29-429 (8) -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
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30 ,
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V,Ay o a 2ao� All
DEPT Of BUILDING INSPECTIONS
Nr,�Tuak`M'F.hA 01060
TO: PARKWEST BANK AND TRUST COMPANY
LAWYERS TITLE INSURANCE CORPORATION
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-
SURVEYOR: �• -L THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
MORTGAGE LOAN INSPECTION PLAT-
NORTHAMPTON, MASSACHUSETTS
RAN DALL PREPARED FOR
0 IZ. y KATHLEEN L. & WILLIAM J. GOLASKI
(35032 SCALE: 1 "=30 ' AUGUST 3 , 1998
s HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS
I f P;"
0
0
vI Of �0� ff2a111}�tott _ �_
Ela�aA ncrtla'
—
�, DEPARTMENT OP BUILOP\IG INSPECTlol S —
212 Main Strect ' Municipal Duild1*1)9
Northampton, Mass. 01060
`-YOR CEWS COMTENSA'MN MSURA-NCF AFMAVIT
I
(li ccuscrJpern>;tree) -
\t.rith a pii,-tcipaI plat:. of busincss/residefce ai.
(sQret/ci(y/stale/zi P)
do hereby cerrifj.-, under the pains and penalties of perjury, ?ha!
( } I `m an employer providing the follovvine worker's coil]ncnsL�jon eover22'e for my
elnplovccs wor�Qng on tills job
(lnsur_nc:� Corns .v)
O I am a sole proonctor, general contractor or homeowner (cl cie one) and have hired
the conuactors Listed below v,-ho h2ve the follOWUg worker's co ns2cion policies:
(11arilC G. Ca:,. nCi0 (II1n1r3111„ Ca1riDy"1}'/hGUL'(
(N2111e of COOtTacior) ( ls-irancc Comaav/Polic-t• Nu_mcrr) (Expu.00n Date)
(Name of Coaa-aclo,) (Insuranc: Comp2-oyfPoL-c� Number) (Expiruon Datc)
(Name of Contractor) Gas-umnc-- Company/Poticy Numb r) (Expiration Date)
(r.aic�vi;:ocil s'kc:if occ_-i..� to a�c!uci-infoccn,._'i oo�rcainins w.L
a sole propnetor and have no One worldog for me.
' aM a home owner performing all the work myself.
NOTE:plc lx as 1rc },,.u{Jc bCQ)c,µo on to cimPloy pcionr to w r-. .cx� c rr;'au%%ork oo t d—U—.-9 of
Cot EL-ore t!`n L`"x=?j in��'uid ibe 13-Mar11 1 rwd�or oa tbe g-a nh zppLctcn=tbcc'.n LT we G,=-all;+wc-d---cd to be
-'Ploy--unCc Lhc..0 1 r1z o�=Ilea Art(GL1 SZ,S)l(S)j ap Ut 6cro by a bomcoav fcr c lick u permit rr_yr&=—c tNc
Icgl vL--of nn cxployo-r under tt o Worko-,Comp—,L>oa Act_
I-Adam—d 6A a oo"of thi,ezYlemea:—y be fof-xnrded to tbu pepenmc i of lnd—aid A—d«LY Offioo of Ir:=ur.voa for the
covmsc rtriLatioo Acid t}Lt L•iltac to soauc bovcry6c tmdcr soclioa 25A of f.iQL 1 S2 na Iczd to tpx iioo of czimiatl pcneltia
00mir,ing of a fine of up to S I}00.00 andpor orup to ooc year L�d civil pemp'uc w Cx form of a Stop Work Order and a
fim of S 100.00 a d_y ag)tin:a me
1 FF,d,-v—,IT—�A u� only umber Lot
iEnacu _of L crrruttcc e
f
V. s
SECr�i(?IO>N �t�Ct10N"SE#t1/ICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Not A p p licable ❑
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 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,St and al Zoni aws St e o Massachusetts General Laws Annotated.
1 -
Homeowner Signature
t
SECTION S-DESCRIPTION OF PROPQSED WORK(check I� l applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: /
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes o
,Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet ❑
6aAf New holi s `-a fr atldi to ` 'W,16xfstlln `had'Mh"` corn' 1e 6Ahe fallowir "A:
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
CT. 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
I. 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 -OWNER AUTHORIZATION'-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
lr
1196KI as Owner of the subject property
hereby authorize /! to act on
my befo all tters relat' t k tho ze by this building permit application.
Signature of Owner Date
Pf
t I
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�7,r the pains and pe alties of erjur .
� lQ �� � r
0
Print>aMe r
JI
Signs ure of Owner/Agent 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 d SQr 0 ira
Frontage 11d, 7Z)
Setbacks Front /S'
Side L: R: L: R: 4
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved / O
parking)(Q
#of Parking Spaces
Fill:
volume&Location)
A. Has a'Spe/cial Permit/Variance/Finding ever been issued for/on the site?
NO v 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 V DON'T KNOW
YES I
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 e any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
I y o hampton
ildi apartment
n 1 i n Street
ROOM 100
DEPT OF BUILDING IN 1M6npto MA 01060
° Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
This Ott q,
to be completed by office
1.1 Property Address:
oz,
a
rYl fl
Zone Overlay D�strtct
EIm,St D�wlp�
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Na Pint) 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
completed by ermit applicant
1. Building co (a) Building Permit Fee
2. Electrical ��� (b)-Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) ll �
5. Fire Protection
! 6. Total = (1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: HV--- Date Issued:
Signature:
i Building;Commissioner/Inspector.of Buildings Date:
� Is�
File#BP-2001-0988
APPLICANT/CONTACT PERSON GOLASKI KATHLEEN L&WILLIAM J
ADDRESS/PHONE 68 GOLDEN DR (413)585-9503 Q
PROPERTY LOCATION 68 GOLDEN DR
MAP 29 PARCEL 429 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
jypeof Construction:_ERECT 10 X 12 SHED
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 LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § _w/ZONING BOARD OF APPEALS
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 Co ission Permit from CB Architecture Committee
4� d
Signature of Building O icial 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.
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68 GOLDEN DR BP-2001-0988
GIS#: ` COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-429 ,CITY'OI+ NORTHAMPTON
Lot:-001
Permit: Building
Category:she BUILDING PERMIT
Permit# BP-2001-0988
Project# JS-2001-1765
Est.Cost:$500.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
eonst.Class: Contractor: License:
Use Group:
Lot SiVW.11.1: 11412.72 OfflnAr: GOLASKi KATIiLEEN;L&WILLIAM 7
zoning:URA AWflcant:'GOL.ASIC!KCATHLUN L & WILLIAM J
AT. 68 GOLDEN DR
AnpdicantAddressr Phone: Insurance:
68 GOLDEN DR -(413)585-9543 Q
FLORENOEMA01062 . ISSUED 11N.-SlIZ41 f1�_00:00
TO PERFORM THE FOLLOWING WORK.6ERECT 10 X 12 SHED
POST THIS CARD SO IT IS VISIBLE FR ROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Finale
Rough Frame:
Gas Fire Deyartment Fireplace/Chimney:
i
Final: Smoke:
THIS PERMIT MAY BE REVOKED BY THE On OF NORTHAMPTON UPON VIOLATION F
ANY OF ITS RULES AND REGULATIONS
Certificate of Occu anc s nature:
Fee Tune: Receiat Nos Date Paid Check No: Amount:
Building 5/31/010:00:00 865 $25.00
212 Main Street,Phone(413)5. 7-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo