37-004 (9) - NOTE
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SKETCH /AREA TABLE ADDENDUM Anx.
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we No 120106110
►'�I dr- I-hat ril i r
File No 01SO4004.TF
Property Address 679 Florence Road
City Florence County Hampshire State MA
Borrower Powers Zip 01082
Lender /Client Florence Savings Bank
Appraiser Name Timothy R. Fuliam — —
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Comments:
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KNOWLEDGE AND BELIEF I THIS PLAT FOR unfirrnaps I Alibi
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SKETCH /AREA TABLE ''�' p
ADDENDUM sj q norrnce kg
sae No 120109110 Not-4414 1Y1 r
File No 01304004.TF
Property Address 579 Florence Road
U CI � Florence
County Hampshire State MA Zip 01082
m Borrower Powers
Lender /Client Florence Savings Bank
Appraiser Name Timothy R. Fullam
Not to scale
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Scale: 1 = 12
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DEPARTMENT OF BUILDING INSPECTIONS ' � { � /�
INSPECTOR 212 Main Street • Municipal Building
,•
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his /her construction sups ::isor. 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 builddng department for the City of Northampton wants any 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, 044A16, , 11fl . Po-wen, (&e aCtr .) 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
r.
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1
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•
DEPARTMENT OP BUIWD'C INSPECTIONS 4 a
212 Min Street )vlunici al Building
P G
Northampton, Mass. 01060
WORKER'S R'S COi1TENSATIO.N CIiSU AFFIDAVIT
•
(li ccm J permitux)
with a principal place of business/residence at:
• (phoneI')
(sn /city /sta.tcfrip)
do hereby certify, under the pains and penalties of perjury, that
( ) I am an employer providing the followine!worker's compensation coverage for my
employees worldng on this job:
•
i ( u ..,n= Conroy) (Policy Nt =nbcr) (r :-pirazion Da`)
•
( ) I am a sole proprietor, general cona or homeowner (cicie one) and have hired
the contractors listed below who have the following worker's compensation policies:
(slam of Cont"'.cio') (Insurance Company/Policy Nurak - 7) -- �i•pir on Da lc)
i (Name of Contractor) (Insurance Company /Policy Nuroc_r) (Expiration Dale)
•
(Name of Connaao;) (Insv.rane; C.ompan Numbli) (Expirtion Dale)
•
(Name of Contractor) (Insurance Comcam■/Policy Numbes) ( Date) .
(antac3 rbec.irncre1., --r to coeiu& (afore ioe pctasa:as to .11 coca -tors)
( ) I .am _a sole proprietor and have no one worid.ng for me_
j I am.a home owner performing all the work myself.
NOTE: plctc be awzrc Lc �+ } hcmcovaacrs o =play p - -oat to do r -, * �r c oo c tgaa work as a d.•cll_,-; of
not @o, o ILLS t.1- me =i , to which the botnoowoc raid= or co tho p-n.11Kb z,ppurtoo thc-C.o LZ o't r= -' y coed. -cd u, tic
cilploy= und the woti;z{s - - --,.m f.a (0LI152 1(5)), applioaoo by • bommaacr fc c be « pcmrt t y evidma the
kgs.l n.- of ea asoloyor coder ttto Worfrole Coaapom.tiou
I ttod.csaod tib.d. a copy of chi. cacc000m cmy be I.-a...mind to the Dcp.rttnocd of Ioduuicl Aoodmv' 0ffo0 or Ins for Lb..
cove Se veile_gioo gad Q L-ihae to socuc tavcra cc lock c ion 25A of MQL 157 an te4 to the in:pOsiian of criminal p
eoasising of • floc of up to S 1-SO0.00 endtor in:priso of no to ooc yr.r cad coil pczo.tic, in t:n loran of. Slot' Wok Ord= and a
fin ors I o0.Oo a city Lgaiasi
For d =�1 u.c Doty
Pcrmit Numb=
„bp- —_ Lot
Simaatun of Lio nsccJPcrrnj Lc= CSE -- i
SECTION 8 - CONSTRUCTION SERVICES i
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
191AkY '0 *.:$4'T- :, Z; 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 ❑
6 !o f1 k€ =000
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 Ozytivi( Perto -P, d�
r
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition IX Replacement Windows Alteration(s) n Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding [0] Other [D]
Brief Description of Proposed /
Work: C ate - �'7 4,26 / /l (Avri/Ltnrnj
Alteration of existing bedroom Yes S Adding new bedroom Yes
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a4 t �thcn� Gi exi6. n a d q tC+Dtl tp1e e2 o[ O i q:
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. 3� / c0
e. Number of stories?
p q g � ,p Dimensions / �C
/ d
v
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 d. Is construction within 100 yr. floodplain Yes �No
j. Depth of basement or cellar floor below finished grade Akr>te •
k. Will building conform to the Building and Zoning regulations? V Yes No .
I. Septic Tank -V City Sewer Private well City water Supply t/
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING. PERMIT •
P (rjA -e,j 4 , 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.
an/4A, 01 ro, /92,
Signature of Owner Date
I, I , 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 n (e). f e r
Print Name
a/VW"— Kr) Po
Signature of Owner /Agent Date 6 !/
Section 4. ZONING All Informatioh 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 (p A
Frontage i / i f = t 1
Setbacks Front I
Side L .10 i i R:! 4 L:; ! R:I
Rear 1/M II .'fr
Building Height ^ _ . , ' ,- r ?
Bldg. Square Footage I-1 i i% I i r i i
1
Open Space Footage %
(Lot area minus bldg & paved 1 I i 7-1 i
I I
parking)
i I 1i
# of Parking Spaces
Fill: i I
I,
(volume* Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES
IF YES, date issued:' Ojai 3
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book 1 i Page; and /or Document # z
B. Does the site contain a brook, body of water or wetlands? NO g) 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 i NO tr#
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 gi
IF YES, describe size, type and location: i j
1
E. Will the construction activity disturb (clearing, gradin• excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 ,- NO - T.
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
a ; e . 7 .s.,:- �,' ,°,,- " , c ue
City of Northampton °s Fd
_1 nn ��- n partment s �� r ' fv
z }I i _ ( r c Li N 1 Main Street �; :A
crrl 100 3�e � n ;.,
Y
�� . SEP ,Northarr�ptpn; MA 01060 x�` � � i« � �, , - „
pho'e 4Q�587� 4 Fax 413- 587 -1272 '� - � 4 -..
APPLICATION TO CQP S tliCT, AL ER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
,; This section to be cornQieted byoffice
1.1 roperty Address: r - ,:t ,
79 R C3 ✓tC ) . � 13
[1) ) \&r n p 1 v1 m Z z
3i
O ueda isiCict
to I _4 .� a s -- 66 16 Ef S t: D ist r i c t s CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED; AGENT
2A Owner of Record:
14 A n A- hil Po 5
Name ) (Print) Current Mailing Address:
L / (il/AA/L(� = . PQ-z,LieA -4- Telephone
Signature
•
2.2 Authorized Agent:
r
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
.,2 ob erco 1. Building �{' (a) Building Permit Fee
2. Electrical „(b) Estimated Total Cost of
Construction from (6)
3. Plumbing • Building Permit Fee
4. Mechanical (HVAC) Q
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number 0N/ q �
This Section For Official Use Only
Date
Building Permit Number ` •Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2006 -0252
APPLICANT /CONTACT PERSON POWERS ANNA M
ADDRESS/PHONE 579 FLORENCE RD FLORENCE
PROPERTY LOCATION 579 FLORENCE RD
MAP 37 PARCEL 004 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid ? Y6 7 arcs
Typeof Construction:_CONSTRUCT 15 X 20 SUNROOM
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
INFf�RMATION PRESENTED:
1 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
Signature of Building Official C 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.
9
A:1)w ,,,-4,014,/ /71, 4-21,4,V til
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579 FLORENCE RD BP- 2006 -0252
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Blocl :: 3 / - 004 CITY OF NORTHAMPTON
Lot: -001.
Permit: Building
Category: BUILDING. PERMIT
Permit # BP- 2006 -0252
Project # JS- 2006 -0359
Est. Cost: $50.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contra
ontractor
Lot Size(sq. ft.): 30056.40 Owner: POWERS ANNA M
Zoning :_SR Applicant: POWERS ANNA M
Al 5/9 t-LOREhCE RD
Applicant Address: Phone: Insurance:
579 FLORENCE RD
FLORENCEMA01062 ISSUED ON :9/14/2005 0 :00 :00
TO PERFORM THE FOLLOWING WORK CONSTRUCT 15 X 20 SUNROOM
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: tav1
Rough: Rough: C'14 S .
,� J 1 I `d d
1l (J� �sT� house # Foundation: A NCR o
,>�� 3 � Driveway Final: . webs' € vv-€) �. �
final: Final: j bo �T 56 6. f A Cr
1 1 0 / 4. I' J Rough Frame: a/c 1! 3t o6„
Gas: Fire Department Fireplace /Chimney: /�
Rough: Oil: Insulation: Q )( 9 l , O ! ��' j _
Final: Smoke: Final: (o
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupanc. signature:
FeeType: Date Paid: Amount:
Building 9/14/2005 0:00:00 $50.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo