32A-035 (3) -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 BE RECORDED.
i
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
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P�
E
TO: CITIMORTGAGE, INC. &
LAWYERS TITLE INSURANCE CORPORATION
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY # 250167
_ -NOTE-
SURVEYOR: �• .1. THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY-
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
tNs -MORTGAGE LOAN INSPECTION PLAT-
. s+ NORTHAMPTON, MASSACHUSETTS
RAPIDAL L PREPARED FOR
E. TARA K. EMERY
�ER
' X3§032 SCALE: 1 "=20"' JUNE 10, 2002
' s p HAROLD L. EATON, AND, ASSOCIATES, INC.
235; EG STERED PROFESS(QNAL,l LAND SURVEYORS
REGISTERED
SELL STREET , "' .<, LEY - Q$Ewd
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Crz#p of Nerfilampton
0 ass a Chits tIts
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street * Municipal Building
Northampton, MA 01060
>r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as iris/her construction supc:-,,isor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or hpo fanzily
dwelling, attached or detached structures accessory to such use and/or fann 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 buildine inspection (before work is
concealed), insulation inspection (if required) and a final buildine 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, �oL_ k• Cm er understand the above.
(Home owner/resident's sigftdture requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date (o — _ d_3
Address of work
location �.
0 4 rn / rl
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oQtttAlrrp0 — --
9= Crxfu if '\Tartl(tilliplLill
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J31 csaacflusr(le' �
P p
'zrn 1)1:PARTM,ENT OF PUILBIT�G INSPECCl 11S
212 Maui Street ' Mumcipal Builtlinr
Northampton, Mass. 01060
I
VVORTQ�,R'S COMTENSATION INSURANCE AFF1_DAVIT
i,
(li�nsce.'rfrnt tuc) - -----
%vith a principal place of businessh-csidence at
(Strccuctt;l:; --
do helCUy CCrili}r, IMACl- 1110 yams anti penaltic" of pc'1111Y, i11F'i
( ) I am an employer providing the follmvlmt %volit:cI-'s COMPe'nsat_ion cover2ge for my
en)plovees wolking on Llis job
(Insurance:- Company) (Peiic;Nu.,ilbcr) - -— (E>.T.)ir,tion Date)
( ) I am a sole prounctor, general connactor or h0II1COWDef (circle one) and have Hired
the contractors listed below who Have the -.vorkers coil pensation policies:
M
(Name of Contactor) (Insurance Comoa:.•;,'Policr NumL--_r) (Ex* radon Date)
�r
(Name of COI:tT-,C10r) _ (lnstlrand Comma v/Poilc; Numtrr) (l:xpim lion Date)
---- --- -------
(Name of Contractor) ([nsur-nec Cornip.m .!Polic; Numn! r) ,.a a Date)
--------------
(Name of Contractor) Date)
Py
(ru.,dt:dai:ictia ri::et ifr:<rcnrr:cr. i7:.!:?c:::.KlnlaO(:,::S:Il::::L`i,:.:eii�r<.:�':• 1
O I Lull it sole pmprieu)r and have no one .vorkin for ale.
I Riil t1 11011?e Oti'!!lC: pertomlIII7 Ill 'he
1+O Ili:plc:ae be nt�-a:e lira:�ti'.:ile he<neaatr_ra�+':a�e-.. 1 •>---::to<.�•- •�..el!in:,cf
.'-➢oY�....., ..�c�cuncS cL:.:::r,:r.:�cs tci;au��„n 4:..
not ux'”th n tluuo w'ks in ML cdt the to vurrs rra: et cu tla •;.:t a:,uric; r1 L>GCto z r ra<ccrxrally
cMployca under tlr (GL152.:3 1(5)),zppl::t•icn 17,a hO1nco%%-x1 for t l cnr�c<per:t:it:::'.y c'•','<tac t!`=
Icgal claws of an employer uoder tLo Wcvkorc Comp rnation A.d.
1 underhand tLas a copy of tlui ctatrnxnt ruAy be for wruSed to tI»Dgxrta a-d of l od utrid Arcilrn&OfG of L•::uru>x for th.
covcnge vcnfic3tioa and that fidure to segue covernso raider section 25A of MGL 152 can I"to the inrl>oson of cri.mLJ' pct•.ab'cs
comisting of a fine of up to S1,300.00 ar-r&I-in,: isormc.: of up to ew.5zar end civil perW6c3 in dx form of n Stcp\Vcrk or'3-usd a
°^ fins of 5!00.00 a asy avast ttr
rt
For dcpwtr'w2eA u►o Drily
Permit Ntuntxr — -----
,' :.testa:.ceJPcrnutttc.k *,
.t
.1,
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SECTION'9 ,CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : _
License Number
Address Expiration Date
Signature Telephone
eQ s e e me mprbvement Contractor a � " i'rt Not Applicable ❑
RUM_012wi .axx G ua..,Grp„ "
Company Name Registration Number
Address Expiration Date
Telephone
k0.
E ?ION 1�OWORKE'RS' COMPENSATION INSURANCE AFFIDAVIT,(M.Ga. 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...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellinils 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 hefshe 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 fe-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
r Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signat re —
x
•� d
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
G,� Q Building Department
Lot Size �� ` W a
Frontage
Setbacks Front 3491 0?
t �
Side L. R: L:�U R: f�
Rear S
Building Height
OF
Bldg.§g1jare Footage 2 % 9Q
Open Space Footage J %
(Lot area minus bldg&paved
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 i— 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 n/ 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: No PA2K/^/6 (cN rr t No j4/M/N6 CPars•hs S
S7ILEE7- S/6 N `Corner oP CA rr y + pw r a•'
D. Are there any proposed changes to or additions of signs intended for the prooperty?YES _
No ,
3(L .
I F-YES, describe size, type and location:
# k.'
Air
" M.
City of Northampton S afus o, r ,
Building Department Cbt�/tD, a, p
2 212 Main Street SM r' Se tic at ab �r�
{� Room 100 Water7Wef1 A�atla` tf"
I„J � �R
r ampton, MA 01060 Two Sets ofStr"c ra P a,. £ y
phone 4 7-1240 Fax 413-587-1272 Plot/SitePlns _�
JUN 1 3 2003 other speei .,.
APPI-LCAIION—TO—CANSTF UCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
DuPf OF BUILDING!NSPECI IONS
NORTHAVIFON,MA 01060
SECTION 1 - SITE INFORMATION
This"secttonto be!completed by office
1.1 Propert Addr ss: �� '
t "
T, llri t
Map Lot��� a� r«.��
�N
Zone Z/"— OverlayDtstr ct
Elm St. District_ ____ CB DtstYrict
SECTION 2 - PROPERTY OWNERSHIP7AUTHORIZED AGENT
2.1 Owner of Record:
-7- iL-L- e M r &/n k 7
Name(Print) Cur nt Moillina A d ess:
_ _ ?elephon
nature
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 permit applicant
1. Building - 00 — -- (a) Building Permit Fee
2. Ele,-ncal (b) = :timated Total Cost of
_ Construction from 6
3. Plumbing O Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection 0
6. Total = 0 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: d Date Issued:
Signature:
Building',,CocymissionerllnspecfaF f,l3U►JdVr Date p �",r
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