct.-. ) f • , as Ow= of the subject
property
r
hereby authorize ,7�. 1� / h.
to act on my half, in all matters relative to work authorized by this building permit - +plication.
\ 7 0 . S-- " - E; .2 011)
Signature of Owner Date (/
1, ()� ,r r i -e r" , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my know1dge
and belief.
Signed under the p ins and penalties of perjury.
Print Na A Ch
Signat re of Owner /Agent Date
. ,t
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 ! .
Frontage . I I ! ...W._.'
Setbacks Front i i
Side L: i R:!_ _ 1 L: i R:= ..
Rear
Building Height i ___._
Bldg. Square Footage 1 1 { t
Open Space Footage
(Lot area minus bldg & paved ; ? _ ?_
parking) •
# of Parking Spaces * -
Fill: . .
(volume & Location) _ -
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES Q
t
IF YES, date issued:I
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 Page, and /or Document # �
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q ,Date Issued
C. Do any signs exist on the property? YES 0 NO 0
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 0
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 Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
ti
Ci of Northampton e 3
,. t B Department _ 1.1'� _ M�
212 Main Street - -. $ i
i Room 100 :E;
Northampton, MA 01060 A
co phone 413- 587 -1240 Fax 413- 587 -1272 - 411.17
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR D A O O R TWO FAMILY DW EL L ING
f ,
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address: —„^
f ? Po w∎ Qho � i e rrgCrZ -Map Lot _ Un
Overlay District
Sim St District CB. District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
VZ;Lr.t c 1; 11 . �. Cr s ( 'yuy71 rr ) ') e d,v 10 I Novq -6 . - /4�',. JY. -- ItY -ro a
Name Print) Current Mailing Address: i q )
A P1 )'1(471 4 11-)L/k—
Telephone
Signature
2.2 Authorized Anent: r� �^ I /�
) P0 -- a/.^cP/' I (o �a ✓� A / - 0/0'73
Na � int) Current Mailing Address:
J ��- �/ ; 7 -0333
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
2. Electrical (b) Ed Tst of
Construction stimateotal from Co , (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection _
6. Total = (1 + 2 + 3 + 4 + 5) -5 / C- ) ) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Comm /Inspector of Buildings Date
58 POMEROY TER i BP-2011-0207
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A - 227 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- 2011 -0207
Project # JS- 2011- 000363
Est. Cost: $5000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT CARRIER JR 059154
Lot Size(sq. ft.): 56148.84 Owner: COLLEGE CHURCH INC THE
Zoning: SC(1)/URC(99)/ Applicant: ROBERT CARRIER JR
AT: 58 POMEROY TER
Applicant Address: Phone: Insurance:
16 David St (413) 527 - 0333
SOUTHAMPTONMA01073 ISSUED ON:9/9/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 4 BASEMENT REPLACEMENT
WINDOWS & REPLACE ROTTED SILL
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 9/9/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
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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
• . • ' • • N, - ' • . - ". , • . ess 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- conjunctionn_to the building_permitissued,_ 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.
__ m _ .__ _.
Address of work
location
The Commonwealth of Massachusetts
Department of Industrial Accidents
I s W r = Office of Investigations
Ili lc 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 /Organizationllndividnal): (0. �y p /' )
Address: / to 0Q / ,,t 4. 5 d
City /State /Zip: t - -.. 1 , 6 to? 3 Phone. #: 5 0i7 A 033 3
Are you an employer? Check the appropriate box: Type of project (required): J
1.0 I am a employer with 4.. ❑ I am a general contractor and I 6. ❑New construction
..i.loyees (full and/or part-time).* have hired the sub- contractors
2. I I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have. no loyees These sub - contractors have g. ❑ Demolition
for me in any capacity. employees and have workers'
working
Y P rtY• 9 Build g addition
[No workers' comp. insurance comp-- ;nsurance. ❑
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a emeowner -deft wont sZ ers 1ha_ve_txercise_d_their _ -Al- - Q 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' 13.0 Other
comp. insurance required.].
*Any applicant that checks box #1 mast also fin out the section below showing their workers' compensation policy information_
t Homeowners who submit this affda »t: 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
employees. If the sub- contractors have employees, they must. provide their workers' camp. policy number.
Iam 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 trader Section of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1,500.00 and/or one :year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator: 1$e advised that a copy of this statement may be forwarded to the Office of
Investieations of the DIA for insurance coverage verification.
I do hereby certi under the , ains and pe.nalties of perjury :that the information provi dedabove is true - azuLcorrecz _ _
A I di
S . I e.. e , Date: C CO — ° "7
Phone #:
Official use only Do` lick The in this area, a be completed by city - r town official
City or Town: Permit/License #
Issuing Authority (circle one):
-'L- 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 Su rvisor: Not Applicable ❑
Name of License Holder : f s 59 `S Y
License Number
/
PG v; . 0to'?3 9 )1-)oto
Add Expiration Date
6#3) 0 333
Sig ature Telephone
9. Registered; k' come': lmprovett entCb . _ Not Applicable ❑
C& ri^ et'.' C m./ -{P . ( /b //33
Company Name tJ Registration Number
Address Expiration Date
Telephone S-04 633
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 buildinrmit.
Signed Affidavit Attached Yes V No ❑
T_he_current_exemption for "homeoers" was extended to include Owner 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
ampton S t . manes;` - a e .n• • ' . i s-General- Laws- Annotated.
Homeowner Signature
s
V
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition El Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors El
Accessory Bldg. El Demolition J1 New Signs [0] Decks [[] Siding [0] Other [0]
Brief Descgption of Proposed / p
Work: K p w.0 LJ-¢ e--W% 4 t in PP, L * ) X I d' /Cr? (e) U? i`u - 50 too T 1 es t. N
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa IfxNeinr.house 'and Oi!additiorrtii-kistiiici hiius nti,: complete the foitoi� ina:
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, 7 it , as Owner of the subject
property �1 C.A. hereby authorize .� r ✓- t e if
to act on my y behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner " Date '' — /0 a
I, Pet- ,",•.,,• L -P0 as Owner /Au l orize{I
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
a nieelief.
Signe and r the pai s and penalties of perjury.
Print NamW X`
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
Frontage
Setbacks Front 3N"M
Side
Rear
Building Height
Bldg. Square Footage - % "
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces - - °
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Boo 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 0
IF YES, describe size, type and location:
D: " - ; r e tFie: e any propos- c interi°de tie property ? YES 0 NO 0
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 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
City of Northampton Sta�S�P `r
Building Department Cutbtft/p y
212 Main Street S � ,A N ..�
7
i , 0 :09 Room 100
Pi J . Nortampton, MA 01060 TWg e � ®
phone - 4113 -5 7 -1240 Fax 413 - 587 -1272 P M ans k�� � ro
_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
4� C O+K Qv a is —re Map Lot Unit
`Zone Overlay District
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
c'oL L j. z C
Name (Print) Current Mailing Address:
/ /r Iv Pis' 7 7'6 G Telephone
Signature f 1/wv� _.4
2.2 Authorized Agent:
P elb.le * e i^ I G Oct. 5 -. �OV1`t�.►,. � f''>�. 0ro73
Name ()I Current Mailing Address:
SA7 .3 3..3
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTTION• COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (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) ItIO• L.o Check Number 2 675 055
• this Section For Official Use Only
Permit Number: I
Date
Building Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
•
File # BP- 2010 -0162
APPLICANT /CONTACT PERSON ROBERT CARRIER JR
ADDRESS/PHONE 16 David St SOUTHAMPTON (413) 527 -0333
PROPERTY LOCATION 58 POMEROY TERR
MAP 32A PARCEL 227 001 ZONE SC(1)/URC(99)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ,
Fee Paid , /i l� 16'L)
Typeof Construction: REBUILD EXISTING 7 X 12 PORCH (SAME FOOTPRINT)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 059154
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOXVIATION 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
/7 r Z5CS
Signature f uildin 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.
•
a 7 -
BP- 2010 -0162
GIS #: COMMONWEALTH OF MASSACHUSETTS
IA-227 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 -0162
Project # JS- 2010 - 000197
Est. Cost: $6220.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT CARRIER JR 059154
Lot Size(sq. ft.): 56148.84 Owner: COLLEGE CHURCH INC THE
Zoning: SC(1)/URC(99)/ Applicant: ROBERT CARRIER JR
AT: 58 POMEROY TERR
Applicant Address: Phone: Insurance:
16 David St (413) 527 -0333
SOUTHAMPTONMA01073 ISSUED ON: 8/11/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: REBUILD EXISTING 7 X 12 PORCH (SAME
FOOTPRINT)
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 8/11/2009 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
JMEROY TERR BP- 2010- 0161..
#: COMMONWEALTH OF MASSACHUSETTS
ivlap:Block: 32A - 227 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 -0162 •
Project # JS- 2010- 000197
Est. Cost: $6220.00
Fee: 555.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT CARRIER JR 059154
Lot Size(sq. ft.): 56148.84 Owner: COLLEGE CHURCH INC THE
_a;_ r(tVTTOl199)/ Applicant: ROBERT CARRIER JR
AT: 58 POMERKOY I.ERR
Applicant Address: Phone: Insurance:
16 David St (413) 527 -0333
SOUTHAMPTONMA01073 ISSUED ON :8/11/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: REBUILD EXISTING 7 X 12 PORCH (SAME
FOOTPRINT)
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:. t/ 03
Rough: Rough: - - E ; I Douse # Foundation: ! /
r-., Driveway Final: 0
Final: Final: . .,.. :1
e
.� ,, Rough Frame:
Gas: Fire T' .-nartment Fireplace /Chimney:
Rough: ui;: ;:...._ :.:� ;:.::.
Final: Smoke: Final: p k /45- °02 7, a q .,rait
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND ! .G . ATIO
40000 .
A pr
Certificate of Occu • an ✓ • Si._ nature:
FeeType: Date Paid: Amount
Building 8/11/2009 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
-