17A-079 MORTGAGE LOAN IN � PECTION
THIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY
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CAROLYN STREET
THE PREMISES SHOWN ARE SUBJECT TO AND/OR TOGETHER WITH THE
BENEFITS OF ANY AND ALL EASEMENTS, RIGHTS, CONDITIONS, COVENANTS,
AGREEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD.
TO THE FLORENCE SAYINGS BANK AND THE FIRST AMERICAN TITLE INSURANCE COMPANY ONLY
To my knowledge, information and belief, from information supplied to me, I hereby report that the premises have been examined and that
this inspection plat shows the improvement or improvements as located on the premises described, that the improvement or improvements
are entirely within lot lines, that there are no encroachments upon the premises described by the improvement or improvement ony
adjoining premises, and that there are no easements of record affecting the tract shown hereon, except as shown.
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I further report that the premises shown on this plan is not located within a Fiood Hazard Area as shown onPlKl�
Department of H.U.D. Federal Insurance Administration Maps, FL
250167 0002 A ` LUSSIER H
Community Number NO.29848
Identification Date APRIL 3, 1978 _ � _ '�, '¢FGISTERE��a`�
P.L.S. NAt IA A-
OWNER OWNER RICHARD M. GLASSMAN
HUNTLE
& AMY YANNI
ALMER HUNTLEY, JR. & ASSOCIATES, INC. LOCATION 34 CAROLYN STREET
Surveyors • Engineers Landscape Architects NORTHAMPTON, MASSACHUSETTS
30 Industrial Drive East
Northampton, MA 01060 JOB N0. JDATE 1 SCALE
�t)otice(413)584-7444 fax(413)586-9159 01 -617 6/25/2001 1 "== 30'
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MassaC411setts
5T DEPARTMENT OF BUILDIj\'G INSPECTIONS /=
INSPECTOR 212 Main Street • Municipal Building
o y.
Northampton, MA 01060
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,,-,: , i;or. 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 occupancv
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
V i<
The Commonwealth of Massachusetts
Department of Industrial Accidents
4 Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): r i; t^,l
Address: L9�a', j-
City/State/Zip: #:
- 1 Phone
7Are you an employer?Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.4 1 am a sole proprietor 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'
insurance.$ 9. E]Building addition
[No workers' comp:insurance comp.
required.] 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 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' 13.7 Other
comp.insurance required.]
appp--titan t that checn box#1 must also fin 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.
TContractors that check this box trust 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
information.
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$1;500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fire
of up to$250.00 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 the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone
Offccial use only. Do not',wrrle in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle'one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
T
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction nnSupervisor: Not Applicable ❑
Name of License Holder: i' t,�a'E � 1e s z�e[ I�� 01 0 1 7l
License Number
Ns,F, r 4c in l ��' �✓
Address xpiration Date
�ss
/�
` 1J C✓7.&H 7
Signature —� Telephone
9..RegI§t&e&l4dniG1 Vroveinent Contractor s. 4 ;. Not Applicable ❑
Company Name Registration Number
Address Expiration Date
1 �� u �r'i.1M 1 �"�j Telephone 4 1 3 `• T7
,---- 0
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFiDAV1T(M.G.L.c.f52,§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....... 81 No...... ❑
ll.F-`Home Owner;Ex�>l�p�iy>
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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition �] Replacement Windows Alteration(s) Q Roofing Q
Or Doors E]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding r–I] Other[0]
Brief Description of Proposed
Work: n r✓ u,
RU)b 21 is '*a^f ,� $Chtc'w5
Alterati n of existir(g bedroom —Yes No Adding new-bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa if fVev�f house attd or a tdrtlon fo existrn4 Eiousinc€ car>ripfete`the c1[lowinc:
a. Use of building:One Family X — Two Family Other
Tot 1?Y15.410i,
b. Number of rooms in each family unit: t'^�"" r' "* Number of Bathrooms .. ���2;:x�^i1t°P�
c. Is there a garage attached? fr'
d. Proposed Square footage of new construction. L' Dimensions ' X
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. r) Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.'of wetlands? Yes o. s cons ruc ion wi i 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
as Owner of the subject
property
hereby authorize O LI G K c r
to act o my beh f,i all matter a tive tQ work a orized by this building permit application.
Signature of Owni i Date
1 as Owner/Authorized
Agent hereby declare that the s atements 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 O ner/Agent Date
� . ~
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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
Buildin.-Department
Lot Size
Frontage
Setbacks Front
Rear 75T—
Building Height A.5- :-A--
Bldg. Square Footage % W� o
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Locat on)
A. Has a Special Perm it/Vari nco/F for/onthe site?
�
|F YES, date issued:' |
IF YES: Was the permit recorded at the Registry of Deeds?
NO C ) DON'T KNOW 0 YES
IF YES: enter Book Page / and/or Document#
��
B. Does the site contain a brook, body of water orwetlands? NO �W� DO07KNOVV k~� YES
IF YES, has permit been nr need tobe obtained from the Conservation Commission?
Needs tobaobtaiomd v�� 0����nad �~� Oete �ssuad' | �
^�� �~� ' �
C. Do any signs exist on the property? YES x�� NO
IF YES, describe size, type and location: '
D. Are there any proposed changes tour additions uf signs intended for the property? Y[3 0 NO
IF YES, describe size, type and location: | !
E Will the construction activity disturb grading. excavation,or filling)over 1 acre misdpart ofocommon plan
that will disturb over 1acre? YES � ) NO K�)
^� �4
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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Department erse only: _ ro
City of Northampton Status of Perrrt ��
Building Department CurbC VDn, wayf-' Im J, `
.; s
212 Main Street SernrerSepticAaEfabrlit� a.
Room 100 aterNltell Avaifabtlity `= ry
Northampton, MA 01060 T,yo Sets of StnrcturaTPtans '
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Qther Spectfy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATIONT
1.1 Property Address: Thi Section to be completed by ofifce
2407
u� L C%
File#BP-2008-0106
APPLICANT/CONTACT PERSON ROBERT J DECKER
ADDRESS/PHONE 193 N MAIN ST SOUTH DEERFIELD (413)297-6797
PROPERTY LOCATION 34 CAROLYN ST'I
MAP 17A PARCEL 079 001 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
Typeof Construction: CONSTRUCT 29 X 20 ADDITION(MSTR BEDRM/BATH/MUDROOM/PLAYROOM)
RENO KITCH.GARACE ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 090170
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9 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
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.
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34 CAROLYN ST
---G IS#: _ COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-079 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category BUILDING PERMIT
Permit# BP-2008-0106
Project# JS-2008-000169
Est. Cost: $106000.00
Fee: $452.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT J DECKER_ 090170
Lot Size(sc. ft.): 11.630.52 Owner: FOX MARK 1.&CRISTI tiA
zoning:URA/WSP Applicant: ROBERT J DEC «R_
Applicant Address: Phone: Insurance:
198 N MAIN ST _ 41� 3) 297-6797
SOUTH DEERFI ELDMA01373ISSUED ON:816120117 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 29 X 20 ADDITION (MSTR
BEDRM/BATH/MUDROOM/PLAYROOM) RENO KITCH,GARAGE ROOF
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: � �� +F House# Foundation: �..
` Driveway Final:
Final:i-. 121°67 ;� Final:I f�lf'/�I
` Ile Rough Frame:
Gas: Fire Departure Fireplace/Chimney:
nil• Insulation:
Final:/,;;7-6701� Smoke: J Final: 0j-c 1 ltu J t-em►t
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
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Certificate of Occu anc Signature:
FeeType: Date Paid: Amount:
Building 8/6/2007 0:00:00 $452.001140
-12 Main Street,Phone(,M)587-1240,Fr.x: (413)587-1272
Building Commissioner-Anthony Patillo
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