17B-010 (2) G
ENDORSEMENT OF APPROVAL NOT REQUIRED (ANR) PLA
File with the Office of Planning and Development
City of Northampton,Massachusetts 2C'05
Use Tab Key To Move From Field To Field
1. Deed recorded in Hampshire County Registry of Deeds or Land Court: Book 5995 iPager32$
2. Street Address 408 Bridge Road_..
3. Assessor's Map: 47B Lot(s): 10 Additional property description:
4. Number of newly created lots: 2..
5. Check list of filing requirements(check the supplied items. Applications MUST have these items.)
Original,reproducible(mylar)Plan,with endorsed Seal of a Massachusetts Registered
Professional Land Surveyor.
Six(6)prints of the Plan.
Original and Six(6)copies of the fully completed and endorsed ANR Application form.
$150 per sheet fee plus$50 for each newly created lot(payable to"City of Northampton").
If any portion of a plan falls within 500 feet of a published control point(see
NorthamptonPlanning.org): four centimeter-accuracy points on each sheet tied into the
Massachusetts State Plane Coordinate System(NAD 1983 datum),using said published control
points or the global positioning system and noting the coordinates of the tie-in points,the datum,
and the source and location of monuments used for data.
An electronic version of the plan in model space in DWG,DXF,or Shape format including:
All property lines,buildings and geographic features shown on the plans.
Closure of all property boundaries of one part in 20,000
Plans show all buildings owned by subject landowner(s)within 100'of any newly created
property lines.
Plans include a statement that the Planning Board's endorsement is not a determination that the
lots shown are buildable lots.
We believe and understanI that:
(1) The attached plan is not a division as defined in the Subdivision Control Law and we submit
it for endorsement that Planning Board approval under this Law is not required; and
(2) we have provided all the information required in the checklist above; and
(3) The plans submitted are now in the public domain and may beopied freely i n orm.
Si gn atre:Applicant(print or type):
Address: �l L_ ['J,G c Phone:
f-L
Owner(print or type): t*5- 44, ,—Signature: /
Address: ,A _ Phone: S 4
Surveyor(print or type): ��hS'*'ort"►� p,sso�,a�ti Signature: �� �` �"
Address: 1A6_dkc" Phone: �3- =�4- X14�
Allow 21 days for processing. It is the applicant's responsibility to pick up the original drawing and
record it at the Registry of Deeds or Land Court within the time limits established by the Registry. All
copies and forms remain with the City. Applicants may file one copy of this ANR form with the City Clerk
to protect their appeal rights.
Date Submitted: r� ` '.LY�J Date Decision Zatu LCJ' i
City Clerk(signature): Clerk(sig
(ANR Application,Form A:last revised 11231200y)
�1tAMPT
Gzfig of Warthainvton r
$ � �lassachusetfs -
ry DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR '212 Main Street • Municipal Building
Northampton, MA 01060 '
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as hds/her construction sup,:.P`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 fai
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
�TIW1pj, i..
j F E 611 1 of �\Tc rfl}a111p 011
R l f �1X5%itchnrcII'l
d DEPARTMEIJT OP BUILDIIG INSPECTION'S
212 Main Strcct TTuwclpal Building
Northampton, Maas. 01060
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,
WORICCRIS C01VOENSATION t;ISURA.NCF A I , A.VIT
(li ccusxJpermitttx)
WILh a pri,-icipal at: — —
�rd e T-,L.G L L - S`T` i'r ~< (I none-')
(srr=V ci ty/sL-ad zi p)
do hereby certify, under the paint and penalties of penury:, :hat
4
I am an employer providing die followInQ tvorkcr's comocnsaoo, cove-'se for my
etuployces worUng on 1ilis job:
7e o ?� 67 Vac)
-!T (I�sw—mac Corr ) (Pobc-, N'umocr) --- (-_:pirdon D2j--)
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( ) I am a sole proprietor, ngeneral contractor or holneownef (ccie one) aid have hi
the conuaciors listed beJow wbo 112ve the folio%ving worker's policies:
(Namc of Cont^cw-1 Colnpan}-i-PoUc-i NIV-m='cI) (E-:.)IiJLQn D11c)
i
(Namc of Contrclor) (Las-arunec C.omoanvi?obm, \umcrr) �ipirtion Dzte)
I
(Name of Coaaacl ) (Lasumncc Compan)•/PoUq- Nu mbar) (Expir-suon Datc)
(Namc of Contractor) (Lnsu=c-- Comr�-- y/Policy Number) (Expiration Dale)-
(atsAch:.dds�o=J rbcct ifnco=�-•ti•to c�c?,�c inform-:ioa pctaaa:a6 to.11
O I am a sole proprietor and have no one worldng for me.
( ) I am..a home owner performs-no all the work myself.
�f 1��
j NOTE:pl==be awwc t+".NJj: bcmcowvc^s•J>O cSplay p o=lD Lj7 d. _ o t . f
trot mete th-- Lb' -t=nx is uilich the bomco+vocr read-,oc oa the aalZt a7v rua_r1 IL,,-e- o-x C-*--.-ny oeerdv>a k
-aVIOycs U-' t6c An(GLi152-n 1(5))•=pplicn.6on by a bomco-Da fw c Gam cc p—it try cvidmcc d-
i
IcVI ns-yc of na-=ployx uod r di w kr ec com{xmayion AeL
I y a--Ot d tba a copy ortlsi.= tc may be foci nrd..d tc tbo pcputmsd of lcadusric!A-4.&o(G.or 4> w+ roc the
o0verase vcrif GIIinO and th1 C-2t=to sersue bo^mse tinder socGoo 25 A of hiOL 152 c=I=d to the ic2pmirioc o(mmisui Pte°
com.isirxg of a foe 01,up to 51300.00 andloc 6nP isoamcai orup to ooc yr3r utd-,Nil pm..Jtio in t5c room or.Stop Work Ordc and
fray Of S 100.00 a d_y cPjC0I tnc
`7 t cr]ntI rtUtD1XS
J D f h Ln p.—_ Lot
Si of Lic=scc/Pcrrniucc e
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SECTION-8-CONSTRUCTION SERVICES +
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9Zerns"eie _ rnpc enercn o * Not Applicable ❑
Company Name Registration um er
/f A 7
Address Expiratft Daf
Telephone
SECTION 1'0-WORKERS'COMPENSATION=INSURANCE AFFIDAVIT(kG 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...... ❑
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-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 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
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SECTION 5-DESCRIPTION�OF,PROPOSED'WORK(check-all auOlicable)
New House ❑ Addition ❑:: Replacement Windows Alteration(s) Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding* Other[E j
Brief Description of Proposed S.�c 1 j 1 Xt y7-
Work: s C
-f d
Alteration of existin g bedroom Yes X, No Adding new bedroom Yes No ,
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll -Sheet
sa �f�ewhogser� �cTitor���cx�sinc��t�'sing��cornplefiet�i` aiiOw�nq:
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
L 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 Ta'-O.WNERAUTI[ORIZATION _T0 BE'COMPLETED;WHEN
OWNERS AGENT°OR CONTRACTOR APPLIES`FOR BOILDINGPERMIT
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 he by declare hat the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and bel' f.
Signed under the pains and penalfes of perjury. '
Print Name
c.
Signature of Owner/Agent Date
Section 4. ZONING All Informatibll 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
li
Frontage
Setbacks Front
I 1
Side L.' R:° ! L: R:
Rear
Building Height
Bldg.Square Footage I I % (- j
Open Space Footage % I(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 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 0 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 0
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:
i
D. Are there any proposed changes to or additions of signs intended for the property? YES NO 0
IF YES, describe size, type and location: I
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 ® ,- NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
city of Nortl��mpton
' Building Department ;
212 Main Street
X05 Room 100
Northa pton; MA 01060 V
,..paoel4i 3-587 1240 Fax 413-587-1272 fi
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: #' Thrs section to be completed by office
` w k x ,'
'e `- ;t►h ' .=-Lot a. ,Unit,
`Tone�� � -Overlay D1Strict
�^fIm,SE Distitct _'��..W '� �CB.�istr►ct = _ .
SECTION 2--PROPERTY OWNERSHIP/AUTHORIZED AGE,NT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
a4.,e. " //
Telephone
3igr�atw
2.2 Authorized Agent:
Name(Prin 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
G,
2. Electrical (4)Estimated Total Cost of
Gonstrucfion.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
Building Permit 'Date,
r.
Issued:
Signature:
i
Building:Commissioner/Inspector of.Buildings Date
408 BRIDGE RD BP-2005-0910
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17B-010 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2005-0910
Project# JS-2005-1272
Est. Cost: $13000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES HARRITY
Lot Size(sa.ft.): 186001.20 Owner: EQUITY BUILDERS REALTY TRUST
Zoning: Applicant: JAMES HARRIIY
AT. 408 BRIDGE RD
Applicant Address: Phone: Insurance:
41 CORTICELLI ST (413) 585-8025
FLORENCEMA01062-1240 ISSUED ON:3130105 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL SIDING & REROOF
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 3/30/05 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
408 BRIDGE RD • BP-2005-0910
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 17B-010 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BE 005-0910
Project# JS-2005-1272
Est. Cost: $13000.00
Fee: $25.00 PERMISSION IS HEREBY GRANT8D TO:
Const.Class: Contractor: License:
Use Group: JAMES HARRITY
Lot Size(sg.ft.): 186001.20 Owner: EQUITY BUILDERS REALTY TRUST
..,n;ng: RR 4viL&gntLJAMES HARRITY
AT. 408 BRIDGE RD
Applicant Address: Phone: Insurance:
41 CORTICELLI ST (413) 585-8025
FLORENCEMA01062-1240 ISSUED ON:3130105 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL SIDING & REROOF
POST TUIS 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:
Fire Department Fireplace/Chimney:
Rough: Oil: ' Insulation:
Final: Smoke: • Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT19N OF
ANY OF ITS RUILES AND REGULATIONS.
Certificate of Occ' anc Si nature:
FeeType' Date Paid: Amount:
Building 3/30/05 0:00:00 $25.00
212 Main Street!Phone(413)587-1240,Fax:(415)587-1272
Building Commissioner-Anthony Patillo