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17D-068 (2) —THIS PLAT NOT FOR RECORDING PURPOSES— ALL DISTANCES BY PLAN E 156 ' w w BOOK 570, PAG 35 LOTS 6 4 & 6 5 N 1 a) a 0 0 f H Ir 156 ' G A R F I E L D A V E N U E TO: THE HERITAGE—NIS BANK FOR SAVINGS & THE FIRST AMERICAN TITLE INSURANCE COMPANY. I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES, AND BASED ON EXISTING MONUMENTATION ALL EASEMENTS, ENCROACHMENTS, AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED IN A FLOOD PRONE AREA AS SHOWN ON FEDERAL INSURANCE MAPS FOR COMMUNITY NUMBER 250167 DATED: July 19 , 1988 —NOTE— THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY SURVEYOR. AND DOES NOT CONSTITUTE A PROPERTY SURVEY Zr` Of X� —MORTGAGE LOAN INSPECTION PLAT- - HA `',ec, NORTHAMPTON, MASSACHUSETTS x L = PREPARED FOR UT 2- � JAMES E. KIRKPATRICK No.�311 SCALE: 1 "=30 ' JULY 19, 1988 •,. s HAROLD L. EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS 9 SUNRISE DRIVE — HADLEY — MASSACHUSETTS �;t1AMPJO goo ti$ GztV of Nart4auiptau - � � �i tassachusctts - r cµt - m DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 , >r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as iris/her construction supc.,.-.,i sor. The state defines"Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 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 regulations. 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 your), a rouLyh 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, 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 Address of work location 4 S,v xrT ZZL\- $ 6 �icssacllnsrtis ' ^r l)EPARTMEArr OF EUILDD? G INSPECTIONS 212 Main Street ' Municipal I3ui!cling T,orthampton, Afass. 01060 WOMCER'S COMTENSATION' INSURANCE /. { t ,'>, qT 1 ----- �! -----Ilk. �! ---------- -- --- - - - _-_ _ -- ,:rith a principal place of businessJrc:ideate CIO hcI-C:by CmuiS ,'- und;C--- the p%ir1S 2iiCJ Pcll-:14lc S (7i 1I��, illflt: O I am au ennployer providing the 011ov.'Int '. of r_cr s cornpeIISt tion c0`erase or lay employees W06dilg on this job: (I.ILMS3.Z1Cy COMP=') (ExT,!7 lion D3IC) ... I am a sole proprietor, general c-Dia, -or t?onieo��ne (crc!e one i and gave 'rirttd, the contractors listed below; ::0 ;•:- c- the oll n:: r-.ori':e ' + < s coL,.p neon , ('f3E 1C of DBIC)- (Name of Contrcto:) -- (71ZSUr_nc° Co��a,�vPc!icr 1"I r) (F. :moon Date) (Name of Contractor) — (Ins r.-mcc Com _D.;/Poke. Numb,-r) Dat'c) (Name of Contnctor) _ (Inslrmc--- Come„_-!Policy Numb,:-r) (F:,: i-:tio- Date) (^IL1G7=.d�i:7 CC:1�SS::Q t'!:••'�"f-:(n i^:f1^•:.,:- '""••t:lC- t - ) 1. I ILTl 1. sU1e 111 U}?nCtl?i 2i1J 1t1VC I10 OI1C ',':O1't :ii 1{ �O; i c. / NOTE:plc st tc n«:1 c ti-j!; Jc Ir<nca tim:+ o c 1 sy ir.r - n;St st_-`,sancc arc_n c r cr::„a r «cl!i no u� t oce tlt n tltrco uni'o in,t:? }�c t:x»:izv-rc: a a;'` •:,�z�•t marl Lhcdc e.t n,x et-vral}, e^ploycs un!rt t}r:vc;}�t cc T• :_i n;r.(<3t.1 s l{Si;,a •' ^e.'ic: ?,y s hncaco« r for e li e cr p:rtni::: trx t.': legal etatur of an c=aployc<under tLc Wockcle Coi;xr ition!.ct I u-ride•-tta d thL a cry of thix ctatcz;.r_•mvy be fo`u+vclo;7 to t!»U-p rL,r-:of Indzuiriel M-�r.�+�Ci ic�o of!: +ru?:o for ltx covera&C vrrir ciioc and th=t f_il uc to en +r.roti g^_ur3: c�,iM 25A of?.JGJ,152 can Ic d to the irTposifion o;cr.:nir_J CO-isting of a fur-of up to S I-M-CEO a:tJor i^pri ter.i-,:•',of::p to or,-)-`r tM civil pcmltia in,4c f r n cf a Stc;+'.Vori_on:=t:-,d.: fim oC S 100.00 a day isain:l m:. -_ Fcx drt;uvtrrtal u.c Drily i Sig t rc of. ;tc .t;cJPcrnrttcc_ T S'. f SI=CTjONB CDNSRUCTIONSERVICES 3 . 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : �JH V j 7M( 1 V& � License Number / 2� z-/ , ��-77/--©J Address Expiration Dat zZO Signature Telephone QXReg s e e Um--Ul7m orn ernerit Contracto :..: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTIOW10�"WOf2KERS' COMPENSATION IN URANCE:AFFIDAVIT(M'G:L .o. 152, § 25 (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"homeoNvner"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 far 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 St f Massachusetts General Laws Annotated. Homeowner Signature SECTfto� E P !©Ny0 OP E D IIORK check ) a laca: '.X Mi New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding( ] Other (� Brief Description of Proposed Work: �lZ74 C[ AAo vF- UNQ 1�ct�r iiu(„ �rpp( —2 , Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0- Sheet D ���itton to exis`-ing�hous ng� co "pie a `he�l�owsng 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? 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 SEGT1® UYYN R U..ORIZATION TO BE COMPLETED WHEN OaNEf � E © CONTRACTORgPPLIES_FOR BUILDING PERMIT ..,; V ON : 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 1' 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 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 Setbacks Front 2 c2 Side L: R: r Rear � ( Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking aces 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: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES i IF YES: enter Book Page and/or Document# i 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: �j I f Northampton I ng Department Main Street oom 100 Nq,Atha pton, MA 01060 : 013-587- 240 Fax 413-587-1272 LO—PU6�TION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE-INFORMATION- T��s,se+cl*on empleEe by Qffce 1.1 ProDertv Address: ;` � � { �� .� t Zvne � '' NerlaYflJStnct `� i�EiJn St."�JStI#t.�"' �" `��"'"' '•��� ti„CB�JStr�Ct SECTION 2-'P.ROP.ERTYDWNERSHIPJAUTHOR ZED:AGENT ` 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signatur 2.2 Authorized Agen : Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATfD.CONSTRUCTION`COSTS Item . - Estimated Cost(Dollars)to be _ bfftcial dJse.Qnly completed by rmit applicant 1. Building oo (a) Building Permit,fee Esti 2. Electrical 4/0 r>iated Total Costof ©a .Construction;from b 3. Plumbing Building Permit fee' 4. Mechanical(HVAC) 5. Fire Protection 6. Total = (1 + 2+3 +4+ 5) ecj�Number This Section-For.'Offic a—Use Onl Building Permit Number: Date Issued: Signature: Building,Commissioner/Inspector of Buildings Date File#BP-2005-0096 APPLICANT/CONTACT PERSON TRAVERS DAVID J&KAREN ROY ADDRESS/PHONE 23 HIGH ST FLORENCE PROPERTY LOCATION 23 HIGH ST MAP 17D PARCEL 068 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Typeof Construction: INSTALL 24'ROUND ABOVE GROUND POOL New Construction Non Structural interior renovations Addition to Existin¢ Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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. N 23 HIQH ST BP-2005-0096 GIS#: COMMONWEALTH OF MASSACHUSETTS : 17H-068 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categog: BUILDING PERMIT Permit# BP-2005-0096 Project# IS-2005-0118 Est.Cost:$0.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg.ft.): 15594.48 Owner: TRAVERS DAVID J&KAREN ROY Zoning URB Applicant: TRAVERS DAVID I & KAREN ROY AT. 23 HIGH ST Applicant Address: Phone: Insurance: 23 HIGH ST (413) 586-4220-0 FLORENCEMA01062 ISSUED ON.814104 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 24' ROUND ABOVE GROUND POOL 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 Sienature: FeeType• Receipt No: Date Paid: Check No: Amount: Building �0 8/4/04 0:00:00 3433 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo