38-072 (2) 141 GROVE ST BP-2004-0365
GIS#: COMMOWEALTH OF MASSACHUSETTS
Ma Bloc38-072 CITY OF NORTHAMPTON
Lot: -001
Permit: BuiidinQ
Category BUILDING PERMIT
Permit# BP-2004-0365
Project# ]S-2004-0525
Est. Cost: $1500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sg. ft.): 17380.44 Owner: DIAMOND WILLIAM D&HARRIET R
Zoning:URB Applicant: DIAMONQ WILLIAM Q & HARRIET R
Ail. i41 GROVE S-1-' ,
Applicant Address: Phone: Insurance:
141 GROVE ST ( 584-1412 Q
NORTHAMPTON MAO 1060 ISSUED ON.1016103 R:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 8 X 10 SHED
POST THIS CARD SO IT IS VISIBLE FROM THE §TREET
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: J
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT N OF
ANY OF ITS RULES AND REGULATIONS. ,
Certificate of Occupancy �Signa (/
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 10/6/03 0:00:00 1590 $25.00
212 Main Street,Phone(413)5$7-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
s.
M
141 GPOpVEST BP-2004-0365
GIs#: COMMONWEALTH OF MASSACHUSETTS
x:,38.672 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0365
Project# 35-2004-0525
Est. Cost: $1500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 17380.44 Owner: DIAMOND WILLIAM D&HARRIET R
Zoning URB Applicant: DIAMOND WILLIAM D & HARRIET R
AT. 141 GROVE ST
Applicant Address: Phone: Insurance:
141 GROVE ST 584-1412 O
NORTHAMPTON MAO 1060 ISSUED ON:10/6/03 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 8 X 10 SHED
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 10/6/03 0:00:00 1590 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2004-0365
APPLICANT/CONTACT PERSON DIAMOND WILLIAM D&HARRIET R
ADDRESS/PHONE 141 GROVE ST 60-0y_
PROPERTY LOCATION 141 GROVE ST
MAP 38 PARCEL 072 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 15 O A9-5-
Typeof Construction: INSTALL 8 X 10 SHED
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 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
� Z L
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.
of Northampton 'S o
v ding Department C
2 Main Street
Q 3 2003 oom 100 a
SEQ N tha pton, MA 01060 T et
p GANt1 6587- 240 Fax 413-587-1272 �Ptti
APP L ON TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This s4 ionjt�to f a completed--pywoffice,
1.1 Pro ert Ad rens:
MapLot� l�tt
,
_ 2
Zone OuerlayDistrict
Elm St. District C&District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record•
°Ja�mj r nt) Currentoei4q Addy s'
• -- 015 -' '� -
Telephone
Sig at re
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 permit applicant
1. Building 1-6>6 . PO (a) Building Permit Fee'
2. Electrical (b) Estimated Total Cost of $11500 . 6 o
_ Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) V l 50 0 v6 Check Number i"
/This Section For Official Use Only
Building Permit Number: ���'7 ��. J Date Issued:
Signature: _
Building Commissioner/Inspector of Buildings 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
qo l 6
Setbacks Front 15
Side L: 0110 R: 3 ��`� L; R.
Rear
Building Height
we v
Bldg. Square Footage -� � % 4. 70
Open Space Footage q %
(Lot area minus bldg&paved t 13.
arkin `J C/
#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:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Rook 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 N/
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, des ribe size, type and location:_,
SECTION 5--DESCRIPTION OF PROPOSED WORK(check all-applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. X Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: aa 61 / l
44
Alteration of existing bedroom Yes No Adding new bedroom Yes -- No
Attached Narrative o Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
6a If N'ewr`shouseandbor"�'ddition't0`ezistinghousing, b6mpIdtbRhe1611 6Win
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
SECTION 7a-OWNER'AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING 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
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 Na e
� 6
Si n re of Owner/Agent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
---- --------------------
License Number
Address Expiration Date
Signature Telephone
`SReg(sferetl Hom Improvement-Contractor
.�, Not Applicable ❑
Company Name Registration Number
Address I 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...... ❑
`���om�e��C)vyneEem� tion
1�1.
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 fer 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 a d Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
' ,��ttnrtnTo
B {tSEAtI(Itfitllfi
c
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building 'a
Northampton, Mass. 01060
WORKER'S CON PENSATZON INSURANCE A.ZTI M A.VIT
(Ii censec/permi tt ce}
with a principal place of business/residence at:
(pfione#)`
(st-:elcity/stalelyp)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
O I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the follewmg worker's compensation policies:
(Name of Contractor) (Insurance ComPany/Policy Number) (Expiration Date)
(Name of Contractor) J (Insurance Comoam,[Policy Number) (ExTir-aaou Date)
(Name of Contractor) (Insurance Compauy/Policy Number)' (Expiration Date)
(Name of Contractor) (insurance Comtra-ITy/Policy Number) (Expiration Date)
(attach aciditionzl t.�cct if nccczzuy to ixrudc i:zfocrnit2 on pertaiarin;tc el1 oxt'sa�or3)
r
( } I am a sole proprietor and have no one working for nye.
( ) I am a home owner performing all the work myself.
VOTE:plcssc be aware tt:at,,wile txa cotnxra wbo cmproy p z s to ua mxmtrnaace,arr:ntC:Q of rtpair wurk ou a dwrIling of
not—co than three units in wbch the hr xou car resida or oa Lie&maz)ds z purteaaat thereto ere ncx&cx-,a .ly contidcrtd to be
employers un&r the Fvaritct's a c: ---tion Act(GL152,�s 1(5)),application by a homcowvtr for a licctise a per na u:ay cvi:',cnoc the
legal matin of an amployor uoder tho Workces Campeozatioa Act..
I uacierst.and that a copy of this eutcmcut may bo fomartl«S to tha BcVwtnrot of Industrial Aocidcnii'Oftioo of[aAw oc a for thn
coven-ge verification and that failure to v.—covctago und,-x saciion 23A of MaL 152 can lead to tho imposition of a min+l Patalties
coasittir of a fine of up to S 1,500.00 and/or ingrizoCnxr i of up to one year and civil Pemltics in the fotm of a Stop Werk Ord-'and a
find of S 100.00 a day spainsi ar-
Foc&P-tr--W use oilly
Permit Ntun
bes
. signature of Liccn,,ee/Petmittee e
-THIS PLAT NOT FOR RECORDING PURPOSES-
ALL DISTANCES BY DEED.
5�
C��ed
N
TRACT I TRACT II ~'`
BOOK 2201 , AGE 3
N
9c l
f I T
1
wellin
low
15 � +
GROVE; STREET ( PUBLIC)
THE NORTHAMPTON INSTITUTION FOR SAVINGS &
THE FIRST AMERICAN TITLE INSURANCE COMPANY.
MEN REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON SKI
-THIS PLAT NOT FOR RECORDING PURPOSES-
ALL DISTANCES BY DEED.
1�6' �ed
0
TRACT I TRACT II ~'',
I.F -r
BOOK 2261, AGE 3
N
O
90' N
w
o i
0
J �
wellin
I+
90++
15t+
GROVE STREET (PUBLIC)
TO: THE NORTHAMPTON INSTITUTION 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 TETE 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: Ogtober 15. 1985
SURVEYOR -
-NOTE-
THIS PLAT FOR MORTHWLOAN PURPOSES ONLY
p% Of AND DOES NOT CONSTITUTE A PROPERTY SURVEY
o� HAROLD yes -MORTGAGE LOAN INSPECTION PLAT-
EATON NORTHAMPTON, MASSACHUSETTS
No.23011 �g PREPARED FOR
`"MvI/AiSL�No' SCALE: 1ER5C01W. & DIANE KOCTOBER�150 1985
HAROLD L. EATON, PROFESSIONAL LAND SURVEYOR
9 SUNRISE DRIVE; - HADLEY - MASSACHUSETTS