17A-099 (2) _ o
—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
► �q - 099
75'f
BARN
NOTE:SUBJECT TO EASEMENTS AND JEnnaED
RIGHTS OF WAYS OF RECORD. ASSES'°� S PIK51(
BOOK 9057, PAGE 77
PLAN BK. 37, PG. 12 i y -7
LOT #4
N
u
H / H-
#27 /
r
75'±
GRANDVIEW STREET
TO:
FIRST AMERICAN TITLE INSURANCE COMPANY
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—
SURVEYOR: �� --�� THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
t� —MORTGAGE LOAN INSPECTION PLAT-
�' s NORTHAMPTON, MASSACHUSETTS
i2 RANE ALL �� PREPARED FOR
U IZER ti MARION S. H OLM AN
035032 SCALE: 1"=30' MAY 25, 2007
Sk
SUR�IV HAROLD L. EATON AND ASSOCIATES, INC.
�
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
��t1AMp�,
Crxr ofrtzl�ttltt #arr
r
�1111ASSAC}tl[SCtf9 -
DEPARTMENT OF BUILDIJ0 INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Nortliwnpton,MA 01060 ,v s
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as 1-As/her construction sup 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 Ks idenet"7s ignature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
ti
:> issued to me.
Date d/_
Address of work
location
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
a 600 Washington Street
Boston,MA 02111
M s� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
4. I am a general contractor and I
1.❑ I am a employer with 6. ❑New construction
employees(fall and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no enVloyees These sub-contractors have g. Fj Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp.insurance. 9. ❑Building addition
required.] 5. F-1 We are a corporation and its 10.❑Electrical repairs or additions
3.� I am a homeowner doing all work officers have exercised their 11.❑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' 131C1 Other
comp.insurance required.] I I
' app roan a c ec ox must also out the section a ow s owing their workers' information.
compensation policy infoation.
t Any Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must 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.
lam 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 fine
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
Sim afore: Date: cT,4, 45L o
Phone#: 0
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#•
SECTION S-CONSTRUCTION SERVICES_
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
9 Retii§tei'ed llom "£' i' Not Applicable ❑
e°lmproyemenkContracfor� N: � �
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 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...... ❑
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) ❑ Roofing ❑
r Or Doors ❑
Accessory Bldg. ❑ Demolition t—+ New Signs [0] Decks [M Siding[0) Other
Brief Description of Proposed
Work: "'DE o'L-1SN 61WQ,) — b€TfJ016S ?Cj (SS0" CTUR
J No Adding new bedroom Yes '� No
Alteration-of exisfng bedroom Yes g •
Attached Narrative Renovating unfinished basement Yes ZNo
Plans Attached Roll -Sheet
s
owing:
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?
X f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes o. s cons ru 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
Q/&i 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.
a4�0 - -d
Si nature-of Own Date
I, Zee 1�1f j�. /ffli!l� ,a caned uthorized
Agent I6ereby declare that the statem its and information on the foregoing application are true and accurate,to the bes o my knowledge
and belief.
Signed under the pains and penalties of perjury.
�UL'/�/c � •
Print Name
Signature of Owne ent Or Date
02 =
Section 4. ZONING Al I Information 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
Frontage
Setbacks Front
Rear
Building Height
Bldg.Square Footage --------- %
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
A. Has a Special Perm it/Variance/Fi nd gi g ever been issued ` .
`
for/on the site?
' ---_--__—
IF YES, date issued:,
IF YES: Was the of Deeds?
NO v���
� DONr mxum ,cu
IF YES: enter Booh / | Page and/or Documont#
B. Does the site contain u brook, body of water orwetlands? NO tr DON7KNOVV �_/ YES
IF YES, has u permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained v-~\ Obtained �\~�~� Date�.� ' �
C. Ou any signs exist on the property? YES 0 NO K�T
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,gradingexcavation,o,filling)over 1 acre n,ioit part ofo common plan
that will disturb over 1 one? YEGK��) NO K��)
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton to t n
` Building Department
212 Main Street ep
Room 100
��07 ,::Corthampton, MA 01060
ph on 413-x,587-1240 Fax 413-587-1272
�A.PPUQATIOI t .0 I4STkUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE.INFORMATION
1.1 Property Address: This section to be completed by lice
��j1ol wow MaP Lot Ucut
(� Zone Overlay D�stcct
EIm St D�stnct CB Aistrict
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print Current Main f/n/.f
Tel�ne
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone_T SECTION 3-ESTIMATED'CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ` 3 4/ (a)Building Permit Fee
2. Electrical (b),Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) �
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number
This Section ForOfficiai Use Only
Date
Building Permit Number. issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2007-1232
APPLICANT/CONTACT PERSON TEMPLE LUCILLE G
ADDRESS/PHONE 27 GRANDVIEW ST FLORENCE (413)586-1906 Q
PROPERTY LOCATION 27 GRANDVIEW ST
MAP 17A PARCEL 099 001 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: DEMOLISH BARN
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 FPCLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
TATION PRESENTED:
pproved 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
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.
OWN BP-2007-1232
IS#: COMMONWEALTH OF MASSACHUSETTS
OWW " 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-2007-1232
Project# JS-2007-001962
Est. Cost: $3000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 9365.40 Owner: TEMPLE LUCILLE G
Zoning: Applicant: TEMPLE LUCILLE G
AT. 27 GRANDVIEW ST
Applicant Address: Phone: Insurance:
27 GRANDVIEW ST (413) 586-1906 (�
FLORENCEMA01062 ISSUED ON.612212007 0:00:00
TO PERFORM THE FOLLOWING WORK.DEMOLISH BARN
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 6/22/2007 0:00:00 $25.001933
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo