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BOARD OF HEALTH OFFICE OF THE .�
MEMBERS BOARD OF HEALTH $ e
ROSEMARfE KARPARIS,R.N.,MPH
XANTHI SCRIMGEOUR,MHEd,CHES
JAY FIEITMAN,M.D.
STAFF 212 MAIN STREET
NORTHAMPTON,MA 01060
Ernest Mathieu,R.S., ,C.H.O. CITY O F NORTHAMPTON
Director ector of Public Health
Richard Meczywor,R.S.,Sanitary Inspector M T=S 01060 (413)587-1214
Patricia Abbott,R.N.,Public Health Nurse FAX(413)587-1221
Madeline Heon,Clerk
L NOV - X004
November 8, 2004
DEPT�. _J
'R!)1� °'G!NSPECI IONS
France Grady Ingo
348 Westhampton Road
Florence, MA 01062
Re: Septic System Requirements for Renovations or Constructing an Addition
Dear Ms. Grady,
It has come to my attention that you have plans to remodel the bedrooms in your dwelling
located at 348 Westhampton Road.
You indicated to me that you currently have three bedrooms. Your septic system was
designed for four bedrooms. No additional bedrooms will be added. The end result will
still be a total of three bedrooms. You will not be required to make any changes or
additions to your existing septic system. Please do not hesitate to contact me if you have
any questions.
Sincerely,
Ernest J. Mathieu, R.S., M.S., C.H.O.
Director of Public Health
cc/ Building Department
r
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1�ASSACh1TSCttS -
DEPARTMENT OF BUILDITjG 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 1083.4 to
act as } is/her construction supc-,, 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 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 rouEh 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
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
Glill of
P 6 R1cssxti}nsrtts ' _
UEPAR`I- fEt.F-r OF INSPECTIONS
212 Mann Street Municipal Building
Nlorthampton, Mass. 01060
WORICER'S COMTENISATTON INSURANCE k AVIT
(liens°Jt'c;mittc^)
%with a principal place of businesslresidenc
�� � Y L(i� G►t� • G6 �s�----- !� —._._(hone'=;_�-�1� -.��L�Z�
------
do hereby Geriil, L'aacr d1C p<::i1S rid pcn 'Ltics nI
O I am an employer providing the compensation coves for Iny
emplovices Working on tilis job.
(InsuanG Corar�m') c c;Number) --- (`rx#mdon Data)
a sole proprietor, y'encrz_l con*=ctor -J'- hen cowoc� (CLcle oral) and "'.ZVC aired
th-1 contractors listeC beiovi ,i.0 tht fpil .L; ,��OrttPr'S c-omptll a":on
(rlame of ConCmcwr} (T "; . ..7Ci: DP.tC�
(Name of Co=—actor) -- (7:tsar,r.cc ComC_.w�Pelie, Nttrnber; (F>:c r,:Iina Date)
(Name Of Cont-mm'-) (jI1SS a11C coi:)`:2-0'01301ic NtunrfIr) X;,'; i:: Dat',)
- (Name of Contnctcr) - - (Itis�rana Cetnr _y!PoLic� Numb��) (E::r. ::i.o Date)
(^ILiC?i adait7tt:�1 S:1CQ::::0�43'.a^::O'�:"'.i::_...:-Y:[:L:Ct:r-5::1:.^.. - eL'.�_(:7o:"ia•�
i
( 1 1LT1 c: solC )rU') 1eCJi i':it1 iinvc- no oli Jrl iii'i! IOr 111e.
1 }
I am L? 1:0mc OViI1C'r tiC1:C`I?11I'" �Il i1. J.;.., ii 11.
'1
*JO"I fi:p!csc be ntrsrc L:r"vL;]c f <r�o nr s :�c;ap! ;, n It>c _: ZC�a:.c'n:C-:m cr::;:air
not rnccc then duoc t:11i<3
eatployes un:er't}r_wc:}::x'a ec:x.•_:a:im or e Lec�,c cc �.-
Icgzl ctatut of an czxplo}'x un 4 o Wcvi c1t l 01^,o rarion AcL
I undc.it�nd the a copy of Ui:x tl_tct cr1 nay Fo f,_,1_3 to t2»IY-{vtzi of Indau riJ An�r�r:f Li o0 of i:r craa:o for tlx
cover,gc vcrifictioa a d th t f iltuc to an uc m�cr ,ut zc�.iM 25A of MC-L.152 can lui tO tlx imposition.rr' i^.1 persl:a
comisting of a frrr_of up to i 1 SCO.00 cr i^:;u ux-z of::p to cr,. ` r.-.j civil pcmItics in yr fc-,nn o(a
Lrlr,of St00-VJ a day tg!-inrt m..
Fcr d,�v:nrsl
permit
Signiturc cat ;.ic�a c:Jl'crm;ac, ----- --.-_-
SECT30N 8.. CONSTRUCT ION,SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : J �� �J ��Cti- 1!%' s q 61 LIo r
License Number
Lt
Address Exp ration ate
Signature Telephone
Regse'reme" mn ouementContracto Not Applicable ❑
Company Name Registration Number
113 5 ti M,,+, <I? �/S Yr 2
Address Expiration Date
Telephone JC��"��� a? L� 204 c-
SEGTlON 10!WORKERS' COMPENSATION INSURANCE:AFFIDAVIT(M G:L. c'. 552, § 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...... ❑
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 of Massachusetts General Laws Annotated.
Homeowner Signature _
M
5ECTI07V� a: DES. ° �'R UGIN OFIRROPOSED WORK check 11 a I�cable
5,w'"F vf+r. ._. �i.':�+nn. xix,.,�-.Y ,P..nT3tu"tv.v,v..,,Y hda q.a_. ,..,w.-iTNF. xers•'dranry
New House ❑ Addition Replacement Windows Alterations) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: it N
Alteration of existing bedroom_ie6yes No Adding new bedroom es L,/— No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll ❑• Sheet
a. :f_ e : ou � "nd or�.a�clrlti/on toezistin�gho si`ng�comple`�etTiefot,lov�in;�:
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. j�("� Dimensions X f
e. Number of stories?_
f. Method of heating?_ K /�ir C- P—,'(— Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction �)-/Io S
i. is construction within 100 ft. of wetlands? Yes ��o. Is construction within 100 yr. floodplain Yes c,-No
j. Depth of basement or cellar floor below finished grade
k. Wilt building confor to the Building and Zoning regulations? ✓✓ Yes No .
I. Septic Tank City Sewer Private well City water Supply
SEC 'ION 7a �1i51NER UORIZATION TO B.,E COMPLETED VYHEN
OWNfkSAIaE�1'C 0�2 CONI'RACTORAPPLIES FOR B.UILDING,P R IT
I, as Owner of the subject property
hereby thorize to ac,. on
MY h in all matters rela o work authorized by this building permit application.
Sig ture 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 the pains and penalties perjury.
f--Ff&C-ti C L 6 �`
Print Name
Signature of Owner/Agent V Date
'I
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK
OF INFORMATION
Existing Proposed Required by Zoning
l r This column to be filled in by
a/ 2,CC �a 5' S Building Department
Lot Size 5^4 2j ACRaE°� 6 3 ,au
Frontage 170 l7� ( 1
Setbacks Front,-
Side L:1, 5 .4R:07 L:/25 R: Z�
Rear
SD
Building Height
Bldg. Square Footage � Z
175"Z
Open Space Footage
(L.ot area minus bldg&paved ;2- Dot,
parking)
#of Parking Spaces
Fill:
volume&Location
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 c:52_14� 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 t re any proposed changes to or additions of signs intended for the property ?YES—
No
IF-YES, describe size, type and location:
.... . ._.......
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413.587-1240 Fax 413-587-1272
j F
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR L6 UU Kv DWELLING
U Nov 10 2004
SECTIQN 1 -SITE fNFORM'ATIQN INSPECTIONS
1.1 Property Address: Th "ff�ce �
Map
L-Cl/l ZMe
EIm StDistr-ct s tH
SECTION 2 - PROPERTY OWNE R tiHILR/AUTH.0- 1 ZMAtLENT i ID .�
2.1 Owner of Record: Nov i
cA-1 /y j V ff 94 WA IONS
Na i Current Mailing dcl DEPT Of MKV.g s: Npg=tte�PiONYA 01060
Signature
Telephone/ y/3— �/ 'RD !S70
2.2 Authorized Agent:
J L 4 ��t lCi s y �o X9210 r y -fC S ��
Name(Print) Current Mailing Address: Dl0'T�
/-Yl�
Signat# Telephone
SECTIONN.3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use only
completed by ermit applicant
1. Building (a) Building Permit Fee
(voo cc)
2. Electrical (b) :aimated Total Cost of
Ccnstruction.from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3-+ 4 + 5) G l Cj0 a 00 Check Number
This Section For Official Use Onl
Building Permit Number: Date Issued:
Signature: _
Building Commissioner/Inspector of Buildings Date
r
File#BP-2005-0588
APPLICANT/CONTACT PERSON J C Pratt Builders
ADDRESS/PHONE 43 MONTGOMERY RD SOUTHAMPTON (413)585-1627 Q
PROPERTY LOCATION 348 WESTHAMPTON RD
MAP 36 PARCEL 199 001 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
T_vneof Construction: (ROUGH FRAMING ONLY)CONSTRUCT 36 X 15 DORMER(ENLARGE BEDRM,
DEN)&INSTALL REPLACEMENT WINDOWS&SIDING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 061401
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF�'RMATION 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 ion
v
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.
1 1
348 WESTHAMPTON RD BP-2005-0588
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 36-199 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Build'InQ DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2005-0588
Project# 3S-2005-0781
Est.Cost: $41600.00
Fee: $208.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: 3 C Pratt Builders 061401
Lot Size(s4.ft.): 294901.20 Owner: GRADY FRANCE
Zoning: SR Applicant: 3 C Pratt Builders
AT. 348 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
43 MONTGOMERY RD (413) 585-1627 (�
SOUTHAMPTONMA01073 ISSUED ON.11129104 0:00:00
TO PERFORM THE FOLLOWING WORK.-(ROUGH FRAMING ONLY) CONSTRUCT 36 X 15
DORMER (ENLARGE BEDRM, DEN) & INSTALL REPLACEMENT WINDOWS & SIDING
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• Receipt No: Date Paid: Check No: Amount:
Building 11/29/04 0:00:00 3881 $208.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
,-
� , � � � ._.- _�-,- .� �-'�r C' , �t � � _�. -�.
;-� ,
_.----� �, �-• �-g,�. �- tz; ,.�
� � �,��
,.
348 WESTHAMPTON RD BP-2005-0588
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36- 199 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-2005-0588
Project# 35-2005-0781
Est. Cost: $41600.00
Fee: $208.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: 3 C Pratt Builders 061401
Lot Size(sq. ft.l: 294901.20 Owner: GRADY FRANCE
Zoning: SR Applicant: J C Pratt Builders
A?: 348 WFST.HAMPTnn' ¢rr
Appiicaiu Aad ess: Phone: Insurance:
43 MONTGOMERY RD (413) 585-1627 0
SOUTHAMPTONMA01073 ISSUED ON.-11129104 0:00:00
TO PERFORM THE FOLLOWING WORK:(ROUGH FRAMING ONLY) CONSTRUCT 36 X 15
DORMER (ENLARGE BEDRM, DEN) & INSTALL REPLACEMENT WINDOWS & SIDING
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:q,;, ,! _ House# Foundation:
i���`� ' Driveway Final:
Final: Final: 1J
Rough Frame: O/�-
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
tNRU JZoaGIs R/d M�nIG oN�Y/
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 11/29/04 0:00:00 3881 $208.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo