12C-084 Top 6 to 8 inches of loam
ONE INCH STONE
WRAPPED IN
DUPONT GREENVISTA
41 CONTROL FABRIC
3
FRENCH DRAIN
SCALE
10'
5'
VARIABLE
° DEPTH
o:
: o
0
o ;
D. 0;
o ;
Minimum of 4'
o . .
o;o;o No. 5 reinforsing rods
o:: I I
o 0:
a a'
006 6 o a o° .7
y., 1Q,.°.oa;a°.a a�.o
aao";oa o .oa .aa
O A .,O ,A ,d >C3„ .O
END VIEW OF CONCRETE FOUNDATION
WITH REINFORCING RODS
AND CONCRETE FOOTING
SCALE
101
5'
PLAN OF LAND IN
NORTHAMPTON, MASSACHUSETTS
Prepared for& by
Eleanor J. and Wayne E. Brown
June 24th 2008
N
French
Drain
fD 44
PROPOSED
r --- ---
[20' x 28']
�- GARAGE
Driveway
RICK DRIVE - - --- -SCALE- --
6' 40'
14Itt{iim4
1' 10'
HOME OWNER EXEMP'T'ION ACRCiOWLEDGEMENT
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/footinas (before backfill).
sonotube holes (before your) a rough building inspection (before work is
concealed). insulation inspection (if required) and a final building inspection.
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancv
u_prtil the work caji 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 oft he 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.
(Ho#owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Address of work
location
The Co.rtmonwew%tI7 01 Ilassaciiuserts
=- Department oflnditstrialAccidents
- 4;Jace of InveStigaiio.=tS
-� 600 TT ashington Srreet
Boston, 1V14 02111
www.mass.o ovIdia
ti%orkers' Compensation Insurance Aftidm it: Build ers/Contractors/EIectricians/Pli inbers
Armlicant information Please Print L.egibl�
Name(Business/OrganizatiotL',Individual):—.� -
City/State/Zip: o1o<1,`Z - /re T Phone 1:
A ❑re you an employer?Check the appropriate box: Type of project(required):
1-❑ I ari a employer with
4. 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 proprietor or parmer- listed on the attached sheet- 7. ❑Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in an i employees and have workers'
3'capacity.P ty 9. ❑Building addition
[No workers' comp. insurance comp. insurance.+
re u rPd �. ❑ We are a corporation and its 10-❑ElectricaI repairs or additions
q ' - ]
3.2 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. ['-,\-o workers' comp. right of exemption per MGL 12.7 Roof repairs
insurance required.] ' c. 1=2, §1(4),and we have no
employees. [tio workers' 13.0 Other
comp.insurance required.]
'Any applicant that checks box=1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors trust 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'rave
employees- If the sub-contractors have employe,they must provide their workers'comp.policy number.
I am an employer that is providinJ workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name- _
Policy#or Seif--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
trine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORD ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DLA for insurance coverage verification.
I do hereby certify nder the pains andpenaldes of perjury that the information provided above is�true�and correct
SisnatLre: 'GGL Date: . LCJte°
Phone 2- 7,-'�
Of Ilse only. Do not sprite in this area,to be completed by city or town offi-ciaL
City or Town: Permit/License Y
Issuing Authority(circle one):
L Board of Health 2.Building Department 3. Cir,,Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
{ 6. Other
i - I
i Contact Person: Phone T: I
Quick Open Space Calculations Coverages
existing 72
Lot area existing proposed existing 960
10579 1132 1692 existing 100
existing
Open Space 9447 8887 existing
total 1132
Open % 89.3% 84.0%
new 560
new
new
total 1692
r D►s "
SECTION 8-CONSTRUCTION SERlft'CES
88.1 Licensed Construction Supe^rsor: Not Applicable ❑
Name of License Holder:
License Number
address Expiration Date
signature Telephone
I
Not Applicable ❑
:omoanv Name Registration Number
.ddress Expiration Date
Telephone
ECTI.ON 1:0-WORKERS'COMPENSATION NSURANCE AFFIDAMt'f(M.G L.c.'152 §-25C(&-J)
corkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
the denial of the issuance of the building permit.
aned Affidavit Attached Yes....... ❑ No...... ❑
' way
' r er
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. SLtth Edition Section 1083.5.1.
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-vear period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that hetshe 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 undersizted"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State ofI Massachusetts General Laws Annotated
Homeowner Si-nature
v'
SECTION 5-DESCRIPTION Or PROPOSErJ' WORK(check all aDolicabie)
New House Addition Replacement Windows Alterations) Roofing
rr Or Doors
Accessory Bldg. Demolition L—! New Signs [0] Decks [L-- Siding jGj Other[pj
Brief Description of Proposed V 6
Work:PU✓'T/aIC /iv F°0 t°A.0'gr 16 lr.,q GARnK�-F Iwo futvr� �Rc(dc 7`lov�+ � 110 ss£
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
roes �ttc o��a, anion,. zt`sitr>cr io�ustria Qii� [ €�:1he.fotfoinr�r�4:
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
c. Energy Conservation Compliance. Masscheck .Energy Compliance form attached?
h. Type of construction
i. Is construction-within 1GO 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 ✓a.-OWNER AUfHQRt7 TIQlr1 SASE COMI?� TEII`V4(ffEi�I
OWN Ell S-AGEWV0EZC0NTRACTORAPF IFS EQt BE 1�IIfl P JVFIT
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
as Owner/Authorized
F.gent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowiedge
and belief. i
Signed under the pairs and penalties of penury.
Frint Name
i
-icnature:f Cwne,, .gent Gale
If
Section 4. ZONING I All information Must Be Compteted. Permit Can Be Denied Due To Incorfiplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size � j
Frontage
Setbacks Front 20 ...
Side L•'3.,�_._�' R R ,;Z3
Rear
Building Height' -
__
Bldg Square Footage R--- -- -...._
Z % Z
Open Space Footage �-7Ti; %
(Lot area minus bldg&paved 7T!` � - � ' 73
narking)
of Parking Spaces 3
Fill: ��A c
(voltmte&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW 0 YES Q
IF YES, date issued:z
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
If YES: enter Book Page, and/or Document.#'.
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:_ _ M
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location.
D. Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation, or filling)over i acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water anagemenfPeRfiitfrom the DPW is required.
Departcirer t use only°'
City of Northampton Status of Ferrnif
Building Department Curb Cut7Drrvevvay Permit
0o 212 Main Street SerarerlSeptrcAvarTaboity
Room 100 ttttater}�ltlett.Avatatiit�ty
_ Northampton, MA 01060 Tyro Sets o#Strleat Ftaris
phone 413-587-1240 Fax 413-587-1272 Plotlst#eans
i �, - E}ttier Sp�c�y
-7 ApPt 1 ATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
J1
L SEQT�ION 1 -SI E1NFORMATION
--— This section to be completed by office
1.1 Property Address:
27117 /UX)l .>�ryA 4/'/uE Map: Lot Unit
/C'L 6 1-, IL I m . U/o L 2 done Overlay District
Elrrr St district CB District
SECTION 2-PROPERTY OWN)=RSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Addre s:
5-s4-iz - z'7-7 y
�I'✓?1 Telephone
Signature
v'
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-IESTIMATED..CONSTREI ON COSTS'
Item Estimated Cost(Dollars)to be Offic�at Use Or<[y':
completed by Permit apolicant
1. Building � &n7d+ng Permrt Fee
2. Electrical (b),Estimated Total=Cost of
eonstruct it)
rT.froFn-(6'
3. Plumbing Suflding Permit Fee
4. Mechanical(HVAC) _
5. Fire Protection
55 Y5
6. Total=(1 +2+3+4+5) 'C heck Number
This.Section Far:Officiat Use.Only
Building Permit Number.
Signature:
Bu�lduig;:Commi§sionerllnspector.:o: ui mngs' - Date
File#BP-2008-1183
APPLICANT/CONTACT PERSON BROWN WAYNE E&ELEANOR J
ADDRESS/PHONE 44 MARY JANE LANE FLORENCE (413)584-2779 Q
PROPERTY LOCATION 44 MARY JANE LANE
MAP 12C PARCEL 084 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T_ypeof Construction: CONSTRUCT 20 X 28 DET GARAGE FOUNDATION
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
INFLATION 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 Bu ding O icial 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-2008-1183
GIs#: COMMONWEALTH OF MASSACHUSETTS
. 2C 0$4 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-2008-1183
Project# JS-2008-001743
Est. Cost: $3000.00
Fee: $135.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group. Homeowner as Contractor
Lot Size(sq. ft.): 10585.08 Owner: BROWN WAYNE E&ELEANOR J
Zoning:URA Applicant: BROWN WAYNE E & ELEANOR J
AT. 44 MARY JANE LANE
Applicant Address: Phone: Insurance:
44 MARY JANE LANE (413) 584-2779 O
FLORENCEMA01062 ISSUED ON.613012008 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 20 X 28 DIET GARAGE
FOUNDATION
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 6/30/2008 0:00:00 $135.00145545
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo