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25A-050 Northampton, MA Property Detail Page 2 of 2 Brick Trim: 0 X 0 Stone Trim: 0 X 0 Lower 1 st Story 2nd Story 3rd Remodeling Data: 10ne Story Frame Year Remodeled: 2007 lopen Frame Porch Kitchen Remodeled (Y/N): IFrame Utility Bath Remodeled (Y/N): Land Data IL Outbuilding Info Square Foot Type Utilities Type Feet Value no Prime information Site 19,400 139,090 Type Qty Year Size 1 Size2 Grd Prime RS2 �1 1995 0�9 ©� Acreage Type Street/Road Type Acres Value no no information information Sales Info F Permit Info Date Permit # Price Purpo Date Type Price Validity 05/15/2007 1110 6,983 NEW SIL 08/24/2004 Land+ Bldg 68,000 11/30/2004 625 5,534 NEW WIN: http://www.northamptonassessor.us/noho/propertydetail.php?map_no=25A-050-001&pa... 10/23/2008 Northampton, MA Property Detail Page 1 of 2 City of Northampton, MA: Residential property Record "9 New Search Property_Type Cla_s_sification Code Reference Card 1 of 1 Parcel - Location - Zoning - Assessment Map-Block-Lot: 25A-050-001 Zoning: Assessm Location: 22 CROSBY ST Neigborhood: 8 Land: #Living Units: 1 Deed Book: 7960 Buildin Class. R-101 Deed Page: 85 Total: Dwelling Information Building Sketch Style: Ranch Year Built: 1954 Story Height: 1 Attic: None Basement: None Total Rooms: 5 Bedrooms: 3 Full Baths: 1 Half Baths: 0 Exterior Walls: Alum/Vinyl 6 c Unfinished Area: 0 44 Ground Floor Area: 1188 13 aFP Total Living Area: 1188 zss Finished Basement Living z� i $$ z r 0X0 Area: Basement Recreation Area: 0 X 0 44 Woodburning Fireplace Stacks/Openings: Metal Fireplace 0/ 0 Stacks/Openings: Heat/Central A/C: Basic Heating System: Hot Water Fuel Type: Gas Quality Grade: C_ Physical Condition: Average Interior/Exterior: Same Condition/Desirability/Utility: AV Addition Information: Vacant/Dwell/Oby Status: Dwelling Additional Features: http://www.northamptonassessor.us/noho/propertydetail.php?map_no=25A-050-001&pa... 10/23/2008 Home Town Structures 627 Southampton Rd Westfield , MA 01085 413 562-7171 a34+'�` � tee; 10' X 14' wooden structure with Vinyl Siding and a tan shingle roof. ` L .s i � I r ;m i �c all Poll a c POO ' SI 4 10 V V a r a 1 ''' ti HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 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 I, understand the above. (H o ner/resident's fignkRke requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 6 Address of work location 12c`� C V^65; S:t The Commonwealth of.4fassachusetts Department of Industrial Accidents Office bf Investigations 600 ff7ashington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name (Business Organizatiorv'Individual): � w4D 1, Address: a CV1Q5 k L4 City,iState/Zip: - Phone #: 7Ae an employer?Check the a propri to box: Type of project(required): m a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction ?.❑ I am a sole propri etor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in an capacity. employees and have workers' Y P n'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5• ❑ We are a corporation and its 10.❑ Electrical,repairs or additions -1. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.KZ Other file ! comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the nacre of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un rte ains and Penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL Citv or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: 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 Improvement 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...... ❑ 11: -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 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 respo ibility for compliance with the State Building Code,City of Northampton Ordinances, State and Lo 1 Zo Laws an State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [7 Addition F7 Replacement Windows Alteration(s) El Roofing ❑ Or Doors F-1 Accessory Bldg.S—er Demolition ❑ New Signs [❑] Decks Siding [❑] Other[E3] Brief Description of Proposed Work: i N STAt,t, S}tEQ / "T Alteration of existing bedroom Yes X No Adding new bedroom Yes k No Attached Narrative Renovating unfinished basement Yes _ k No Plans Attached Roll -Sheet 6a. if New house and or addition to existing housing, 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? 11 l d. Proposed Square footage of new construction. � -`� Dimensions e. Number of stories? ') f. Method of heating? 1� �� Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. (�' Masscheck Energy Compliance form attached? h. Type of construction U q too nQ �(�1�..1[�l S 4NO Is construction within 100 ft. of wetlands? ^^ ,,Yes �No. Is construction within 100 yr. floodplain Yes 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 ,,— X-14, LJIU I 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 1, s Owner uthorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to th of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date 4 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 Lot Size Zia 4�?..� . ZOO(7 .. .,. . W I 5 1 �L Frontage _ _ __ Setbacks Front Side L: R:. I�`.-R �r3t� _ .... L: Rio u��.�I l FSS Rear Za- t" Building Height X Dal V6(A)A-V,1636 Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) �... _ .. S{i E L) - �59 #of Parking Spaces Fill: _ )7H (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued forlon the site? NO 0 DONT KNOW [, YES 0 IF YES, date issued:;,' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES IF YES: enter Book _ Page and/or Document#'' B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 0 NO 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. r "r Department use only City of Northampton Status;Of Permit: Building Department Curb Gut/Dnveway Permit 212 Main Street SeW6r/SepticAvalabiiity Room 100 WaterfWell Availability Northampton, MA 01060 TwoSetsof Structural'Plans phone 413-687-11240 Fax 413-587-1272 P1otts4e Plaris =. OtherSpecify; _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 as Cvb5�� S+ , Map Lot Unit tivwott�wx f lzu ULI Zone Overlay District / Elm St-District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: wv-f , \0, Name(Print) Current Mailing Addr L4 l o Telephone Sig 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 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) drO ' Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-0469 APPLICANT/CONTACT PERSON DION MARK W&CAROLYN R ADDRESS/PHONE NORTHAMPTON (413) 586-2237 Q PROPERTY LOCATION 22 CROSBY ST MAP 25A PARCEL 050 001 ZONE URB(100)_/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out d) pe go qcz Fee Paid c Typeof Construction: ERECT 10 X 14 SHED New Construction Non Structural interior renovations Addition to Existing Accessory 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 INFjORMATION PRESENTED: V 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 Permit DPW Storm Water Management Demolition Delay 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. BP-2009-0469 GIS#: COMMONWEALTH OF MASSACHUSETTS " 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-2009-0469 Project# JS-2009-000635 Est.Cost: $4500.00 Fee: $28.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 19384.20 Owner: DION MARK W&CAROLYN R Zoning URB(100)/ Applicant: DION MARK W & CAROLYN R AT. 22 CROSBY ST Applicant Address: Phone: Insurance: (413) 586-2237 () NORTHAM PTONMA01 060 ISSUED ON:1013112008 0:00:00 TO PERFORM THE FOLLOWING WORK:ERECT 10 X 14 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 10/31/2008 0:00:00 $28.0032579 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo