35-295 (3) 1
TOP' OF FOUNDATION
,50.6 NIN FINISH GRADE
26,10 MIN
FINISH 6RADE 2100 MAX NOTE: No DREAROIIr GONGERNS
26t6 MIH DUE TO FIAT SITE
i+ox
� � - 4• ryG I' fvG o 25 -
V INV, • END
S 201 ►ROKriED S IOI GALLON
C00 OF iRENGIfy
P'REC.AST C.ONC.RETC 267.00
SErTIG YANK INVERT INTO
INVERT • DIST. eox
FOUOATION 267-50 50TTOM OF )TONE
266.2 INVERT OLrr 266.00
DIST. DOx
INVERT ORO "fmKT OUr 267.30
SElT1C. TAW SEP'TIC. TANK ESTIMATED MAXIMAL
267.15 267.75 GROUE7WATEK CELOW 776.0
ii
PROFILE
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290
SEJ'TIC TANK
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AREA 36.'US S
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U175' PLAN VIEW
! S.-ALE. f • 20•
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w DEP/,,RTMEt,rT OP BUILDr)\,C INSPECT1O1,S —'
212 Main Strcct Municipal Building
Norlhamplon, Macs. 01060
WOMCER'S COZ'ITENSATION MSURANCF AI�I�D�:VIT
0ia.n, f =),ttcc)
v.�Lh a pli.ncipa! place of business residence zt:
(s�tici ty/AatcfZi p}
do hereby certifj-, under tic paint cad penalties of penury., -hat
( ) I am an employer providing die followine v�-orkcr's comnensrdo, cove 2ge for Irly
eluplovices worUng on uiis job.
(Irsunan= Conr cv) lPcbc-: Nunzixr) --- (:-pirtior, Datc)
( ) I am a sole proprietor, general contractor or homeow-oer (ci cie one) and h2ve hired
the coouactors listed below vgbo have the follo%ving workers CaE.2oenszdon policies:
l'+nPJC Oi CO^rT:?Ci0") Or1R!r311c: Comoa.nyi-Pobc NLLMLC:)
of C00fJ2Clor) — (LFS-.uznc;, COMDaOti'/Polley \ujmccr) �zDirtidn Date)
(N!! e of C0umcto,-) (Ln_ntranc ComT=)-/pouq• tvambu) (Expimdon Daic)
I
_ _ I
(Namc of Contractor) (Insurance ComranyfPolicy Numb,$) tE-cp -ll Darr) .
(eIIar,�_d1::oca1 Lich Jn<c�ezan to metes tnror+.+•�oo perreiuias w.11 oo¢r-�n:�) i
j
{ ) I am a sole proprietor and have no one world.ng for me.
SI
am.a home owner performing all the work myself.
NOTE:pl__sc be ewatc tfi,_..tJc bcmcrn ubo ccnplay perT-0=Lo do r a =cas e oo rgau..orz o-i L d-1.1--Z of
erne most tbsc t _v�r�is u+�the hor�r.do or oa the me zpyutrol1 Lhe cn r c we�rl}y«�tl7etii to be
cizployc�unCc ttx� a �m Aa(GLI 52.n 1(5)�zppti=L600 by e bom00%-=fcn-U=-v:or painh r=y c idcnc�Lbc
lep.J n.z1u of en<rployer under d-n Wlkel Goaspom•yion Act
r
-04—Lx d dha a°.Vy of tlsi.mremem onay be foe--rdod In eh,-Depnnmme of I>A.r iJ Aooda&Off o of lrr..r.noe for tbo
00va-9,c vcT Tictuoo&.&d 1}11 L•.ihac to rmrrt)c*%�TZ,tn3dcr suction 23A of 1.(OL 152 cin lad to Lb,-,iaposilioa of aimimsl pcaillio
om--ro of a floc of up to S 1 500.00.rtdfo,, of up w ooc yrsr end o.,j7 pc n kja in Lc form or.Slop Work Order end e
r�ors 1 oa.ogc day L�,� ----------
fF,dcq+.rcz only
perm;t NLLML"-s
Z7 t.dap:'_- Lot
S; 1tu o Li�IPcm)jucc e ) A"
O O
Cr, rf lafdZf�cllT�1;QIt
L Z
� jljlTrlassac}fusrfis � "
DEPARTMENT OF BUILDING INSPECTIONS �.
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supr: : °or. 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 any 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 DE AY the project until such time as the proper permits and inspections are
made J
�' understand the above.
(Homeowner/residen., signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date 7
Address of work
location
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
9.Registered Home lmprovement Contractor 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 affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
1I.-- Home Owner Exemption
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 buildine 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"certifie d assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Lf al Zoxiing Laws d State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTIONS-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) El Replacement El
Or Doors 0
Accessory Bldg. ,� Demolition ❑ New Signs [0] Decks [M Siding [0] Other[ED]
Brief Description of Proposed
Work: w J
Alteration of existing bedroom Yes _No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes < No
Plans Attached Roll -Sheet
6a. if New houseva'nd o"r-addition to existing housng;'complete the following:
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 behalf, all,rfiatters relative to work authorized by this building permit application.
Signature of Owner Date
as Owner/Authorized
Agent hereby declare that t e s tements 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 p ry.
Print Name
i /,Z7 0
Signature of Owner/Agent Date
Section 4. ZONING All 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
Frontage
Setbacks Front
Side
Rear
Building Height f
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
A. Hasa Special Permit/Variance/Finding ever been issued for/on the site?
NO [ �� D0N7KNOW /—� YES /��
-
IF YES, date issued: !
IF YES: Was the permit recorded at the Registry ofDeeds?
NO ( ] DON7KNOVV 0 YES 0
___-_=--_
IF YES: enter Book Paga! ! and/or Document - -
B. Does the site contain a brook, body of water nrwetlands? NO DON7KNOV YES 10( �
\^�
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained /~� Obtained /-� Date Issued:
�-------------'
`~� \.� ' �
[o any signs-exist onthopnqperLy? Y[� �� mo
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: --- --------------------� '
E. Will the construction activity disturb(clearing,g�ding Uon.orfiUing)over 1oomor�dpa�ofa common p�n
that*N|di�udbover 1acre? YES �� NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department'use only;:
City of Northampton Status ofPermit: -
- ;Building Department curb Ctlt/Dnveway ermit
'212 Main Street Sewerfepttc4iratlabttitl
Room 100 1/afaterilell Ava�lahi)�tgr
N,' i Northampton, MA 01060 1woS @ts fStructuralPlaras
phone 413-587-1240 Fax 413-587-1272 PlotlSita Pans"
_ 3ther Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed.by Office
Map Lot Unit
�j � L✓�i�r D`
Zone Overlay District
Elm St.District CB.District
SECTION'2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: /
`� �,Cleo
Name(Print) Current Mailing Address:
s' Telephone
Signature
IV
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 (a)Building Permit Fee
2. Electrical (b)Estimated'Total Cost of
Construction from 8
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) (,1 Check Number
This Section For Official'Use Only
Building Permit Number: IIsssued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2007-0591
APPLICANT/CONTACT PERSON JORDAN PETER A&SUSAN J
ADDRESS/PHONE 85 WOODLAND DR FLORENCE Q 587-9916 Q
PROPERTY LOCATION 85 WOODLAND DR
MAP 35 PARCEL 295 001 ZONE SR
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: 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 FOLLOWING 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 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 Office of
Planning&Development for more information.
85 WOODLAND DR BP-2007-0591
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 -295 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Caterv: BUILDING PERMIT
Permit# BP-2007-0591
Project# JS-2007-000876
Est.Cost: $2600.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot sizes . 1 : 38942.64 Owner: JORDAN PETER A&SUSAN J
Zoning: SR Applicant: JORDAN PETER A & SUSAN J
AT. 85 WOODLAND DR
Applicant Address: Phone: Insurance:
85 WOODLAND DR () 587-9916 ()
FLORENCEMA01062 ISSUED ON.121712006 0:00:00
TO PERFORM THE FOLLOWING WORK.-ERECT 10 X 12 SHED
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 12/7/2006 0:00:00 $25.002105
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
85 WOODLAND DR BP-2007-0591
GIs#: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 35 -295 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-2007-0591
Project# JS-2007-000876
Est. Cost: $2600.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 38942.64 Owner: JORDAN PETER A&SUSAN J
Zoning: SR Applicant: JORDAN PETER A & SUSAN J
AT: 85 WOODLAND DR
_ Insurance:
85 WOODLAND DR O 587-99160
FLORENCEMA01062 ISSUED ON:121712006 0:00:00
TO PERFORM THE FOLLOWING WORK:ERECT 10 X 12 SHED
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: - -Fi►��;: OK (�G$�0(� (.ONI h
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Si nature:
FeeType: Date Paid: Amount:
Building 12/7/2006 0:00:00 $25.002105
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Conunissioner-Anthony Patillo