32C-202 (7) A"K 1111111111114
File No.052303-6.915 Pape#7
SKETCH File No. 052303-6.915
Borrower/Client Kirsten Ubczynski
Address 85 Williams Street
City Northampton County Hampshire State MA— Zip Code 01060
Lender/Client Applied Mortgage Services
th
Bedroom Bedroom
Bedroom Bedroom
34.0'
Bath Kitchen
Den
Living Room Dining Room
34.0'
Sketch by Apex IV Windom TM
Comments:
AREA CALCULATIONS SUMMARY LIVING_AREA BREAKDOWN
Code Description Size Totals Breakdown Subtotals
GLAl First Floor 748.00 748.00 First Floor
GLA2 Second Floor 748.00 748.00 22.0 x 34.0 748.00
Second Floor
22.0 x 34.0 748.00
TOTAL LIVABLE (rounded) 1496 2 Areas Total (rounded) 1496
Designed by United Systems Software Company (800)969-8727
MORTGAGE LOAN INSPECTION
THIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY
46'± 'f
W/F
GARAGE GRAVEL
DRIVE
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2 STORY CL'
BRICK PORCH Q
HOUSE
50't
WILLIAMS STREET
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 SUN TRUST MORTGAGE AND THE CHICAGO 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.
tN OF
I further report that the premises shown on this plan is not located within a Flood Hazard Area as shown on
Department of H.U.D. Federal Insurance Administration Weps, O PAUL
All A.
Community Number 250167 0002 A , u LUBM
Identification Date APRIL 3, 1978 NCL 2111W
P.LS.
iR11Q
HUNTLEY OWNER ��w� �` W. SYDNEY STERN
HUNTLEY ASSOCIATES, P. C. LOCATION 85 WILLIAMS STREET
Surveyors * Engineers • Landscape Architects NORTHAMPTON, MASSACHUSETTS
30 Industrial Drive East
Northampton„ K4 01060 JOB N0. DATE SCALE
voice (419)584-9'444 fans (413)586-9159 03-535 6/16/2003 "= 20'
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., DEPARTMENT OF BUILDING INSPECTIONS I?
212 Main Street • Municipal Building
INSPECTOR Northampton, MA 01060
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as 1-.is/her construction sups; ,, 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
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 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, _ _ _understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
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1)@P/UtTME•N7 OP BUILDD)G INSPECTIONS
212 Mnin Street ' Municip&I Building
Northampton, A'Inss. 010GO
WORKER'S CONITENSATXON INSURANCE i.FFMAVIT
,v th a principal place of business/r�!:;idence t
rSLT"C°U�7i;i;i ICJ%!p) —
do hereby celiuy, un<l r the pr:;ns ;;nd pen,flies 01 perjury, tha::
O I am an employer providin- the follov";ns coinpcnsation covcra�,c `or Iny
eiuplovices wot-l.Ilg on t,I jab: v
Namur) --- (Expir:adon Data)
(Y I am a sole prop 7etor yjen°rai c:�ia c p; ;r noIlico.�ne: Ic' cic one i and
the contractors lister be:ov,,
folio :ra �yorners compensa ion ��oilc�es:
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(I�Jamc of Contractor) (Insarsmcti Dat'c)
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SCTON; CONSTRUCTfON;SERVICES j
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Rlht��QL3 T ��� L S o �}
c u License Number
3`t CeLj"-/<,�- I °l }AN.wn¢ ✓ t 1. C�yn�a✓,
Address Expiration Date
lmA,� i1,- kcia 442
Signature Telephone
Reg"s :e. xn. mp some en1 ontracto P Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
GT1ONWOKERS' COMPENSATION INSURANCE AFFIDAVIT(M G:L: c. 15"2, § 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 acecptable 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
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SEGTI.O. - - S R T€lONAF PR�UP0SED YVGRK c ecka I ka le
New House ❑ Addition ❑ Replacement Windows Alterations) L� Roofing ❑
/ Or Doors Or'
Accessory Bldg. ❑ Demolition2r New Signs [ ] Decks [✓✓f Siding[ ] Other [ ]
�AI•Th
Brief Description of Proposed Work:7c�.� 4 �`u�`^'�'i`', 71t w E x�� w uL��w� k+���c�.�:� s }, I sti�f,y h ��
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement No ✓No
Plans Attached Roll 0 • Sheet 0
Ira..' -70 :o r a diiti;onito ex stingAouscng comae e- lie of own
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 Nc
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
S�C ( %E, �IKtRAC-,M ATION; TO BE COMPLETRAPPLIES FOR BUILDING°PERMIT
' ` as Owner of the subject property
hereby authorize �-�t� �. Wk�C� Jam-, to ac; or
m tSeh in all at r r native�to w ork authorized by this building permit application.
f
Ow or Date
l 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.
4
Signed under the pains and penalties of perjury.
Print ame. n
l r
zz! A141t�t A'6
i at re of nerd/Agent U Date
Section 4.
ALL INFORMATION MUST BE COWLETED, 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 3 a'S ,
Frontage �D
Setbacks Front S t
Side L: T R:_ L: R:
Rear Z�
Building Height t
Bldg. Square Footage .�
Open Space Footage %
(Lot area minus bldg&paved -4-0
parking)'l
#of Parking Spaces
Fill:
volume&Location) PLA
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 the 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:
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413.587-1240 Fax 413-587.1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.-J ' 0 R ec 'o o,h oni e` y fific` P �:
1.1 Property Address:
EImSt District" CB �str ct = �
SECTION 2 - PROPERTY?OWNERSHIP,/AUTHORIZED AGENT
2.1 Owner of Record:
d C I'D-co 4 qloc7y-s�i.
Eir7,wtl.. H. Hc.�vincke `142 . wy,. Sf-, K\jt ciy,,,Jy , 10 �sl�E�c
Name rin_ t) �tw�v n Current Mailing Address:
Telephone
Signatibrej
2.2 Authorized Agent:
'T- rN�4�, :1 ✓ . _ �c�Sf4c.w,�-�J�, . �/ytc. . G � o� �
Name(Print) Current Mailing Address:
61.1 Signature Telephone
SEMON.3 ESTIMATED'COIJSTRUCTION'COST
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ` (a) Building Permit Fee
`[ L p
2. Electrical (b) sti mated 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 Onl
Building Permit"Number: z��(` ?y Date Issued
'_gna t ure: C
Building Cotnmissionerllnspector of Buildings, D to