29-496 (8) ORTGAGE LOAN INSPECTION
THIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY
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MATTHEW DRIVE
THE PREMISES SHOWN ARE SUBJECT TO AND/OR TOGETHER WITH THE
BENEFITS OF ANY AND ALL EASEMENTS, RIGHTS, CONDITIONS, COVENANTS,
AGREEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD.
TO THE SOURCE ONE MORTGAGE SERVICES CORP. AND THE FIRST AMERICAN TITLE INSURANCE COMPANY — ONLY
To my knowledge, Information and belief, from information supplied to me, I hereby report that the premises have been examined and that
this inspection plat shows the improvement or improvements as located on the premises described, that the improvement or improvements
are entirely within lot lines, that there are no encroachments upon the premises described by the improvement or improvements of any
adjoining premises, and that there are no easements of record affecting the tract shown hereon, except as shown.
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I further report that the premises shown on thie plan is no. ioccled within a Flood Hazard Are.i as shown on
Department of H.U.D. Federal insurance Administration Maps, o� PAUL yb�
Community Number 250167 0001 A o R.
LUSSIER H
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Identification Data APRIL 3, 1978 No. �
P.L.S. �'�s�9fCISI'E��s�`
HUNTLEY OWNER JAMES F. BOYLE
& PATRICIA A. BOYLE
ALMER HUNTLEY, JR. & ASSOCIATES, INC. LOCATION 14-16 MATTHEW DRIVE
Surveyors • Engineers • Landscape Architects NORTHAMPTON, MASSACHUSETTS
30 Industrial Drive East
Northampton, MA 01060 JOB NO. DATE SCALE
voice(413)584-7444 fax(413)586-9159 99-566 3-25-1999 1 "= 20'
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B � �aSEAC}�ttECIIE
m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AFFIMAVFr
(Keens permittee) —
with a principal place of business/residence at:
(phone#)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration 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)
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(Name of Contractor) (Insurance Compairy/Policy Number) (Expiradon Date)
(Name of Contractor) (Insurance Company/PoUcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addit.oail sboct if ncccasiry to include information pertaining to all coaJado s)
O I am a sole proprietor and have no one working for me.
0 I am a home owner performing all the work myself.
NOTE:please lx aware that wfiilo homcowvcra who employ pazons to do m i„trn.n;oxlst-,c oa o-repair work on a dwct g of
not more than three units in vfuch the housoowvcr r=dc3 or oa the Rounds ap�utenarrt thce arc not gcocr2ny comidcrcd to be
employers under the woricrr'a coav}tz�on Act(GL152,s 1(5)),application by a horncow ncr for a bccwc or permit may evidmoe the
lofftl&tamer of an emPloya under tho Wor�s Compomation Ace.
I understand this a copy of this rtatemeTf may bo forwnnied to tbo Departmccd of Industrial Accidt.&Offioo of Insiva000 for tho
eovcmx vaification and that failure to seatre coverngv cruder section 25A of MGL 152 can lead to the imposition of criminal Penalties
oomisti of a fine of up to S1,300.00 and/or imprisoamutt of up to one year and civil penalties in the form of a stop Work Order and a `
fum of s 100.00 a day against M
For dcgartrixnTal uao only
Permit Number
Lot#
Signature of Licensee/Permittee Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
�Re reties mprbvmengntrac n _ ``M` 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...... ❑
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 al Zoni aws and State of Massachusetts General Laws Annotated.
Homeowner Signatur 1 '
SECTfON-5 DESCRIPTION}OF PROPOSED WORK(check�all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration's) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] / Decks Siding[ ] Other [ ]
Brief Description of Proposed Work: i4� Dezz To d;rx S
Alteration of existing bedroom Yes "� No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑- Sheet❑
6a If Nev�sho e° aridratldition.toezilsting--------housing,:complefethefollow.in :
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. Mascheck Energy Compliance form attached?
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 regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION"7a'=OWNEWAUTHORIZATION'--TO BE COMPLETED WHEN
OWNERS AGENT'OR;CON7RACTOR APPLIES FOR BUILDING PERMIT
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
ignature of Owner/AiKnt Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size f2
Frontage
Setbacks Front 0
Side L: R: L: 4 R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved V�D
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does t .> site contain a brook, body of water or wetlands? NO DON'T KNOW
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 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:
Northampton
Ef^91 E 1y� LSg T g Department ..
,- Main Street y5 r
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Boom 100 :VY
JU1N ` 5 LORgort 'pton, MA 01060 v ets
phone 413 87-1240 Fax 413.587-1272 Pio fS�te Pia
r___ AlSPLI TION TO CONS TRW ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be'�completedtby"Coffice
1.1 Property Address: �
�1v• -.c� ^A . v is 4-L Zone .1;10 Overlay District
Elm St. District: CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
� ulyt I
Name(P>Ko Current Mailing Address:
Telephone
Signature
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
compl eted by ermit applicant
1. Building �/ 1577o, (a) Building 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 =(1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: 6 Date Issued:
Signature:
i Building Commissioner/Inspector of Buildings,, Date
File#BP-2002-1074
APPLICANT/CONTACT PERSON DEXTRAZE TODD P&
ADDRESS/PHONE 14 MATTHEW DR (413) 582-6895 Q
PROPERTY LOCATION 14 MATTHEW DR
MAP 29 PARCEL 505 001 ZONE URA
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: CONSTRUCT 16 X 14 DECK _
New Construction
Non Structural interior renovations
Addition to Existin¢
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
INFgRMATION 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 Commis
66 vd Signature of Building Officia 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.
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14 MATTHEW DR BP-2002-1074
GIs#: COMMONWEALTH OF MASSACHUSETTS
MaR:Block: 29-505 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2002-1074
Project# JS-2002-1718
Est.Cost: $1500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor_
Lot Size(sa. ft.): 10018.80 Owner: DEXTRAZE TODD P&
Zoning:URA Applicant: DEXTRAZE TODD P &
WATT.-,'.E'.r QP
Applicant Address: Phone: Insurance:
14 MATTHEW DR __ _(41' 5 2-6$95_0
FLORENCEMA01062 ISSUED ON:617102 0:00:00
TO PERFORM THE FOLLOWING WORK CONSTRUCT 16 X 14 DECK
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:t7/C t(—oZ0-4o,Z
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL ION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy si nature:
Fee Type: Receipt No Date Paid: _ Check No: Amount:
Building 6/7/02 0:00:00 1509 $50.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo