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06119/1008 13r:X24 0. 14136655501 NASH HEARTH LEISURE PAGE 01
�a Descriptor/Area
A:2Fr/B -
' ' 1 000 sgft
B:FDH
f r 40 sgft
G .-_..._v_ 1' - G:FRAY
Wood Deck B sgft
I 144 D:FG
j—_C 1 480 sgft
40 20 E:1 Fr
14 sgFt
F: 1 Fr
25 2Fr/B �--�—y F F'6 10 sgft
1
0 0 480 G- Woad Deck
144 sgft
1 r<-
\S Q?
i
i
6
1
W of
tJ
Quick Open Space Calculations Coverages
existing 1000
Lot area existing proposed existing 480
13735 2848 2848 existing 1200
existing 168
Open Space 10887 10887 existing
total 2848
Open % 79.3% 79.3%
new
new
new
total 2848
to % 4
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. 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 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
h ♦ ` t M ••
1 he Coins. ,weaiz of hfassaenctsci s
_ . �e7artntent o"`7 zatcstrial.zccidents
O,�ce of Investigations
606 TT ash ington Street
Boston, 31A 02111
ww>-ti'.rn ass.go v1di a
Workers' Compensation Insurance -Affidai-it: Builders/ContractorslElectricians/Plumbers
oWicant Information Please Print Legibly
Nanle (D Lis iness/Organizanon/Individual): } _
AdG''rtss: /v
City/State/Zip: Phone,'T:'
Are you an employer' Check the appropriate box: Type of project(required):
i.
[]'I am a employer with 4• ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g_ ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
[No workers' comp. insurance comp.insurance.-
required.] 5. ❑ We are a corporation and its 10.7 Electrical repairs or additions
3."[ ,I am a homeowner doing all work officers have exercised their 1 LE] Plumbing repairs or additions
myself. [N o workers' comp. tight of exemption per MGL 1-).7 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
N
employees. [ o workers' 13.71 O her
comp. insurance required.]
Any applicant that checks box#i must also fill out the section below showing their workers'compensation.policy information.
Homeowners who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new affidavit indicating such.
}Contractors that check this box must attached an additiona'.sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have e=loyees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
inform ation.
Insurance Company Name: —
Policy f or Self-ins. Lic.r: Expiration Date:
Job Site Address: Cirv/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and'or one-year imprisonrnent, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250 .00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certift%under the pains and penalries of perjury that the information provided above is true and correct.
S-artature ; ----�- Date:
Phone Li N 5 �I— e) �33
J,�ficial use only. Do not write in this area, to be completed by city or town offtciaL
Citv or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. Cir,,/7own CIerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
j Contact Person: Phone T:
SECTION 8 -CONSTRUCTION SERVICE-S
8.1 Licensed Construction Suoeniisor: Not Appiicable
Name of License Holder:
License Number
F�.ddress Expiration Date
Signature Telephone
9.Registered Home improvement Contractor-,, Not Applicable ❑
Comoanv Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 452,§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.
Sianed Affidavit Attached Yes....... ❑ No...... ❑
11. Noire 1,Ownergemptiari
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 en.-a2e 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 be
responsible for all such work performed under the building permit.
As actin°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 co phance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State+ f Mas husetts General Laws Annotated.
Homeowner Signature "'
r V r �4
I
i
SECTION S-DESCRIPTION OF PROPOSED WORK lcheci;a!!armlicabie?
New House F i Addition Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. !_ Demolition ❑ New Signs [01 Decks Siding[C1 Other[p]
Brief Description of Proposed 1 ,( C
Work: 1.421�,Tlvtt C �r� �i�j oLit JN�C-J
r �►- -Ae
Alteration of existing bedroom Yes No Adding new bedroom Yes r No `
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a..If New house and or addition to existing housing; complete the fo[lowina:
a. Use of building : One Family Two Family Other
b. Number of rooms in each ,`amity unit: �� Number of Bathrooms Z
c. Is there a garage attached?
d. Proposed Square footage of new construction. f Y T Dimensions
x
e. Number of stones?
f. Method of heating? !`',!(; " r✓' ' 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 100 yr. floodpiain 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 L '_
SECTION 7a<-OWNER AUTHORIZATION-70 BE COMPLETEDF.WHEN
OWNERS AGENT OR CONTRACTOR 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
� y�S 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-paa.ufy.
Pnnt Name
Sicnature of Owner/Agent JQ1e G• Lr
Section 4. ZONING ALL Information Must Be Completed. Permit Can Be Denied Due To incomplete Information
ExiszirI2 Proposed Required by Zoning
This coiumn to be filled in by
Building Department
Lot Size
pFronta_e acc
ks Front
t
Side L:
Rear
8 ui iding Height
J, -----
Bldg Square Footage X361 %
Open Space Footage %
(Lot area minus bldg&paved
oarkime)
of Parking Spaces
Fill:
Ai
(volurne&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON7 KNOW 0 YES 0
IF YES, date issued:,
IF YES: Was the permit recorded at the Registry of Deeds?
r 7 0
NO 0 DONT KNOW YES
IF YES: enter Book Page and/or Document
B. Does the site contain a brook, body of water or wetlands? NQ,,� DON7 KNOW 0 YES
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 an'!y 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
IF YES, describe size, type and location
E. Will the construction activity disturb(clearing,grading,excavation, or filling)over I acre or is it part of a common plan
f '*�r"
that will disturb over I acre? YES NO _'
eKI)
0
IF YES,then a Northampton Storm M_feR Management Permit from the DPW is required.
Department use only
City of Norhampton Status'ofl?ermit.
l Curb Cut(Driveway Permit
212 Main Si eel Sewer/Sen6cAvailabilit t'
j Room 100 Watk/WellAvailabilrty �
Northampton, MA. 01060 Two sets of Structural PIa �
phone 413-587-1240 Fax 413-587-1272 Plot(Site Plans
Other Specify;
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TVI O FA;SQLLY-DDWE
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
lc I_ [-, Map Lot Unit
Zone Overlay District
Elrri 5t District C8 District
SECTION 2-PROPER T Y OWNERS HIPIAUTHORIZED AGENT
2.1 Owner of Record:
--
Name(Print) )� ^ Current Mailing Address: C�
T3
Telephone T
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item I Estimated Cost(Dollars)to be Official Use Only
completed by permit aoolicant
1. Building (a)Building-'Pemnit Fee
r CY15
2. Electrical (b) Estimated Total Cost of I
Construction from(6)
3. Plumbing Building Permit Fee io/s
4. Mechanical(HVAC) 0 n�Y CT)
5 Fire Protection I
6. Total= (1 +2+3+4+5) ( Check Number
This Section For Official Use Only
Date-
Building Permit Number: Issued:
Signature:
Building Gemmiss�oner/lnspe�tor of w pings — Date
a
File#BP-2008-1137
APPLICANT/CONTACT PERSON NASH PHILLIP A&MARGARET J
ADDRESS/PHONE 31 GOLDEN DR FLORENCE (413)539-0433 Q
PROPERTY LOCATION 31 GOLDEN DR
MAP 29 PARCEL 421 001 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: ENCLOSE DECK TO SUNROOM
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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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 Commission Permit DPW Storm Water Management
Demolition Delay
Signature of Building Official D
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 grantin authorities.
*Variances are granted only to those applicants who me t the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
i
� � .'; B P-2008-1137
GIS#: COMMONWEALTH OF MASSACHUSETTS
- '�16 .RI k:29_-42I CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-1137
Project# JS-2008-001671
Est. Cost: $3000.00
Fee: $84.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 13721.40 Owner: NASH PHILLIP A&MARGARET J
Zonin :URA Applicant: NASH PHILLIP A & MARGARET J
AT. 31 GOLDEN DR
Applicant Address: Phone: Insurance:
31 GOLDEN DR (413) 539-0433
FLORENCEMA01062 ISSUED ON.613012008 0:00:00
TO PERFORM THE FOLLOWING WORK.-ENCLOSE DECK TO SUNROOM
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 6/30/2008 0:00:00 $84.005091
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo