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37-008 (3) prom; pox Saw (4J3)543.1847 To.QAI(3MU 644:dn4 /04 Time: 1a:32:3b Pup 241'4 .. I � 1 r 1 i i3 q. 4. * / k it p�" / ( 7 1 g if {�` ' , , ! , o f n, i - �\ � I ! � !� 3 I J d r F ' il � ' ' � j M / % # 70,b Q 1■ / �9 1 ~ .`k si M ! =� a gtig 1 Ili F I i/ a i,--1—.1" I a 1 / � ,I 6 1 111 ti .4 t p. Fii \ \ , ( i U4 I!i H Ifl t! .41 i il i f*Pir. i 1 p i ,'; i i \ by b 1 a : I+ l' N X ! , Iggh% z.' ry gs i L \ s.,,,,,,,,,, r, ,.y KT 'S ( � � 0' 1',1 � 2: 41, i s ,, Z . 4: d r _ -V d j i Illg i , '111 2 x V t ' 7 ■ w Oi i1 ill' ' 3 A , � l w., . t i A Y • XXK 6 _oars nc M r 9 1 ny „ —. n n .i Al. 14t i # t/ ,,, , NIA . A - 7 •cey 4 v II 0 ( ----- ---1 12 1 IC 71 .4 14 ' tf i pt ) 71 • 5 1 1 ti fil i. 4 4_ al, I A iv 1 1 1 )1 1 x 0 -' ) 1 I 1, i . i { , / I 1 i 4 Sildj V ' 15 t < 1 / ..... t 4 Ao 3 1 -... , 2 ,24 ir,,,,,d,44 ti YR - 4' c 4 Ng V / J 4 )-)t)e e )1e9q ir7.22331vci tr) 7v1 J 7c'i --+ fi/7/1-6,15)Aiti )-1 ler o)) i r) )1 1/lef 1 NoRTI-IAMPTOKI I Ai *D. SCAk.LEt l =60 , • ow Ne w zAitEN t.. HOrv1PHRitS . ,.-',,I.•‘ • gEr : DK. 2.695 PG.t7 . z`lki. FL.814.. / 1 , PG- : 24, • 1. ,, ,, : ' •‘: i , , _ e ,,? ,' 4. 4 • 4 . 4. _ el • 1, 1 ' . ur• t.P. F NI Go, 1.P.F■40. i es 5 54-'57 os a -..„,,..,-,f-,..., i v 4 s 4.72, • , ,, ,. . Pc L.3 1 --"---/-- — — 1 - - - - I i me 41.-cASIkAA ., / ( \ 0.4k.4°) U . ,41 ,. ; 44 . " -- u.e. e, IT,CoIJC. Dlt Ng 5 J 0 , ..•,.., . — •I) — . • . ! i' t."J ON 0 (11 4 a4sr 41; -. ‘ ' 1 . (1 ‘I t I ci Pc L .1 , * PCL,1 724 87 N VI - - / ..) -- 0 • • . .r. • , '.• ' . 1-• „,,# OA ET 4173 C3., 1.616:1 ' " 14. IP.F i N --g— N 5 1'3 8'3 ew • tr:F•krv. , o ..), y .* I. / • RICHARD .. , 1; LARARGE.SR. .. - , , 1346°5 ' SOO ,,. ..,.. ,.. Richard 1 LaBarge Sr. . .- ,1 Registen14 Land Susvoyot . .,' ,',, 4 i ..0,• _____-_------------\ 4 1 i \-------"---"---"--"--\------------ ,Ifi 1 1 : 7 1 ,,3 ..-6kioid 9 'i (NA , r t < V VO I _.,...- - wN W -- YQ3--I c" L b ..._, 6 , . C- I --- , i 4i 1 w........ ,.. , 1 ....c 1 - •:). ', 7 1 (r) i 1 1 I 1 1 i ' I 1 %or 1 , k ic v '5 471 ! ) iCi ----- % t -----4 0 AI I 1 , --..... I o , ' *J*5 So t I t .45 1 6 f i I r 'I nit: --): .,.. 0. , r0 l ilt . , te pt, 4 14444 1 ; CO ' i liDtitP 4 9_. 4 ,'a:e.'it'q J ../ 3C(' o ,) 44 wi 3,4k 4 Z .1 ; b . MIN 1t ---- 1, t' / , i 'C e l — ..) • 5 get - CC 01 . lood , — 9 1 * 'd '5 t-4 il 1,_ 1 -- ._ c , . . . R . # 0. �/ $ Crzf r of Naz;ij&inphin 1L = = P . $ t ' of y`; ji lassachusrtts ^ 0-=____:11111----==.----. DEPARTMENT OF BUILDING INSPECTIONS � '� : 3 _ L= /_ INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 . r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction sup%: ,'sor. 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 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, 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 A ' . , Q {.- ) - = --__:_- -_:' k 2/ - el # fr itti _JitLI af rtI Nalaiiipfon ,f ,1,"t!, • : - - -...,_ = ....._ .... , -..-_ - : - . , :el ,..) N. e. if • A 4..r_.■-• - .4:1. DEPARTN`,ENT OF DUILDI)G INSPECTIONS •=.1. . _._. . 212 Main Street • Municipal Building , Northampton, Mass. 01060 , WORKER'S COMTENSA'IlON INSURANCE AFFIDAVIT /l Jr .----,_ ... . • 0L)) /Ur pIL 0 itilt21/0 Ro, AL rii/i pi oo 0 , :;.q �/4.4 .4- (lic,.-...n.s::ciporrnittc) with a principal place of business/residence at: t- _ LA,. ,,Q(7,L S i - PO 2T 4_4A (N LciA, n(600 ne!)tf t 5 .._ i- (strtic:t).1:;-Jilf:P.-ip) do hereby ccr under the pains and penal tie:; or perjury, :hat ... . ( ) I am an employer providing the follov;inc:. worker's compensation coverage for my employees working on this job: - (Lasuranc... Company) (Pclic.-.y Number) (Expiration Date) ( ) I am a sole proprietor, zentral C or homeowner (circle one) and have 'aired the contractors listed beiovi who have the fn1.10 worker's compensation pc:I.:cies: (Nanac of Contractor) (Insurance Coir.1: Nuinbcr) ( Date) (Name of Contractor) (las Corm:.,anwPolim' Number) (Expiration Date) — _ (Name of Contractor) ( Ina: r:mc:: C.o IL V/201 i Cy NILLI)i),:.' r) E.xraL]o:... Date) (Name of Con:I (Insurance Conap.alp Numb.er) (Fixpli Date) (ml...,...± .....6:4.,tion....i ..f,....,,,,, tn-, :. --- •- • -•- -, • - ,-. i ; c■:,; -' ' • (O ten a sole ioprietur and have no one - ',..,.orkin for me. ( ,) I am a home owner li c,rfc)71 in ,-, all the ,... NOTE: pl r,,,,-, It h.,:,,-,0,-, ,,5 0 <-:::-ploy p- u :'.) :...- , ._:-■,-.:2_ancc, c,, :::t cnon or ; r. pa ir '.% r '-'7. ,t %, c.: not flee tLni throo unit, in v. the n. - o-o - r.-::::5 .7„, ca cal t5,-..-, i i_I r.: ty.:_t c-cicsally o-,--,,:,---; • c:_.- -- th,- ‘vc,k4- c-- ,t_ (GI, 1 52_,;(5y ,..r. i. a homeowner for a Lc.c---.4 oc SO C': s•- legal c of an .arployor und-er ti.,,, Woric_cet C-'on...-p-cr.--_-atian .A.ci._ I un-d.c.- th.-= a espy of chi. gzatc.r.....,-1 may ho forwitrd,..i to tt.e, 1): of Lo•dustrIa.1 Accie..... Of it of , .:1,11.ra.,74 for the C°V--L V r-nd that failure to v- Taa, und..74 scc',.icc. 25A of MOO 152 con 'cad to tie imposition 61c: per-allicz, Citing of a fin.: of up to S1_500.&0 "Dr ipri7. of :2 p to on:. y•car ar. civil pcnaiticz in ! fc,cm of a Stc-_ \'‘,',-,.ri: Ori,-L and a fir4 of S100.0t) a day a_in... Foc ciqtmcIrs :DI gna tairt of 1 .icc:1:;edi rnt il,tr:f5. i- --:;:_t;:‘'..,-, s.; SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: L Not Applicable Cl Name of License Holder : OA 1 3 /v, [ v�2-� ( K" . C S 6-03 0"24 License Number O . L u S i , l` thp, ) - ; 1 ,14. 6101) r': '31(a Address Expiration Date rY Signature V elephone Re_ eyed= o" ie`; firiVirMTri7Con recto Not Applicable ❑ i!) Co u 1 L OR/1S l w, LT(Mr4t: �OilJ LU k' lc IAJ1y .4'.5• t 0 3 ct S Company Name J Registration Number ✓ e-C r /V (JC4 (4Aa, Pi H4- 01060 ''t (t o (a Address Expiration Date Telephone L. (O' b��'g`� ✓? SECTION 101NORKERS' COMPENSATION INSURANCE- AFFIDAVIT (M ,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 C7 No ❑ 11.E ©meiJ.wae e e tan 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 _ y; SECTION D li TIONto ROPOSED WORK (check alt applicable) New House ❑ Addition in Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] • Brief Description of Proposed Work:400 aCy.LiU 644-46x-/frt4 6 6 Giiie'i PART op Eucs1 hd FArticy Pai,. Alteration of existing bedroom Yes l No Adding new bedroom Yes i-V Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 6a: ifiNe h'dttge at d o rgadd'ition `:t aeittif.a housing Tddifp`iete tied fol":laweng: a. Use of building : One Family r/ 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. Mascheck 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 4WNERAUTHORIZATION TO BE COMPLETED. WHEN OWNEkS AGE TOR CO NTRACTOR APPLIES FOR BUILDING PERMIT / I, - ;,,<! , as Owner of the subject property hereb authorize La/ i/1 a' /V . 1eT � to ac:. on my b -hal , in all matters relative to work authorized by this building permit application. / ANN.. 6 /*ay__ i: • • re of Owner / Date I, ✓ etti (0 A1' Foit (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 knowledge and belief. Signed under the pains and penalties of perjury. OAU A)- 4 4-' Print Name 4 ^l1 Signature of Owne gent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ) F . 1 et ° Frontage (h 3 < C 1,7_5 Setbacks Front ! r 3 C ic. r Cct' Side L: � R: b7. d L: i O av R: J '^i � ; 20 / Rear 1 u ' f 140 C 514, Building Height t ; 1 j �tl Bldg. Square Footage 01.3 a 5,f, 3 3 % 3 a a) SF � � 5 7 Open Space Footage t� (Lot area minus bldg & paved J? r) 1 sq n n ri 9oA parking) F, j'. # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit/Variance /Finding ever been issued for /on the site? NO DONT KNOW !i' 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 # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Q✓ YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO E/ IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: f ' City of Northampto ' �- ✓ Building Depart ment �, q si r 212 Main Street - $ s � .. « ` " - o v Room 100 �' �� orthampton, MA 01060 = " � ` r - -' pho �e� - 587 -1240 Fax 413 - 587 -1272 �� � . C,) ` /C�� rr.^ E " !e .'S F. sa .. 4 ,. r e, ',v. `a. T n-rs AP . i' O CO , ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING I SECTION' 1- Si ORMATION 1.1 Property Address: - I Th secti to be co mpleted by office 0 n/C 4L MaP J7 Lot - S U nit Zone , k OverlayDistnct , EIm St. `= CB District SECTION; 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: a —nnt) , Current Mailing Address: Telephone - / / -) / ',nature �� _ y ���`� 2.2 Authorized Agent: 0 i J �02T1 11 L Al i 2tZz Cr' n/271f4 /3T0/U b-14."°(6 Name (Print n Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCT COSTS Item Estimated Cost (Dollars) to be Offidal Use Only completed by permit applicant 1. Building ri' 3srac" (a) Building Permit Fee 2. Electrical (b) Esti Tst Construction mated otal from Co (6) of 3. Plumbing ' ) ` '2 Building Permit Fee 4. Mechanical (HVAC) t 0 . u 5. Fire Protection , r c 6. Total= (1 +2 +3 +4 +5) � I (b0000 Check Number / ' 3y� This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date • File # BP- 2004 -1280 APPLICANT /CONTACT PERSON David Fortier ADDRESS/PHONE 32 Laurel St NORTHAMPTON (413) 586 -8965 PROPERTY LOCATION 770 FLORENCE RD MAP 37 PARCEL 008 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out /49 1 / Fee Paid ,- Tvpeof Construction: CONVERT STING GARAGE T FAMILY RM & ADD 21 X36 ATT GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 008026 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOJMATION 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 Co n 22, coy 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. 770 FLORENCE RD BP-2004 -1280 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37 - 008 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit # BP- 2004 -1280 Project # 3S-2004 -14 Est. Cost: $91100.00 Fee: $344.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: David Fortier 008026 Lot Size(sq. ft.): 71874.00 Owner: HUMPHRISS KAREN L Zoning: SR Applicant: David Fortier AT: 770 FLORENCE RD Applicant Address: Phone: Insurance: 32 Laurel St (413) 586 - 8965 NORTHAMPTONMA01060 ISSUED ON:6/22/04 0:00:00 TO PERFORM THE FOLLOWING WORK:CONVERT EXISTING GARAGE TO FAMILY RM & ADD 21 X40 ATT GARAGE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: /a /iy/, y Amp* Meter: Footings: Rough: Rough : /& / / House # Foundation: Oil /' ,�.,.1 7-1,* Of ` y � l 1 r Driveway Final: Final: Final: Z b 1.1Qt, 7 Rough Frame: ok 6. /3. ©!� Gas: Fire Department Fireplace /Chimney: Rough: tlfl: Insulation Final: Smoke: Final: Oie THIS PERMIT MAY BE REVOKED BY THE CITY OF ' THAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RE .. Certificate of Occupancy Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 6/22/04 0:00:00 1369 $344.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Pai;llo