05-048 (13) FROM Gougeon&Locke Builders FAX NO. : 14132680354 Oct. 20 2004 01:15PM P1
GOUGEON & LOCKE BU I I DERS VOICE;: (413)268-9323
26 SOUTH STR("LT, WILLIAMSBUR0, MA 01096 FAX: (413)268-0354
MOBILE: (413)374-6287
EMAIL: glbuild(a),verizon.net
FAX COVER SHEET
TO Building Inspectors ATTENTIONOF: Linda
REPLY REQUESTEDP ❑ Yes ® No WHEN?
BY: ❑ Mail ❑ FAX or ❑ Telephone
PAGES SENT: 1, plus this cover DATE:
SENT BY: Jim Locke SUBJECT: Sperry addition
NOTE: Hi Linda- Here's the plot plan for that addition foundation I applied
for this morning. The dotted line to the rear of the house is an existing deck. The
new addition will he on the right side of the house. The house has an attached
garage and a separate garage, too, and the attached one is closer to the street line
than the addition we're building will be. The actual dimensions to the lot lines on
this plot are more accurate than those on the application,within 5%or so. Let me
know if you need more info: 413-374-6287, and thanks, Jim Locke
Transmitting to FAX number: 587-1272
FROM Gougeon&Locke Builders FAX NO. : 14132680354 Oct. 20 2004 01:15PM P2
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P. 1
10/14-'04 SAT CU IS FA.I 18028665106 SPERRY GROUP -+- SPBRRY NOIiE
001
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THIS PUT IS COMPILED FROM DEEDS, PLANt AND OTHER SOURCES AND IS NOT
TO DE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO OE RECORDED.
BUILDING LOCATION ACCL4PACY IS NOT GUARANTEED
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TO: FIRST A?W.RYCAN TTTLE 10SURANCE COMPANY
TO THE BEST OF My INFORMATION, KNOWLEDGE AND SELIEF
I HEREBY REPORT THAT 1 HAVE EXAMINED THE PREMISES AND RMED ON EXISTING
k10N'JMEWATIoN ALL VISIBLE EASEMENTS. ENCRoAL%MENTS AND SIALDINGS ARE LOCATED ON
--l- .e Qumwm awn TmAT TFIIr BUILDINGS ARE ENTIRE Y WRNIN 7W t OT t iMFC,
t.
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 001992
Birthdate: 12/05/1946
i �
Expires: 12/05/2005 Tr.no: 11510
Restricted: 00 i
JAMES W LOCKE
26 SOUTH ST ,
WILLIAMSBURG, MA 01096 Administrator
Beard Of BsiWine Rtgulatioaa and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 100209
Expiration: 6/12/2006
Typo: Partnership
GOUGEON&LOCKE
James Locke
26 South St.
Williamsburg,MA 01096 �~
Administrator
-= - - 10 Department of Industrial Accidents
— OtliC9Of IBM ff9atluns
600 Washington Street
Boston, Mass. 02111
Worikers' Compensarion Insurance Affidavit
tf
C• J1 L-B- .,- GOUGEON LOCKE
26 South Street
lam ,
Cj I am a homeowner perforning all•-•cec:nvself.
[) I a n a sole proprietor and have no er._ .vcrxing m any capacity
Q I am an employer providing wor<:rs• _cceensation for my ernpIoyees working on utis job.
comeanv name: GOUGEON St. LOCKS
26 South Street
a
Whams burg, MA MY96
city- C ��p /� / phone#:
jasar�nez co.
(A-W fLi(l PZAVI�'1 �/4S ��S pole W(.�J Q��✓ 7�j /. 3•
Q lam a sole proprietor,general concnlctor,or homeowner(circle one) and have hired the cot�cis listed below who have
the following workers' compensaicr--ciices:
company name:
addrtss-
c�tV- phone*tr
comgary name- -
a2ddress ..
city: phone*
nofic #
ins�nee co•
Failure to secure coverage as required under-5,--non:5A of.N1GL 152 can le=d to the imposition of criminal penalties ofa floe up to sizoo.00 and/or
one •ears' imprisonment as well as civil peaaida is:he form of a STOP WORK ORDER and a rime ofSiDO.DO a dsr spinst me. I understand tbat s
copy of this statement may be forwarded to t1c 4i ice of Investigations or the D L-k for coverage verification.
!do hereby certify under the pains and?-e= a of perjury dra the information provided above is true and=rr--
S i gn a. - �,/ Ca_. Date 7 `12 6 7
Print name Ci t9 Pher.:= Ye/ l Z•6 S'9 3 Z,3
of iCial use only do not write in this ar-s m se completed by city or rovrn oiTcial
ci r�• or town: permit/license# -Banding Department
-Lirming Board
check irimmediate response is require•] "�eectmen's OtTice
-Hn(th Department
contact person• phone;- -Other
—.1"W ;•os NA)
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / / f Not Applicable ❑�iQ
Name of License Holder:
License Number
Address / Q Expiration Date
Signature V Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
-- L,//z Ztzr6
Address Expiration Date
Telephone Z4-10--?.32 Zj
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 162,§26C(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...... ❑
11. - Home Owner Exemption
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 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"homeovvner"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 ❑ Additio Qvl [� Replacement Windows Alteration(s) Roofing
F,V� Or Doors 0
Accessory Bldg. ❑ Demon ❑ New Signs [O] Decks [Q Siding[0] Other[O]
Brief Description of Prppossed
Work: 0,41 J S'mil' ��L l Z�Yh �
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. if Newhouse and� additio o existing housing, complete the following:
a. Use of building : One Family Two Family Other.
b. Number of rooms in each family unit: Ll@ umber of Bathrooms _3-Lex g "�(
c. Is there a garage attached? Ywj, f�-
d. Proposed Square footage of new construction. //&FJ Dimensions g x S 4( fi K
e. Number of stories? / /
f. Method of heating?Itt.44A / i%E,Cflr Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction &"4 , '00,V"` "-"-
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? 4� 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
I, W � S`"� R / as Owner of the subject
property
hereby authorize
to act on my behalf, in ag ri atters relative to work authorized by this building permit application.
Signature of&wneIr V Date
as Owner/Authorized
'Age 911 eby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
an belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Own ent 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
Q Building Department
Lot Size ( ae/w)
Frontage
Setbacks Front -Q"1r A,-n CiLakLg L,[
l Q
Side L:i R: I L: W"�R: 90
Rear 3805
Building Height t-l" to
� "A4crl
Bldg. Square Footage d, + '% %( t �� ,e
Open Space Footage r o/a
(Lot area minus bldg&paved 3S-31W !9,/D
parking) i
#of Parking Spaces
Fill: n tG
(volume&Location)4' ftC✓� lru�
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW
YES ' °2-7a' `fa rPA-r e_q4l &J '(S Vk4,,,L°fK'te�& P&Ad
IF YES, has a permit been or need to be obtained from the Conservation Commission? O t %100'("W'eer
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 ere any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
Department use only
n r f Northampton Status of Permit:
It �' l" t5� �u I l ng Department Curb CutfDriveway Permit
?12 Main Street Sewed Septic Availability
��1 (� ,i Room 100 Water/Well Availability'
r Norfiar:,npton, MA 01060 Two Sets of Structural Plans
phone 413-587'1240 Fax 413-587-1272 Plot/Site Plans
-' Other Specify
I
APPLICATION TO CONSTRUCT,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 office
n
3%-4 Avc(u �uv� - l , Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: RA(J�" l/t �Vlll r - Ice
Name(Print) Current Mai ing Address:
Telephone
Signature
2.2 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 , (a) Building Permit Fee
2. Electrical vG ` (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) / '2 Q S 0 Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2005-0484
APPLICANT/CONTACT PERSON James Locke
ADDRESS/PHONE 26 South Street WILLIAMSBURG (413)268-9323
PROPERTY LOCATION 324 AUDUBON RD
MAP 05 PARCEL 048 001 ZONE RR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 40 4
Fee Paid
Typeof Construction: CONSTR(JCT FOUNDATION ONLY FOR 18 X 54 ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 001992
3 sets of Plans/Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INV�MATION 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: § )OC�41P -v(340
Finding Special Permit Variance* On�C,y
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 ion
tbC�
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.
��4�
BP-2005-0484
324 AUDUBON RD
COMMONWEALTH OF MASSACHUSETTS
GIs#:
CITY OF NORTHAMPTON
av:B10Ck:OS -048
1VI PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Lot: lo
Permit: Buildim DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Category:
Permit# BP-2005-0484
Proiect# JS-2005-0636
Est Cost, $61295.00
Fee: ost, $0 PERMISSION IS HEREBY GRANTED TO:
Contractor: License:
Const.Class: 001992
Use Group: James Locke
Lot Size sq. },. 306119-160 vyp ; SPE-RRY-R I MAER&CLAUDIA
Zoning:RR Applicant: James Locke
' AT: 324 AUDUBON RD
Phone: Insurance:
Applicant Address: (413) 268-9323 Workers
26 South Street
Compensation
WILLIAMSBURGMA01096-9726 ISSUED ON.-10122104 0:00:00
TO PERFORM THE FOLLOWING WORK-CONSTRUCT FOUNDATION ONLY FOR 18 X 54
ADDITION
POST THIS CARD SO IT IS VISIBLE FROM THF. STREET Building Inspector
Inspector of Plumbing Inspector of Wiring D.P.W.
Underground: Service: Meter:
Footings: ,-
Rough: House# Foundation: 6 k
Rough: g Driveway Final:
Final: Final: Rough Frame:
ilr.Ttar±n:eni
Fireplace/Chimney:
Gas: Fire
Insulation:
f!-- Rough: Oil:
i-
Final: Smoke:
Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu an Si nature:
Feel e: Receipt No: Date Paid: C t:
Check No: Amoun
Building
10/22/04 0:00:00 13326 $165.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Conunissioner-Anthony Patillo