38B-197 (3) Y . -THIS PLAT NOT FOR RECORDING PURPOSES-
ALL DISTANCES BY DEED
SEE 44$05, PAA/s For,
be-fAics of, 56 rB4(45
69. 76 '
N
•
M
.—
M 48.501
46.55 '
0
H
BOOK 2375, PAGE 221 - w
w
x
X I 1 w o
o
136.92' 1 m
TO: THE HERITAGE-NIS BANK FOR SAVINGS &
THE FIRST AMERICAN TITLE INSURANCE COMPANY.
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT
LINES. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED IN A FLOOD PRONE
AREA AS SHOWN ON FEDERAL INSURANCE MAPS FOR COMMUNITY NUMBER 250167
DATED: August 21 . 1.186
SURVEYOR 7 L: 041
-NOTE-
THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
or )1f,'-'1N, AND DOES NOT CONSTITUTE A PROPERTY SURVEY
// HAROLD y� -MORTGAGE LOAN INSPECTION PLAT-
EATON y NORTHAMPTON, MASSACHUSETTS
No.23611 a
�° PREPARED FOR
�`c∎I. ''iGisifR�SJ ELAINE M. REALL
H`L _LA n
0.4.,v_tag L1� SCALE: 1 =30 AUGUST 21 , 1986
. 1"'f4..,4
HAROLD L. EATON, PROFESSIONAL LAND SURVEYOR
r 9 SUNRISE DRIVE - HADLEY - MASSACHUSETTS
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
understand the above.
I (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
' The commonwealth of Massachusetts
n - Department of Industrial Accidents
Office Of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers
Applicant Information Please Print Legibly
°
Name (Business/Organization/Individual): sA' A e, LL /S4 0(1+ •_
C� 7 � y
Address: � �-7 6 City/State/Zip: p\,06,�, c� rlo e#: C U -9313
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2. a I am a sole proprietor or partner- listed on the attached sheet. 7. 4 Remodeling
ship and have no employees These sub-contractors have 8. 121 Demolition
working for me in any capacity. employees and have workers'
g Y P n 9. RBuilding addition
[No workers' comp. insurance comp. insurance.#
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
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
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$250.00 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 un er the pains and penalties of perjury that the information provided above is true and correct.6
Signature: / � Date: - ! - 09
Phone#:
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#:
-5
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 5 � 1 v 1'- cc.5 71 7 t '
License Number
r- Q ee,6 � , ow 7 c0 3 - 2�
Address A CY Expiration Date
t4 /3) k)3 ( - 5D) 3
ignature Telephone
9.Registered Home Improvement"Contractor .s� "�`"' Not Applicable ❑
SPYCZAA--t cTU C-YRP 36'_
Company Name Registration Number
(-tr( e.ad ( � UI U'Z o 22— Coco
Address Expiration Date
Telephone(if 13)(3 3y-66(3
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 ❑
1: -Home Onergemptiori
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 1083.5.1.
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
I
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition [' Replacement Windows Alteration(s) 71 Roofing n
Or Doors E
�-1
Accessory Bldg. I i Demolition ❑ New Signs [0] Decks [C] Siding[D] Other[0]
Brief Description of Proposed 1
Work: R-ervlo t- 24$3,�Y16` i �Z c 4r�1 Gulf c'hJ� G,+�� vL.,to,,�ck W� Fuft 2 cy.. ,01
Alteration of existing bedroom Yes X No Adding new bedroom Yes iD No
Attached Narrativ Renovating unfinished basement Yes No
Plans Attache of -Sheet
sa_ If New house and or addition to existing housing, complete the following:
a. Use of building :One Family Two Family X Other
b. Number of rooms in each family unit: `J/ S Number of Bathrooms V I
c. Is there a garage attached? 0 Sr- t
'(
d. Proposed Square footage of new construction. U l 2 S 2 Dimensions 2 y �'l� x l 6 —0 t`
e. Number of stories? ..
f. Method of heating? C , acs-2 b ocorck Fireplaces • Woodstoves y_....J Number of each
II--�..
g. Energy Conservation Compliance. 1 S , E o Y�b'11* Masscheck Energy Compliance form attached? ..5-6,A--
Q e_ryw.;l L. 1-1c-k l -�.-
h. Type of construction WOOcA.
i. Is construction within 100 ft. of wetlands? Yes x No. Is construction within 100 yr. floodplain Yes X No
j. Depth of basement or cellar floor below finished grade L I°
k. Will building conform to the Building and Zoning regulations? X 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
leX y�f� ' L 2- -K '�" ._ , as Owner of the subject
p /
hereby authorize S , U L- _---
to act on my behalf, in II matters relative to work authorized by this building permit a plication.
l' ' �'�`� o9)
C � mss.
Signature of Owner Date
I, .,l L p K , 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.
1 (g_arr„_"_
Print Name /�
�l t � _ Date 6/e/v
Signature of Owner/Agent
,
. .
' .
•14.
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 `,. ___~
Frontage 6) . 1
Setbacks Front �5e-f r�--
..•4_4 ���/ „__�
r�� �=/ ��� -��
Side ��c.m�- ��.���� L:����' ��:�is- 775— | /�
��
Rear ��
[ u_ ZO,-
Building Height r��J ,..26.! ,_~ ,5
y
Bldg.Squar Footage ����C� F---1 % ���---` r---1
~�� ��-^ _-__� ~=�==~
Open Space Footage �� 96 __-
---- 62151' ---
�,a�mi�»�&v�« ���, LJ -���
parking)
r�- r��
#ofy�kiog Spaces L��^� ��=��
~
Fill: --- ----------- -- ------- - - - -
(volume&zucammn) ^__________
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO : m DONT KNOW 0 YES 0
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0/ DUN�| KwVvv YES� -1
IF YES: enter Book \ Page | and/or Document#
. �_-_________� �______.__
B. Does the site contain a brook, body of water or wetl.ands? NO AI� DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obta ned from the Conservation Commission?
Needs to be obtained v�� Obtained
e /-� Date |ssued' |
»�� �_/ , Issued:
C. Do any signs exist on the property? YES 0 NO 0
�-------- -- ----- -- - - ' l
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 0
IF YES, describe size, type and location: �
E. Will the construction activity disturb( /ioy. grading, vntim� or filling)over 1 acre orimit part ofa common plan
that will disturb over 1 acre? YES K � NO 0�)
�� ��
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
i
�. Department use onty
/��n r�Ct - pton Stafus of ctntt. 1
1 e Builds g JJe'-' ent Curb cu#ID veway Per tlt g
l �c 1 S eet Seaver/septic Avaiabdify
�^, �, 24yEtA i 0 Water vef1 AualtabiI ty
lortha��<im c MA 01060 TwoSetsufStr�itctura1Ptans , �`
hon �4�13 5 . Fax 413-587-1272 P1ot151te Ptans
� � �; �� •Other Specifyi �
Jr �
APPLICATION TO CONtt�C ,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
` /;
i
SECTION 1 -SITE INFO,MATION
This sec- to be completed by office
1.1 Property Address:
of <3o I s Map Lot Unit
1� j Q r , 1 a1 vl Zone Overlay District
i V 1'+4 ' `O
Elm St.District CB"
B District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/2 l C fa , Y z--- oh o f 14 S t �'�I $k 11 "�
(Print)L_ t
Name Current Mails g Address:
(� � �( Telephone
Signature
2.2 Authorized Agent:
Name(Fri ) / Current Mailing Address:
ignature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building , r i 4 (a)Building Permit Fee
/d b Estimated Total Cost of
2. Electrical t -O�
(b)
�� r Construction from(6)
3. Plumbing f. ( Building re
Fee
4. Mechanical(HVAC) _ ,\
5. Fire Protection CI" '-'lJ l
/[v Check Number `' t 'a
d
5. Fire Pr (1 +2+3+4+5) / 7 et F v J � �6
///15-40779h is Section For Official Use Only
Date
Building Permit Number: Issued
Signature:
Building Commissioner/Inspector of Buildings Date, ria"it/K-
I
File#BP-2009-1057
APPLICANT/CONTACT PERSON SARAH STULL
ADDRESS/PHONE P 0 BOX 48 PLAINFIELD (413)634-5013 0
PROPERTY LOCATION 206 SOUTH ST
MAP 38B PARCEL 197 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out gyp,
Fee Paid ` 9!!
Typeof Construction: DEMO EXISTING 1 1/2 STORY ADDITION&REBUILD 2 STORY ADDITION(25 X
16)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 071711
3 sets of Plans/Plot Plan i+
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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 Commission _ Permit DPW Storm Water Management
Demolition Delay
-
Signature of Building 0 ficial 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.
,:.. 80 ST I BP-2009-1057
GIS#: COMMONWEALTH OF MASSACHUSETTS
°ma, : o tit x'r' 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-2009-1057
Project# JS-2009-001537
Est. Cost: $111500.00
Fee:$696.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SARAH STULL 071711
Lot Size(sq. ft.): 11194.92 Owner: KAYE ERIC R&NANCY G
Zoning:URB(100)/ Applicant: SARAH STULL
AT: 206 SOUTH ST
Applicant Address: Phone: Insurance:
P O BOX 48 (413) 634-5013 ()
PLAINFIELDMA01070 ISSUED ON:6/25/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMO EXISTING 1 1/2 STORY ADDITION &
REBUILD 2 STORY ADDITION ( 25 X 16)
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 6/25/2009 0:00:00 $696.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo