36-127 (2) M & S ELECTRIC, INC .
119 Elm Street • Hatfield, MA 01038
Master License #A9366 • Stanley Symanski 247- 330
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M & S ELECTRIC, INC .
119 Elm Street • Hatfield, MA 01038
Master License #A9366 • Stanley Symanski 247-5330
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M & S ELECTRIC, INC .
119 Elm Street • Hatfield, MA 01038
aster License #A9366 • Stanley Symanski 247-5330
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u`j/2u/2Uu6 U61: 51i 413b861U12 LABARGE PAGE U2
THIS PLAT NOT FOR RECORDING PURPOSES 8 k,6,41 I., PG-,234
PL.MK. 49�
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LOT 2
544 s.f
v 4271
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ToiHANKgF.WEST.ERN ►�A?S. FeIRS7'pMERICA0T1-17 LE IrJ-5.co.
1 HEREBY 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 ONES. I FURTHER
REPORT THAT THE PROPERTY IS NOT LOCATED IN A FLOOD PRONE AREA AS SHOWN ON FEDERAL INSURANCE MAPS FOR COMMUNITY
NUMBER 2 C7( Cv 7
DATED: 09- 2-8 -04 NOTE
THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES
SURVEYOR: NOT CONSTITUTE A PROPERTY SURVEY.
MORTGAGE LOAN INSPECTION PLAT
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W O R-T-H A M P TO N MASS .
1 aW NE:R
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(34603 L 10 KI I— G. CST-A RY A titN RpMA lt4
Sub SCALE : ("r 4p
Fuohard J. LaB",Sr.,Fbylstered Protssslonal Land Sur.,oyor
110 lamp Str"t, Northampton, Massachusetts 0 1080
¢gt1AMP�.
$ � �1Tilassachusrtta
of Worthallytou
ry' � DEPARTMENT OF BUILDING INSPECTIONS
'212 Main Street • Municipal Building
INSPECTOR
Northampton,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 his/her construction super,•i:6or. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or twojhmily
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 DELAY the project until such time as the proper permits and inspections are
made
J, , understand the above.
(Home owner/ sident's s gna' re requesting exemption)
I will call to sched0e all required uilding inspections necessary for the building permit
issued to me.
Date 3
Address of work
location T`- r'/ i`� S < ( �
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DEPARTMENT OP DUILDr>\G INSpeCTiONS
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212 Train Strcet 'Municipal Building
Northampton, Mass. 01060
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- «'O RICE IZ'S CONOENSA'nON G`ISURANCE : FFD),, .vi
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v"Ith a principal plat:. of businessfresidence at: --- -- -
(phone-')
(stTec-.t/ei tr/sta.tcfri p)
do hereby certify, under the.pains and penalties of penury, :hat
( ) I am an employer providing the followinc, %vorker's comocns-n6o, cove se for Im
employees «•orldng on this job:
onsuran=Comp=y) (Polio:Numiycr) -- (r pirtior,Dal--)
�C} I am a sole propr,etor, general contractor o ho_meo tier cu c?e ore) and have hired
the conn-actors listed below wbo have the followioQ workers coMpen-tallon pokles:
( i C 0. CO i0r) (tasurznc;: Coinp3, 'fPobc.
- (N:mzc of Corirfac-tor) (1iis =cc Compaati•iPoUcv Nuncrr) (—t.kDirtion Date)
(Name of Con=do;) (insi-anc Compa.n)'[Polio}- Nambrr) (Expimdoo Date)
(Name of Contractor) (IIISUraac-- Comrany/PoUcy Number) (Expirtion Date)-
(ta,ac?1 oczi bcC,ifacxi.--V to mc!u�tafonn�.soo pcts.ining to.0 cc=--_co,)
{ ) I am a sole proprietor and have no one woridng for me.
( } I am.a home owner perfor=,c, all the work myself.
NOTE:pl=-u be cwArt tfi.•ktjJ 6cmco.�acr3 w'bo c=ploy pcsoat to do s c,�Cr rgair,.-ork oa.d-xil--Z of
ant moot tt,-m t''�ec vii'-is'-b'h the bomoowocr rgede oc cc the v z,:b zppurtru_r1 theeo c-c ax�=>. -Ry a crd.-n�to be
eirplor--unc'.e the-Vck=z oQ=PK • Iioa Aa(Gut 52ss 1(5)),applinbon try n bomcow-ac for c uc=--=or permit t>_y c�•id Lbc
lc-gs!twat of aadcr dro Waticrla Coa�pom.=ioa AoL
[and—L—d tbA x oopy of thu 6bL m my be f-,-,id to tbo Dc -,_m of j.AL zr id Acedc &OQ,oe of(.ur.000 roc tb.
oovc 8e Vt ifeaioa and Ih_t L•i um to L*=m)co%craso undo soezioa 23A or MOL 151 c=lc.d to the imaoai ioo of crimiazl pccAWcz
eoasr ng or a fiat ar up to S i}oo.00 and/or orup to ooc y=cod civU pmatia is 6c room of a Stop W or';Ordc tad a
Gm 0(5100.00 a d_y tptin-A MI_
Fat do p ^ •--'•r u.e only -
j r i perm.t Numbrr
NUP-" Lot .
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SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
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Address Expiration Date
Signature Telephone
S-Re°istereilxEomein ra�riitenCoitfracto " .
RIA; Not Applicable ❑
9
Company Name Registr tion -um er
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE:AFF,IDA1f17tAIf.G:L.c. f5Z,=§25C(fs}}
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...... ❑
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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 alt 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"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 WORK(check all°aaalicable)
New House ❑ Addition [ ., Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ De lition ❑ New Signs [p] Decks [p Siding[0] Other[0]
Brief Description of Proposed ��D ®O 7 XtS rf nV C f
Work: fcr,r!�-f C
Alteration of existing bedroom Yes No Adding new bedroom Yes
Attached Narrative Renovating unfinished basement Yes ' No
Plans Attached Roll -Sheet
a�-.'� � Mt, �#�}'-'K,x i:�:,+nt ���an« � .�^..- e.,
sa_ft Nev ft ttse'3an addr icz to ex�st� rc fio>I slr c.Ec�rlTp etrNtti 1 [fa�iiGi :
a. Use of building:One Family yr Two Family Other
b. Number of rooms in each family unit: `7 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? ��D% Gt/f}�"ItOL. Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. – Masscheck Energy Compliance form attached?
h. Type of construction 14/000 F/�qvr►�_
i. Is construction within 100 ft.of wetlands? Yes E--No. Is construction within 100 yr. floodplain Yes L—No
j. Depth of basement or cellar floor below finished grade &, /
k. Will building conform to the Building and Zoning regulations? 4---- Yes No.
I. Septic Tank City Sewer� _ Private well City water Supply L/
SECTION 7a-OWNERR AUTHORIZATION TO BE.COMOLETED...WHEN
QWNERS-AGENT;OR CO'NTRAGT6R APPLIES`FOR�BUILDtNG='PERMI'F
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1 as Owner of the subject
property
hereby authorizer` 7
to act on m behalf,in all matters relative to work aut oFi rizea by this building perm t appl ation.
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Signature of Own Date
1 as Owner/Authorized
Agent hereby declar at the stat&nr 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.
Prin Name
W�Z(
Sign ture of Owne ent Date
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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
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Frontage { `
Setbacks Front c�'
Side L R: L: R:=
Rear 7760 '— V
I?uilding Height
f
Bldg.Square Footage % [ !
Open Space Footage _^ %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: I '
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
N0 0 DON'T KNOW 0 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 DONT KNOW Q YES 0 .
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 0 NO Q
IF YES, describe size, type and Iodation:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q 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 O ,. NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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� Iitdirg Pepartment GotQ enya
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212'ill din Street '
Rgo�;100r �
R - 8 QAamptan,1 MA 01060
phone 413-5871240 Fax 413-587-1272 toS�t � s
APPUCAT16N TO CONS-1b TER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: Thts sect►on to be com feted!Y07 ce
Ovecfay Distrrcf
Flo&e111 t-C:. EIm Sti Distr
�' ici � CB D�stricY
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record: t
/z Ct�
Name(Print) C ent Mailing Address:
Telephon L j
Signature
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 J (b)Estimated Total Cost of
Construction from 6
3. Plumbing �� Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number �f
This Section For Offieial'Use.Onl
Date
Building Permit Number.`
Issued:
Signature:
Building Commissionerlinspector of Buildings Date
3 y a
File#BP-2005-0834
APPLICANT/CONTACT PERSON MIGLIORE HOLLY A
ADDRESS/PHONE 271 BROOKSIDE CIRC FLORENCE (413)584-2172 Q g
PROPERTY LOCATION 271 BROOKSID CIR �9(�13 c�
MAP 36 PARCEL 127 001 ZONE URA ��vf�F
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: CONSTRU T ROOF OVER EXISTING DECK&ADD 10 X 10 DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
jT�HIE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
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
Ile/.�
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.
271 BROOKSIDE CIR BP-2005-0834
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36- 127 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildina
Category: BUILDING PERMIT
Permit# BP-2005-0834
Project# JS-2005-1155
Est. Cost: $3000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sa.ft.): 26528.04 Owner: MIGLIORE HOLLY A
Zoning:URA/VVSP Applicant: MIGLIORE HOLLY A
AT. 271 BROOKSIDE CIR
Applicant Address: Phone: Insurance:
271 BROOKSIDE CIRC (413) 584-2172-0
FLORENCEMA01062 ISSUED ON.3111105 0.00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT ROOF OVER EXISTING DECK & ADD
10 X 10 DECK
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 3/11/05 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo