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VAA K C:IL Id6 S" 0tjCRLx1'c �ou� WpuS -MsftPv 1NT) !Z" Fnr,i PA14��f4A t=des'+' wAt.LS (7 3 F6 o F-19 (7-) 3 i GirJC•5a�1 iot�t��l c PP 3 x 3000 PSr wWCIe0'0(r-t. .Pf� i-(XDA a,n ilt 4-<A LL AJ 1;C• W 6 G IA''rOZ5:/Ow A}SPeuTs ter" Co -raiTitIS Cj_qLAl2 I � c � Aw?-2 ant •: +t 7t W QdD r T Ijo! zwsr. _ i r ; CFi'�« 1 i f r € I t tit E•W 7~L oa r'Z f2 L A ta( i 7R_'= AAA CriN of .�aLtll�ni}ifo�l — DEPARTMENT OF BUIL.DIRG INSPECTIOF S - I::SnC-C1'00 272 Alain StrCCt ' A4unicipnl I3tiildinr, �, I Nor Lim mpLori, Hass. OIOGO Square Footage Amount 3aseme.,t P - $,15 67 _ Z7 d lst Floor @ $-�o 2nd Floor E $_30 1/? Floors, Attic. Garage Deck Porches $_15 TOT-Ai/ r ��tlAMp�, Grzty of &Naxrt4antp#art - �I855A[hltStttS J o • m DEPARTMENT OF BUILDING INSPECTIONS I. INSPECTOR 212 Main Street * Municipal Building 'a,� s •` Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups,,'sor. 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 I, 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 r" 1 �.u✓t/�N te ' -0 ficc: ti -- � 1E 6 f1�135 AC11 tt6[tt5 � = ^� m L)EPfiRTMENrT OF EUILDDI G INSPECTIONS 212 Alain Street ' Municipal Building ' Northampton, Mass. 01060 WORTCER'S COMTENSATION INSURANCE A Y t AVIT Frith a principal place. of businesslre:;icence Mr1tP��_C1PCti. �t1?� 1� 6/66 '� _(pllolle'=;` 13-568 �� (stTce tic ir:i: do hcrC)y Ccr—df1', undi-n- dic ),aiils i'.ild pena ltl, . Oi pC;fjllll 1lli!_ O I am an employer providing the follo,.vint ..ori_c>1s compensation covert c for my employees working on thus job: (In_nuancz- Compain) (-c-c:Nualbcr) ( Gil Ll^l Date) ( ) I azi a sole prounetor, genera± c:ona-a(7`or Ui t?oT 0 -ner ;circle one) and 'gave tliret the,, contractoIs lIsteC below„fho iiavc, the -w pr mp orrt scot., en�:�o� (r:AS➢C Of CO 1tnCLGi) (I IlSLI'I1C� l vIP.^-.:7}'/PGtlef rJlliZli) (��; . ..iGa Date) (Name of Conti,,cto:) -- (7IlSJ P.CC Cn-mra.tti,(Pdic- Nun,b--S} (I xGir tiny D2tC) (ir'ame of Caatractor) (lIIS� 3I1C� ( O :1 t/2�Q�1�: T U111rr=I� (_ \;,i;: 0 Dat') NName of Cont lctcr) —- (IasZ r nc-c- Comr Y;y(i'olier Numb--r) 71tio-Date) (stLlGl:.(�'�l:1Mal SC:Crt::;]G.:rSV. LO L:1'.1.I2;:::'[:[a[:Ct: Gf--:eIi C:G7o:�i:c•l X / I <7rT] �, SUIC })1'Upr]CR)i iti11 i]i?VC i10 nn". (, I am <L home O�VII^.` iiCi`C` Ii11Ii� ll i'. iI Y: lt. NO"fF:plc:sc u-,au-arc L+::_.lL-ilc k <;KV t:r z ,:�r.:.�!. +, ;,.__:Vuxcc c�:r_r m Cr,-)air '- not UKvc th--n 1 rcc unite ir,u9 ct Lht 1 ,r;:i rc: a u o.' •_:.^s zr t cr rS Lhcdo c cxt�crsalY)'cc ::ci:::': tt c-^.aploya-z urx:cr Qr work&Z t x-�:_i n,c;((ii.!52�2!O),a,: ._a:ia:vv a h(,mco,t-rr for Gca_.c cc legal etatue of cn n:xployx uaur tLn Wortielr t:oz.;>ar...tion Aci [tutde,•:v,.ad thi:a copy of t2t✓elate:--^•r_uy bo fa-�ti'Ytrc.ir.!to cir,[Y_Siart:lrizt oFlndav:.riJ An--iL�v�Citicw of i:_+-ra.�:a Fot 11x coverl&c v>rificiioa and th.t f:ilurt to a!a c coG rg~urd r zcC,ict125A of tCI.152 rut lui to the impoziLio.-t o;r iy nal pa:ml%:es romist ng of a Cur of up to S I SOU.CuJ nt;;p too }- ..:.1 civil xrutt u in do f<nn cf a St-,) lh :t 1 s fry oCS100.00 a day ig.inr.1 m= - For dr�;artnatai u�c crtty i Ycrmtt Nutntx�r _ -- -- Mal;" - _ r SUCTjON 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: { Not Applicable ❑ Name of License Holder : C�/��60� S�/Q.�l f/ll�� CS License!Number U 7 1 2/- Zo 05- Address Expiration Date q13 Signature Telephone Reg s e e rn ma o ement Contracto Not Applicable El 0105 4?U/[.o/—:4 S / Zoo 8,5 Company Name Registration Number /0 - l S- 2 i 0 Address Expiration Date Telephone SECTIOIZF30�1N0„RKERS' COMPENSATION INS URANCEWAFFIpAVIT(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....... .0I No...... ❑ 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"homeoNvner" 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 SECTIO R PT ONOFJ?ROPOSEDIVORK checklJ:a lacale New House ❑ Addition ]S( Replacement Windows Alteration(s) Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition) New Signs [ J Decks Sidin g[ ] Other ( ] Brief Description of Proposed Work:-AQ/),f/oAf or Dri1E-STaIQ�/ FAM ,?nn nAFRFA,Q OF ycqSE lF,(7EFiJSlaw1dF,Fl71-u Alteration of existing bedroom Yes No Adding new bedroom Yes _ No Attached Narrative 0 Renovating unfinished basement -Yes No Plans Attached Roll 0 •Sheet 0 d�tionto ex stinoi "sing=, c�ipie a fieo` Iow-�ng 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?—A) d. Proposed Square footage of new construction. 3 a0 Dimensions 16 W X Z o L e. Number of stories? OA).= Z�iZo G(.Eq� f. Method of heating? /-/0 7-Ai/Z Fireplaces or Woodstoves �_ Number of each F&zE A-eG g. Energy Conservation Compliance. )EE s Mascheck Energy Compliance form attached? pie) �! u h. Type of construction 2-X Woo oD Fk�r 44 a 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 4' k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer�_ Private well City water Supply SEC�TI© NERD U HORI-ZATJON; 70 BE COMPLETED WHEN f OWN F, E CO� GTOR A�PPOES FOR BU(LDIPCG'PERIVIIT I, /V�cHa1-A s SCy,j-r,y f a Owner f the subject property hereby authorize L?soK y s7' to act on ISignature behalf, in all atters relative t work authorized by this building permit application. ' z Z of er Date I, GRF'G� P fTif�Ai�"NE/� as Owner Authorized Agent hereby declare that he statements and information on the foregoing application are true and accurate, to the best o my knowledge and belief. Signed under the pains and penalties of perjury. G` C­.-a" ,V P i li�/C-ZJ Print Ni m L Z� a Signature of n A ent Date .. 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 Building Department Lot Size o cs o 5-A A4 U f Frontage lad 5,4 M L Setbacks Front Z 2 Co Side L: I R: 38 L: Z/ R: 3 8 Rear yS 3Q O Building Height 14 /4 Bldg. Square Footage c % 1,73R, Open Space Footage % (Lot area minus bldg&paved GOp/ SS O 8 Z parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO '4_ DON'T KNOW 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 _ 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: D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF-YES, describe size, type and location: a � City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 t� x APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAIVItL D €LLINt, . MAR 2 9X0 .4 SECTION 1 -SIT:E CNFORMATION 1.1 Property Address:• r a F)-,6 R 6—/V CL= MA 5 SA C14 u 5 t r-r S SECTION.2 PRO:PERTY::OWNERSHtP%AUTH.ORIZED AGENT 2.1 Owner of Record: Nicyoc CyNrirll - 61e1M,4LPj CxDler v.-- , i5ry6eF- A/K Name(Print) Current Mailing Address: Telephone Signature 2.2 Aut zed Agent: (:5-2,5 6oRV R � rR�rin/E2 Name( rint) Current Mailing Address: 1,3 - 565- /0510 Signature Y j Telephone SECTI0Nk3 EST(`MATED CONFSTRUCnON°COSTS Item Estimated Cost(Dollars) to be off icial Use Only completed by permit applicant 1. Building (a) Building Permit Fee 'y0�4 Ob 2. Ele c.rical (b) ,-Estimated Total Cost:of Construction.from 6 3. Plumbing 21 S76 o Building Permit Fee 4. Mechanical (HVAC) 4,200 5. Fire Protection — 6 — 6. Total =(1 + 2 + 3 +.4 + 5) A/5. 70d Check Dumber This Section:For Official Use Only Building•Fermit Number: Date.Itsued: Signature: Building Commissioner/lnspector'of'8uildings Date r File#BP-2004-0920 APPLICANT/CONTACT PERSON GPS BUILDERS ADDRESS/PHONE 48 MARLA CIRCLE WESTFIELD (413)568-4056 Q PROPERTY LOCATION 27 RICK DR MAP 12C PARCEL 088 001 ZONE URA �( J� 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: CONSTRUCT 16 X 20(FAMILY RM&EXT KITCH)&8 X 8 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 053457 3 sets of Plans/Plot Plan THE FOLLOWING 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 C ssion Z� 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. 27 RICK DR BP-2004-0920 GIs#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 12C-088 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-2004-0920 Project# IS-2004-1371 Est.Cost: $45700.00 Fee:$217.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GPS BUILDERS 053457 Lot Size(sq. ft.): 10018.80 Owner: GRIMALDI NICHOLAS D JR&CYNTHIA Zoning:URA/WSP Applicant: GPS BUILDERS AT. 27 RICK DR Applicant Address: Phone: Insurance: 48 MARLA CIRCLE (413) 568-4056 O WESTFIELDMA01085 ISSUED ON:416104 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 16 X 20 (FAMILY RM & EXT KITCH) & 8X8DECK 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• Receipt No: Date Paid: Check No: Amount: Building 4/6/04 0:00:00 1623 $217.60 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo S 62'10'50" E 100.00' --- apparent building encroachment 0 0.7ft o shed 0.1 ft 5.1ft 16.0 8.0' 30.9ft deck o shed 4.9ft o proposed Ln } N \addition Z 21.0ft 38.7ft O CD O O O N O O v O O m 21.3ft 38.4ft i porch i N 62'10'50" W 100.00' o RICK DRIVE: kilAR 2 r A 60' WIDE PUBLIC WAY,.-,, .,7 LEGEND 0 FOUND IRON PIN UNMARKED POINT of AA 0 RANDALL tiN E. v IZER y #35032 "EXISTING CONDITIONS== suRV PLAN OF LAND IN NORTHAMPTON, MAS SAC H U S ETTS PREPARED FOR NICHOLAS D. GRIMALDI, JR. AND CYNTHIA M. GRIMALD SCALE: 1 "=20' FEBRUARY 23, 2004 HAROLD L. EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET — HADLEY — MASSACHUSETTS 413-584-7599 413-585-5976 (fax) email — hleaton®aol.com 0' 20' 40' 60' flAlOZ 4!��ZeC �Gfi�ly� �ovy r;SM T 27 RICK DR BP-2004-0920 GIs#: COMMONWEALTH OF MASSACHUSETTS Lot:-0 01 1 12C-088 CITY OF NORTHAMPTON Lot: -0 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-0920 Project# JS-2004-1371 Est. Cost: $45700.00 Fee: $217.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: Use Group: License: GPS BUILDERS 053457 Lot Size(sq ft.): 10018.80 Owner: GRIMALDI NICHOLAS D JR&CYNTHIA Zoning:URA/WSP Applicant: GPS 3U 1L ERS AT: 27 RICK DR Applicant Address 48 MARLA CIRCLE Phone: Insurance: lJ) 568-4056 O WESTFIELDMA01085 ISSUED ON. '6104 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 16 X 20 (FAMILY RM & EXT KITCH) & 8X8DECK 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:P&dlk� vC Houe# Foundation: Z( W C Rough;—/e'-� Driveway Final: r Final: S c{j 4`� /'030/0 {l�RG� Rough Frame 64 �nJ/ Gas: Fire Department /` l r X G Fireplace/Chimney: Rough6 - Oil: T Insulation: Final: Smoke: THIS PERMIT MAY BE REVOKED BY THE Y OF NORTHAMPTON ANY OF ITS RULES AND REGULATIONS. ON UPON VIOLATION OF Gi Certificate of Occu anc Si nature. FeeTVpe_ Receipt No• Date Paid: Check No: Amount: Building 4/6/04 0:00:00 1623 $217.60 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo