Loading...
29-117 (2) BUILDING PERMIT PLAN S 05'19'30" W 80.38' S 05'19'30" W 119.09' shed z 4 BOOK 6579, PAG 74 ca PLAN BOOK 56, PA E 24 z `D `I -�D - �0 2 - a2rv3st t ! 0 R=40 • L--27 VL 02�� NY 34.31' �h 00 R�s�s 0)N 00'16'10 W 0 FOREST GLEN DRIVE N 00'16'10 W 35.89' L=27 R=50 .00' R=40.•0 L=96 . 5 PLAN OF LAND IN NORTHAMPTON , M ASSACH U SETTS PREPARED FOR t� °F 'ass ROBERT AND LINDA JACQUE RAND ALL SCALE: 1"=40' MAY 7, 2008 E. HAROLD L. EATON AND ASSOCIATES, INC. IZER N REGISTERED PROFESSIONAL LAND SURVEYORS 935032 ' 235 RUSSELL STREET — HADLEY — MASSACHUSETTS RV � 413-584-7599 4i3-585-5978 "fax) _ o, email q-o, hleaton@aol.com 120' m} r: i' +,} i s r,S-�:.:i,. r}r,io ,�,} 8!' t.'!�. .:? .� i�} ,. � �=c..l ?1'"."I '1".t °''I"F`}' (' I r`(�� � s�.If,I:I` 1. I .} f >! R — i ' , '• '-fit__ • •. LIN jgt k � r i10 zv e 9699Z#JGPJOGH _w rw 4 °'1. .!wr�•.n�... ��#, .: 3 h _ _ 9699Z#Japroaa From the workshop cat: bt ; yCt,�I ing. m 5t?5- Ba' s Reorder#25695: 26' It —20 —18= t, X —16 r C —t5 _. . .. -14 _..13 it cril 4 04 �I1 t - =s _".7 X ,? -4: _3 LhId I'd hl,I'Ll Jd,l Ili tAO bbld 41 A j4J.1,14i11 k,litJAA.E,���.l+M�ka,L1,�,ITV,u�.i,l,i,�,i�lxi,�u,l,o�,€�,�, 0.,3$mfs from.the workshop aw PUi� r - 8 Reorder#25695 `2a X —13 Xt qj .�,. � CA 34 -8 ZO Zb, ` - .� <" sc , ,-3 ,PAS f3 A' _ :. . ._.. .... : : .. -2 -E - -y ju�f�€� t,1� ,��tJ�tx�,t�k�I,j,i,i�i��,t,ldil�i,Iti���i�lau�i�l,t�7�tC�F��t:].a,E, �11i�►elt{�ts1,t�,�,,t.1,t�a�r1 6A1, f,l rkro+tll,t.f�i��,trlr,te.kt,! �L�#, +,k,1r a�l.l,��1�fA1�l�.�ia� �i<I�G,xE�d�t.�.r,l tit�l�la,��trlt fi 32nds - I - IoOW I J II I Tt �z/1.'f}�•� � �J _ ' ELK i H_1��� _ Gn ; 21 (( - _ i P 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 . � t -* The Commonwealth of Massachusetts x Department oflttdustrial.4ecidents -- Office of Investigations ' 600 fd7ash.ing ton Street Boston, MA 02111 _ - n,tti'w. nass.gov/dia Workers' Compensation Insurance Affidas-it: Builders/Contractors/Electricians,/Plumbers Applicant Information Please Print Lesibly Name (Business/Organizarion/Individual): Address: .Z f} U z_Cy_ City;/State/Zip: 1"o-ITtt 1 Lt., 616(,o Phone#: Are you an employer'Check the appropriate box: Type of project(required): I.❑ I am a em to er with 4. N I am a general contractor I employeesp(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 S. ❑Demolition working for me in an y capacity. employees and have workers' 5 P ty 9. RJ Building addition [No workers' comp. insurance comp. msurance.- required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ lam a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks box III must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,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 information. Insurance Company Name: Policy#or Self-ins.Lic. #: �f i�t•' (o L l '1 ("1 KVU Expiration Date: 10 iS o _ (_ ,�I Job Site Address: rt1/uZS 1 G(A? d'' ) - City/State/Zip:Aj`+tT n i��J./ t ®(vu() 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$L500.00 and/or one-year imprisonment, 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 tify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: I:— (2 Of use only. Do not write in this area, to be completed by city or town offciaL Citv or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone n: s � r SECTION 8-CONSTRUCTION SERVICES I 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: T t J ��'�l ��✓L- 4 G�� _ � License Number Address Expiration D to Signature ` Telephone 9.Registered Tome Improvement Contractor:-,. :.M _ Not Applicable ❑ lv3CtL I Company Name Registration Number 04L) ry"L ( R/L t7 '7 110t0`l Address J [ Expiration ate 71 L/✓�}L) L , jy /'L?W Telephone; �O u SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G L c.152,§r25C(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....... Ji No...... ❑ 11.-Home.Owner aempti on 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-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,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature t SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ® Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors F—I Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding[p] Other[0] Brief Description of Proposed Work: h o 0 6191 r! Alteration of existing bedroom Y_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ga. If New and or addition to existing housing; complete the fo[[owinA: 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 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--OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property - hereby authorize to act on my half, in all matters relative to worts authorized by this building 4eit application. re of w er 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 r� i Signature of Owner/Agent Date 3 Y Section 4. ZONING I Aii 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 9 Side L: R _t_�.�.,��_ L: R..n�'�.� ..w. Rear Building Height Bldg. Square Footage u Y t Open Space Footage __. (Lot area minus bldg&paved parkin ) #of Parking Spaces Fill: (volume&Location) ----- -A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:` IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT 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 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 any signs exist on the property? YES NO 0 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 0 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 pian that will disturb over 1 acre? YES 0 NO M IF YES,then a Northampton Storm Water Management Peimitfrom the DPW is required. Department use only City of Northampton Status of Permit:. Building Department Curb Cut(DrivewayPermit 212 Main Street Sewer/SepticAVailability Room 100 Water/Well Availability = Northampton, MA. 01060 Two Sets of Structtical Plans G M AY 1 3 �2 one X1,3-587-1240 Fax 413-587-1272 Pldt/sf6 Plans Other Specify APPLICAI�Or >rON T UCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING i SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address:G2 �a CL ��i� x✓� Map Lot Unit Zone Overlay District Ft 0 UL(?4-,'C, Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Ma vi LU x o 9—u�°- -Q l�1 T�v FIQ)0�jQ /Y1�01d�2 ;Name( ) Current Mailing ddress:Telephone gnature 2.2 Authorized Agent: . /A V t'1 -0k>L7L I +Ai;A CIL :Jr Te:���t Name(Pry ) Current Mailing Address: —q1(4- LZ a Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS-7 Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building C/Cj tl . /t�, (a)Building Permit Fee 2. Electrical tt / cam•' (b) Estimated Total Cost of 3306' 06 Construction from(6) 3. Plumbing uU Building Permit Fee 4. Mechanical(HVAC) C C` 5. Fire Protection 6. Total=(1 +2+3+4+5) EGG. CC; Check Number � t � This Section For Official Use.Onl -Date_ Building Permit Number. Issued: Signature: Building Commissioner/Inspectorof-Buildings Date File#BP-2008-1013 APPLICANT/CONTACT PERSON David Fortier ADDRESS/PHONE 32 Laurel St NORTHAMPTON (413)586-8965 PROPERTY LOCATION 88 FOREST GLEN DR MAP 29 PARCEL 117 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out C:4 oc 44 Fee Paid T_ypeof Construction: CONSTRUCT 22 X 14 MSTR BEDROOM/BATH ADDITION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 008026 3 sets of Plans/Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOYAATION 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 Co ssion Permit DPW Storm Water Management Demolition Delay 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. f me- " AT ins 1. A1 TAT Om all } T n. q i 3 T Y, r C ,l 4 9 _ s s. 3 4 y s 88 FOREST GLEN DR BP-2008-1013 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma :Block:29- 117 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: BUILDING PERMIT Permit# BP-2008-1013 Project# JS-2008-001516 Est. Cost: $49700.00 Fee: $154.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: David Fortier 008026 Lot Size(sq. ft.): 14157.00 Owner: LUCEY STEVEN E& Zoning: URA Applicant: David Fortier AT. 88 FOREST GLEN DR Applicant Address: Phone: Insurance: 32 Laurel St (413) 586-8965 NORTHAMPTON MAO 1060 ISSUED ON.512012008 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 22 X 14 MSTR BEDROOM/BATH ADDITION 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: O� Rough:�� _03�X Rough: /?�b7 House# Foundation: �°C/ Driveway Final: Final: �^-�� � ���;,�nal:�•a'b,(jg' Rough Framga*k 7 1,4��8 Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation:OA—o-011ew- 4ac/i Final: Smoke: Final: Old of f 14/07 6ct t s THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA N OF ANY OF ITS RULES AND REGULATIONS. % _ Certificate of Occu anc 11-1111f Signature: (/ FeeType: Date Paid: Amount: Building 5/20/2008 0:00:00 $154.005247 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo