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39A-063
—NOTE— THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. • OZZS...--' ✓. Ii c Z.)/e • moo e'fiic,u 30 _.._ q F \\:\. Eo 0 *69 TO: SOURCE ONE MORTGAGE SERVICES CORP. & • ' 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, EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY # 2 S O 1 fi 7 • SURVEYOR: ak,Wi. �•. ...1- -NOTE-- THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY of -MORTGAGE LOAN INSPECTION PLAT-- RANDAU. NORTHAMPTON, MASSACHUSETTS I 32 PREPARED FOR ' i ELLEN GOLDSMITH & SAMUEL LEVITT 4,� SCALE: 1 "=20 ' MARCH 14, 199E HAROLD L EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS �• "�" 235 RUSSELL STREET - HADLEY - MASSACHUSETT WORI{ER'S COMPENSATION INSURANCE AFFIDAVIT I. Vveive6 tIgNl VVN ( ) with a principal place of business/residence at: cot 41,‘G• ,so.s 'lei.A• 1 A i l. 01373(phone-)y13-644-:f0i$ (street/city/state/ p) do hereby certify, under the pains and penalties of perjury, that: . ( am an employer providing the following worker's compensation coverage for my I y employees working on this job: l.4R as v v2 Qnee, G 1& 3 7 7--- G a f 3 (Insurance Company) (Policy Number) .irae on Date) >< ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compa.ny/Policy Number) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shoct ifnecrnary to iflchsdc information p---taixtittg to all contractors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeowners who employ persons to do mxiatrns-nc cortteructioct or repair work on s dwelling of not morn than throe units in which the homeowner rrsidn cc CO the grounds apptutenant thereto are not generally considered to be employes under the worker's on ion Act(GL152,ss 1(5)),application by a homcowo r far a licctzse or permit may evidence tax legal etatus of an employer under the Worite's Coecpamation Art. . 1 undesztand&mt.a copy of this resteaseos may bo forwarded to the Deport:mot of Industrial A.00deate Offioo of lvsur■aoo for the coverage verification and that failure to secure coverage under section 25A of MOL 152 can lend to the ittsposit1Oa of uimiaal penalties consisting of a of up to$1.500.00 and/or of up to one year and civil penalties is the form of a Stop Work Order'and a .. fine of 5100.t,:a day agaimtt tnc . m only I F t Number a / - - 7 - ' z o� _%// / 7 t?sigature cfi. , mitten • la SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑n Name of License Holder: ji/t,/(J O(. /1 ZIL5 T 4) CS 0'1 J{ 57 License Number CM/V-4 4 r S0. :r tto> M ' 41373 41f 1`1 Address Expirati n Dote nature / Telephone yl3 - c65-- 9.Realstered Home Improvement Contractor: Not Applicable ❑ "TriAy 4-4.566106 5 1'.Q !.4 140 n0 Company Name / Registration Number 54,,,96/1-15 s/ o.� �YIDl& Ad1373 G12� <y Addres gri,( Expirati n Da 1 / S' Telephone q13-44 is Y t 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 buildi permit. Signed Affidavit Attached Yes fi3 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 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 Q e� �/ 80 1 Building Department ` Lot Size ! � 10 ` /7`�` Frontage 77.t1 r f 77' ✓55 Setbacks Front III O. G ,' t• ��• � l(` 6 Ji ( i Side L: i l R: L: i 1 R: 7J 7 i Rear c!6 i 3 d Building Height Zs` Zs'I Bldg. Square Footage SO fF �?Jr- % UN 0. 55—?o Open Space Footage % (Lot area minus bldg&paved IA 86 �6 I 1 6 3—`g O parking) #of Parking Spaces Z Fill: O o (volume&Location) A. Has a Special Permit/Variance/Findin ver been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Rtry of Deeds? NO 0 DONT KNOW Regi YES 6I IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 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 O NO IF YES, describe size, type and location: 6 D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, exc ation,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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ � ( Or Doors El- / Accessory Bldg. 11:1 Demolition E I New Signs [Dl Decks [O Siding[�] Other[D] • Brief Description of Proposed Work: 2ulnot s jcr?AJp t 41,415 a1'�ii iey mnl /iA-2�` 1C•en 0 �/�1 1/00$4"�/Arro �da44 L Alteration of existing bedroom lII. Yes No Adding new bedroom Yes No 3 r28k c ceer Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house 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? ,2'e•� ) ,[ �/ d. Proposed Square footage of new construction. �Q .0' Dimensions it` 1 ( Z C! ->�+' � 1 e. Number of stories? 7i f. Method of heating? AMPliA kik Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 11, aaj c QOM,€ i. Is construction within 100 ft.of wetlands? Yes V No. Is construction within 100 yr. floodplain Yes No 71 j. Depth of basement or cellar floor below finished grade /Yes k. Will building conform to the Building and oning regulations? No. I. Septic Tank City Sewer Private well City water Supply V SECTIO . OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNE- AG T OR CON CTOR APPLIES FOR BUILDING PERMIT I � ,as Owner of the subject property " l hereb authorize ri� �0&) . ' to ac : m •ehalf,'1 -,ift.'ers relativ: to work authorized by this building perm't ap ication. t r►�� 9 11 13 Signature of Owner Date VEQ/UGk) kali.S6 i JJ ,as-emes/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 p ins and penalties of perjury. Print Nam' /j atu -of-ewifer/Agent / Date ,, lh ` ),, , g i/el J� .. c5�,o Department use only ' it N 6a�o`° City of Northampton Status of Permit /\ Q it 4, Y p e", ��(, ‘C) q'', Building Department Curb Cut/Driveway Permit � \ \��4Q 212 Main Street Sewer/Septic Availability \GQo<ra Room 100 Water/Well Availability Leo` 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 6r z riu t - Map Lot Unit NQ, 77/411 >TA I /U. Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: • E cte 1! ---Pfr1fl In *kV \ esitt t (A/7T Name Rri Cr).t), 'l . Current Mailing Address: l saw' A5 •PQ0A TY�FZ Mc5.s '1.��' I= )'&60'-- Telephone Signature dia3.5: 0.8868 /1113.5.37-f.ZIO 2.2 Authorized A• - t: awn 4 W: ► .! TO/ 8 ethot, . 1AG f so. 'e(4), 444 %l%7'3 Name(Pi/ '// Current Mailing Address: G,� � % � yl3. 66 5- liol9 ure 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 2. Electrical j ell.o (b) Construction from(6)of 3. Plumbing OOO. 00 Building Permit Fee 4. Mechanical(HVAC) J � ) St7 a 5. Fire Protection 'y,�I` -Z Z• O0 6. Total=(1 +2+3+4+5) !J 07..LI. _ Check Number J/7.-9.,3 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissionerllnspector of Buildings Date 1 ✓ File#BP-2014-0317 APPLICANT/CONTACT PERSON THAYER STREET ASSOC INC ADDRESS/PHONE 8A COATES AVE SOUTH DEERFIELD (416) 665-4018 PROPERTY LOCATION 69 LYMAN RD MAP 39A PARCEL 063 001 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 �/Q 3 5v7 Fee Paid Q 9 Typeof Construction: DEMO 2 STORY PORCH&CONSTRUCT 2 STORY ADDITION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 045159 3 sets of Plans/Plot Plan hc T' OsifG/C' THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ION PRESENTED: 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 y 9- ,P(5-/ 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. 69 LYMAN RD BP-2014-0317 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A-063 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Peanut: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Peanut# BP-2014-0317 Project# JS-2014-000496 Est.Cost: $95024.00 Fee: $570.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THAYER STREET ASSOC INC 045159 Lot Size(sg. ft.): 7013.16 Owner: LEVITT SAMUEL W&ELLEN L GOLDSMITH Zoning: URB(100)/ Applicant: THAYER STREET ASSOC INC AT: 69 LYMAN RD Applicant Address: Phone: Insurance: 8A COATES AVE (416) 665-4018 Workers Compensation SOUTH DEERFIELDMA01373ISSUED ON:9/23/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO 2 STORY PORCH & CONSTRUCT 2 STORY ADDITION 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 9/23/2013 0:00:00 $570.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner