36-043 (3) MAR-31-2005 15:20 CANON REAL ESTATE 1 413 527 8433 P.02
—NOTE—
THIS PLAT IS COMPILED FROM DEEDS. PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO 13E RECORDED.
SUILDING LOCATION ACCURACY IS NOT GUARANTEED
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rn0: GMAC MORTGAGC CORP,&
COKMONW.O,ALTH LAND .'ITLE INSURANCE COMPANY
Y0 THE BEST OF MY INFORMATION. KNOWLEDGE AND BELIEF
I HERE_ Y- REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMEN ATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN ANO THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT NS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY # 2 01 6 7 --�
` —NOTE-
SURVEYOR:�d-��� 1 .� _ THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONStITUFTv A'PROPERTY SURVEY
MORTGAGE LOA 1N INSPE ON PLAT-
NORTRAM2TON, MASSACHUSETTS
RAND Ail PREPARED FOR
3 IZF3� N
CAROL A. DION
X35032 SCALE: 1 "=3C' FEBRUARY 25, 2005
yav av O� HAROLD L. EATON AND ASSOCIATES. INC,
REGISTERED PROFESSIONAL. LAND SURVEYORS
235 RUSSELL. STREET - HA.DLEY — MASSACHUSETTS
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TOTAL P.02
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Nortlimpton,MA 01060
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as has/her construction super, sor. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two farm
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 fegulations. 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 projec n '1 such time as the proper permits and inspections are
made
I, understand the above.
( me owner/resident's signature requesting exemption)
I wil call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
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DEPARTMENT OP BUILDr).,10 INSPECTIOI.'S ;
212 Alain Strcet Municipal Building
Northampton, Mass. 01060
- W01U0 R'S CON'fPENSATIOV MSUIZ,,%-NCE :11.1'iJJllVj-j-
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01 ccnsalperml ttcc)
�> itll plZncipal place of businessfresidence at: --- -- .
(phone.
(su ticit-/sta_tclap)
J do hereby certify, under the.p2ins and penalties of perjury, ha i
( ) I am an employer providing the following!lvorlcers coinocnsaoan cove fzgc for u1y
etuplovees worldng on tills job:
1 1
Raniran=Comrz•) (Pclic!Nu_rAb--r) -- -(r:-pirdor, Dm--)
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( ) I am a sole proprietor, general contractor or homeowner (ci tie one) and have hired
the co=actors lister+ below wbo have the fobotviog worker's comoensaaon pokles:
I
l`+Qmc O; C0-EmCi0"1 (IIIR I'n( C011103,'1}'PGUCi Drill bc—) (Y ali1UQ?1�11C
)
(N me of Coatraer) O11Si razz. Companti'/Po1c' `ur�l'crr) (%»iriion Date)
I
(?`lame of Conrracto;) CLasuraQc; C:ompan}'/Pont}' tvambcr) (Expirdoo Datc)
(Idzme of ContracZOr) (Lasuranc-C Comca>1y/Policy Numb•:r) (E��iradoo Datt).
(aII,ad, ..t�-,:oca1 v'ect,if ae�to ine?u�iaf—m-=- oa Pctn_iains to all
I
O I am'a-ole proprietor and have no one worl;3ng for me.
I am.a home owner perfon=g all the work myse.l.f.
NOTE:plGSe be ewirc tfi,kf le 6emeowecn ItO Cmplay P.—anal w do or rcpzir..uric cc.d.—lLZ of
ant most th n
Lb---s is t�eb ttx bomoowocr raider or oa the pvua6 zppurLca:r3 tbeeto�c nor�=-Uy oecrd=vd to be
c vloyi=umd=the- -�;Ca=p
txi Arc(GL152.a 1(5)),aPpiiaboo by.bomeoava fv a 6C=_or pa=il 2y tJ:e
Ic-pl rt=^,•of ea—Ioyx uadvr dw Woric.o(a Cooxpamatioa AcC
[uodczzaad Liza a Z--7 rimay be for---t-d to Lb.DW-m,w oflo.&snd Accd�om.orLcur.00e roc tb.
COV�"s`��oorckovct under-c6oa 23A of h(GL 151 c.lmd to the inrxss4ioa ofQimiall PC-16-
ooaxiSiag of a fiat o napritioa oC uP b ooc yrw tmd evil pcaxl-ua in tx form of a Stap W ori;Order aad a
Ilm of: 10.o0 a 6y
., for di.— u. only _
Pcrmll Ntlmbcr
?.tap• Lot
Slgnaturc of LiC=1SCC/Pcrmiucc e -- J
SECTION 8-CONSTRUCTION SERVICES t
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
k R6 sfere o V4Wffl v erne,b-6- �a Not Applicable ❑
Company Name Registratlon um er -'--
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATIOWINSURi4NCERFFIDAVIT°(Kin.L.;c-152,;§25CI6j}.
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...... ❑
:.
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,von 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
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SECTION 5-DESCRIPTION--OF,'PROPOSED=W.ORK(check,afl applicable)
New House ❑ Addition ❑:. Replacement Windows Alterations) Roofing
Accessory Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[O] Other[p]
Brief Description of Proposed
Work:_ Kf 1 `�yl 1�n C,44 ( VO tSIArb
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
r' fi t en ro se � i s c o t � GO:
FR
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
L 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.
1. Septic Tank City Sewer Private well City water Supply
SECTION Ta-OWNER.AUTHOR1ZATIbN ;TO BECOMPCE'[ED WHEN
OWNERS AGENt'.012`CONT.RAC?OR APPLIES.FOR131JI[DIhLG PERMIT
1, 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
I, 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 he pain nd penalties of perjury.
Print Name
Signat a of Owner/Agent Date
Section 4. ZONING All Informatioh 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 I I
Side L R: L: , R: r !
r
Rear E
Building Height .
Bldg.Square Footage — j I % }
Open Space Footage �_ %
(Lot area minus bldg&paved i �!
parking),
#of Parking Spaces
Fill:
volume,&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
N0 0 DONT KNOW Q YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES
IF YES: enter Book Page's s and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued: s
C. Do any signs exist on the property? YES 0 NO Q
IF YES, describe size, type and location: 4
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q
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 plan
that will disturb over 1 acre? YES 0 , NO 0
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IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
ortpampton
C �Ui&g bepartment
21:2*Main Street
Room 1.00e
APR 1 hot`' fimpton,"MA01060
phone 413-587-1240 F x413-587-1272
APPLICATION`TO CONSTRUCT;ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
�7]SECTION,1.-SITE'INFORMATION'
s This seetiari to be cQm"l' 'b?�nffrce 4
1.1 Property Address: i
TIME
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C7 l J(S
OrrertaK"Dts#rrc�, �
Eltx &@ D�sfict v' Ei3 CIS IC
SECTION 2-PROPERTYOWNERSHIP/AUTHORIZED AGENT;
2.1 Owner of Record:
FRA��i S s
Name(Print) Current Mailing Address: �
Telephone , C.� 2 /;1
Signatur /` f�— / 3 7
2.2 A thorized 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 �oo (a)Building Permit Fee
2. Electrical (0)Estimated Total Cost of
Construction from 6
3. Plumbing soo Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) a Sow Check Number
This Section For Official`Use Only
Building Permit Number. Date:,
:._ _ � _. � ;Issued:
Signature: •
Building Commissioner/Inspector of Buildings- Date
File#BP-2005-0973
APPLICANT/CONTACT PERSON DISENSI FRANK J
ADDRESS/PHONE P O BOX 1163 EASTHAMPTON (413)433-3105 ()
PROPERTY LOCATION 27 WINCHESTER TERR
MAP 36 PARCEL 043 001 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: ERECT 8 X 12 SHED&REPLACE KITCHEN CABINETS
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Buildiniz Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9}61ATION 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 Conunission Permit from CB Architecture Committee
Permit from Elm Street Co sion
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.
'
27 WINCHESTER TERR BP-2005-0973
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-043 CITY OF NORTHAMPTON
Lot: -001
Permit: BuiidinQ
Category: BUILDING PERMIT
Permit# BP-2005-0973
Project# JS-2005-1347
Est. Cost: $3000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sg.ft.): 10018.80 Owner: DISENSI FRANK J
Zoning.URA Applicant: DISENSI FRANK J
AT. 27 WINCHESTER TERR
Applicant Address: Phone: Insurance:
P O BOX 1163 (413) 433-3105-0
EASTHAMPTONMA01027 ISSUED ON.4126105 0:00:00
TO PERFORM THE FOLLOWING WORK.-ERECT 8 X 12 SHED & REPLACE KITCHEN
CABINETS
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 Occu anc si nature:
FeeType• Date Paid: Amount:
Building 4/26/05 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo