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29-221 (3) 10. Do any signs ebst on the property? YES NO , IF YES,describe size,type and location: Are there any proposed changes to or additions of signs intended for the property?YES NO l IF YES,describe size,type and location: 11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. �j/ 3 �,/1 J<�This CO2== to ba fiZZec3 in �✓`� by the Building Department Required I Existing Proposed By Zoning Lot size .S-r-e 3 aS' A /O� a Y/to Frontage " � 3 3 l0O , 8> 8t ' Setbacks `�'' 3,7"f o - side L• R: '-/o' L: 31 L R:_ yy' �f - rear house 39 ' 9arafP S�' 30 Building height Bldg Square footage a O �o us-P -�-8^� /.��(� 7, (� era GY - v. %Open Space: (Lot area minus bldg 7J`' 7 9q z C-17o &paved parking) ��J # of Parking spaces Z f of Loading Docks -AI Fill: (vol-ume--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: 7--Lt!- n ti APPLICANT's SIGNATURE NOTE: Issuanoe of a zoning permit does not relieve an a lioant's burden to oomply v #" zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Publio Works and other appilomble permit granting authorities. FILE # i. J U L 2 9 2002 F'i 1 e lvo. l 03 1& '/� J/1� nEP?of B01-DING INSPEc NI G PERMIT APPLI MTII E TYPE OR PRINT ALL Ili 1. Name of Applicant: Ray-m o h L. yaflr d ws H Address: // z c r,019►roaA ,►or e -e Tele honer 2. Owner of Property: P -, ci x _IIAN1 Address: /J2 lj c/t b[(jo k ./-?c. _Telephone: .My-o q G y _- 3. Status of Applicant: 1/ Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# Parcel# oho?/ District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) /I 5. Existing Use of Structure/Property I4JmM-a 6. Description of Proposed UseM1'ork/Project/Occupation: (Use additional sheets if necessary): 5 /os- /y'Jc0' ► eh , / yVlS Ad4 ; r;�, n lvs d Ys2s©N pf W11"I"Irk 36 , 7. Attached Plans: Sketch Plan _Site Plan Engineered/Surveyed Plans Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files. 8. Has a Special Permit/Vadance/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# 9. Does the site contain a brook, body of water or wetlands? NO_je,-- _ 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: (FORM CONTINUES ON OTHER SIDE) • *"JA File#MP-2003-0015 APPLICANT/CONTACT PERSON HATHAWAY RAYMOND L&PATRICIA ADDRESS/PHONE 112 ACREBROOK DR (413)586-0964() 3 3 PROPERTY LOCATION 112 ACREBROOY,DR a f MAP 29 PARCEL 221 001 ZONE URA/�4� © ` L2 CTC6' (� q I d© THIS SECTION FOR OFFICIAL USE ONLY: {Ct PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM ILLED OUT O ' d ` Building Permit Filled out Fee Paid Typeof Construction: ZPA-CONSTURCT 14 X 20 ADDITION&24 X 36 DET GARAGE&REMOVE 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: —*—Xpproved 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 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 the Office of Planning&Development for more information. 112 ACREBROOK DR MP-2003-0015 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIs#: 4945 Map: " N" Lot:ck: ZONING PERMIT Permit: ZONING PERMIT APP APPLICATION PERMIT (Category: Zoning Permit­-- �Permit# MP-2003-0015 PERMISSION IS HEREBY GRANTED TO: Project# JS-2003-0204 Contractor: License: Cost: $0.00 Homeowner as Contractor ,Fee: $10.00 L#of Fixtures: Owner: HATHAWAY RAYMOND L&PATRICIA Applicant: HATHAWAY RAYMOND L&PATRICIA AT. 112 ACREBROOK DR ISSUED ON: 15-Aug-2002 AMMENDED ON: EXPIRES ON. TO PERFORM THE FOLLOWING WORK.- ZPA-CONSTURCT 14 X 20 ADDITION&24 X 36 DET GARAGE&REMOVE SHED-MAPS 210,221 &220 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. . Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Zoning Permit Application REC-2003-000330 29-Jul-02 5076 $10.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272 GeoTMS@ 2002 Des Landers Municipal Solutions,Inc. .Uri 5t OQ(t1NIp�0 171:.- �;RTMtNT bF BUILDING INSPECTIONS 212 Main St1 eet ' Municipal Building INSPECTOR Northainpton, Mass. 01060 y �� Square Footage Amount Basement @ .10 lst Floor @ _40 2nd Floor @ .2.0 112 Floors, Attic, Garage , .10 Deck, Porches .1.0 TOTAL _ i 9 6 �lasasc}lnactta` DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ' WORKER'S COMPENSATTON INSURANCE AFFIDAVTr (licensteJpermittee) _ with a principal place of business/residence at: (ptlone�) (st=t/city/staLehip) do hereby certify, under the pains and penalties of pe4ury, that ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (mince Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and Have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compar y/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (E),piration Date) (attach additioail sheet ifnoccssary to inctude info maticn pertaining to all oDctmd rs) ( ) I am a sole proprietor and have no one working for me. I am a home owner performing all the work myself. NOTE:please be aware that while homcowvcn who employ persom to do r.,i.,t�art r oa cr repair wort;on a dwelling of not mote than time units in which the homnowncr resides or on the hounds appurtenant th=to arc oot generally coasidcrcd to be cmploytrs undo the worker oration Act(GL152,s3 t(5)),application by a homoowwr for a liccnsc or pclmit may-id—the Ie821 status of an employer under the Wodola compemation AcL I understand that a copy of thin ctatemcat may be forwarded to tho Depart c c of Industriel Accidca&Othoo of Iasuranoa for the coverage verification and that failttra to acaue coverago tinder soaioa 25A of MGL 152 can lead to the imposition of criminsl peaaliies coasisting of a fine of up to S 1,500.00 and/or of up to one year and civil penalties in the form of a Stop Work Ord--and a fins of S I DO.QO a day against me. Foc 6T=ti rn uao oaty Permit Number ?&F# Lot# i w r Site of e LicenscxJPerInittee or yi ill 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone n OEM Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone S, CTlQN 10 WORKERS'.COMPENSATION=INSURANCE A0,11DAVIT(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...... ❑ A 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, State and Local Zoning Laws and State,,off Massachusetts General Laws Annotated. meowner Signatures CT10, �R E ° k ale a �'t�'; ,k"� New House ❑ Addition ❑ Replacement Windows Alterations) ❑ 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 V' No Attached Narrative D Renovati-g unfinished basement Yes L-.- No Plans Attached Roll[/Sheet o I:fiNe. o e t Tiny otin" h. s n co' "1e a fib,; . . : 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 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 SECTIONa„-ow NERAUTFIORIZAT,ION „TO BE C.OMPLE`fED' WHEN OWNERS gGENT OK bbN'TRigCTOR APp "ItS POR BUI'1DING PERMIT 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 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 ., Signature Owner gent Date r � 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 r4 ,"�qxJb Building Department Lot Size (a, 000 � � � �!� /I�l� �(1 arc a7 , Frontage 7 4)714 Setbacks Front 37 Side L:3.;2,? R:3 L;'?a R: Rear (� � Building Height 35- Bldg.Square Footage I % L d Open Space Footage I �9�j (Lot area minus bldg&paved /LIP P S7lJ� D �/ " parking) #of Parking Spaces Fill: volume&Location A. Has a Special 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 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: i orthampton Bu I i Department o i — 9 2CG2 ain Street Ro m 100 i �-- x amp on, MA 01060 p'�r a1'!lt�iNG iPJi bmW 44L�t. 0 Fax 413.587-1272 e APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION, -SITE LNFORMATION 1.1 Property Address: EIm 5ti, trice SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:©© /e tri c+'e- Ile, l...I'a�:j 2�1 /C/vrrnc C. 074 Nam rint) Current Mailin Ad ress; �� Telephone (c S1gna 6r e 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 2. Electrical (b) Estimated Total Cost of 4.1 Ova Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 + 2 + 3 + 4+ 5) Check Number This Section For Official Use Only r _ Building Permit Number: 0 3 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date.. File#BP-2003-0377 APPLICANT/CONTACT PERSON HATHAWAY RAYMOND L&PATRICIA ADDRESS/PHONE 112 ACREBROOK DR (413) 586-0964 Q PROPERTY LOCATION 112 ACREBROOK DR MAP 29 PARCEL 221 001 ZONE URA/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid C-5 _ Typeof Construction:_REMOVE 12 X 10 SHED&CONSTRUCT 36 X 24 GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan i FOL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON ATION PRESENTED: pproved 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 C ssion 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. frt r y ewe 6 { `°�:ice v O. d a x y, 'ate #. i a€x }': 5 „,. `� T NJ ow id -.�, «A ' � -M a y rte, Fes. �'�rt:- vy M yy $ 'i £",-,, of � � T � .�` Y• � �� T fb ! A:- s 1 • 11t�ACREBROOK DR BP-2003-0377 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-221 CITY OF NORTHAMPTON Lot:-001 Permit: Building Cate BUILDING PERMIT Permit# BP-2003-0377 Project# JS-2003-0637 Est.Cost: $22000.00 Fee: $86.40 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor_ Lot Size(ssq.ft.): 10018.80 Owner: HATHAWAY RAYMOND L&PATRICIA Zoning: URA/WSP Applicant: HATHAWAY RAYMOND L & PATRICIA 119 ArRFr3Rk00K D(? Applicant Address: Phone: - Insurance: 112 ACREBROOK DR (413) 586-0964 O FLORENCEMA01062 ISSUED ON.10/15102 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE 12 ,X 10 SHED & CONSTRUCT 36 X 24 GARAGE POST THIS CARD SO IT IS VISIBLE FROM TIIE STREET Inspector of Plumbing Inspector of Wiring ".W. Building Inspector Underground: Service: Meter: Footings: Rough: ou ,: /�3 House# Foundation: f9.,, -6v 7( D9 ay Final: Final: Final: *6u gh Frame: -Cr 73 Gas:!.' FireAwartment Fireplace/Chimney: Rough: Oil: Inflation: Final: Smoke: Final d. THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATTF is.. ANY OF ITS RULES AND REGULA'T'IONS. ertificate — ee Type: _ Recei t No• Bate 'aid: ('keel:Nij: Amount: � 1 f uilding 10/15/02 0:00:00 5127 $86.40 i 212 Main S t'cot,Phooe(4 13)587.1210,Fax: (413)58 i '.27Z bgildirg C Ant�•.ony Paidlo • MIN t