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29-490 (2) 'goal thampton Appraisal Associates File No.110802-6.453 Page#5 SKETCH File No. 110802-6.453 Borrower101ient 1lmoteo&Lydia Soto Address 461 g fan Road City Northampton County _Hampshire State MA Zip Code 01062 Lender/Client -Eastiampton$dv_ings Bank______________ P3 i I i i i I O I 42.0' i 11 I l SkWdh ey Apax N WhOOwa'• /� 'ter Comments: ` V i s • � � �. `; i i I A f� I I i I i i i i r " � R c� Gr/a G6n� i j A,� ��� w��� %"���`won iw ������• i lo /-'Zw Roo A$e f "�rS •✓ � trv� G�c��it � %1�'� ill 6Ae- 7ele o o`i' --U� � DEPT4 TMFNT GF EUILD_7�G L--4-SP---=O-,VS I??Main Strew 0 Muziic:ipal Buildin_ NSF--T C Nortbampton, MA 01060 -- TTl1TXT' lMW,L''D sr'WN(1W '. T. 'lli'F.t1✓tF.NT TThe�S­tate f Mass achuse�s allows the homeowner the right under 780CMR 108.3.4 to his'her construction sup°: - Sor. The stare defines "Homeowner" as, '—.Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family welling, 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 Lie 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 bacMiiil). sonotube holes (before pour). a rough building inspection (before work is can-sealed). insulation_inspection (if required)and_a final_buildup-i=ecti.on. 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 untR the-work can-be inspected- If the homeowner hires other trades to perform work(electrical, plumbing&gas) the homeowner will I 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, Al understand the above- (HonO owner/residen s signatu.e requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Address of work location G �/ .^ , ' The Commonwealzh of���assachusetrs _—�-- Department 0f1ndz1stria.I.4ccidents ©j Ice of Investig a.;ions — i 600 f'ash ink on Street Boston,_IL I 0 111 www.mass.gov/dia Workers' Compensation Insurance a�fidayit: Builders"Contractors(Electricians/Plumbers ADDlicant Information Please Print Lesibly 'a=e(Buzness/Organization/Individual): Address: City/State/Zip: Phone Are_you an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.ED I am a employer with � 6. ❑New construction employees (full and/or part-time)-* have hired the sub--contractors i ,_ listed on the am:c4ed sheet. + 7- ❑Remodeling 2. I am a sore proprietor or partner- Ishi and.have no e=lo;ees These sub-contractors have g- (�Demolition working employees and have worke s` I for me m any capacity. - - 9. �]Building addition !Tio workers' - comp.in i ance.* L- o .m;.-ice required.] 5• ❑ 'We are a corporation and its 10-❑Electrical repairs or additions a homeowner doing all officers have exercised they I L Plumbing repairs or additions yself o workers'ca right of exemption per MGL [!`� mp. 12..❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No worlcers' 13.7 � comp.insurance required_] "----"}t�21v aF1pl1CdI7 w7 k'S DOb it ISDSSL a•SO II out me secnon oe•ow snowing - e>r woric^:s'compensation policy mfortnanon. - Iotneawners who submit this afndavit indicating they are doing all worit and then hire outside contractors mnst submit a new amdavit indicating such. ^Contractors that check this box munatrached an additional sheet showin-e the natne of the sub-contta=rs and sate whether ornot those eatities have employees. If the sub-conaactors have e npioye s,they must provide their work='con3p.policy nUtnbM Iam 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.r: Expiration Date: Job Site Address: City/State/Zip: Attach a coov of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to se-c ire coverage.as required under Section 25A of IvIGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1-500.00 and/or one-year imprisonment as weE as ci vil penalties in die form of a STOP WORK ORDER and a 5—nne 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 In vesti_ations of the DLA for insurance coverage verification. I o here cerdfy under the pains and enalties of perjury th the 'f anon provided above is true and correct 4i ig 3fII7e ---- ---- Date: v Phone=: vl xuu use omy_ i s not x>rue in this arch, tb be completed Lv cuy ur fawn official City or Town: ____------- __-- _ __ Permit/License" Issuing Authority(circle one): 1.Board of Health 2.Building Department 5.City/Town Clerk 4.Electrical Inspector 5.PIumbing 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 I 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-vear 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 he 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 Iiable 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, St at and Local Zoning Laws and Tate f Massachusetts Genera Laws A otated. Homeowner Signature V SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alterations) Roofing Or Doors 9 Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [[] Siding PO] Other[01 Brief Description of Proposed Work ©�G Alteration of existing bedr m Yes_ No Adding new bedroom Yes _ No 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? J- d— Q 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 glad i. Is construction within 100 ft. of wetlands? Yes --A—No. Is construction within 100 yr. floodplain Yes No I. Depth of basement or cellar floor below finished grade `" 6 k. Will building conform to the Building and Zoning regulations? k Yes No . I. Septic Tank City Sewer x Private well City water Supply ^ 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 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 t O Signatu of Owner/Agent Date Section 4. ZONING AU 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 Side L:LV-,f R: 12! L:SAM R: f4t*0- Rear /. s Building Height Bldg. Square Footage z� Y 1 . / . Open Space Footage // /.. % (Lot area minus bldg&paved parkin ) #of Parking Spaces Fill: _ - (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: 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. WlI the constriictinn activity disturb(clearing,grading, excavation, 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 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 2�312 Main Street Sewer/Septic Availability, Rogm 1 0 Water/Well Availability ` Northampton, MA 01060 Two Sets of Structural Plans phone 413'-50r9-Z49-5'ax 413-587-1272 Plot/Site Plans Other Specify APPQICATJDN TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 PrODertv Address: This section to be completed by office ( �� Map Lot Unit rDA'd!/"'-- Zone Overlay District ©6� Eim St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Na (Print) Current Mailin Address:s-ry it Telephone ignatu 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 ermit applicant 1. Building `J7 4�• ;1 (a)Building Permit Fee 2. Electrical '7 0 (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5 Fire Protection 6. Total= (1 +2+3+4+5) C.Z`7 . ed Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: ----- --in -- ---io-- --spec- Butlding Commissioner/Ihspecto�ofBui mgs —° Date File#BP-2008-1059 APPLICANT/CONTACT PERSON SOTO TIMOTEO&LYDIA E ADDRESS/PHONE 461 RYAN RD FLORENCE (413) 584-8986 Q PROPERTY LOCATION 461 RYAN RD MAP 29 PARCEL 490 001 ZONE URA/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid - Typeof Construction: ENCLOSE PORCH AREA ON EXISTING DECK New Construction Non Structural interior renovations Addition to Existing Accessoa Structure Buildiny,Plans Included• Owner/Statement or License 3 sets of Plans/Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,PMATION 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 Delay 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. .Y 3 } w yr. a r .c " c Y' ffi4 k F ME , r .i a�7 m t �az; `��."� .��.�§� ��� � R� �r- s zrc qtr„ t `a."`., �.-•R` -�� � t a, t�,,� a�;„ � - �, A. r{ ; owl4 N- x f , TOR K .r , s u . ,• C"antractv�^. License.. Homeowner as Cclntrac#©r fr 1 th+►ner; Sfl`I C3 T IMflTEC), 'i'DIA E 4 OT II �YE LYQ A E insmLance. AD 4W VY 4Z 5 4-$986 `�:FLORWCEMA01062 ISSII D f11?:S Bi'21 $t:trlaQ�aR11 ° W `TOLLOKNO WOR&ENCLOSE PORCH AREA ON EXISTING DECK f t toz nE ag D.P:W. Building Inspector ids rvlce. Meter: Vol$, . Footings: Rough: d1� House Foun4ation: vi ivgvay ftal: j hough Frame:67K 7-90.-a t,r I r &9 got Fire place/Chimney: H yy .. Insulations Final: / v SAN BE REV I I?IIY THE CITY OF NORTHAMPTON UPON VIOLATION OF t I`II"SI:ES Atli UG IflNS t R Signature: '+ Dati Paid• Amount 512812008 0:00:00 $50.003153 212 Maio Street,Phone(413)587-1240,Pax:(413)587-1272 Building Corruiussioner-Anthony Yatllo r, ;