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29-381 (2) t MORTGAGE LOAN INSPECTION LWW 10E OVE B" 3160 PAGE 225 PLAN BOOK 77 PACE W X ! NIF K� i 12•.i i BwO cove Z•p. Fremont Investment and Loan First American Title Ins. o. AND: i Til I C � � Cindy L. Ashton I Eby repmt tW*a prmim dmm an this pun an LOCATION: 17 Brookwood Drive mlooaftdwkhln&PioodffxmdA=udmmostU Northampton, Massachusetts Federal Eewgawy M6mgem Agapays Flood bmmnco Rate Map, Co N6. 250167 - 0001A E. B. HOLMBERG &Associates Bffaw"Date A" 1 3, 1978 LAND SURVEYORS '` t .,� �v' y'' P, 4` "�, � ( z_. L? __�� �' I , ; \ /. �� a� 07/02/2005 05: 29 12076218029 MIKE ROLLINS PAGE 03103 cu a. ov YA C10 7c 2� kA. �2 I L 7Z C\ 5 7n Tr CO/ZO 3DVd SNI710d 3AIN 6Z08 TZ9LOZT 6Z:90 SOOZ/Z@/LO M/02/2005 05:29 12076218029 MIKE ROLLINS PAGE 01103 of yy �A -n: o LA .I!;- J CA -.,c vt Lp- LA g.CKgyP�, , Lxty of 'Nort4aillptan L F Q x « yutaesaci+useiie I , DEPARTMENT OF BUILDING INSPECTIONS / INSPECTOR 212 Main Street • Municipal Building North=pton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act aS llis/her construction sup(::,' .,or. 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 JI, understand the above. (Home`o ner/resident's signature requesting exemption) I will call t schedule all required building inspections necessary for the building permit issued to me. Date Address of work location / 7 f',;1e-p t)c)oc� �G . r } ,w r pr A ti C> iii of ATCrillaillp toll g E ��asaachnr.cIIs —' o DEPARTMEbT OP BUILDr>tC INSPECT70?dS 212 Train Strcct Municipal Building Norl.hampton, Mass. 01000 i. WOMCER'S CON'[PENSATTON G SUR CE AIF)r1V11" l' I, (IiccnsxJ{xm>;ticc) %Irlth a pri cipal place of business/residence at: — (phone:') (st=UCi ty/a=/zj p) 1` do hereby certify, under die.pa_ins and penalties ofPcqury., ILIt ( ) I am an employer providing the follo%ving worker's compensa�o, coverage for Iny employees lvor.Ung on ties job: (Iasu an=Coar, m,) (Policy Numocr) -- (r piruor, D21`) ( ) I am a sole proprietor, general contractor or homeowner (circ:e o:Re) and Live hired the contractors liste-d below who have the foUo�ving workers comoeru2tion pe!icies: r (iiamc of Co:=ctof) (Insurance Coinoa,-1}.Pi ouct ` ) (` Datc ' �tln't�C Yx�tidC3^� ) I (Name of Coomczor) (Insuaoc: Companyi?o!.ic; \tum^r) Dale) i (Name o(Conrraao;) (La7ua.nc Company/Pouq- Numbs) (Exp'Lmdoa Datc) (Name of Contraaar) Gasurmcc Comcauy/Poucy I Iumb r) 'E D' Date). (an' addi":ocar 6cct,ifnccaar}-to crcudc inforat,.:joc perta.iai.ng to,11 { ) I am a sole proprietor and have no one wori;ing for me. I am.a home owner perfortniag all the work myself. NOTE:plea be eauc L*r v{ ]c 6emco.�acn�bo cmpfoY P-zags w da cc.–.: ,,Q a fair work on a d.. [1",of ant taco then 'thrt =rJ in u'sica ebc bomoowner r=64=cc oa the p-ounc:b zppurtcn r theao cc,;ooe�cclty oeez dcrod to be `Plc)e ttndc the o=p - m Ace(GL152s I(S)3 =Pplinbon by a homwaver fcr:lie:_or perms t=y ride=the Icgst at,,,.of ea ertloy.r coder duo Wackoe,Coozpem.tion Act i t+odcrzaad tba a copy of tbi,c==­=o y bo faces nrtied to Lb.pry.,tmmt of 1nds.rid Aoad=&Oaio.of lnz,�for tb. covcrasc vcirolioa=W th1 L ileac to sawz eoverase &T soetion 25A of),(GL 131 can ic.d to the impasitioa of eimiosl peailrio comisitzg of a G x of tP to S 1 S00-o0 andfor impruoam,--,n oCup to ooc y� end cj a pca,haa in the room or a Stop Wort;Order and a III=of S 100.00 a day apiaA me «sly pC'frIIlf l`I ILII]tX7 . SiQ,, of Li crmiucc e d r SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Appiicabie ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9 Reaistered'ltome Iiiarovement Goiatractor-° ray Not Applicable .❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152, 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 faun 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 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,Stat d Local Zoni La and State of Massachusetts General Laws Annotated. JHomeowner Signatur SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement W'dows. Alteration(s) 2 Roofing a Or Doors IYl Accessory Bldg. ❑ Demolition © New Signs [i3] Decks [p Siding(02T Other[O] rief D�scr' tion of Proposed Work: K¢. ca�u P W li Q Q (I C�[� t,�i p(�n v.�S QA8 S IA P� r)a C Alteration of existing bedroom Yes V- No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll -Sheet No rto e sceJsafw is ar odio i i oriut : 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 i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 10O 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 Ta-.OWNERAUT.HORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR GONTRAGTOR:piPPt1ES'FO 6UILD1NGPERMIT 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 -�Qce�l p as Owner/Authorized Agent hereby de tare 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. b Print me Lo Sig ature of Owner/ gent 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 ` TT Side L: R: L:' R Rear �^ Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved F— azkin j #of Parking Spaces — - Fill: } volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T 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 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 Q Obtained 0 Date Issued: s C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO I0 IF YES, describe size, type and location: E. Will the construction 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 0 NO l IF YES,then a Northampton Storm Water Management Permit from the DPW is required. se"' City-of Northampton Statas o * � �� `,BllIliding Department u v� tlDmre Per> i i Main Street sveretrA IRoom 100 e e(CAa A i z J'�Northffipton, MA 01060 - phone 413-687-140 Fax 413-587-1272 - APPLICATION-TO-CONST CT,�LTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION 1.1 Property Address: This sectidti tube tompr6ted bycof Jce Zone $ ' OveriayrDistnct (_r r L- o6 Ro 1� � Elim Sf Distrrct ... ;'"'f.C�Disftrct ,,.: SECTION2-PROPERTY OWNERSHIP/AUTHORIZED-AGENT 2.1 Owner of Record: 1 <_40-4...1 Nam Print) T C ent M cling Ad res �- 3� `�1,/ Telephone S' nature 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 com feted by ermit applicant 1. Building (a)Building Permit Fee X00 . D 2. Electrical (b)'Estimated Total Cost of 0 Construction from 6 3. Plumbing Buildingi Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) S '50 0 . 0 U Check Number This Section For Official Use Only - ._. Building Permit Number. Date Signature: Building Commissioner/Inspector of Buildings Date r F` • File#BP-2006-1276 APPLICANT/CONTACT PERSON NOBLE STACEY&KAREN ADDRESS/PHONE 17 BROOKWOOD DR FLORENCE (413)584-8141 Q PROPERTY LOCATION 17 BROOKWOOD DR MAP 29 PARCEL 381 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Typeof Construction: RE-FRAME WALL ON EXISTING ENCLOSED PORCH/ADD WINDOWS&ADD SLIDER 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 INF9AMATION PRESENTED: _IZApproved 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 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-2006-1276 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2006-1276 Project# JS-2006-1877 Est. Cost: $5500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sa. ft.): 15158.88 Owner: NOBLE STACEY&KAREN Zoning:URA Applicant: NOBLE STACEY & KAREN AT: 17 BROOKWOOD DR Applicant Address: Phone: Insurance: 17 BROOKWOOD DR (413) 584-8141 O FLORENCEMA01062 ISSUED ON:512512006 0:00:00 TO PERFORM THE FOLLOWING WORK.-RE-FRAME WALL ON EXISTING ENCLOSED PORCH/ADD WINDOWS & ADD SLIDER 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 5/25/2006 0:00:00 $50.001802 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo