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28-004 Northampton, MA Property Detail Page 2 of 2 • 4 Additional Features: Lower 1 st Story 2nd Story 3rd St Brick Trim: 0 X 0 Basement One Story Frame Stone Trim: 0 X 0 IFrame Garage Remodeling Data: Open Frame Porch Year Remodeled: 0 Frame Bay Kitchen Remodeled (Y/N): Bath Remodeled (Y/N): Land Data Outbuilding Info Square Foot Type Utilities Type Feet Value no Prime information yp Qty ^��� Site 22'079 88°770 T e Year Size l Size2 Grd Co RS2 1 1990 I I 80 ©C Acreage Type RS 1 Ol 1990 64 ad ©C Street/Ro Type Acres Value no no information information Sales Info Permit Info Date L Type Price Validity Date Permit # Price Purpos 02/01/1991 Land+ Bldg 70,000 n Ino information http://www.northamptonassessor.us/noho/propertydetail.php?map_no=28 -004-001&pagec... 7/15/2008 Northampton, MA Property Detail Page 1 of 2 City of Northampton., MA: Residential Property Record Ca New Search Property Type Classification Code Reference Card 1 of 1 Parcel - Location - Zoning - Assessment Map-Block-Lot: 28 -004-001 Zoning: Assessmen Location: 396 SYLVESTER RD Neigborhood: 2 Land: #Living Units: 1 Deed Book: 3685 Building: Class: R-101 Deed Page: 106 Total: Dwelling Information Building Sketch Style: Ranch Year Built: 1947 Story Height: 1 Attic: None Basement: Part Total Rooms: 5 Bedrooms: 3 Full Baths: 1 Half Baths: 0 14 Exterior Walls: Frame 10 OFP 10 Unfinished Area: 0 Ground Floor Area: 840 42 12 Total Living Area: 848 20 1 FrlB 20 Finished Basement Living saa FG 0 X 0 20 z4a 20 Area: Basement Recreation Area: 0 X 0 42 Woodburning Fireplace 1 12 Stacks/Openings: 0/ 0 Metal Fireplace 0/0 Stacks/Openings: Heat/Central A/C: Basic Heating System: Warm Air Fuel Type: Oil Quality Grade: D- Physical Condition: Average Interior/Exterior: Same Addition Information: Condition/Desirability/Utility: FR Vacant/Dwell/Oby Status: Dwelling http://www.northamptonassessor.us/noho/propertydetail.php?map_no=28 -004-001&pagec... 7/15/2008 3-9 6 sVc, As-r�R- O� Quick Open Space Calculations Coverages existing 140 Lot area existing proposed existing 840 22079 2164 2356 existing 240 existing 144 Open Space 19915 19723 existing 800 total 2164 Open % 90.2% 89.3% new 192 new new total 2356 t r try :`� , "' ,•r r �. lu Nt�. ■ IF wow« « t i g ...'•. jr Ile ale ' ,t r t ; r t» t .- 1r ,• r:• r «° • t Via. ,,•,. t r" EL as , �r r h r' r r \ 'Oe Ile r — • ,1rr r : r .• y,« a r ,.. 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 your) 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 _v ? _ .,� understand the above. 1, 1 � z. 0 (�lr� (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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washing Qton Street - a Boston, MA 02111 .�� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. F-1 I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole propri etor 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. F-1 Building addition No workers' comp. insurance comp. insurance.: required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.Fj 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. 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 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 inform ation. 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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 thepains andpenalties ofpeijury that the information provided above is trite and correct. S ignature ..,'j;/ " '�' L�t 1.K Gs44 L � Date ? �.h 5 Phone# O fcial 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 Horne Improvement Contractoe 4 „,r! 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 responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. JHomeowner Signature r � SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition ❑ Replacement Windows Alteration(s) Q Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding[O] Other[O] Brief Description of Proposed Work: �C _ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to'.existing housi.ng 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 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 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. Print Name Signature of Owner/Agent -/ Date * .t 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 Setbacks Front Side L ,.., R. ... Rear Building Height -, _ Bldg. Square Footage % Open Space Footage % �� (Lot area minus bldg&paved parking) #of Parking Spaces __.__ _._.._.w Fill: (volume&Location) I _..,.... _. ..__. ., ., '­"­­j-­ ...,,..._...._. .._,, --9.-­ l,,,.. A. Has a Special Permit/Variance/Finding ever been issued for/'on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book i Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 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 0 NO 0 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 0 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. —R eparttrent use only City of Northampton Status ofPermrt ding Department Curb Gu#bnveway Permit 2 '2 Main Street Serer/septreAvailabltty Room 100 ,vailabiflty OO Nortf4a pton, MA 01060 TwaSets afStructural Plans lr, JUL AAA A130-5V-11240 Fax 413-587-1272 Plobtite Plarrs Ot#�er AS(LI C LTER,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 Tr(l? Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: /_ 1 �!j C. S L, .cam/ �- , A!C) !` L�(�tr'C`)k �� L�L'r!�y -'t Sir C 61 I211n_l C1-_ 1,2.4 a 16'e Name(Print) X77 f f :'����t f�G, ( f✓Lr,ey7 Current Mailing Address: —14 Ctf cT/�. .. �, —�6 ��. Telephone Signature 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 coin feted 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=0 +2+3+4+5) `` ,7 C, �� , -°) ') Check Number 7 s This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-0058 APPLICANT/CONTACT PERSON HURLBURT EDWARD H JR&MARTHA J ADDRESS/PHONE FLORENCE (413) 584-6765 Q PROPERTY LOCATION 396 SYLVESTER RD MAP 28 PARCEL 004 001 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinjz Permit Filled out Fee Paid r Typeof Construction: ERECT 12 X 16 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 INF ATION 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 Demolition Delay Signature of Buil mg 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-2009-0058 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-2009-0058 Project# JS-2009-000070 Est. Cost: $2000.00 Fee: $34.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 22084.92 Owner: HURLBURT EDWARD H JR&MARTHA J Zoning: RR Applicant: HURLBURT EDWARD H JR& MARTHA J AT. 396 SYLVESTER RD Applicant Address: Phone: Insurance: (413) 584-6765 O FLORENCEMA01062 ISSUED ON.712112008 0:00:00 TO PERFORM THE FOLLOWING WORK:E RECT 12 X 16 S H E D 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 7/21/2008 0:00:00 $34.603577 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo