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25C-024 (2) \Cxo PQ�n /�taws to x�4 � NE W dOrt�'1 ZoX�V' I6-w � o 1'Ae-o-t I 25G-oZ4 -ooi g 5c-262-oot TO: CITIMORTGAGE, INC. & CONNECTICUT ATTORNEYS 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 TliE 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- O O � � �iGlassetcf�usetfs DEPARTMENT OF BUILDD�G INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 y •y HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as has/her construction sup:-, ,,isor. 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 !0 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 i O��iVJ.fpTO ,R .`ti (rzf� LTf ��tt1:f��i11]1�Jf011 _ — 9 � E �la�aRrhacrtla• _ DEPARTME11T OP BUILDI)\G INSPECr10t.'S 212 Main Strcct Municipal Building Northampton, A1ass. 01060 { «r O RICER'S C O iKP E N S A'I"I O N L`z S URAI CE A I7 FM A Vii' I - \kritb a prLZCipaj place of business/residence at: i (phone:') (sa-�t/c�ty/stalcia p) do hereby certify, under tie pains and penalties of perj'ur ., hat ( ) I am an employer providing the follo%vine worker's coinoctisZJor coverage Cor In) etuplovecs working on uus job: Qmsumm=Corer ti) (Polio: NLmlyc'r) FIX pirtior, Dzir) i O I am a sole proprietor, general contractor or homeowner (ci c:e one) and have hued the coniractors listed below wbo hive the `olloIIV* g worker's cot pensa 'on po-tries: i (i'amc of Co_imc-Lor) On ur ncc Coinown YI cbci i f l (Name of Connclor) (1ris 2zcc Comoan}'1P0!ic-; \trrncrr) -p r;:tion D 1e) (Name of Coaracto,) (Inswaa= Compare)'fPoUq- Number) (ExpLra600 Date) (Name of Contractor) (Imuranccc ComcanyfPoUcy Numyzr) (Expiration Dar). (aazch-,64jcoc j e ccl.irocca--v to a�cu6c wforn,moc pertaiains w.1J ooa�-ro:-�) { ) I am a sole proprietor and bave no one worlang for me. } I am,a home owner perfot-rning all the work myself. NOTE:plesc lx aw:Lrt o,.-k{Je y pw cvs Ito cap cry pcsoas m d3—i- -•• rcpaa-ori an a d..ell_ of CDC mote than tl r:irtr in«',rich the bomoo avc resides or oa the p-waca zp•puricu-rs the-eo e-r Doc�arny ecrsdaoi to be c=Ploy�--3 b "�k �TM-- oa Acr GLt S2.ss t 5 ' � � )!.=pptfr3600 by a bOmcOaa7 rer:6r `Y__or pennrt ley--td_^OCY the j' lcp rtx=of as c=Ployer uada ttw Workxea Compomation Aa- I uadcnaad that x Dopy or thin mr®u.d may be ford carded to the Dcpercm_a Or, jj Aead nLS OIL of Irra r�ooa for tho --6t-c-tGc=,ioa and th1 C i]r�e to smyrc eorery� pion 25A of h10L 152 rsn lad to the i�OSitioa of Qimias!peatllio 000zisirzg of a fiat of up to s l500.00 arAlor it -i of up to Doc yczr and civu pcnattia io tx form Ora Stop Work Order'and a fish o(S100.00 r day apioit mr: F, u.c E--Pctmtt Numb= l,taP°—_ Lot n ; sig=tum of Lic=zec/Pcrmittc L)Bte SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable .lam 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.162,§26C(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 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 // - SECTION 5-DESCRIPTION OF PROPOSED WORK(check all ai)plicabtel New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg.'5;ir Demolition ❑ New Signs [O] Decks [p Siding[E3] Other[C1] Brief Description of Proposed Work: Ic,)c 14 GAM+J te"E'-'), w!'W /q ow--' C�0 S-rpru'E TAD Alteration of existing bedroom Yes>_No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. 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? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. 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 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 �-r" LSoN as Owner/Amthoro7ed Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signe under the pain and nal' s of perjury. Prime Date Signature of Owner/Agent 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 Frontage 5® jCs Setbacks Front /i3 Side L: 17— R: jZ L: +6 R: 40 —I Rear 8� L� Building Height 30 (z— Bldg.Square Footage 11-3 % /8'f 0 171 S Open Space FootageZ, ova ,O � (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 ® DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW )a YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only ;-City of Northampton Status of Permit-. Building Department Curb Cut/Driveway Permit 1212 Main Street Sewer/Septic Availability Room 100 WaterNVell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-58711240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: 0 9_2-c> NooCTT4e:-t AV EJfz3 E Map Lot Unit �tG�tt-iWV`nPTC�i MIN 61Cc 60 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of {Re/cord: NiM4 'k 7-0 N0,1Z3MeeW AVIENUE�1`iOCL`f�lRW1(jCGly I►M�F Name,(Print) Current Mailing Address: Telephone L; I2> t_jgc� 9.+- b Signature 2.2 Authorized Anent: 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 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of C> Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2006-1351 APPLICANT/CONTACT PERSON WILSON KEITH P&AMY L ADDRESS/PHONE 20 NORTHERN AVE NORTHAMPTON O 585-9476 O PROPERTY LOCATION 20 NORTHERN AVE MAP 25C PARCEL 024 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Typeof Construction: ERECT 10 X 14 SHED 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 F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,XMATION 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 Stree mmission 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-2006-1351 GIs#: COMMONWEALTH OF MASSACHUSETTS R CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1351 Project# JS-2006-1999 Est.Cost: $4600.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groin Homeowner as Contractor Lot Size(sq. ft.): 5009.40 Owner: WILSON KEITH P&AMY L zoning:URB Applicant: WILSON KEITH P & AMY L AT. 20 NORTHERN AVE Applicant Address: Phone: Insurance: 20 NORTHERN AVE () 585-9476 Q NORTHAMPTONMA01060 ISSUED ON:611612006 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 6/16/2006 0:00:00 $25.001059 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo