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I - - i 1 I , I ' f 1 1 F J - — , 1 ; , i . t 1 � 1 �_ i I { } (. t r j I 1 : v iri Y• y ,1,1 ;P.1 - 7) AYV .c7 0 A N 7d . v IsTv r; ( " Northampton, MA Property Detail Page 2 of 2 Woodburning Fireplace 0 / 0 Stacks /Openings: Metal Fireplace 0 / 0 Stacks /Openings: Heat /Central A/C: Basic Heating System: Hot Water Lower 1st Story 2nd Story Fuel Type: Oil Quality Grade: C Basement One Story Frame One Story Frame Physical Condition: Average One Story Frame Enclosed Frame Porch Interior/Exterior: Same Condition/Desirability /Utility: AV Open Frame Porch Canopy Vacant/Dwell /Oby Status: Dwelling Additional Features: 11 Brick Trim: 0 X 0 " " IP Stone Trim: 0 X 0 Remodeling Data: Year Remodeled: 0 Kitchen Remodeled (Y/N): Yes Bath Remodeled (Y/N): Land Data Outbuilding Info Square Foot Type Utilities Type F Q Value no Prime information Site 7,980 125,910 Type Qty T e Year Size 1 Size2 Grd Cond RS1 1 1901 1 72 D P Acreage Type Street/Road Type Acres Value no no information information Sales Info Permit Info Date Type Price Validity Date Permit # Price Purpose 09/01/1999 Land + Bldg 134,500 0 no information http: / /www.northamptonassessor.us/ noho /propertydetail.php ?map_no =32C- 203 -001 &pagec... 4/2/2010 Northampton, MA Property Detail Page 1 of 2 City of Northampton, MA: Residential. Property Record New Search Property Type Classification Code Reference Card 1 of 1 Parcel - Location - Zoning - Assessment Map -Block -Lot: 32C- 203 -001 Zoning: Assessment: Location: 6 KARY ST Neigborhood: 16 Land: #Living Units: 1 Deed Book: 5785 Building: Class: R -101 Deed Page: 200 Total: Dwelling Information Building Sketch Style: Conventional Year Built: 1930 11 5 5 6 Canopy Story Height: 2 �� 5 s 5 D Attic: None 26 Basement: Full Total Rooms: 6 Bedrooms: 3 Full Baths: 1 25 25 Half Baths: 0 Exterior Walls: Alum/Vinyl Unfinished Area: 0 Ground Floor Area: 650 26 Total Living Area: 1325 c 5 Finished Basement Living 0 X 0 Area: Basement Recreation Area: 0 X 0 Addition Information: http: / /www.northamptonassessor.us/ noho /propertydetail.php ?map_no =3 203 -001 &pagec... 4/2/2010 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_req-uires 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_buikling_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, V understand the above. : m - wn • r /resident's signature requesting exemption) I will • o sc edule all required building inspections necessary for the building permit issued to me. -- •mate- �-- � --- -- �._ —�. _ . _ _ _ -._ _ Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations rr 600 Washington Street c tf= Boston, MA 02111 �.� . www.mass.gov /dia -Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization /Individual): Address: - City /State/Zip: Phone. #: Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4.. 0 I am a general contractor and I 6. 0 New construction employees (full and/or part-time).* have hired the sub- contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have. 8. ❑ Dernol on for me in any capacity. employees and have workers' working Y P ty # 9. 0 Building addition [No workers' comp. insurance comp. insurance.: required] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 34 I am a- homeowner doing a + ork- - -have tercised their _ ❑ 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. ❑ Other comp. insurance required} "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. . t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :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. 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 under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1, 500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. to advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi er the pains and penalties of perjury that the ins formation provided above zsirueuand corr-ect. � ��rL! j�s .a, i• . -cure: Phone ##: �-! ( -s 7 96c Official use only. Do not write fir ibis area, t be conmpteted by city or town officiaL City or Town: Permit/License # • Issuing Authority (circle one): I:- Board of Health 2. Building Department 3. City/Town Clerk 4. EIectricaLInspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: f - SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone g- RegfsteredHdrne3linei overrierttdohtra "eCor• ' , g ; ,.,. °; .,,I Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ❑ No ❑ 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 referenceto 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 Northamptori Ur ina a e . • .1 • ° ifs General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ® Roofing Or Doors al Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [CI] Other [CO fi r' ' (gS / ) Brief Description of Proposed Work: rer e(LeI pan fr a4^e adc( _5( eeie dc'C rem- Jo Alteration of existing bedroom Yes x No Adding new bedroom Yes > No Attached Narrative . Renovating unfinished basement Yes No Plans Attached Roll - Sheet s IPA G u boustilt& h6tisirra coin efe t ie f©[lau incr a. Use of building : One Family x 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 la - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Nam: . Ai / ` 2 Y Sign • ure o • ner/ gent 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 I C' )c ) ($ • .. .� h o _ cal Q 1 d 1 _._._.,.I_.... Frontage L _ p Cfi a C— ( __ Setbacks Front _ r 3 Side L ', _. -..` R _ , L:71/ R:=�..I Rear _..._ 'L Building Height 7'°`9 Bldg. Square Footage € '" 1 i 1% i 7 i i Open Space Footage _ % (Lot area minus bldg & paved i .- parking) �_ e_._ L �<_� , # of Parking Spaces =- -• --- -- ° - ,_.. Fill: i (volume & Location) [ .. — q — -- .-- --- A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Q DONT KNOW 0 YES 0 IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES 0 IF YES: enter Book ` I Pagel and /or Document #' B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: _. - `— _ - I `- Are hire an ro osad"d}ian es o or a rtioris o s� ns me ed ft ro Property ? YES 0 NO .4 YP P '; ';� P P Y 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Building Department 212 Main Street Room 100 Vt4114 e - Northampton, MA 01060 � � phone 413- 587 -1240 Fax 413- 587 -1272 k5 . APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION b 2010 1.1 Property Address: This section to be comptetedby office KARli STCT Map "' ' a ' L C70 Unit /V 0 q Nom , (1, OrQ6 0 ` Zone Overlay District EIm St. District CB District SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: c (A.J2 /ice ( /r lQ 1� S r Name (Print) Current Mailing Address: , / / III 3 Z- 6 C 3 1' v / Telephone Signature 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS 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 �b Construction from (6) 3. Plumbing bO Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 0 6. Total = (1 + 2 + 3 + 4 + 5) 7 •6 0 0 Check Number 36 This Section For Official se Only • Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0862 APPLICANT /CONTACT PERSON URLA JACQUELINE L ADDRESS /PHONE 6 KARY ST NORTHAMPTON (413) 582 -9653 0 PROPERTY LOCATION 6 KARY ST MAP 32C PARCEL 203 001 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 _ Fee Paid 367 Tvpeof Construction: ENCLOSE EXISTING PORCH,REMODEL PANTRY & ADD 8 X 12 SCREEN DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan TH FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON ORMATION PRESENTED: A pproved 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 /4-- - //glip Signa e 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. 6'CARY S' ' BP- 2010 -0862 91 COMMONWEALTH OF MASSACHUSETTS 40141ockt 32C - 203 ::1 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 -0862 Project # JS- 2010- 001282 Est. Cost: $7800.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner aS Contractor Lot Size(sq. ft.): 7971.48 Owner: URLA JACQUELINE L Zoning: URC(100)/ Applicant: URLA JACQUELINE L AT: 6 KARY ST Applicant Address: Phone: Insurance: 6 KARY ST (413) 582 -9653 () NORTHAMPTONMA01060 ISSUED ON:4/8/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: ENCLOSE EXISTING PORCH,REMODEL PANTRY & ADD 8 X 12 SCREEN 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 4/8/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo