17D-019 (8) P. 03
i
AUTOMATING COVER SHEET
DATE : NOV - 19 - 2004 07 : 26 AM
TO
FAX 4 : 14135871272
FROM MP CONSULTING ( CIVIL
& E )
FAX U : 413 289 003
3 PAGES WERE SENT
( INCLUDING THIS COVER SHEET
HM sma txxati R F
ROLL ROC
W PELT PA
FIR y"s WATER
Vy
R^3s rTwaGI-As NGULATION
Zxb C:9LWs JOWS W*O.G.
W 4AM W/G"OOT11 FVftW
1, 06
`! s Ilou
I` ON
•� cccac� Ft3T. ib C3 'g-iTATO? nNIiinsNOo dW W" VZ; LO tOOZ-[I-^ON
� .
NOV 18 2004
MP CONSULTING
j DEPT nK`wit" `'INSp0'0100IL ENVIRONMENTAL ENGINEERING
� 01oo
tit
FACSIMILE TRANSMITTAL. SHEET
ro. PROM,
Tony 14 h9A Piss
CCWANY: DATE:
Northampton Build%Dept. 11/18/m
PAX N"ER, TOTAL NO.CF PACES INCA UUNG�fyVER
413-587-1272 2
PHONE NUMBER: SENDERS REFER$NM N(> FIL-
413-587-1244
RE: YOUR REMMOM NUROPI:
117 Straw Ave.,Pietias Pem it Review
0 L=ENT ®POR REVIEW PLEASE COMMENT ®PLEASE REPLY ❑PLBAM RECYCLE
NOTESIC OMENTS:
Here is an updated section that shows the em*=ying brAm and cck,rrftl.
CaR rm if you have any c0ftlr0em/'questicifw
T
P.O. BOX it
LUDLOW, MA 01056
(4 13) 547-1916
6200 68Z 21t, ( 3 'B'I I A I D> DN l i-inSNOO dW WU £Z:40 b0OZ-61-AON
i I I I I
LOT-10 LOT-9 OT-8 LOT-7 LOT-6 LOT-5 LOT-4
of of of of to I of
of of
9.0' 60.0' - - 6�.0 - - 60,01 _ 60.c
STRAW AVENUE , FLORENCE
( AKA : H ❑ LY ❑ KE STREET )
TAKEN FROM H,C,R,D, Bk, 8 Pg. 40
CORTICELLI SILK COMPANY
ti ; Crzt r of Wart4alllvton
- S
_ � 1�835AC}�liStttB
t
DEPARTMENT OF BUILDING INSPECTIONS /=
INSPECTOR '212 Main Street • Municipal Building
North unpton, MA' 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as has/her construction sup .,,,isor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or"two fame
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
home owner."
The building department for the City of Northampton wants any person(s) who seek to
use the home owner exemption, to act as their own:construction supervisor,to be aware
that by doing so you become responsible for compliance with state building codes
and r',egulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings (before backfill),
sonotube holes (before pour) a rough building inspection(before work is
concealed) insulation inspection(if required) and a final building inspection.:The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work(electrical, plumbing& gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, �� `C'O`Q (�� understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date \t C)ti
Address of work
location \
r
of �\Tcu: julllp3 011
�lasa itch nscIIeI
o DEPARTMEI-1T OP DUILDD\1C INSPECf1ONS
212 Main Strcct ' Municipal Budding
j Northampton, Mass. 01060
tip'O uaR'S CON PENSATTO.N MSURA-NCF Al=A 11'
i
(li cc-ascxJper-ml Litt}
%t.•ith a principal place of businesslresidence at
(sa-«.t/city/sla.tc np)
do hereby certif--, under thc.pzlns and penalties of per'ury, ihat
j ( ) I am an employer providing the followinQ%vorkcr's colnocnsadop cove-rage for Illy
tniplovices worlang on tills job:
(Llyu-r-aa=Conn. v) (PCLic:tau-mbcr) (c:pinvor,D2j-)
( ) I am a sole proprietor, general contractor or homeow--Der (c cie orle) aid have hired
the consactgrs liste below wbo hzve- the fok ioQ workz�s 0.003 nsauon pokie-s-
ONaIII: O; C0`-`.'^CiOr) (In]R rancz—Colnown)-i-Pouc DnIC)
- (Nzim, C of Coulractor) (lnsufanc:.Comoa Y[Polic \ulllcer) (Eapu tlon Date)
(Name of Conlraelo,) (lnsurancc C'.ompan}•/PoUcy N,,urbr) (—Expiraoa Date)
(Namc of Coatractor) (Losuraacc Comrauy/PoUcy Numi>-,r) (Expiration Darr).
(aalr�l--d�-oc=1 dlcc .if acc a-,V to iaform.=oa pctaiaias to.iJ mcc-row)
{ ) I am a sole-proprietor and bave no ooe worh3ng for me.
I am,a home owner performing all the wort: mlf
yse
NOTE:plc--be aMrC CfiL: to caiplay pctoar w rgasr wark on c d%,v-U^f,of
aot mete th_n dzo L-aeu is tc$i(:h the b,m= 0cr r,:"da 0,ea the uV n.d,z�purt.cn-s1 tbcen L-c ox�^�.:-ity ae::dzoi to he
—ploy--ttnd the--k=--c=pc==tica Att(GUI SZ=1(5)).=WUcotloo by a homeo-=fcr c Gem=a perwit rz:y c';d O=the
kS21(toast of an-=ployx uadcr dto wackcet Compo-=t Act.
I unda-rtaad dut a Dopy of th;.mtemcm O xy t a for-arerdod to tbo pep,rtaxoa of 1ndaLYSici nsodmu'011—of La,.rr+noe fac LE-
covcrkSc vaiCc=ioa and nlu L-iltnt to scar--covcraZc trod--=ciioa 23A of h(GL 152 C=Laud to the midi*of a dDA Pca W-
oomisiag of a floc of up to S 1 500-00 andloc capt-is0am� or up to Doc yrzr sad i,il P.0ja is Cx form of L Stop work ordc Lad L -
fl=0(5100.00■d_y Latinsz me
For fcp.rtm='I u• only -
permit Numbcr --
Lot
Sigtaturc of Lio=scx-JPCCmiucc - --
SECTION 8-CONSTRUCTION SERVICES t
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
� Not Applicable ❑1 07!"Tas eco c,9-
R64 -66c
Company Name Registration Num er - --
Address Expiration Date
Telephone_,
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(Ma .L.c..I52,§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 forms 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 resp niibility for compliance with the State Building Code,City of
Northampton Ordinances,State and cal Zo Laws, tatea of Massachusetts General Laws Annotated.-
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all ayolicableT
New House dd- on Replacement Windows teration(s) Ro ing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[p] Other[a]
Brief Description of Proposed ®® 44
Work: cea�SK�� c,, S d CXZ� " 0.S
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
fia ]ftNew:<ti'��Sexanct�iicCdit�o�.�a��crstinc�ahoi�sinc��c'ari�ptet�*�t(ie�€otfov��i�:
a. Use of building: One Family�_ Two Family Other
b. Number of rooms in each family unit: Z> Number of Bathrooms Z
c. Is there a garage attached? WD
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? Z
f. Method of heating? Fireplaces or Woodstoves��Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes le�c_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.
1. Septic Tank City Sewer, Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION=TO BE COMPLETED WHEN
OWNERS AGENTOR'CONTRACTOR°APPLIES FOR'BUILDING PERMIT
I, 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
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 QNrjury.
� t k J�Qb--�
Print Name
0 I D
Signature of Owner/Agent Date
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 - VVY'-�O `►' I
Frontage y ��
Setbacks Front ,5?� F--,
Side L`��r? R:=L-5 L:� R:` �{
t—
Rear
Building Height
Bldg. Square Footage ; % --
Open Space Footage %
(Lot area minus bldg&paved
arkin
#of Parking Spaces
Fill:
(volume I&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
N0 Q DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document U
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0
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 0 NO Q
IF YES, describe size, type and location: j
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
c
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 ,. NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Oty bf Nortf ampton Statute M e
Building Departmentb
212 Main Street
�� Sewe a 1 § �
Z Room 100 fer ?�x va
Northarppton, MA 01060 Tu►co meets o tr�`r�ia tans f
phqqq 41,3-587-1240 t Fax 413-587-1272
yc �
Qtliewpeci
. .
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
jp Lot UniC
lau} �J
:Zone Overlay District
ttrrSL District _' __ CB D�stFliCt„
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) , Current Mailing��aa re
o� 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 y� (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) Q Check Number
This Section For Official Use Only
:,Date
Building Permit Number' :Issued:
Signature: r
Building Commissioner/Inspector of Buildings Date
File#BP-2005-0539
APPLICANT/CONTACT PERSON PIETRAS MICHAEL
ADDRESS/PHONE P 0 BOX 11 LUDLOW (413)583-5254 Q
PROPERTY LOCATION 117 STRAW AVE
MAP 17D PARCEL 019 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinjz Permit Filled out
Fee Paid 0
,Typeof Construction: CONSTRUCT BATHROOM DORMER
New Construction
Non Structural interior renovations
Addition to Existing
Accesso_ry Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan ,�t%' %, ,�i ✓�
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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 ssion
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.
117 STRAW AVE BP-2005-0539
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mau:Block: 17D-019 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2005-0539
Project# IS-2005-0707
Est.Cost: $17500.00
Fee: $87.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group Homeowner as Contractor
Lot Size(sq. ft.): 19819.80 Owner: PIETRAS MICHAEL
Zoning.URB Applicant: PIETRAS MICHAEL
AT. 117 STRAW AVE
Applicant Address: Phone: Insurance:
P O BOX 11 (413) 583-5254 O
LUDLOWMA01056 ISSUED ON:11130104 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT BATHROOM DORMER
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 11/30/04 0:00:00 823 $87.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
"00000%
'o let00000l
-701, rev P
J
117 STRAW AVE BP-2005-0539
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D-019 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
C imo-ry=- BUILDING PERMIT
PernLt# BP-2005-0539
Proieet# IS-2005-0707
Est. Cost: 17500.00_
Fee:$87.50 PERMISSION IS HEREBY GRANTED I'O:
Const. Class: Contractor: License:
Use Group Homeowner as Contractor
Lot Size(sc . £t. : 19819.80 Owner: PIETRAS MICHAEL
7rnninfc: i?P' PTFTP;C rMr_Hnt=°_
AT: 117 STRAW AVE
Applicant Address: Phone: Insurance:
P 0 BOX 11 (413) 583-5254 (1
LUDLOWMA01056 ISSUED ON:11/30/04 0:00:00
TO PERFORM THE FOLLOWING ►VORK:CONSTRUCT BATHROOM DORMER
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector(rf Plumbing Inspector of Wir:ng D.P. V. Building In:;pector
Underground: Service: Meter:
Footings:
Rough: Rough:1'12610 House# Foundation:
Di ivevvay Final:
Final: 1� G. r
�� Rough Frame: & vL
Gas: Fire Department Fireplace/Chinmay:
Roush: 0ii• Insulation:
Final: ~make: 3,inal: O K 3—V 7- D G
THIS PERP.IIT AIAY BE REVOKED BY THE CIT`. OF NO11TAAMPTON UPON VIOLA OF
ANY OF IT'S P.ULES AND REGULATIONS.
Certifir_ate of Occupancy _ sivi atum: _
FeeTvjv:� Receipt No: Date Paid: Check No: Amount:
Building 11/3,1O40:00:00 823 $87.50
212 Main Street,Phone(41_)587-1210,Fax: (4 ')587-1272
Building Commissioner-Anthony Patillu