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38D-018 (7) form for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,MI. Q 1 i1 X rn o n X % 0 O � -n T _ rn rn D _ rn U3 rn zrn X r- 3 rn r- rn d O W Q _ z O A -{ rn � O rn M d d - rn O rn rn O rn rn rn d o ( C� z r - ti X 3 rn � z O C� ? � O O Z 2 i� Q Q t!, l - 1-ti N r rn z n 'alley Home Improvement, Inc. 25 HAMPTON ST. SCALE:SEE VIEW SHEET NUMBER MA FRONT PORCH 340 Riverside Drive, PO Box 60621, Northampton, MA 01062 NORTHAMPTON, DATE:5.6.15 Office Phone 413.5b4.1522 Fax 413.585.0820 ROUNDS PERMIT DRAWN BY:S.G. Z =ind us on the web at: uuw, /alle Homelm rovement.com REV#12 RevMon N: form for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,VHI. Q C3, AO ( rn o 0 Z rn. j � rn z U oA N r z y_ L m QN z rn r rn O z alley Home Improvement, Inc. 25 HAMPTON ST. SCALE:SEE VIEW SHEET NUMBER 340 Riverside Drive, PO Box 60621, Northampton, MA 01062 NORTHAMPTON MA FRONT PORCH DATE:5.6.15 Office Phone 413.584.1522 Fax 413.585.0820 ROUNDS PERMIT DRAWN BY:S.G. Find us on the web at: uuw.\/a11eL4Home1mprovement.com I I REV#12 pevhlon p: 05/06r�2015 13:08 4135390774 LUDLOW PEDIATR'ICS,INC. O 45417 P. 002/002 NOTE: PROPERTY LINES SHOWN ARE APPROXIMATE, A FULL FIELD SURVEY 1S REQUIRED TO ACCURATELY DETERMINE THEIR LOCATION. 110'1- F-- BOOK 8384, PAGE 116 GAR. NOTE: Llj BOOK 526, PAGE 50 SUBJECT TO EASEMENTS AND LOTS #20-21 & PORTION OF LOT #22 RIGHTS OF WAYS OF RECORD. U) Lo Lu Q =" #25 Ljj C� f L;Ali of ;rnra toytew 11a � HAMPDEN STREET T0: FLORENCE SAVINGS BANK & LAWYERS TITLE INSURANCE CORPORATION TO THE BEST OF MY INFORMAT40N, KNOWLEDGE AND BELIEF 1 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 1S NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY #250167 --NOTE— SURVEYOR: t .i. THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY o QF s X11 — i�ORTGAGE LOAN INSPECTION�LAT�-- NORTHAMPTON, MASSACHUSETTS R N ALL 6 PREPARED FOR S sZ 'R v �� CALEB M. & MARGARET B. ROUNDS SCALE: 1,,=30 T JULY 16, 2008 �y� �°£ ° HAROLD L, EATON AND ASSOCIATES, INC.IX REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET — HADLEY — MASSACHUSETTS i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' E� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): V a,G�-u Address: h ya � j��>v �t\``� City/State/Zip: `QI �(1(� , `(� Rhone#: 1�_)%,A 2,Z Are you an employer? Check the appropriate box: Type of project(required): 1.M I am a employer with I S 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full 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 employees These sub-contractors have g, ❑Demolition working for mein,any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E] 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' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: b G` A M,� 'e CC U.2 Policy#or Self-ins. Lic.#: cy;�)CJ©J 0,2— 1 Expiration Date: 11 Job Site Address: r�5 o c� City/State/Zip: -)ygm„owA ow"0 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 frification. I do hereby certify the pains a.d penalti perjury that the information provided above is true and correct Si afore: r -••� Date: Phone# Official use only. Do not write in this area, to be completed by city or town off:ciat 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#: a SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: 1r 56n Sid\U114 V 0(D 0M 12< ULkl� ,1 r , z1c_ License Number 'P.0 _6cy- c��a� l �ore�r�cr a ono b2 9 J22'L Address Expiration Date Signature Telephone 9.Register ome m rovement Contractor: Not Applicable ❑ 5su3 Company Nafne Registration Number QZ ,&y, (CCi�� . -111-1 l )�0 Address Expiration Date Telephone,4k?7E --I zz 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 pen-nit. Signed Affidavit Attached Yes....... No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-oecupiled Dwellings of one(l) 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"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 4. ZONING All 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 �® 2v Frontage Setbacks Front Side Rear Building Height Bldg.Square Footage x % is a i� Open Space Footage y / (Lot area minus bldg&paved parking) #of Parkina Spaces 4� Fill: volume&Location)_,....,.... ..__.._..._...' A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 71W 0 YES 0 IF YES: enter ook Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , 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 inten ed for the property? YES 0 NO IF YES, describe size, type and location: , t E. Will the construction activity disturb(clearing,grading, excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors (] Accessory Bldg. ❑ Demolition ❑ New Signs [E3] Decks [M Siding[[ ] Other[dj Brief Descri pt)''on of Proposed �C61�6Iaf 1'�SB�J� S Ofo)'n4�j °���//f Cr�UiO"/l�rf'f d!!�F�, `� Work: �/�5✓;✓d ���� r G e- Fre�7 6 reti — ►-1-0 J1 MCw f v'Cg y S7H� U/.:,c�w, 73 � Alteration of existing bedroom Yes_,f to Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _1/IQo Plans Attached Roll -Sheet 6a:If New house and or addition to existing housing, complete the following: 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? N d d. Proposed Square footage of new construction. Dimensions n� e. Number of stories? / f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 1. 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 gr)// 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 I, (74h h 4 1167/ S a/c, '- /�U+J 611' ,as Owner of the subject property hereby authorize E\Snn ��� «} t �+` �' � � �Vn��OJGfY121'�' `z t L -- to act on my behalf,in all matters relative to work autho ' ed by this building permit application. Signature of Owner Date as Owner/Authorized Agent hereby declare that the statements an nformation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. \1e 50n S"�,�\,e Print Name Signature of wner/Agen Date i Department use only �/J I ity of Northampton Status'of Permit: Curb Cut/Driveway Permit D Building Department 212 Main Street Sewer/Septic Availability MAY" 1 1 2015 Room 100 Water/Well Availability rthampton, MA 01060 Two Sets of Structural Plans Electric,Plumbing& 587-1240 Fax 413-587-1272 Plot/Site Plans Northampton, MA 01060 Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address,: dJ /`17�7�i Map Lot Unit /UQ �7 yl.64)/10111f-� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: , G =- Telephone3 �� O6 Signature �� 2.2 Authorized Aoent: jye�son Sh` � \10ACj-t Name(Printf Current Mailing Address: Signature 17 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building d (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of �5 4 Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) `Y0 D© d Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date at` PLA4 QON Ef�nl File#BP-2015-1092 APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESS/PHONE P O BOX 60627 FLORENCE01062(413)584-7522 PROPERTY LOCATION 25 HAMPDEN ST MAP 38D PARCEL 018 001 ZONE URB(100)/ 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: ENLARGE FRONT PORCH REPLACE SIDING&INSTALL REPLACEMENT dpw P4g WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building,Plans Included: Owner/Statement or License 060300 3 sets of Plans/Plot Plan THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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: § 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 Permit DPW Storm Water Management e io lay of Build' g ffici 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. 25 HAMPDEN ST BP-2015-1092 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38D-018 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2015-1092 Proiect# JS-2015-002070 Est. Cost: $40000.00 Fee: $240.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 060300 Lot Size(sq. ft.): 11020.68 Owner: ROUNDS CALEB M&MARGARET B Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT. 25 HAMPDEN ST Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.511812015 0:00:00 TO PERFORM THE FOLLOWING WORK.ENLARGE FRONT PORCH, REPLACE SIDING & INSTALL REPLACEMENT WINDOWS 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 5/18/2015 0:00:00 $240.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner