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IF REQUIRED 1 Z r '- / `/7 ZBIG l o D L7 0 -ri CD 9 I O 645 trTS Zbigniew Lewantowicz A o a m FLOOR RESIDENCE Regist Architect I FIRST I 129 RIVERBANK RD CT REG. # 7562 C31 i FRAMING PLAN y U Co Southampton, MA 01073 1 31 1 N --t all r 11 t I _ = ri _ i _ ___ z M __ z • I C _ _az _= �� I i ilititititititititi411tI1F - m - 1 1111111111111 AL - 70 =ILI= -z 1 < 1 I 1t1t111111 1111 1111I = 1 4 44441 144 -. II r11111t11 111111111111111111111 z F 1 141414 44 11111111 0 r rn < < - ^ 1 IIII 1�1 = 11 /ilitilil < < CP 1 O , t� 1 11 111t111111111111 1 1 1 1 1 11111 1 1 1 1 1 1 ,/ <<< 11 111111111 111i411111111111111t11I n 1 1 1 1 1 1 1 1 1 1 1 1 1 ` ,1 << E a NI t tll ll llFl 1 llll ^_ << << <<t 1 IIII N 3 , yt14114 4 4 4 4 4 4 4 4 41141 I IIIII Iltlllll (1 11111111111111111 <<<(<<< ' — �� t I I I I F F l 1.1 i l l I l I I O m ,l.l.al.l.i.l.l.F.L1a.F.l.l.i. 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IM A 102 East Street = Southampton, MA 01073 4P 33 -0" 4' -6" 8' -2" 1 15' -1m" 4' -6" 1 . 1 1 -1 Ill - r1 (P LU 1 X X n om = r+ -I I Z - U n b o n - zz A I t o 3 - < 1 C P z rn m --I c = I A O - cp -0 ill �m 11, 11 I 3 i t , 11 , 1 1- v' --I �I O ' - _ 1i/ 11 . I CIwO IV �' D X ti O 19 p I \ , 111 — to ° 13 -11 3/4 X i ' �I ' / �� III m z I II F- m m cn VIII 1 !;;� 3' -3" t D o I -- - Q I I --0 cr O Z D IUD 0 1 G � — 3 \ /' :E_ .....• I W W 19 \ w I — 3 -6 1 6 4 110 0 [ ,n. , 17 oi x i I:I__ - _(\ '1111 \ , 1 -i.. 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" - 4 a o m II'' II t y � ' �+ Zb1gI11e Registered et o o w m W4 I L ING RESIDENCE MA REG. # 07007 ni l CT REG. # 7562 FIRST FLOOR PLAN 129 RIVERBANK RD iV 0 (413) 527-0078 NORTHAMPTON, MA East Street Southampton, MA 01073 , �> 1 I I f { I I I I I I .EXIST 2xg e 16'1 OC 1 1 I 11 1 II II I EXIST 2x10 e30" II I z I ! f II � c rn ti Il I .. i , 1 1) 13' -. I ,_ dam__- L- _ _� 1 rn O EW 2 -2x10 ..1. . 1 1;i r 1 4 ' r C 1i rn ,. II I • 1/ I vi• ii . • r - I A I m ( 1 ,7 - ; 1_ 1 --- 11Li_ t_L 4EAM' ' u , I CP Z ; I d Z ' I I -- \J __ ±�r.rrT = G- -r - r '' -- - I . O I X 'I II ► ti W o D �; 8X Q :: i, II z A° �— II L � � Iti 11 I x II , T 0 0 0 2 17.71171 . K e. 1 _limil_ 7 I 4x B AM _ �� _ __ II ! ` • ' - I I O w VIEW 2- 2x ! _ -I, -- — D Cl r I '►V ti , I p 0 } �� • :T I O ti p I F Z P 0 _ • D 1 . J • . z Xo n b.•‘7. I m O ! I m Co �' � � r z ' 0 • Al X s —0 V' 1 Gl z Z O ra ! O _ , m� fin. Cl o w W 0 E -4 U� D C l I m cP i i I Cl p 0 D • -- 3 0 r p • I ) I 0 D . °v 1 I n -o m _ 17' g" NEW FROST WALL _ ii r r IF REQUIRED tz g A 6 I 10 fa> P ig o -4 „ N 31 k r KR c. m T � O 1-- rN gO rMi g N to k) - II i m us rn m to W �' n D�p 5< T - O e rr tn DD r rfi 2- r i g k .t k4 �� Ty in j[ tg rr 16 i � Tll N -•. B —1 m m rn m _ 6 ii: u; ° /j o - R P "' / /r, Fy M N c -... ..../0)11 N 0 f o — hV1g g m Zbigniew Lewantowic t o u ,< WATLING RESIDENCE Re Architect MA REG. # 07007 I 1 ti BASEMENT PLAN 129 RIVERBANK RD ( ) CT REG. # 7562 l'"" r 6 n (413) 527 - 0078 NORTHAMPTON MA 102 East Street 1 -0 2 - m 1. 44 r I. Z Z - m - i ° cP r "' 6 cn O om v - -may r � v M N v S 11 ) m Ui s-, m g . ffi A , 2 cP cap mr n r 1 -', '3 .--' 2 r i ) M 6 1 g ' t? :< b $P p il t ii -zz= 3 ‘.. 7. ' mg r c Li P 5 g: 6 O N cn r N m m b .. rn40 N v \\,) o J ` 11 ii -n O 63 1. O Es o _ r i c 3K O a \� u' i „ s ti TO \�} �° 1- 4 * , 3 0 y� t o , O ' J1 - 60 111 . �� Z 3 — - * i �° �-- i4 ' �/ 03 C > v 0 . 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NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. J111tlnl min rr1TfTIIIF fill 911 limn i mil nrurnAI 1 IAnii Iry rr,r.i 1 nrni Innrt nr m _ _......_.._..._ ..___..._ _.. _._... Pkl<IIITI 9K1S11... 4 1 ri oIMS MonF n nrrl IR P4F�.F.JIP„LABtloamum) $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 7 POLICY n 7118 n LOC AUTOMOBILE LIABLITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY �. SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABIUTY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLALIABIUTY EACH OCCURRENCE $ — I OCCUR n CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 1 TORY 1 IMT751 1% EMPLOYERS' LIABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ It yes, dcre under SPECIAL es PROVISIONS below E.L. DISEASE - POLICY LIMIT 8 A O THER Flood 87020678482008 07/02/08 07102/09 Dwelling $84,700 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS "Other Lines Information ' ” POLICY # 87020678482008 - Flood Policy'* " Homeowners Coverage Information " (See Attached Descriptions) CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL 10 DAYS WRITTEN NOTICE TO THE CERTFICATE HOLDER NAMED TO THE LEFT, BUT FALURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTH RUED REPRE Jr ACORD 25 (2001108) 1 of 3 #7764 SMF @ ACORD CORPORATION 1988 Processed by: POLICY #: 87020678482007 Flood Insurance Processing Center P.O. Box 2057 Kalispell MT 59903 -2057 4, To report a claim call: (800) 759 -8656 TgE mol HARTFORD FLOOD POLICY DECLARATIONS Policy Renewal TYPE: DWELLING POLICY PERIOD: 7/02/2007 to 7/02/2008 These Declarations are effective as of: 7/02/2007 at 12:01 AM INSURED NAME & ADDRESS 1111 II,tI IIL11J111111111111LI11 ,11,111111t ,11111111111111 PRODUCER NAME & MAILING ADDRESS WATLING, RICHARD PRODUCER #: 06200 - 00005 -052 129 RIVERBANK RD KING & CUSHMAN INC NORTHAMPTON, MA 01060 -2516 PO BOX 447 NORTHAMPTON, MA 01061 -0447 PHONE# (413) 584 -5610 POLICY INFORMATION PREMIUM PAYOR: Insured COMMUNITY NAME COMMUNITY NUMBER NORTHAMPTON, CITY OF 2501670002A INSURED PROPERTY ADDRESS PRIVATE RESIDENCE POLICY TERM: One Year 129 RIVERBANK RD NORTHAMPTON, MA 01060 -2516 BUILDING DESCRIPTION Coverage Limitations May Apply, Refer CONTENTS LOCATION Single Family to your Standard Flood Insurance N/A Two Floors Policy for details. With Basement or Enclosure PROGRAM FLOOD ZONE CONSTRUCTION Regular A13 Pre -Firm Construction COVERAGE & RATING INFORMATION BUILDING CONTENTS PREMIUM PAID Coverage: $84,700 Coverage: N/A Premium Subtotal: $705.00 Deductible: $500 Deductible: N/A Previous Premium Subtotal: $.00 ICC Premium: $75.00 Rates: .810/ .680 Rates: N/A CRS Discount: $78.00 Expense Constant: $.00 Federal Policy Fee: $30.00 Endorsement Amount: $.00 Total Premium: $732.00 FIRST MORTGAGEE 2ND MORTGAGEE FLORENCE SAVINGS BANK 85 MAIN ST FLORENCE, MA 01062 -1400 This Declarations Page. in conjuncion with the policy. constitutes your Flood Insurance Policy. IN WITNESS WHEREOF, we have signed this policy below and hereby enter into this Insurance Agreement. INSURED COPY :1 BLD rresl secretary 6/22/2007 artford Insurance Company of the Midwest 1R 10. ,, Oo any signs exist on the property? YES NO V • IF YES, describe size, type and location: Are there any proposed changes to or additions of signs intended for the property? YES NO V IF YES, describe size, type and location: 11. Will the construction activity disturb (clearing, grading, excavation, or filling) over acre or is it part of a common plan of development that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building rtmen EXISTING PROPOSED Depa REQUTBED BY ZONI NG Frontage Setbacks Front - i 1 1 2. 4 . Side L: ; R: ' L: i R : . L: 0 . R, t P Rear V-Z t) d fik . Building Height 1= 4 4 Building Square Footage 1 �_ //7 Z set �(o 51 l l b tu #N efie % Open Space: (lot area i i 1 pf., minus building Et paved t( Z 5 2 1 I "" parking 1 . _ ,.� , � NI W # of Parking Spaces 4 - # of Loading Docks O Fill: (volume a location) 0 0 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Date: - 3 - CZ. - O Applicant's Signature __A(; NOTE: issuance of a zoning pern it does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Historic and Architectural Boards, Department of Public Works and other applicable permit granting authorities. W:\ Documents\ FORMS \original \Building Inspector \Zoning Permit- Application- passive.doc 8/4/2004 ,_.. File No. 0,69P A E ? 2009 MAPP Please type or print all information and return this form to the Building Inspector's Office with the $i5 filing fee (check or money order) payable the City of Northampton 1. Name of Applicant: '� c Ar' 418+ 1 t'1 5 Address: l 2 c l iecit Telephone: /r3 3 ZO —7 vs/ 2. Owner of Property: R, c A rJ ^ 3 Address: k ---(;=\. 2 . _,, .4/.4 re4 Telephone: 3 Z -- 7 Ys/Z 3. Status of Applicant: Owner V Contract Purchaser Lessee Other (explain) 4. Job Location: / 2. ' t t Rok M WirMeRWifibtAisVitt4fiikellelitig30.101aZ.OVIgg160 -71 ', - 7;:tr PqRaitqatiWAV 5. Existing Use of Structure /Property: " 41. ? " t(„ ■J I ada,4415 6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary): f 2r5ancl. cA P r of --c-tct 7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans 8. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO v DONT KNOW 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 # 9.Does the site contain a brook, body of water or wetlands? NO V DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , date issued: • (Form Continues On Other Side) W:\ Documents\ FORMS \original \Buis ding - Inspector\ Zoning - Permit - Application- passive.doc 8/4/2004 rr File # MP- 2009 -0080 APPLICANT /CONTACT PERSON WATLING SHERYL V & RICHARD H WATLING ADDRESS/PHONE 129 RIVERBANK RD (413) 320 -7442 0 P . * 4'12, ► . �� w • rki 129RIVE MAP 25 PARCEL 026 001 ZONE SC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE CNING FO ILLED OUT ) ree rai Building Permit Filled out Fee Paid Typeof Construction: ZPA - RESIDENCE/HOME OFFICE 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 INF_ OAVIATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER : § Aj Intermediate Project : Site Plan AND /OR Special Permit with Site Plan yjitt_,, j,(1 Major Project: Site Plan AND /OR Special Permit with Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Coo', 404 v 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 .treet Commission Permit DPW Storm Water M<na_ement 1' ZO Sign of B ilding 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 the Office of Planning & Development for more information. ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO - FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: g, (.,, }_� , i Site Address: 7_ e � print Town: V q 1 � , , ,,.. /44 01 04-0 Applicant Phone: '/3 – 3 Z o 7i Y Z Applicant Signature: —_ Date of Application: S' cD NEW CONSTRUCTION: (choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE - AND TWO- FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Basement Slab Option 1: Fenestration exposed Wall Floor Perimeter U- factor floors R -Value R -Value Wall R -Value AIDE HSPF SEER R -Value R Value and Depth National Appliance Energy R-10, Conservation Act (NAECA) of .35 R-38 R -19 R -19 R -10 4 ft 1987 as amended, minimums or greater as applicable Note: This form is not required if you choose either of the two versions of REScheck as rsted below. ❑ Option 2: ' REScheck Version 4.1.2 or later variant software analysis must be completed (780 CMR 6107.3.2) REScheck –Web which can be accessed at http : / /www.enerwcodes.aov /rescheck/ ADDITIONS OR ALTERATIONS TO EXISTING BUILDINGS OVER 5 YEARS OLD* *Buildings under 5 years old must use option #1 or #2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b - a) SF 100 x – _ % of glazing (b) Glazing area equals SF b a If glazing is < 40% use the chart below. If glazing is > 40 % proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW -RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM 111 Fenestration Ceiling and Slab Perimeter Wall Floor Basement Wall U- factor Exposed floors R -Value R -value R -Value R Value R -Value and Depth .39 R -37 a R -13 R -19 R -10 R -10, 4 feet a R -30 ceiling insulation may be used in place of R -37 if the insulation achieves the full R -value over the entire ceiling area (i.e. not compressed over exterior walls, and including any access openings). ❑ SUNROOM – An addition or alteration to an existing building /dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120.P) ........ / ` h i ... 1._„,,,,, , ...,-L.,„..2._ � 1 .._.__ ...r _...._. i r'1R ■ 1 �I { .. ...., ...., ......, ,, 1 ct {I C i �I i , ., .,....... , , , ., . H •, 1 . . ' ' 1; t ' '' ' -, „7r ----,-- ° - '''' ' t - ' i ' t ' ' 1 (,,,,: i fl { J j I a t i ' i ti 4' _. - - I I 11 t 1 1 1 moo i mmoimilik C r ' ' o f f i ..- F-,1=,--Z ------* i .. „ y 1 4 c )9 ......--- 4.... ! i 1 i %( '..\-......,. , ( i ...) --", c j , ',J .. . (... C1 c, 1 i { r,.,, I k , 1 1--""----1 , 1.....- p ... t f I 7 ------ --'-'-' - ' - - . -: ' , .......--mt..- ' • i .--...,, , , - - - .,,,z <,„.....,,_..- -' - , , l-g- •i° ri ',' .....- i P ..,_ 1 I ' 1 '- ' - - -. - -1 '- r ' l ''' -: ' •r - - ' ' - i ' ' 0 ' I L MEM ' Mill NISSIMinil 'i - - - 1 ' - r7----.-■„ 1 . .... . .. , \....,,-- ,.„.1 fl ........ ,. .., 1 I - i ' I I • I. f / , , i --- --- - , 1 1 1 .---,-------- , ..., P , +....\ , ......, .....) ,- .,,,.) L ....--- 3 4. ■ eXZPAIFP \ I - \ 1 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 ua1l to sultedule all required building inspections necessary for the building permit issued to me. Date Address of work location `.. The Commonwealth of Massachusetts , i 7 .---4=-„,-,-:, Department of Industrial Accidents -- ,, ,. ' - Office bf Investigations 600 Washington Street .. = . Boston, MA 02111 '' `. ,-- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Leg rin ibly • Name ( Business /Organization/Individual): /� /,, Are/' / i. J A o't 1 n�i — Address: A 7`� Cat .� e. 1, a,ti ej J City /State /Zip: r-1- , , - / V4 0 (0 (0o Phone #: y/2-- _s 33Z /e 3 , 7yv Z Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. E] I am a general contractor and I 6. ❑ 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. 0 Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp. insurance.t required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.E Other employees. [No workers' 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. 1- 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 employee's. 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 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 $20.00 a day against the violator. Be 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 certify under he • ains ' ndpenalties of perjury that the information provided above is true and correct. Signature: / �� Date: --�� ‹. 1 AI Phone #: 7 /.7 Z ° ^ 7 ? 7 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. Plumbing Inspector 6. Other Contact Person: Phone #: • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: 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 ❑ 11. - 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ReplacementWi ows Alteration(s) ❑ Roofing Or Doors pal' Accessory Bldg. ❑ Demolition New Signs [0] Decks [Q Siding Other [0] Brief Description of Proposed Work: 3 e'e o zJ 4 A> c> f p r .i 1-i i)-- Alteration of existing bedroom Yes ✓ No Adding new bedroom v Yes No / Attached Narrative Renovating unfinished basement Yes V No Plans Attached Roll - Sheet 6a. If New house and or additions to existing housing, complete the following: a. Use of budding : One Family ‘/ Two Family Other b. Number of rooms in each family unit: / v Number of Bathrooms c. Is there a garage attached? A 0 t tr r, d. Proposed Square footage of new construction. 1 7 75" Dimensions . S 2 3 h - 19 7 e. Number of stories? 2 f. Method of heating? ZJecd S + , 0 \ ...:lei Fireplaces or Woodstoves Number of each 1 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 Co ' / k. Will building conform to the Building and Zoning regulations? �V Yes No . I. Septic Tank V City Sewer Private well City water Supply Z SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , 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 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. Print Name / 17 Signature of Owner /Agent 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 ,) Z �� ? 6, Z tE Frontage , V, 7 ce ( y 7 6 Setbacks Front J 7' t. - 7. I ' it Side L: 2c Co 1 L ?, Rear '/Z Building Height ke 4 / a Zc(�rp ti Bldg. Square Footage /1 7 Z ' % ZG4 6 Open Space Footage % (Lot area minus bldg & paved .. ‘ k. Z 3 1 ' Z parking) # of Parking Spaces Z Z Fill: (,f I 0 (v & Location) A. Has a S•,. •:l Permit /Variance /Finding ever been issued for/ the site? NO I'�� DONT KNOW 0 YES IF YES, date issued: y1 r je. IF YES: Was the permit recorded at the Regis of Deeds? NO O DONT KNOW YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO e Zk ---- IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excav on, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability '/ AY , _ �,��1 3 ` Room 100 Water/Weli Availability ,'et ti , LJ.J Northampton, MA 01060 Two Sets of Structural Plans phone 413- 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 11.6k ' `u e-k.t1 U, ILA Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: �'' +'/► 7 Q / / Z ✓ C: �4/1 Cr Name (Print) Current Mailing Address: (Y 3)` to 33?( Telephone Signature 5 db / a 2.2 Authorized Agent: 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 1. Building (a) Building Permit Fee /UU UDv 2. Electrical (b) Estimated Total Cost of /1.) cJ v a Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) / 5. Fire Protection - -O ! v/ 6.��Total= (1 +2 +3 +4 +5) / Check Number Ste 7 � f This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2009 -0912 APPLICANT /CONTACT PERSON WATLING SHERYL V & RICHARD H WATLING ADDRESS /PHONE 129 RIVERBANK RD NORTHAMPTON (413) 320 -7442 Q PROPERTY LOCATION 129 RIVERBANK RD MAP 25 PARCEL 026 001 ZONE SC(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 /6o Typeof Construction: CONSTRUCT 2ND FLR ADDITION (2 full baths,2 bedrooms /office) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: �Q�t Owner/ Statement or License / / ��� 'w` � Q �� 3 sets of Plans / Plot Plan THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 _■P- Loa 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. 12 BP- 2009 -0912 GIS #: COMMONWEALTH OF MASSACHUSETTS two** 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- 2009 -0912 Project # JS- 2009 - 001188 Est. Cost: $140000.00 Fee: $600.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 5314.32 Owner: WATLING SHERYL V & RICHARD H WATLING Zoning: SC(100)/ Applicant: WATLING SHERYL V & RICHARD H WATLING AT: 129 RIVERBANK RD Applicant Address: Phone: Insurance: 129 RIVERBANK RD (413) 320 -7442 () NORTHAMPTONMA01060 ISSUED ON:6/9/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 2ND FLR ADDITION (2 full baths,2 bedrooms /office) 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 6/9/2009 0:00:00 $600.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo