32C-202 COMMONWEALTH OF MASSACHUSETTS
Hampshire, ss
On this ( P S day of a g 0 "7 , 20 (.. , before me, the undersigned notary public,
personally appeared VC . ems, I- C;' '4. . ha "; . =1
proved to me through satisfactory evi of identification, which
were ‘r.t \i' ., '"i 4,, ,•••• , ,,,, TJ C: c LL , to be the person whose name
is signed on the preceding or attached document, and acknowledged to me that (he) (she)
signed it 4
t voluntarily for its stated purpose. `` l t E i � t i
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Notary Public: s ,', _A, H ` , b , .. ,,' :A m:
My commission expires: .... ='�� : `
I
MARIAITNE L. DO I TTE
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Bk: 10206Pg: 57 Page: 1 of 3
Recorded: 06/17/2010 11:31 AM
Know All Persons By These Presents
That Elizabeth Haymaker and Kirsten Rybczynski, owners
of the real estate at 85 Williams Street, Northampton, more
particularly shown as that certain tract or parcel of land,
with the buildings thereon situated on the Westerly side of
Williams Street, in Northampton, Hampshire County,
Massachusetts, and designated as Lot #7 on a Plan of Lots
recorded in Hampshire County Registry of Deeds, Book
302, Page 230, _ f { :0 ( , vx book 2 7 17 �a y � 196,
The owners, Elizabeth and Kirsten, hereby Covenant and
Agree that the accessory structure at 85 Williams Street
Northampton will be used as a studio. It will not be used
as a dwelling unit or sleeping space without first obtaining
a special permit from the Zoning Board of Appeals.
Executed as a sealed instrument this 15 of June 2010.
Elizabet r Hayma
/
Kirsten Rybczynski
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MORTGAGE
LOAN INSPECTION
THIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY
,F -4 ;t,V �-
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GARAGE
GRAVEL
DRIVE
Lti
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.2k 01
H-
2 STORY
BRICK = PORCH Q
HOUSE
WILLIAMS STREET
THE PREMISES SHOWN ARE SUBJECT TO AND /OR TOGETHER WITH THE
BENEFITS OF ANY AND ALL EASEMENTS, RIGHTS. CONDITIONS, COVENANTS,
AGREEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD.
41 3 . -
TO THE SUN TRUST MORTGAGE AND THE CHICAGO TITLE INSURANCE COMPANY — ONLY
To my knowledge, information and belief, from information supplied to me, I hereby report that the premises have been examined and that
this inspection plat shows the improvement or improvements as located on the premises described, that the improvement or improvements
are entirely within lot lines, that there are no encroachments upon the premises described by the improvement or improvements of any
et .t;n;ninn nrs.n. ac .. net +heft- +hors nrs nn anes "Ins "fa of rs.•nrei nffsni;new + hs frnn+ chnu.n harm" sve.an+ ne shnu.n _ . .
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
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 me.
Date
Address of work
location
The Commonwealth of Massachusetts
Department of Industrial Accidents
=W� Office of Investigations
te 600 Washington Street
Boston, MA 02111
www.massgov /dia
- Workers' Compensation Insurance Affidavit Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): A 41kc, A i t -4 : 4
Address: 71 .o < <, �,. �► w 4 e~
City /State/Zip: - ou. ; 0 1 060 Phone. #: ( 3 - y 5
Are you an employer? Check the appropriate box: Type of project (required): r'
1. ❑ I am a employer with 4. fl I am a general contractor and I
6. ❑ New construction
___"employees (full and/or part-time).*
listed on the attached sheet 7. have hired the sub - contractors
2. I am a sole proprietor or partner- ['�
ship and have. no employees These sub - contractors have. 8. [�Demodeling
exnolition
work' forme in an act employees and have workers'
y caP ty 9. Q Budding addition
ms nce. #
[No workers comp. insurance comp' 10.5Electrical repairs or additions
required.] 5. 0 We are a corporation and its
officers have exercised their . 11.(3'Plumbing repairs or additions
3.0 I am a homeowner doing all work
myself [No workers' comp. right of exemption per MGL 12. Q repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13.❑ Other
comp. insurance requited.].
*Any applicant that checks box #1 must also fiIl out the section below showing thew 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:
: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' 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 crimrinal 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 fire
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
Investications of the DIA for insurance coverage verification
I do hereby certify under the and penalties ofperjury that the information provided -a bove isirue _aridcvrr »rt
Signature: D ate: 1 6� i 0 _
Phone #: 3 -- S a - ' �
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. PIumbing Inspector
6.Other :.
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : A ,4• L e•t,} v . "I e
A / License Number
LA t. /� ( 7 1t(..p� ( iAJ�� �(+H A l O(d LD tal 9..01)
Address `
Expiration Date
1• ( A if r 5 - ��
Si nature ►\ Telephone
9. Registered Home Improvement Contractor Not Applicable ❑
I 'f o s2
Company Name Registration Number
A k w( cv ,4L • 5 1 ).13// U
Address Expiration Date
"z 3 CA LAL4&C G. S / -.. Q- (i � Telephone S ) qt 1�
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 ❑
IL. 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 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 h
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House [] Addition [] Replacement Pdows Alteration(s) Er Roofing d
r Or Doors p
Accessory Bldg. ED Demolition LJ New Signs [D] Decks [C] Siding [im Other [0]
r e f c ptio of ' 1". " 4a o 4 -l')(4 - t t " U 4 •. C. w . 6'i In RA- , c4 -t--. 0 �•- i 4 14 4 -....k
Brief De of Proposed r
Work: cr.t..i ., ` X Hie k4 w •.-t 4 el. i - e - 0.64 ii x s S �- -afs.. c�,...f- c rte„ -o .4- c,-,41- i7.,.. cs."t�(?,,• q 1 i-,'"1-444. Alteration of existing bedroom Yes i"' No 1 Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes c/ No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
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? i3 r
i
d. Proposed Square footage of new construction. 1 <4 Dimensions 5"X (N
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, 1 "7 C l k fkLyv , as Owner of the subject
property
hereby uthorize i c .. t ui C- - S
to a behalf, -- . tters relative to work authorized by this building permit application.
2 �] _/ // / 5 /9
Sig :t re of O wn . Date
1, A " ..'tw j .. L. 4t•K , '41Y , 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.
.A'. -D u l ? S j ' 1-.. 4--
Print Name
Signature of Owner /Agent Date
.5L1 G t 7� S€ a
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
Side L. „ ,. _ . . R.. -.- ..._...., L ,_.. ..__.,, R
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 ef YES 0
IF YES, date issued:
IF YES: Was the permit str of Deeds?
NO 0 DONT KNOW a YES 0
IF YES: enter Book ` Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES 0
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 O
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
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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
°- Cityo# Northampton Status %/
NOT '� Building Department 'Curb C L6 (TEIZ. of OT A . 5161 °1
212 Main Street Sewer
Room 100 uteri
� 3 \31A 1 0 Zei4lortha npton, MA 01060 two SI
phone 413-587-120 Fax 413 - 587 -1272 O
S Other
APPLICATION TO.CONSTRUCT ALTER, REPAIR, RENOVATE OR DEMOL
SECTION 1 - SITE INFORMATION
1.1 Property Address:
Th
lc). \ . c.�.y C Map
lam; -y -� k .+ •, t z -. t C? C Zone Overlay District
Elm St District CB District
SECTION 2 - PROPER OWNERSHIP /AUTHORIZED AGENT
1 „/ 2.1 0 ner o Recor4
eff Z. l /i 'mac 4 - u s
Nam (•fnt) Current Mailing Ad es : 6
`� '
Telephone
Signature /
2.2 Authorized Agent: ! / y
A 1 K CT ✓�. y lea /i��t�'l. + `�. ? 4.- a+.. i... �� l.� ;1� -F i.'.- y �%fiv Q�tt�c t 06e-
Name (Print) -� Current Mailing Address:
Q Q.CJ `t, � ' — t(s - - 1 - k
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building ry (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
y , c: ` (,) Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection �/
6. Total = (1 + 2 + 3 + 4 + 5) 3 " i3�J . Qr) Check' Number 11 "I Z7R.4D
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -1140
APPLICANT /CONTACT PERSON ANDREW T WALSH JR
ADDRESS/PHONE 23 COLUMBUS AVE NORTHAMPTON (413) 522 -7795 0
PROPERTY LOCATION 85 WILLIAMS ST
MAP 32C PARCEL 202 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ! 't ga g
Fee Paid �
Typeof Construction: CONVERT GARAGE TO STUDIO & ADD 5 X 14 ENTRY /STORAGE TO GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 082029
3 sets of Plans / Plot Plan
TFOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN RMATION 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
41 X7/10
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.
BP- 2010 -1140
GIS #: COMMONWEALTH OF MASSACHUSETTS
t 32C -202 - 4 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 -1140
Project # JS- 2010- 001673
Est. Cost: $38000.00
Fee: $228.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ANDREW T WALSH JR 082029
Lot Size(sq. ft.): 3789.72 Owner: HAYMAKER ELIZABETH & KIRSTEN K RYBCZYNSKI
Zoning: URC(100)/ Applicant: ANDREW T WALSH JR
AT: 85 WILLIAMS ST
Applicant Address: Phone: Insurance:
23 COLUMBUS AVE (413) 522 -7795 ()
NORTHAMPTONMA01060 ISSUED ON: 6/1 7/201 0 0:00:00
TO PERFORM THE FOLLOWING WORK:CONVERT GARAGE TO STUDIO & ADD 5 X 14
ENTRY /STORAGE TO GARAGE
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 6/17/2010 0:00:00 $228.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo