37-012 (2) 06/09/03 11:46:08 AM
RESIDENTIAL PROPERTY RECORD CARD CITY OF NORTHAMPTON, MASSACHUSETTS EFFECTIVE DATE OF VALUE: JANUARY 1, 1998
PARCEL ID: 37 - 012 -001 00635 FLORENCE RD PLOT: LIVING UNITS: 1 CLASS: R - 101 CARD #: 1 OF 1 „
CURRENT OWNER /ADDRESS ZONING: SR NEIGHBORHOOD ID: 3.00 FINAL VALUE FLAG: MARKET VALUE
DRISCOLL THOMAS D LAND DATA
- ASSESSMENT INFORMATION -
635 FLORENCE RD TYPE SIZE INFLUENCE FACTORS LAND VALUE
PRIME SITE 26800 29,840 PRIOR COST CURRENT
1 FLORENCE MA 01062
LAND 29,800 29,800
BLDG 61,500 71,400 81,400
TOTAL 88,300 101,200 111,200
DEED BOOK: 1505
DEED PAGE: 543 SALES INFORMATION
DEED DATE: TOTAL ACREAGE: 0.615 TOTAL LAND VALUE: 29,800
LAST UPDATE /COST: 20020417 DATE TYPE PRICE VALIDITY
LAST UPDATE /COST: 20020417
X DATE: ADDITION DATA
Lower Level First Floor Second Floor Third Floor Area
DATA COLLECTION INFORMATIONv L; C. !�
\\
A Opn Frm Prch 1 4 60
E NTRANCE CODE: UNOCCUPIED B b
INFORMATION SOURCE: C - v r
�
DATA COLLECTOR: ED D ‘1 c'1 C7
DATE: 19991203
E a .�la _ _ �!.
DWELLING INFORMATION G m
H L'
STYLE: RANCH /��� `c
YEAR BUILT: 1968
STORY HEIGHT: 1.00
ATTIC: NONE / _-
Basement: FULL - - -
TOTAL ROOMS: 5 4 % I .L° a ° =� Q -
TOTAL BEDROOMS: 3 - - �-� —` C
FULL BATHS: 1 ADDITIONAL DWELLING INFORMATION M
Half Baths: 1F3r9s
BASEMENT GARAGE( #CARS) 1 ADDITIONAL FIXTURES: _ 'Z )
EXTERIOR WALLS: FRAME BRICK TRIM: X
UNFINISHED AREA: STONE TRIM: X
GROUND FLOOR AREA: 1044
TOTAL LIVING AREA: 1044 REMODELING DATA
FINISHED BASEMENT LIVING AREA: X
BASEMENT RECREATION AREA: X YEAR REMODELED: w
MASONARY FIREPLACE STACKS /OPENINGS: /
METAL FIREPLACES: KITCHEN REMOD(Y /N)
HEAT /CENTRAL A /C: BASIC BATH REMODEL (Y /N) 24
HEATING SYSTEM: ELETRIC
FUEL TYPE: ELECTRIC
QUALITY GRADE: C PHYSICAL CONDITION AVERAGE
COND /DESIRABILITY /UTILITY GD INTERIOR /EXTERIOR SAME
OUTBUILDINGS & YARD ITEMS PERMIT DATA 36
TYPE QTY YR SIZE1 SIZE2 GRD COND DATE PURPOSE PRICE
21
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NOTES:
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/ 12
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%� DEPARTMENT OF BUILDING INSPECTIONS ^ ' � _'•. ` �;
INSPECTOR 212 Main Street • Municipal Building '`a,, ,:'
Northampton, MA 01060
0
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 : :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 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 r'� //�
I, 4 �' a—' 4',c,9 : 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 670_3
Address of wor
location
J / /4 /ee' ee f/
riae/Ii / na, S s' (`/c7 ""
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ap / �/; � �� csaxchccsctla �� a; �
• � Ai DEPARTMENT OF BUILDING INSPECTIONS i=
212 Main Street • Municipal Building
Northampton, Mass. 01060 ' 11I'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I , R ! �-� 1J? -0 ki t.qT — 0 I _, 7 Ot t n 4—
(liccnsccJpermittcc
with a principal place of business/residence at:
y i r 1 'A31 ST C,.!c / J •ktZ. .__ rphone. Li l3 9 `l'j(.r G.
(street/city /state!eip)
do hereby certify, and - er the pains and penalties of perjury, ilia:
I curl an employer providing the following worker's compensation coverage For my
employees working on this job:
__Ps l 1 11(N VYV.ATI U., 1A--..., UU (in 2-8 'r%'‘I' aq9 I-10 ( 1- 1/ LI" L I
(Insurance: Company) (Polio; Number) (Expir tien Date)
I a.1 a sole prouriet , , gen-ral contractor --, homeowner (circle one) and have laced
tle contractors listed beio e..-e t le following workers compensation policies:
•"C 0' .. ` ___MA_ f V C L A (v'1 .! h V` , L... ..„- JLA q V J l- _I-- --t-d i L-1)1 I o `i
(Name of Contractor) (Insurance Company/Policy Number) (Expirauon Date)
(Name of Contractor) (Insurance Company /Policy Number) (Expiration Date)
-------- —_..__ ______ - --
(Name of Contractor) (Insurance Company/Policy Number) ( x,:iratic'c Date)
(Name of Contractor) ( Insurance Coiutmy /Pol-icy Number) (Expi aa.tion Date)
(attach additional shtott if ecce:s.. to inc- .dc 1: crnu'im p c.- taming :c n11 c_<:::2C :
( ) I am a sole propnetor and have no one working for rue.
( ) I am a borne owner performing all the worn: myself
NOTE: plc ..sc be At,-arc tl:a: •.s`,_i1c l're:T OWIY_71 r+11.0 chrp lay it tt to c.) :nn:::triuncc, a:.:=c cr : ' ,,,:t Cn n L;.,tl!i^:: cf
not more than three, unite in t�ti the Ihono Ds - trs ra:dia or as t-S.: ' :.:s :prurt:n re thereto are rx< Gcrrrally CMCo:C: /t :o t`
r nploycs u_rytr t12C wod ct's c1 satim Act (G L152.-7.1 I (5)), r_ppL_:` by a hotncosirxr fora tccuc or pelmet May r.:'21r1CC 150
legal clatuc of an employe under ttra Woricces Compornxtic'n Act_
I un& that a copy of this dater% cat may be, forwnniod to the, DcparLncod of lndrurrid Ao50o i' Otfoo of In_suran.a3 for lira
coverage verification and that failure to otcure cove ut'd r section 25A of MC31, 152 can lure to the imposition of criminal pcnaltica
comiuting of a rum of up to S1_500.00 a ^3'or i:nprisorancnt of up to cn year aid civil penal c in d c form o(a Step Work ()Ric and a
firm o(S100.00 a day akin t rtr_
_ For da;atnxrial u.so only
t 1 j,!� it Pe Ntunbc
ik
/ ` Lot
i lure of Liccn ec/Pcratittcc .. - late
•
SECTION 8:,-.CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable CI Name of License Holder : Le-0 0 - V u (---S
k C- t�i�tua y LAR_Dr' License Number
Address Expiration ate
,, I . .-`-� �. � � � � 3 S , 9 9 - a(06,0
Signature Telephone
9.'Re i�feretl.NotrieIrri rove'rrienf „a - ;,`' " Not Applicable ❑
� jI Q
I � -� � �. to �e_6(4_ i }J _ � � � , C!- . �.,�1 �' Vet
Company Nam e Registration Number
i'5 1 S i _ g J .S_
Address Expiration ate
C tAl 6.2.1 Telephone ("1)3 a 5 ' te
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 o he building permit.
Signed Affidavit Attached Yes No ❑
1 7:144,, wnerr G'Exem'ption
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 fer 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 _ ,_
SECTION 5- DESCRIPTION:OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [�
, L ,.
Brief Description of Proposed Work: Al �7 u�-� (��L��r�Q �" � t� _..
_ r-PL J+C , V
Alteration of existing bedroom Yes o Adding new bedroom Yes ✓No
Attached Narrative ❑ Renovating unfinished basement Yes —'No
Plans Attached Roll Li Sheet
6a.'' If'Newhouse . 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?
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. Maschec:k 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 -_- Nc
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
OXI`Scot , as Owner of the subject property
hereby authorize I 'e ktiNk vii hj_ _ — _ to Of
my behal`. i all matters relatke to work authorized by t'n's, ouilding permit application.
Yhatitt-.CA-,1( 4/7/43--
Signature of Owner Dat
I, s . =_Xj $ CO// _ , a Own /Authorized Agent
hereby declare that the statements and information on the foregoing application are true and acc e, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
4s � DX cal -- -- --
Print 017,gs,...."--, ...69 — — [v/
Signature o Owner /Agent Date v �
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 C776/ (�
Frontage
Setbacks Front /0 6
Side L: R: LQ?O " R:07014 -- /
Rear /016
Building Height
Bldg. Square Footage
—
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
_Kvolume & Location) i 1
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO V DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page _ and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO LON'T KNOW
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
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:
..
- -, -, - D epa dti sei ) :,
� w : ;
City of Northampton St o 0 � ' g � _? � ,i
Building Department C u r b § C ut D rve Nr a , 'el' I f � y j� 4 ;, , ,
_ ---- - - 21 Main Street Sewer/Se l:ic allab � - �-
n E I ,.. :P �� p
t �i 11 �f _ � r Room 100 Wa "er /�WeiT Ava ab�lft °� ' "�
�� � rth.a npton, MA 01060 Two Sets of Str c Ural Plans ��� j
ph u0 ouR X13 - t5S7 - 1240 Fax 413 _ Plot/ � ` i , F
'' juN :. Other Specify � � `��� �
APP -1 ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
rrr Cs C ` t
SECTION 1 - SITE INFORMATION
This section to be completed by office
1 1.1 Property Address:
Map C/ / Lot 1 .. Unit
a
i Ff erene e _ ) Zone `-' Overlay Distric
1 1
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
I
2.1 Owner of Record:
`fit ;s �_0j, _ ,3 1 er�Ce°1e4
r ,n,e i ir�ti, r 0 � � �. :
/ `T J , . i� ��, ess
f 1�.-' . � ,
Sian2U-:re
2.2 Authorized Agent:
^darn - r mt) .. iieii. Maili Address:
t'
rnat_,re
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
I Item Estimated Cost (Dollars) to be Official Use Only
I I
comsleted by p ermit applicant
I Building j (a) E3uilding Permit Fee �
S^
'id -, ted Total Cost of
I i ;:cnstruction from (6)
c 3. Pii,mbine Building Permit Fee
1 I
1 Mtcnanic (F'JAr)
I
5. Fire Protection
6 Total = (I + 2 e 3 + 4 + 5) _ L Number ��? 7 �v
This Section For Official Use Only
Building Permit Number: / /02-o Cate Issued: — --
Signature: _ —
Building Commissioner /Inspector of Buildings - _ _ __Date —
File # BP- 2003 -1120
APPLICANT /CONTACT PERSON DRISCOLL THOMAS D
ADDRESS/PHONE 635 FLORENCE RD tad,'
PROPERTY LOCATION 635 FLORENCE RD
MAP 37 PARCEL 012 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out % 1 le
Fee Paid
Typeof Construction: REPLACE 24' ABOVE GROUND POOL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 111889
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN 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 Commiss' •
Signature of Buil' mg 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.
. s
w BP- 2003 -1120
GIS #: COMMONWEALTH OF MASSACHUSETTS
7 012 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit # BP- 2003 -1120
Project # JS -2003 -1768
Est. Cost: $2500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TEDDY BEAR POOLS & SPA 111889
Lot Size(sq. ft.): 26789.40 Owner: DRISCOLL THOMAS D
Zoning: SR Applicant: DRISCOLL THOMAS D
AT: 635 FLORENCE RD
Applicant Address: Phone: Insurance:
635 FLORENCE RD (413) 586 -2389 0 Workers
Compensation
FLORENCEMA01062 ISSUED ON:6/13/03 0:00:00
TO PERFORM THE FOLLOWING WORK: REPLACE 24' ABOVE GROUND POOL
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 Sisnature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 6/13/03 0:00:00 2677 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo