29-466 in -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.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
NOTE:
SUBJECT TO EASEMENTS AND
RIGHTS OF WAYS OF RECORD.
100.00'±
BOOK 5503, PAGE 307
PLAN BK. 77, PG. 99
LOT #45
-H F - -H
o I o
o I o
o a
L #15
100.00'±
CRESTVIEW DRIVE
TO: SUNTRUST MORTGAGE, INC. &
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE 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 #250167
-NOTE-
THIS PLAT gg,. THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
�---- AND DOES NOT CONSTITUTE A PROPERTY SURVEY
,A OF -MORTGAGE LOAN INSPECTION PLAT-
s9y NORTHAMPTON, MASSACHUSETTS
o= RANDALL PREPARED FOR
E. -
IZER �� Li'N1*4 L- REAGAN
1J5U32 SCALE: 1"=30' AUGUST 23, 2007
"moo `,Sl HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS
'�+, , •• '
0�
L ��
� 5
�0� �-
,� i
15
1
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\v
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMiZ 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 occupancv
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, V understand the above.
(Ho a owner res' ent's signature requesting exemption)
I will caR to schedule all required building inspections necessary for the building permit
issued to me.
Date � j
Address of work /p
location (S
The Commonwealth of_Vassachuse:ts
- Depar rmen-,aj Industrla Accidents
r mice of rivestigarlons
IX
600 U'ashin ton Sr.eet
Boston, MA 02111
ww>v.mass.j of/din
Workers' Compensation Insurance AffidaNit: Builders/Contractors/EIectricians;Pl7.:.-z:bers
r
,Dlicant _information Please Print Leaibly
N=e (Business/Organizanom'lndividual):
��C1'eSS:
Cltv/State/Zip: Phone n:
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. 17 employees (full and/or part-time).* have hired the sub-contractors New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These ub-contractors have g_ ❑Demolition
workm— for me in any,capacity. empl ees and have workers' 9 ❑Building addition
[No workers' comp. insurance co insurance.:
required.] c- ❑ We e a corporation and its 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work o ers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. rig t of exemption per MGL 12.❑Roof repairs
insurance required.] ' C. _,2, §1(4), and we have no li ❑ Other
e plovees. [No workers'
c rap. in required.]
*Any applicant that checks box A.I must also fi ll out the section below showing their workers'compensatior policy information_
Homeowne s who submit this affidavit indicating they are doir. all work and then hire outside contractors trust submit anew affidavit indicating such.
=Contractors that check this box must attached an additional shee showing the name of the sub-contractors and state whether or not those entities have
emplovees. If the sub-contractors have emplovees,they must prdvide their workers'core.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 dame: —
Policy r 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_'VIGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 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 3250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DLA for insurance coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct.
Signature: Date:
Phone=:
Of;icial use on Iv. Do not wrire in this area, to be completed by city•or town of I
Cin,or Town: Per mib'Zicense r
Issuing Authority(circle one):
1.Bcard of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector Piu^.-ibing Inspector �
I6. Other
Contact Person: Phone;-:
SECTION S-CONSTRUCTION SERVICES
8.1 Licens=ed Construction Suoer/iscr_ � Not Applicable ❑
Name of License Holder
License Number
4dcress Expiration Date
Signature Telephone
r..Rcedistered Home Imoroveritent Cnnb-actor FAp e ❑
:omoanv Name Number
-r6bD`1 B(AYL, f a G-5
.ddress e
Telephone
ECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G.L.c.132x§25C(&))
1crkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
the denial of the issuance of the building permit.
oned Affidavit Attached Yes....... ❑ No...... 0
t� Ioe=(3 -�epra
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.CNIR 780, Sixth Edition Section 10835.1.
Definition of Homeowner:Peron(s)who own a parcel ofland 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 Derson 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 buildins Dermit
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 ofEmployers 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, e Z oc Laws and State of Massachusetts General Laws Annotated.
R—� Homeowner Signature'[_ `
V 0 06 0
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aooiicable)
New House Addition Replacement Windows Alteration(s) Roofing I
Or Doors
Accessory Bldg. Demolition 0 New Signs [O] Decks [ice Siding [L-i OtheL j
Brief Description of Proposed
Work: A „1c !Si in, k'_0 �CSG �—�,✓-!C' hf7�l1
~iteration of existing bedroom Yes No Adding new bedroom Yes No
AY.ached Narrative Renovatina unnnished basement Yes No
Plans Attached Roll -Sheet y
sa.'if L evi hoes: arrc ac acidFtian.ta ex€stf�a`housincr:coMDW tf�e fo[tov�riny
a_ Use of building : One Family Two Family Other
b. Number of roans in each family unit: Number of Bathrooms
Ic- 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?
I
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
k- Will building conform to the Building and Zoning reguiations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a--OWNER AUTHORIZATION .T.asE.COMPEETEIY�.-WHEN
OWNERS-AGENT 012 CONTRACTOR APPLIES POIt E UILDI NG 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
(A K as Owner/Authcrzed
A'.cert hereby declare that the statements and information on the foregoing application are true and accurate, to the best cf my knowiedge
and belief.
Signed r, er ,e airs penalties of penury_
Fnnt��{arr
S;cn2t,_re of,�_wneriFaent
^ate
ISection 4. ZONING I All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
i
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size �.1 ' d ',_
Frontase _.._....� _..,.._,__-,.__ ......_ ______._.._ _.....,_.,. ..... _ ..-...._..
Setbacks Front
Side L: ...._._._ R: . L J R .
Rear
Building Height _.._...
Bldg. Square Footage _ °/U
Open Space Footage(Lot area minus bldg&paved --
oarlang)
if of Parking Spaces ---
Fill:
(volume&Location) —-
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES _0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW C) YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:Y M x
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:
E. Will the construction activity disturb(clearing,grading, ex avation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Ncrthampton Storm VVatef Management-Pei it from the DPW is required.
Department use only
City of Northampton Status of Permit.- -(--_-
Building Department Sev�a
212 Main Street
Room 100 We`iie le Avaiiab lity,,.-
I Northampton, Mr. 01060 'af S ra l iwis-40
phone 413-587-1240 Fax 413-587-1272 Plot/Slans
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMO�JSH A C E(�O' R TWO FAiiL*-HWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
lv; . 'i I Map Lot Unit
Zone' Overlay District
Elrn St District CB District
SECTION 2-PROPERTY OWNERSHIP/A UTHORIZED AGENT
2.1 Owner of Record:
( � i
Name(Print) Current Mailing Address:
- ' Telephone
Signature `T
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 aoolicant
1. Building I (a)8ui1dng<Permit'Fee-
2. Electrical (b) Estimated Total-Cost of
Construction from(6')
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=fl +2+3+4+5) jdoD I Check Number 3
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Date
Building,Cosmissioner/lnspi c�_o ui mgs
File#BP-2009-0020
APPLICANT/CONTACT PERSON CHEEK RICHARD&ANGELA
ADDRESS/PHONE 15 CRESTVIEW DR FLORENCE (413)341-3877 Q
PROPERTY LOCATION 15 CRESTVIEW DR
MAP 29 PARCEL 466 001 ZONE URA/WSP
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: INSTALL ABOVE GROUND POOL
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
IlY 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 Street Commission Pernut DPW Storm Water Management
Demolition Delay
a�
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.
O
15 CRESTVIEW DR BP-2009-0020
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-466 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-2009-0020
Project# JS-2009-000026
Est. Cost: $5000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sg. ft.): 10018.80 Owner: CHEEK RICHARD&ANGELA
Zoning:URA/WSP Applicant: CHEEK RICHARD & ANGELA
AT. 15 CRESTVIEW DR
Applicant Address: Phone: Insurance:
15 CRESTVIEW DR (413) 341-3877 O
FLORENCEMA01062 ISSUED ON.711112008 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 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 Signature:
FeeType• Date Paid: Amount:
Building 7/11/2008 0:00:00 $25.00392
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo