17C-201 (4) -NOTE-
THIS PLAT 1S COMPILED FROM DEEDS, PLANS AND OTHER
SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE
SURVEY AND IS NOT TO BE RECORDED.
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TO: FLORENCE SAVINGS BANK AND —NOTE—
FIRST AMERICAN TITLE INSURANCE COMPANY THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING AND DOES NOT CONSTITUTE A PROPERTY SURVEY
MONUMENTATION ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON �Q�tN
OF �' '�
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, wtnoau —MORTGAGE LOAN INSPECTION PLAT—
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN E
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR ; NORTHAMPTON, MASSACHUSETTS
/35500 32 PREPARED FOR
COMMUNITY # 250167 y FFSS BRATTON COURT NOMINEE TRUST
o ��
SURVEYOR: �� su SCALE: 1 "=20 ' AUGUST 29 , 1995
—. HAROLD L. EATON AND ASSOCIATES, INC.
`4' REGISTERED PROFESSIONAL LAND SURVEYORS
2.35 RUSSELL STRFFT — HADI FY — MASSACHUSETTS
_" -.._
I
�UZ AUG 9 2MO
Alteration Narrative for Acces.Soj:y Anortme,nt � DE111 l7(
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w a DEPARTMENT OP DUILDf\FG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
w0 RICE, IZ'S C0 MT ENSA710N INSURA-N CE A F AVIT
(li ck v- Pcrmi ttcc)
\krith a principal place of business/residence at:
(phoney,)
(Sax---Uci ty/statr-fa p)
do hereby certify, under tic pains and penalties of perjury, -hat.
( ) I a-n an employer providing the following workers co►nncnsaion covervIc for ln}
eluplovecs worming on this job.
(Insu any Comp-acy) (PoLic:Nfimb-cr) --- (i :-piratior, Date)
( ) I am a sole prooricior, general contractor or homeowner (ci;cie one) a_nd have hired
the contractors listed below who have the following workers COMDens26on policies:
'' (Name of Cont-+cto-) (1nsliranc; Comoan)vT'oUct Nu-ml-c-.) Datc)
(Name of Contractor) (Insurance Company/-Policy Ntrnccr) expiration Due)
(Name of Com-actor) (Insuranc: Compao)-[Polio• Nu nkr) (Expiraoo Daic)
(NMC of Contractor) (LaSUFMCti Compafry/Policy Numb,U) (L-xpu-ation Daic)
(ntli.c�addi:ioc�1 c'xci if ucc�s.:y to ac udc inf"-Mxn oc Pc-u nin6 to all oDair on)
( ) I am a sole propnetor and have no one working for me.
am.a home owner performing all the work myself.
NOTE:plc b twat tr,,.M{ ]C txaro-v_n Nbo Cmpioy p,=,aw to d:) rc�au work ou,d..c1I-.m&of
not mote th_n ff--rn—'—o in%"MCe>the k>ocmouver Ido a oo the p-ouac 3 zapuiten.�.rIl tbeGO LT we Ce- -Uy oec'..(3-rd to be
cmployc-3 une-the«uirt:oc:�rioa Act(GLI52-�1(5)�zpprica6on by a homco%� far c lice(x pcnr-n Lb
Icy OW), of ea cm,layer uodct d>a WorVices Coc poop ioo Au
I u-6—fund did a ooyy o(tbii aitcmcm may b.fog xnnSnd to tbo pcpert_,A of lnd.isricl Aoodcutf Offioo o(li��rot rho
covcrnsc vcfjfiaoa aid aw f-L-Tc to ccnirc c -r&-E�c uadcx scQ oa 25A of MOL 152 c�.la.d to the-4>-s fioa of aimi-A pcnaltia
ooaiiriu oft Cinc orup to S I}00.00 and/or
rim of S 100.00 t d-y tpia�tzKLOa �of up to otx yvt end aviJ pmat'o n to fo vi o(n Swp Wo{Od z eDd a
/�� For dcp=nn>,�1 u,c only
����d:/�,�Z Pcruiit Ntimbcr -
-� Lot -
c - nom-
SECTION$ C6NSTR0CT10N"SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
,
:fie 1 ' vie :en tt r t `,.� .� ..`". _ ... .._:. . � �....�. . .rio Not Applicable ❑
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...... ❑
twl IOU
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.Aperson 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"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and Local Zoning L ws and S of Massachusetts General Laws Annotated.
Homeowner Signature
GTION 5 DESCRIPTION OF PROPOSED WORK{check aljappfl;cable
)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition[] New Signs [ ] Decks [ ] Siding[ ] Other[ ]
i
�r�a, � s������ !";���•� ���'� a�aa�� Ix�,rrt" in't v w::.�.� ssc�� c��; j-. ,
Brief Description of Proposed Work:
i
Alteration of existing bedroom Yes / No Adding new bedroom Yes _�� No
Attached Narrative B' Renovating unfinished basement Yes No
Plans Attached Roll o - Sheet
cousin A WWI
WI
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?
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
SECTION-7i OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNt"RS,-AGENT'OR CONTRACTOR APPLIES FORBUILDING PERMIT
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
a��t /14w��1 , as Owner/Authorized Agent
hereby declare that the st tements 4nd 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 Owner/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
Building Department
Lot Size
Frontage
5 C� r Vii`
Setbacks Front I '
Side L: R: L: � R: `3 `
Rear �C
Building Height i
Bldg. Square Footage
Open Space Footage ^� % '.
(Lot area minus bldg&paved �"-
parking)
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
If NO DON'T KNOW YES
IF YES, date issued: ` U tI
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 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:
i
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:
City ofti Northampton
' ,t'— Bulldi ig Department
212)Main Street
R m 100
_u Ntkat p on MA 01060
pEgj01 1 40 Fax 413-587-1272
ROME III
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
This-section to be completed by�bffie� �� ���
1.1 Property Address:
Map � tA r
� 3.
t✓,l � ��: � .�Ewa° �,?� '�¢� �¢ }�� ,� s Efin St..Distnct,
SECTION 2'- PROPERTY OWNERSHIP/AUTHORIZED fAGENT
2.1 Owner of Record:
I / f ! 1- �;; r I 1 Chi Ya
Name(Print) Current Mailing Address:
Telephone
signature
2.2 Authorized Agent:
'r
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 �2 (a) Building Permit Fee
2. Electrical ; (b) Estimated Total Cost of
Construction from 6
3. Plumbing j Building Permit Fee'
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4 + 5) '' �{, '�1-L Check Number
This Section For Official Use Only
Building Permit Number: Date'lssued':
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2001-0144
APPLICANT/CONTACT PERSON HEADY WILLIAM D&ANITA M
ADDRESS/PHONE 5 BRATTON CT (413)586-4739 Q
PROPERTY LOCATION 5 BRATTON CT
MAP 17C PARCEL 201 ZONE GB
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: FINISH LIVING SPACE&ALTER INTO ACCESSORY APARTMENT
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:
Approved as presentedibased on information presented.
enied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
+, Received&Recorded at Registry of Deeds Proof Enclosed
f/ Variance Required under: §�3- Z r w/ZONING BOARD OF APPEALS /i
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 Commis ' Permit from CB Architecture Committee
Z lzei C9�}
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.