29-077 (2) lop
THIS PLAT NOT FOR RECORDING PURPOSES
3B 1
Plan Book 56 Page 108
Lot #20
f
#70
--j--j
100 ,
Acrebrook Drive
To: The Heritage Bank For Savings &
The First. American Title Insurance Co.
I HERE13Y REPORT THAT I HAVE EXAMINED THE PREMISES,AND BASED ON EXISTING MONUMENTATION,ALL EASEMENTS, ENCROACHMENTS
AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, I FURTHER
REPORT THAT THE PROPERTY IS NOT LOCATED IN A FLOOD PRONE AREA AS SHOWN ON FEDERAL INSURANCE MAPS FOR COMMUNITY
NUMBER 250167
DATED: F)ecember 2 , 1991 NOTE
THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES
ig
SURVEYOR: NOT CONSTITUTE A PROPERTY SURVEY,
MORTGAGE LOAN INSPECTION PLAT
WC HARD x V- Northampton, Massachusetts
J, Prepared For
LABARGE,SP- Frank E. & Pamela M . Tudryn
#34605
Scale: 1 "-,40 '
Su
Richard J LaBarge Sr., Registwec Professional Land Surveyw
110 King Street, Northampton, Massachusetts 01060
Q.'Ct�PTO
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$ 6 �:ssarhnsrtla'
DEPARTMENT OF BUILDITjG INSPECTIONS
212 Main Street * Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
T °
( permittee}
vrith a principal place of residence at:
(streeilcity/ rip)
do hereby certify, under the pains and penalties of pegwy, that.
O I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiratfon Date)
( /am a sole proprietor, general contractor or omeow_`ner . cle one) and have hired
the contractors listed V
rs below wh�have t}�e follo�ylfl��workel's compensation policies:
Al
PO d 7-K,-
—F Y�"e,-C.9
(Nome of Contractor) (Insurance Company/Policy Number) (Expiration Date)
r.
(Name of Contractor) (Insurance Compai y/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy NmiilKi) (Expiration Date)
(attach ad!itioctal sheet if nccuzsry to include infrxnution pertaining to all ooatradors)
O 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 hoarOv' eD=who cmplay persons to do lnajnttnlnCY.ee.Jsris�'Jon or repair work on a dwelling of
not more to--n thtuo units in which the hotmoswcr rtxida or oa the grours zpp vten, thttdo a c Dot gcncrzlty oomidcrtd to be
caVloyas under the work&,compcas4oa Act(GL152,a 1(5)),application by a homcowncr for a license or permd may evidcace the
legal ct2iiu of an omployoc under the Worker's Compoos t Act
I undcrrtind that a copy of this rtat cmmi may bo forwuu to tbo Dcpartmcat of Industrial A.&a&Oboe of lnsivanoc for tba
coverage va-&C"ioo and that failure to secure covcrago under scetioa 25A of MGL 152 can lmd to the imposition of criminal pcmalties
000sisting of a fine of trp to S1,500.00 and/or imprisonuxal of up to one year end civil pcnalt n in the form of a Stop Work OrdG and a
fine oC S a day against mc.
For dq=tnrdal ssso oaly
Ptrmit Number
.,,. ., of bier •�
-A- a Map' Lot#
6
ECTI��N 8 C� S� RUCTIO'N,S1=RVIaCES 1� '
8 1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
iiiiiiii 1 1 N ill Not Applicable
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 affida
will result in the denial of the issuance of e building permit.
Signed Affidavit Attached Yes....... No......
Q
14� , 4�dTl�'/I1lysE!� l/�cE
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)familic
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 Superviso► 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(.,
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 `
�, �e " r � ti
SECTION,5 DESCRIPTION�OF PROPOSED�WORKf(eheckal applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work:1� 1 .4A4l;ez7 , Gt
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑- Sheet❑
6a snhui- zon cple 11 If'NeWh0 el H1, i h f 0 R:
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.-- Si..r.f— niniensions � T, —
e. Number of stories?
f. Method of heating? jy _ p
(�� .S Fire laces or Woodstoves �Number of each c�nsr�
g. Energy Conservation Compliance. WJI.A —Mascheck Energy Compliance form attached? A,IA
h. Type of construction / 1
i. Is construction within 100 ft. of wetlands? Yes —/_No. Is construction within 100 yr. floodplain Yes_,Zi
j. Depth of basement or cellar floor below finished grade ,3 FFF T
k. Will building conform to the Building and Zoning regulations? --Zyes No .
I. Septic Tank City Sewer Private well City water Supply J�
SECTION 7A,-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENTSOR CONTRACTOR-APPLIES,FOR;BUILDING PERMIT
as Owner of the subject proper
hereby authorize to act
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I h M N7 Y J]Z D /A tL— ���/f/ as OwnerAHtkB ii�eel Age it
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed u der the pains and penalties of perjury. f
Prrnf Name
Signature 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 /C� `�d SQ Gt i S F7 16o tt-Z2
Frontage f IS7 _
Setbacks Front 3 Fr .3 G r
Side L:J/, R: I Q L:6 R: �8
Rear
Building Height
FTC
Bldg. Square Footage 11,4 & g �1%
Open Space Footage O %
(Lot area minus bldg&paved 9G'r8� /" / cPC/
parking) U
#of Parking Spaces
Fill: e/K1,,S n� crass 4 Soi) C� r,`S f1'n� 9r�ss� so)/
volume&Location a r 4f 0 t7 Ott i3O
A. Has a Special Permit/Variance/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 #
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:
r
r
City of Northampton °
Building Department Gu
i, APR 2 3G2 212 Main Street
Room 100 "A e etI A a r " i
Northampton, MA 01060 Two
Y, p'h ne 413-5 7.1240 Fax 413-587-1272 PlotfS;ite P s. ��
er°
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
S.ECTION1 -SITE INFORMATION
Thassection t�obe com I tedIty ftc
1.1 Property Address: * £
Map
-3 V/9 erlay District
EImSt:"'D.istrict' CB-Ristnct'
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: yd'Xevc
i
ame Print �pp � /� Current Mailing Address: a
Telephone
Signature
2.2 Aut rized Agent:
r
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 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6'
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(I + 2 + 3 + 4 + 5) Check Number '-
This Section For Official Use,Only
Building=Permit,Number: Date Issued:
Signature
Building,Co"mmissaner, ln pector of'Buildings Date
File#BP-2002-0925
APPLICANT/CONTACT PERSON O'BRIEN WILLIAM&JUDIANNE
ADDRESS/PHONE 70 ACREBROOK DR (413)584-8345 ()
PROPERTY LOCATION 70 ACREBROOK DR
MAP 29 PARCEL 077 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL 2T ABOVE GROUND POOL
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
INFO,,UMATION 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
4—
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.
0 ACREBROOK DR BP-2002-0925
GIs#: COMMONWEALTH OF MASSACHUSETTS
29-077 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildin£
Category: BUILDING PERMIT
Permit# BP-2002-0925
Project# JS-2002-1503
Est. Cost: $12728.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor. License:
Use Group: Homeowner as Contractor_
Lot Size(sq. ft.): 20603.88 Owner: O'BRIEN WILLIAM&JUDIANNE
Zoning:URA Applicant: O'BRIEN WILLIAM & JUDIANNE
AT: 70 ACREBROOK DR
Applicant Address: Phone: Insurance:
70 ACREBROOK DR (413) 584-8345 (�
FLORENCEMA01062 ISSUED ON:4126102 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 27' ABOVE GROUND POOL
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 4/26/02 0:00:00 4408 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo