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17A-057 —NOTE— THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. BUILDING LOCATION ACCURACY IS NOT GUARANTEED ty .9 J � a ----- 3 Q i TO: INFINITY MORTGAGE COMPANY & LAWYERS TITLE INSURNACE CORPORATION TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY # 250167 —NOTE- &' THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY SURVEYOR: AND' DOES NOT CONSTITUTE A PROPERTY SURVEY MORTGAGE LOAN INSPECTION PLAT— OF S NORTHAMPTON, MASSACHUSETTS RAN DALL �� PREPARED FOR E. MARSFA S . JANSON & JOHN L. ROLLINSON, JR. i o #35032 CAL 1 "=30 ' AUGUST 2 , 2002 suR�� HAROLD L. EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET — HADLEY — MASSACHUSETTS I eat (P6,4A V(& j �/9� l3�ioG�e �'oao � la- �Fc_o2e�c� I 3 New Oovlz�.Irl( 4ppaox. rY r gbh�'t col �ivi ors J( C 0.I � 0 r --}-. C) Gc c rF�q:inm 7(�r'il46 �l-A opcK of rq5 r300c�c FLcra-ence. C� pit Li TP(Sr LA-Y OLCT (FCA-Xl U i t-W) per ; , IJc-eK i IG zx 17 Ali t .xx 7 1 i �K►+narpr Gz#� of Xort4ainptou z = $ � �lassac{lusctts =' DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Nortiumpton,MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 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 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/resid nt s signature requesting exemption) I will call to schedule a 1 re uired building inspections necessary for the building permit issued to me. Date q — ( � " -0 5 Address of work location 16( j k3 n ' J qR– l2 4�t1AMp O goo afl �x of wart 11 ally ft111 9 B �ttssxcfrnsctts' cfl DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFI)AVTT (Itceuseelpennittee) with a principal place of business/residence at: (q.5 �G� f°S� i`K9-t.•(Ce- I1' 0062. (phone#) (st=Ucity/s &ZiP) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following workers compensation coverage for my employees worlQng on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiratioa Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional sheet if n6ocsury to include mfocmiIIoa pertaining t4 ell ooh radon) ( ) am a sole proprietor and have no one working for me, (r I am a home owner performing all the work myself. NOTE:please be awam that while hou=wnera who employ palow to do main�c=SzS lion or repair work on a dwelling of not moee than thrco units is which the honmwner rc=dea or oo the gcouods appurtcnanr thereto arc not gcrnratly oomidcred to be cmployrrs uncics the worker's ocmp=Aiioa Act(GL152,ss 1(5)),appdcaDon by a homeowner for a 60=3c cc Permit may-id—the legal star=of an employee under the Worico(Is compomat AcL I under s d that a oopy of this rhLtcmcUt ntay ba forwarded to tho Department of Industrial Aaadcof> Offioo of In�for the covtx g va-6catioa and that failure to azure oovmr under soctioa 25A of MOL 152 can lead to the imposition of criminal pcualties oonsistiag of a fine of up to$1,500.00 and/or imprtsoarncut of tip to om year and civil pcnaltia in d)c form of a Stop Work Ordcr and a fine of s L00.00 a day against mc. For dq—tn�—only -. Permit Number MaPI Lot# L,i of Liccnsee/permittee e :71 SECTbN,$ ;CONSTRUCTION,SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone en n �� Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone - 0 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...... ❑ � 4 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 ccrnpletion 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, S e and Local Zo ' g Laws and State of Massachusetts General Laws Annotated. Homeowner Signature c -- �a SECTION�� �DE� �P IOI� F PROPOSED W0F ch`� gall a licable � 3 New House ❑ Addition 0 Replacemen endows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [✓]" Siding[ ] Other [ ] Brief Description of Proposed Work: ncto con tguctioo o Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll o - Sheet❑ IM, s hip °� r�� edition fa existing housing complete the'J61'l.V9 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. Mascheck 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 _Owo SEC7l�ON 7a `�OW�[�ER�AUT,�OR(ZA'�ION '.TO BE:COMPLE'TED WHEN s� r o co AC�ro APP�>IES �o Bu�t:D1r�IG P RIVIIT 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 1 JT®ho Rol itylSO4 ' 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. Jo-ha Al-St)V Print N D���C��✓J Signat a of wner/Agent 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 / � A I'l I L 1 De c f< Building Department Lot Size 7/ 3 77.+ LLvl 4-11 A"I" Frontage - C:bl 4 1 - Setbacks Front Side L: R: 2 L. L: R: -30 /Ji Rear ` ' -3 c,7 O Building Height �7 (6'p� Bldg. Square Footage �Sr ,b % F Open Space Footage Y % (Lot area minus bldg&paved parking)t #of Parking Spaces Fill: volume&Location)_ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW tr 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 V 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 t IF YES, describe size, type and location: City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-58.7-1240 Fax 413-587-1272 " e z APPLICATION'TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING R'R 1 2003 SECTION: -$ITE INFQRMAT16N "ft This sects to b completed'by ffice 1.1 Property Address. MaY A �0e 1 l►r>i\1...���� l J I l� y6s�''vd " rys _.. CB District 5 ,Elm"St District" • � a� SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �,T©ht-t �oilirls®rl (�t'S t3�0���Ro 4 C-vrZ��Ce ®1QG2- e(Print) Curre,4 Mailing Address: 3 - 'Ab ,4867 Telephone ig ure — Authorized Agent: Name(Print) 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 T (a) Building Permit Fee 2. Electrica; (b) Estimated Total Cost of iU Construction from 6 3. Plumbing N' ,� Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) eck Number a This Section For Official Use Only Building Permit Number: Date Issued: Signature �BuildwngC4riimisslo�er7lnspec tor of:Buildings' , Dates File#BP-2003-0879 APPLICANT/CONTACT PERSON ROLLINSON JOHN ADDRESS/PHONE 195 BRIDGE RD (413) 586-4967 Q PROPERTY LOCATION 195 BRIDGE RD MAP 17A PARCEL 057 001 ZONE URB 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 12 X 16 DECK 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 INFO 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 2 oc7 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. 'Altl ' ft BP-2003-0879 GIs#: COMMONWEALTH OF MASSACHUSETTS ivtlt CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Deck Addition BUILDING PERMIT Permit# BP-2003-0879 Project# JS-2003-1420 Est.Cost: $850.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 8276.40 Owner: ROLLINSON JOHN Zoning.URB Applicant: ROLLINSON JOHN AT. 195 BRIDGE RD Applicant Address: Phone: Insurance: 195 BRIDGE RD (413) 586-4967 O FLORENCEMA01062 ISSUED ON:4125103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 12 X 16 DECK 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 4/25/03 0:00:00 1456 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo