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LULUS REFERENCE
BOOK 3572 PAGE 20
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PLAN BOOK 68 PAGE 73
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TO: --- OWNER•
' l a-m--J: --Jail-n— L Duggan
AND: First American Title Insurance Corp. Maxa.&re-t--D,4ab 1e
I hereby report that the premises shown on this plan is not LOCATION:
located within a Flood Hazard Area as shown on the Federal 11 Marc Circle
Emergency Management Agency's Flood Insurance Rato'Map, Northampton, Massachusetts
CommunityNuMber 2SO167-0002A E. B. HOLMBERG &Associates
Effective Date April 3, 1979
LAND SURVEYORS
I also report, to the best of my knowledge, information and 87 UNION sTREET,EASTHAMPTON MA 01027-0945
belief, that this inspection plan shows the improvement or 37 DAMON POND ROAD,CHESTERFIELD MA 01012-0176
improvements as located on the premises described,that the
improvement or improvements are entirely within lot lines, and
that there arc no encroachments upon the premises described ,.� SCALE:
by the improvement or improvements of any adjoining premises, ��;4���c�A���
except as noted. I further report that there are no easements1�; "" Q�' t - lit
= 30
EMILY y\m
of record affoctmg the tract shown hereon, except as noted. „11P DATE:
HOLMk3ERG ``r November 27, 2001
#34308
SSIQ�,�%' �� JOB NUMBER:
01-229
Y p�
THIS PLAN IS FOR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY.
AND IS NOT TO BE USED FOR CONSTRUCTION PLANNING OR LAYOUT.
n
Lot Size Existing Proposal
11,486 sq.ft. 11,486 sq.ft.
Frontage 86.68+/- 86.68 +/-
Set Backs See Plot Plan For Shed
From Front
From Side
From Rear
Building Height House Height 13' House Height 13 feet
Building Sq. House 24 x 40 = 960 + Shed 96 sq.ft.
Footage Carport 14 x 20 =280
Porch 17 x 5 = 85
1325
Footage 1325 11.5% Footage 1421 12.3%
Open Space Footage Building Footage 1325 + Shed 96 sq.ft.
Driveway
42x17 = 714
20 x 5 = 100 814
814 2139
Footage 2139 18.6% Footage 2235 19.4%
#Parking Space 1 in carport 1 in carport
Fill - 3 cubic yards of%" stone for under
the shed
o ,
$ � 1�asaac}�useffa -
r
DEPARTMENT OF BUILDI)NIG INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Northunpton,MA 01060
- r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 7800MR 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
divelling, 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, rderstand the above.
(H me owner/residen s signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date — ® _ "17,
Address of work
location
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
�„ s�•�� www.mass.gov/dia
-Worke ompensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information 4 r1ease Print Legibly
Name(Business/Organization/Individual):
Address:
City/State/Zip: Phone.#: J
Are you an employer?Check the appropriate box: Type of project(required):
1.0 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
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. 0 Demolition
working or me in an capacity. employees and have workers'
g Y P h'- 9. E]Building addition
[No workers' comp.insurance comp.insurance.:
required.] 5. We are a corporation and its 10.0 Electrical repairs or additions
3_,b `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 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.0 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
employees. 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 file
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 under the pains and penal ' s of perjury that the information provided above is true and correct.
Si ature: Date:
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 CIerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
$1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
e""�stereii'Home m" ' e'merit:Contrac�o
Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,;§25"C(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...... ❑
�2�! ;� `'q' ' 'V✓is 's,�'s.- �ffi.1.-r'Spk yy.}� �.
��� .Hom���a�nerem�tlllon
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 buildine 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
s
SECTION 5-DESCRIPTION OF PROPOSED`WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding[0] Other[ CL
Brief De cription of Proposed
Work: e- / vi A e—d f7ili X�Jz .
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
cif-New house and-oraaddit!661 -ExIStma- ouslna,.=comple eAheldl(oiyvmg:
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. Masscheck Energy Compliance form attached?
h. Type of construction
L 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-OWNER AUTHORIZATION-TO"BE COMPLETED WHEN
OWNERS AGENT
OR;CONTRACTOR R
;APPLIES FO 'BUILDING_PERMIT
1 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
a Owne uthorized
Agent hereby declare that th tatements and information on the foregoing application are true and accurate,to the st of my knowledge
and belief.
Signed under the pains and penalties of perjury.
G
Print Name
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
Frontage
Setbacks Front
Building Height
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
A. Has uSpecial Permit/Vahance/Findi been issued for/on the site?
NO 0 DON7KNOW /7%0" YE3 O `ka'f�&
|F YES, date issued: got/
'
IF YES: Was the permit recorded at the Registry of Deeds?
NO K J DONTKNOW Tr YES
IF YES: enter Book Page. and/or Donumant#'
B. Does the site contain ubrook, body of water orwetlands? NO 0 DON 7KNOV 2y' YES 0
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained x,� 8bta�ne� � �~x Date
�~� \~� '
��
C. Do any ggnsexist on the prnpe� ��y? YES �^� NO ���' '
|FYES. 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 location:
'
E. Will the construction activity disturb(clearing,grading
on.orfiUing)over 1oueor��pa�ofu common plan
that wiUdisturb over 1acre? YES NO y
IF YES,then a Northampton Storm Water Manage me nt,Permit from the DPW is required.
• Department,use only
_ Qity of Northampton Status of � , x �
I _ � n , "0'�
blfflding Department GurfiiC t -W, le
212 Main Street Severe a lab�fi x
Room 100 ±: ettaa �i �" �
Q 2',07 Northampton, MA 01060 vsro S s ofSti�uc CiialT ans d "` �`
�,�"" •- ne"�*-ix`r; „'�F^° ` � < s rr ��"ef3p m au F
phone 413-587-1240 Fax 413-587-1272 dottfSS�te laps h � r
APPLICATION TO-CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be,00rnptetpd by office
1.1 Property Address:. =
Map. dot Un►t
J fi R I V C H' Zone Overlay District
Elm St Distract CBDistnct
SECTION 2`-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
D 2 C' /j o X ZP 0;?H �Aqlred—r 1141
Name , rint) Current Mailing Address:
Telephone
USignafure
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
comloleted ermit applicant
1. Building Ji_,_ � m (a)Building'Permit'Fee
2. Electrical / , (b)Estimated Total Cost of
l r h -.Construction from 6 `C'C
3. Plumbing / Building Permit fee
4. Mechanical(HVAC) ITl�
5.Fire Protection /
6. Total=0 +2+3+4+5) Check Number lS2
This Section For'Official Use Only
Building Permit Number. Date
Issued_
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2007-0949
APPLICANT/CONTACT PERSON BERTRAND GEORGE&SHIRLEY H
ADDRESS/PHONE P O BOX 60248 FLORENCE Q 584-6452 Q
PROPERTY LOCATION 11 MARC CIR
MAP 12C PARCEL 080 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ERECT 8 X 12 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
TH FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ORMATION 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 Stree ssion
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.
BP-2007-0949
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: BuR! ng
Category: BUILDING PERMIT
Permit# BP-2007-0949
Project# JS-2007-001547
Est. Cost: $2600.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 11499.84 Owner: BERTRAND GEORGE&SHIRLEY H
Zoning:URA Applicant: BERTRAND GEORGE & SHIRLEY H
AT. 11 MARC CIR
Applicant Address: Phone: Insurance:
P O BOX 60248 O 584-6452 (�
FLORENCEMA01062 ISSUED ON:4/18/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:ERECT 8 X 12 SHED
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 4/18/2007 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo