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44-103 (2) 1 n �v 0 In A th t16 ii iw FLr%l w wmi 11-w , ,.v,r, TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. BUILDING LOCATION ACCURACY IS NOT GUARANTEED NOTE: SUBJECT TO EASEMENTS AND >y RIGHTS OF WAYS OF RECORD. BOOK 9618, AGE 303 PLAN BK. 12 PG. 6 LOT # rn io rn ,/ FF f-3 CJ? �C 1V -j G" of G} �=• � ti rt 1 1 L=11 ROCKY HILL ROAD ROUTE 66 TO: PEOPLESBANK AND FIRST AMERICAN TITLE INSURANCE COMPANY 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:�� �. AND DOES NOT A PURPOSES CONSTITUTE APROPERTYSURVEY OF -MORTGAGE LOAN INSPECTION PLAT- NORTHAMPTON, MASSACHUSETTS RAE ALL PREPARED FOR IZER y DOMINICK LASAPONARO !35032 SCALE: 1"=60' MARCH 8, 2013 - HAROLD L. EATON AND ASSOCIATES, INC. SURV REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET - HADLEY - MASSACHUSETTS - 4 4 CITY OF NORTHAMPTON Cons' tructlon Debris Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work. -- =: - -covered.by-a-Building Permii shalt be disposed-of-in a-properly licensed.disposal facility, as defined by M.G.L: c.•111- § 150A. . Address of Work: yS/ ,E?oelc,4 9, c f tore r r; 114 o 6 Z the-debris_wfll.be-trans_po.rted by: The ddbris.will be received:a#:. ' Ca4 c/.h - Signature of Permit A'p11&ant 'Date 15� Ruiidin" g Permit Number: - r City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS r.1 y " 212 Main Street • Municipal Building yJt .b Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 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 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 �tls pp d �&o understand the above. (Home owner/resident'h 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual): Dom io I6 LQ<ct pay is r,5 Address: 14 31 PR p e k,l a a c City/State/Zip: F1 d ce , M N Phone M /�/3 s8� Z S' 7 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. F-1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. F-1 We are a corporation and its 10.❑ Electrical repairs or additions 3., I am a homeowner doing all work officers have exercised their 11.F-1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name 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. M 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 under the p ins and penalties of perjury that the information provided above is true and correct. Signature: y Date: Phone# 13 �g� `t(Z 5"7 Official use only. Do not write in this area, to be completed by city or town official City 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.Im prove metit 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 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 La and State of Massachusetts General Laws Annotated. Homeowner Signature. 0 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition EQ Replacement Windows Alteration(s) Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [O] Other[O] Brief Description of Pro osed ss d` 1 11 � i Work: Keyn&a;& l XrS�iV =s ckect� ar-J 'Ad A (vt/r14 T�O�In ;n A-kt- ��� "�� ��` �6 i h� i2 X (� Alteration of existing bedroom Yes No Adding new bedroom Yes ✓' No Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll -Sheet sa:If New house and or-'addifon to"existing housing, complete the follownd: 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. ��Z Dimensions e. Number of stories? / , �_ f. Method of heating? el,P c'�� /�6f /to4Jer �C�ctf Fireplaces or Woodstoves�_Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i'VG'4 7t-4n11_--'t 4 n11_--' i. Is construction within 100 ft. of wetlands? Yes V, No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade Z-/"C - 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 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 1, O Vh tN tC L0.SAP d r p. 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 of perjury. D D V11 i Yl L-•, k Gt5 ck S(A . d N a(\r) Print Name A� 51/0 ) Signature of Owner/Agent Date ^ ^ Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning 'nis column to be filled in by Building Department Frontage Setbacks Front LL�L RE Rear Building Height Bldg.Square Footage 9/0 Open Space Footage r7. % (Lot area minus bldg&paved I #of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? xDl �~� �~� NO ��' DON7KNOVY �~� YES �~� |F YES, date issued:| | IF YES: Was the permit recorded at the Registry of Deeds? NO K J DUNlKNU 'ES �� YY IF YES: enter Book Page and/or Document# �� D. Does the site contain a brook, body of water orwetlands? NO o�� DONT KNOW �=� YES IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tnbeobtained v,� Obtained «—� Date Issued: ��� «_� ' C. Do any d ��signs YES �~/ NO IF YES, describe size, type and location: D. Are there any proposed changes toor additions nf signs intended for the pmpert 0 y� YES NO .�Km� IF YES, describe size, type and location: ( | E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre orisd part ofa common plan that acre? YES K 3 NO K�� . x~� "�~ IF YEG,then u Northampton Storm Water Management Permit from the DPW ia required. w'.'. pepartrteht use ortlx V�ctr,- City of Northam pton 'Status;ofPer�� Building Department 92014 p 212 Main Street erl5e ticRoom 100 :W a te--- -- foras Northampton, MA 01060 Twa Sets ot5tructritai Plans Php 13-587-1240 Fax 413-587-1272 Plof/Site Plans . a �- i r k f 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 Map Lot Unit Zone : Overlay D►strrct Ibrt?v►ce , M N. i Elm St Distract C8 DiStnct SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: DOMIy1iC11 I.-ascapc 11urC2 -43 Name(Print) Current Mailing Addres : p Telephone Signature �1-3 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 i i n G (b)Estimated Total Cost of Construction from 6 3. Plumbing C7 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection ) Z GC2 6. Total=0 +2+3+d +5) ' a Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-1182a APPLICANT/CONTACT PERSON LASAPONARO DOMINICK ADDRESS/PHONE 431 ROCKY HILL RD FLORENCE (413)586-4257 PROPERTY LOCATION 431 ROCKY HILL RD MAP 44 PARCEL 103 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out /L!/I IS Fee Paid Typeof Construction: REPLACE DECK W/12 X 16 DINING RM ADDITION New Construction Non Structural interior renovations Addition to Existing Accessory Structure _ Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 Commission Permit DPW Storm Water Management Demolitio Delay / 4Signa 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. 431 ROCKY HILL RD BP-2014-1182 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44- 103 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2014-1182 Project# JS-2014-001999 Est.Cost: $10300.00 Fee: $96.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): 59241.60 Owner: LASAPONARO DOMINICK Zoning: Applicant: LASAPONARO DOMINICK AT: 431 ROCKY HILL RD Applicant Address: Phone: Insurance: 431 ROCKY HILL RD (413) 586-4257 () FLORENCEMA01062 ISSUED ON.511612014 0:00:00 TO PERFORM THE FOLLOWING WORK.REPLACE DECK W/12 X 16 DINING RM ADDITION 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: FeeTyne: Date Paid: Amount: Building 5/16/2014 0:00:00 $96.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner