03-024 (5) -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
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TO-: .FLORENCE SAVINGS BANK &
LAWYERS TITLE INSURANCE CORPORATION
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BEUEF
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 # 2 5 01 6 7
—NOTE—
SURVEYOR - THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
M,S —MORTGAGE LOAN INSPECTION PLAT-
NORTHAMPTON, MASSACHUSETTS
RANDAL.L PREPARED FOR
u IZ. H BERCUME BUILDERS, INC.
#35032 SCALE: 1 "=80 ' DECEMBER 27, 20.00
s RV HAROLD L. EATON AND ASSOCIATES,SU�IN .
REGISTERED PROFESSIONAL LAN
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
2 C,
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52 Alain Street 'uutlicil>nl Puildinr,
fhr:ml�tou, Mnt>>. Q1 060 -
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the col=tr ctor5 Kged bNon0p h2vi C}] '
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(1V31.1'.. of (Apr .0 1 ._,Ali-.! Cc...,;:...�
(Name of
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(2vame of Comm-)
I :lIll :;U�C pI(TI !IO )IlC
�- 1 :fill <? I:0:7];' A,'!�.�' al::' ,II t_.., v'-
w: r_ra�r. < :��'Y Ir ��.: acu<mnc�err Cc.,Y I �>.ur _.... in
riot mote lfL n t1 rco tan ti it:w{_:c�i n-t[�r al;c•- ` _ _
c�;y1o}�s urvlcr t}r«vd rt's a�� .,_.r:n r�:((;1,'.-`2_s 1(511. ,.,ic •. -
..,
lcgil dztnn of en..Whys under l::n
I u7dc,-ttwd diet a copy of th_. cuy f.o Iativnnlod to tf»LYtxirtsxil of I:>bi�n;.l��hrn=�'C_ioo of i:_..0 ua=o for Lzc
covca&c vcific-atioa and llut flilurc to sc�:uc N�rtn�ur.3-r zcGim 25A of?.fol.152 can lc d to the inl;v—iti
Ooasiuting off,fin,of up to S I,SDIDO wv r �f up to e,M civil lxrultic3 in do fcmn
firms of Sl(�.(1O a<iiy agzina m-_
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SECTION 8 -.CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / Not Applicable ❑ 7
Name of License Holder : 1` V � —01)
License Number
Address j Expiration Date
i
Signat re Telephone
9.`Re isteredHorrie-Irri r vemeiit Contractor ;„ , Not Applicable ❑
Company Name T Registration Number
Address y / Expiration Date
Telephone c 1-7 �GG
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...... ❑
IRA Nome OwnerExemp.tion
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
completion of the work fe-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 ❑
Or Doors ❑
Accessory Bldg. Demolition[] New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work:- 10
Alteration of existing bedroom _Yes _/_- No Adding new bedroom _Yes _- _ No
Attached Narrative ❑ Renovating unfinished basement Yes —/"_No
Plans Attached Roll ❑ - Sheet ❑
6a. If Newi.hou'se and or"addition to existing housing, complete the:.followin Y;
a. Use of building : One Family--_-___ T,%o 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
I. 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
OWNEf�S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
t, --Chef t4 � �_--.�[��_G�D -- -- - - --. -- --____- as Owner of the subject property
hereby authorize to ac; or
my beh_ If, in all matters relative orK �ut'no _,:d by .h building permit acplication
Signature of nor Dat�MEW
f7 s f✓9
as Owner r/Author zed 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 pans and penalties of perjury.
�7
Print Name
Signature of Owner/Agent Date _ —_
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Isisting Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size /� SOO
® UQ
Frontage
Setbacks Front Q
6
Side L: R: L: ®R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg R paved
parking)
#of Parkin Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 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 c.)ntain 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:
°DepaFttentuse only: � � t
z � ji
City of Northanipton Status of Permit s y
Building Depal tmenl Curb Cut%Dnveway� ,e rm it,
a x zx t
212 Main Street Sewer/SepticAvailablll.ty41ii-A
Room 100 Water/Well Avatlablllty�
Northampton, MA 01060 TvroSPts'0. rictural
{?hone 413-58; 1240 Fnx 413 58712%2 Plot/SitePlans
Other Specify
l APPLICATION TO CONSTRUCT, ALTE P ,�IV�TLRREH A ONE OR TWO FAMILY DWELLING
ri � (� i
JUL 1 LJ J� t1
SECTION 1 - SITE INFORMATION I
This section to be completed by office
1.1 Property Ad-dress: y,t ,� f Q )
I y '
___._..----•-----I a p Lot Unit --
Zone Overlay,District _
Elm St. District- _ _-, _ CB District _- ---
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2 /gyvn_e-r of Record: n /��� Q
5Z ._(O_ CO - )�(X -r 11�7tL�. / )'1
— - - nt .,ai� Address
-
i
2.2 Rut orized Agent_ /
i lilt,- C
�.��� , irJr:�,
- - -
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item -stimateu Cost (.Dollar,; tc �, � Official Use Only
mpi ted bv Fermi` 3pplic a nt -----
E (a) 3ui1c1ing Permit Fee
C h` t�mate Total Cost of
s onstruction fror7 (6�-- -- _-- -_-_--
f i�mbin------ �
Building Permit Fee
+ ��echanic�l (i''✓AC; i �i
5 Fire Protection
- - _- —
h-- � Check Number � �• —__
b=
Total + 2 , + 4
This Section For Official Use Only
Building Permit Number: __ _—__ Date Issued:_- -----
Signature: -- -- — - — --- ---
Building Coinmissioner/in pcc�or of B iildwg; Date
File#BP-2004-0049
APPLICANT/CONTACT PERSON Roy Omasta
ADDRESS/PHONE 21 North St (413)247-5666
PROPERTY LOCATION 575 COLES MEADOW RD
MAP 03 PARCEL 024 001 ZONE RR
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: ERECT 10 X 14 SHED
New Construction
Non Structural interior renovations
Addition to Existinp,
Accessory Structure
Building Plans Included•
Owner/Statement or License 006763
3 sets of Plans/Plot Plan
THE F 01,L(OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I✓ ORMATION 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 Co son
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.
BP-2004-0049
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0049
Project# JS-2004-0085
Est. Cost: $3200.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor., License:
Use Group: Roy Omasta 006763
Lot Size(sq.ft.): Owner: SCHWAB JONATHAN&CHERYL
Zoning:RR Applicant: ROY Omasta
AT. 575 COLES MEADOW RD
Applicant Address: Phone: Insurance:
21 North St (413) 247-5666 Workers Compensation
HATFIELDMA01038 ISSUED ON.7117103 0:00:00
TO PERFORM THE FOLLOWING WORK.-ERECT 10 X 14 SHED
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 7/17/03 0:00:00 14988 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo