38-073 (4) i
12 BURTS PIT RD BP-2005-0874
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38-073 CITY OF NORTHAMPTON
Lot: -001
Permit: BuiidinQ
Category: BUILDING PERMIT
Permit# BP-2005-0874
Project# JS-2005-1210
Est. Cost:
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Sackrey Construction 040714
Lot Size(sg. ft.): 11412.72 Owner: PUSHKIN MICHAEL A
Zoning.URB Applicant: Sackrey Construction
AT. 12 BURTS PIT RD
Applicant Address: Phone: Insurance:
83 SOUTH MAIN ST (413) 665-9995 O Workers
Compensation
SUNDERLANDMA01375 ISSUED ON:3/22/05 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMOLISH SFH
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 3/22/05 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
i� . Giity�of Nort ampton eta
Boge Ing Department t -
212 Main Street
1vi.i"'R 2 1 2005
Nortf --m 100 e
ton; MA 01060
phone 41 a,,587- 240 Fax 413-587-1272 Pto $ an
t"- PLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1.-SITE INFORMATION
1.1 Property Address: This sec#ionto be completed byofficez
2 "bu RTS Y1-T
41Overlay Dtstrref
�"'�` � '"` x tmYSf~O�strrct CB-D�striict
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT,
2.1 Owner of Record:
1 2-
Name t Current Mailing Address:
'EIS- sb'I b-i01
Telephone
Signat e
2.2 Authorized Agent:
�a�-,� �� • S S. A,t44 ST.
Name(Print) Current Mailing Address: r
413- c,(. T -moi
Signature Telephone
SECTION 3-rEATIMATED CONSTRUCTION` OSTS
Item - Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building r (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=(1 +2+3+4+5) Check Number ZQ QI
This Section For Official:Use only
Building Permit Numberbaler
Issued;
Signature: r
z2ops--
Building Commissioner/inspector of Buildings Date
e
Section 4. ZONING All Informati6h 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 f 1 t �(5 �5 -i ' �'t��a( �J ._.__
Frontage
�e.� � '140,76 i
— I ` I
Setbacks Front �I-2
Side L: yo R:i 3 Ui R:'
Rear
Building Heig1t ;2
Bldg. Square Footage OD 3 S % ( �
Open Space Footage %
(Lot area minus bldg&paved 'S 13 Zi ; O
arkin
Z I I
#of Parking Spaces
Fill:
(volume/&Location)
I '3
A. Has a Spe ial Permit/Variance/Finding ever been issued for/on the site?
N0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Paget and/or Document U
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Date Issued:
C. Do any signs exist on the property? YES 0 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:
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? YESQ , NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
a y
r.:
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑:. Replacement Windows Alterations) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition New Signs [0] Decks [Q Siding[0] Other[p]
Brief Description of Proposed
Work: WW0 1'9-40'Mfi 5V46i& Ai1C►J S&
Alteration of existing bedroom Yes ✓No Adding new bedroom Yes ✓ No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
x�r �.,.fay:.
sa-ii New-ro se nd it ctdMix, i> c�1 o, stnct4,x gip`a W. arW.ictct: d
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. Masscheck 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 OWNERAUTHORIZATION-TO BE COMPLETED N
OWNERS AGENT"OP CONTRACTOR APPLIES;FOR:BUIL'6INGP'IT-
i, K\1 C4A4ML_ ?05 W-K-Vr--I as Owner of the subject
property
hereby authorize ,Olzfi-� 4� fttG.�L Iy�
to act my a If, ' relative to work authorized by this building permit application.
31 2-116
Signature of Owner Date
I, - as Owner/Authorized
Agent hereby declare that the statements and information Ion the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
-�oW�-k 4 - S
Print Name
L L/6&—
Signature
of Owner/Age n Date
SECTION,8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: t Not Applicable ❑
Name of license Holder: S Xgt� C)1 4(3 5
License Number
C8 VY-1i &<V,
Ad ess Y" Expiration Date �!
SignatUV
Telephone
Not Applicable ❑
�;:Re rse �nrt�l.m r�eMenllractvr� .
d 40( 09
_ .__ _
Company Name � i � Registration um e
Jack -z�--4 �.srv,$ i �t t�
Address Expirat' n Dalb
Lb1 , elephone �l'a'�►�)�g�Cgf'
SECTION 10-WORKERS'COMPENSATIOtt INSURANCE`AFFI AVIT'tM.G:L.c.
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 buildigg permit.
Signed Affidavit Attached Yes....... No...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellinizs 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 786 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 Budding Official,that he/she shall be
responsible for all such work performed under the buildiney 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
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R (Lzt-�3 Pf -
A € r31as.,tChncr1re'
DEPARTMEI-rT OF BUIL00 C INSPECTIONS
212 Alain Strcet 'Nfunicipal Duilding
Northampton, Mass. 01060
WOMCLR'S CON'[PENSA710N MSFT RAhCE
� (licx-u.�Jlaczu��ttcx) �
t��th pl-,tcipal place of busir3esslresidence at: -------__.
SU Kp eytLp
(sZI"C.rt1 c7 rX/sz3tsr 1II j�)
do hereby certif)i, under thc.ppins and peimkies of penury, that
( I am an employer providing the followiiw, ivorircr's coinpcnsZzion cove:-C for 1t1}
e-111ployccs wortoag on tills Job,
51
(irlSI.r=n=Comr-Im) (Potic:Nu--no--r) +pira an tD2j--)
{ ) I acn a sole proprietor, general contractor or homeowner(ci:c'.e one) and lave hued
the cooira(nors listed below wbo lave the following Worker's coopen_szaon pokles:
() amc 0. Cont^cwo (InRlrznc-c Companyot o6c-,- (l_�Plnluon Datc)
--(Nzmc of Couuucaor) (bsuraacc ComoanwPojicr Nu_mb-_r) (—E.�Du aon Date)
('Name of Conaacto.) Gmssuraucti Comj=)-1PoUcy- Mimb j) (Expirrioo Datc)
(Tgzmc of,Cona-actor) (Iosuraacc Compazy/Policy Number) kT_xpiratioa Datc).
(aa�tfi�_.d3itioc3l r'.1,-C.i.fncr_}cu:p to csc!ue=iafor ,:ion p�Za.iains to.11 a ,-ae.,n)
{ ) I am a sole proprietor and have no one working for me.
( } I a.m.a home owner perfon-nmg all the«cork myself.
NOTE:plc...c be ew',rc Lb-vtzI homcouvasbo ca ploy pamoat to da c.—a iso c repair work on.d"v_�-S of
ant more thea lbl--t145 in-bleb the bomoow rcaidc or oa the pvuod,xppurtea:.r3 thcr-_D arc oa C= Xy occ=d=d to be
-aVlcycr unr'.c the.+ui clz c=p,—�oo pct(G LII 52=1(5)),zppliosion by a homco, v=fcr c 6c=----or pcm% rzc y c idmoc Ebc
IcSA1 aa_-u of to an,Ptoye uodcr dso WorS'e,C.ompocmalioa.Aa-
s
1 urah-'rt.zzsd ttxxt>Dopy of thi,=u=m-i may 13-r«-,+nrd.d to tba rSc{xrcmoot of raodi+xtiJ prodaEY Otr,o of traumas for th.
aavcM&c vlaiCcaioa&M drat f_um to secure tcov=-kt tmdc saction 23.A of MOL 152 ray teal to the i iiioa of a•iminzl pcnattia
egmr stg of a fiat of up to S i 300.00.rtdloc iznu-isoamcal of up b cx y==d aril p=xjje in tSc form of a Stop W oh order and.
rim of S 100.00 s dr.y LpImi EDc
for part Daly -
Sigaaawrz Lic=Ls C/PcrISuucc
a e ,..Crity of 'Northaillptan _
-
� ,�rlxasxc!}nsrifs
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR '212 Main Street • MunicipaI Building '>o
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supe.,,, sor. The state defines"Homeowner" as, ",Person(s)
who owns a parcel on which he/she resides or intends to be, a one or twofami'ly------ a
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 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, 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
f
P a aQ
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s
�fJBa Stat�eGas
1 Y
y A NiSouroe Company
March 15, 2005
MIKE PUSHKIN
2 BURTS PIT RD
NORTHAMPTON MA 01060
Dear MIKE PUSHKIN,
The address listed below has had the gas service(s)
disconnected and is now ready for demolition.
ADDRESS: 12 BURTS PIT RD
TOWN : NORTHAMPTON
STATE : Massachusetts
Sincerely
Terri Miner
Workforce Planning
Massachusetts Electric
A National Grid Company IV
March 17, 2005
Michael Pushkin
2 Burts Pit Rd.
Northampton, MA 01060
Dear Customer:
To Whom It May Concern,
This is to verify that Massachusetts Electric has removed the electric service and meter at
12 Burts Pit Rd,Northampton, Massachusetts effective March 16, 2005, for Building
Demolition.
Sincerely,
r.
t '
'1 9
—'Jim Nichols
Supervisor
Distribution Design
JN/ekp
V
365 State Street
Spfld., MA 01105
Attn.:I�
RE: Facilities
This is to confirm that the Verizon facilities attached to the
following location:
have been removed so that you may go forward with your plans
for it.
;St
Jackele, Manager
Veri - DRC
CITY OF NORTHAMPTON, MASSACHUSETTS
DEPARTMENT OF PUBLIC WORKS
125 LOCUST STREET
NORTHAMPTON, MA 01060
4a 413-587-1570
FAX 413-587-1576
George Aiidrikidis, P.E.
Director ofP71blie fforks
March 1, 2005
Anthony Patillo, Building Inspector
Municipal Office Annex
212 Main Street
Northampton, Ma 01060
Dear Mr. Patillo:
The water service supply to 12 Burts Pit Road has been shut off at the property line and
the water meter removed from the premises on November 12, 2004.
Please contact me if you have any questions.
-�- Sincerely,
David Sparks
Superintendent of Water
Cc: George Andrikidis,Director of Public Works
Ned Huntely, Assistant City Engineer
C/
�tiuts�
Ron Morin
Technical Operations Supervisor
New England-West
Ccomcast®
Comcast Cable Communications,Inc.
71 Bradford Street
Northampton,MA 01060
Tel:413.587.0208 Fax:413.586.5733
Pager:413.257.0188
Ron-Morin2@cable.comcast.com