31B-023 (5) p ECE � � C
J U L 1 3 2001
DEPT OF BUILDING INSPECTIONS
NORTHAMPTON,MA 01060
6-JUN-2001 09:00:10 Hampshire County Registry of Deeds Receipt No: 147674
Marianne L. Donohue, Register of Deeds
33 King Street
Northampton, MA 01060-3298
Name: TOM BOYLE Addr: 43 DAMON POND ROAD
CHESTERFIELD, MA 01012
Receipt Type: OR
Payment
Total Pages: 0003 Fees Taxes
Fee: $ 10.00 Cash: $ 0.00 $ 0.00
Tax: $ 0.00 Check: $ 30.00 $ 0.00
Misc: $ 20.00 Charge: $ 0.00
Charge Code:
Comment: FINDING RECORDING--19 ALDRICH STREET
Receipted By: BETH Status: PAID
DOCUMENTS: 992112680 to 992112680
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Type Page Doc Mref Consider$ Record Fee Excise Tax Stat Misc Fee Record Date Document# Book/No/Page Status
---- ---- --- ---- ----------- ----------- ----------- ---- ----------- ----------------- --------- -------------- ------
MIS3 003 0001 0000 0.00 10.00 0.00 20.00 6-JUN-2001 08:59 992112680 OR /6234/0245 INIT
Page 0001 of 0001
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DEPT Of BIIILDING INSPECTIONS `
NORIHAM,TON,MA 01060
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(ll censee/peimi tree)
with a principal place of business/residence at:
& l E,4 6 (phone#),q/3-d9el J"v
(street/city/statr/riP)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following workers compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Daze)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(allach additioml sbod ifnoccb.aryto in�information pertainno to all ooutnn rs)
(tam a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pica=be aware that vihile homcowncra who employ pczsozu to do maiat nA ce,o=str ution or repair work on a dwelling of
not morn than three units is which the homeowner resides or on the vvjarfs appurtenant thereto arc not generally coandcred to be
employers under the woz*.cez compansatioa Act(GL152 ss 1(5)�application by a homeowner for a 110cme or permit may evidence the
legal dRuu of an employer under the Wodcor't Compomation Act
I undcntaad that a copy of thin ctatcmcrd may be forwarded to tho Department of ln&Litri d Accidca&Offroc of Inv-w oo for the
coverage verification and that failure to&carve covctngo under scctioa 25A of MGL 152 can lead to the imposition of crimkLd penalties
ooq&4Cmg of a five of up to S 1,500.00 and/or imprboament,of up to one year and civil penalties in the form of a Stop Work Order and a
firm of 5100.00 a day against tae.
Fpermit -c use only
Number Lot#
Si o L' ermittee e ..
1
S�GTI,';bN 8O[�57Rt� t10N i771
8.1 Licensed Construction Supervisor: `� y Not Applicable ❑
Name of License Holder: !1:to n 1j- �T ) b Y�,E --✓—� o yo g ?9
License Number
Address *17 /�" Expiration Date
�3- a G � �
nature Telephone
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...... ❑
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"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
N' iaDE�{
i AR 333 Y 33rk 3 3 3333 „w}y33
" New H ouse .. .s.. ., ,
❑ Addition ❑ Replacement Windows Alteration(s)W� Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work '
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ • Sheet❑
a. Use of building : One Family_C Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? A&
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
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
SECT]C?N 7a O ERAUTHORIZATION TOiBE"Cf3MPLETED WHEN
+¢WN)*HS GENT QR GONTF2AC1"4R APPLlE$%0dR BUILD"ING PERMIT
1 1 C/Y.yet_ YIVE'V as Owner of the subject property
hereby authorize 7-0 M yoyL e Z& 06.epEi rr to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Ow er Date
, as Owner/Authorized 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 pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
f
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 614. 9")( V o• r O
Frontage • ten-�- ;>S^
Setbacks Front 1 d l / a ` JL-0
Side L: L: s R:
Rear a / ` 1- 0
Building Height � sJ���
/ 5�a
Bldg. Square Footage -- %
Open Space Footage % (�
(Lot area minus bldg&paved 30
parking)
#of Parking 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: 6— (a— D I
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES ---,X
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:
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:
1
ki Northampton
B i i g Department
7001 Main Street
om 100
harr pton, MA 01060
587 240 Fax 413 587 1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address:
° F =This st+c is fo" be�cam ��#ed bye ff�e�
Md ys ,
Al jRrn P7'a r(/
y
Elm St District tBDl�strlct
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ame(Prin ) Current Mailing Address:
y,3 - -"p6r- -�
Telephone
Signatur ,
2.2 Authorized Agent:
ICHgpI- /9 'fj,0l2/ek Sr , /r/oo27y ahi�Tosy
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3- ESTIMA EQ CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use-Only
com I ted by ermit applicant
1. Building �jc S�2 (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 For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Comrtr ssioner/Inspector of.Buildings Date":
File#BP-2002-0052
APPLICANT/CONTACT PERSON Tom Boyle
ADDRESS/PHONE P O BOX 15 (413)296-4544
PROPERTY LOCATION 19 ALDRICH ST
MAP 31B PARCEL 023 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid / C7
r
T_vpeof Construction:_ENLARGE EXISTING PORCH TO 20 X 66"
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 040979
3 sets of Plans/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and 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 i ion
Signature of 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-2002-0052
dIs#: COMMONWEALTH OF MASSACHUSETTS
" k:31, 025 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Cat p—M:ALTERATION BUILDING PERMIT
Permit# BP-2002-0052
Project# JS-2001-1038
Est.Cost: $9500.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Tom Boyle 040979
Lot Size(sa.ft.): 3136.32 Owner: SHEA MICHAEL H JR&JOANNE SHEA
Zoning,:URC Applicant: Tom Boyle
AT: 19 ALDRICH ST
Applicant Address: Phone: Insurance:
P O BOX 15 (413) 296-4544
CHESTERFIELDMA01012 ISSUED ON.71201010:00:00
TO PERFORM THE FOLLOWING WORK.-ENLARGE EXISTING PORCH TO 20 X 6'6"
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 7/20/010:00:00 5119 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo