37-065 (50) 119 BLACK BIRCH TRAIL BP-2006-1109
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao:Atact 37 CM • CITY OF NORTHAMPTON
Lot: -119
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1109
Project# JS-2006-1640
Est.Cost: $2400.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
use Group: HOME OWNER EXEMPTION
Lot Size(sq.ft): Owner: Hartley,Thomas and Jennifer
Zoning: SR Applicant: Hartley, Thomas and Jennifer
AT: 119 BLACK BIRCH TRAIL
Applicant Address: Phone: Insurance:
119 Black Birch Trail
FLORENCEMA01062 ISSUED ON:4/20/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:Install Metal Chimney
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: OI: 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 4/20/2006 0:00:00 $50.00623
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2006-1109
APPLICANT/CONTACT PERSON Hartley,Thomas and Jennifer
ADDRESS/PHONE 119 Black Birch Trail FLORENCE
PROPERTY LOCATION 119 BLACK BIRCH TRAIL
MAP 37 PARCEL 065 119 ZONE SR
THIS SEC-IION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONINGgeFORM FILLED OUT
F
Paid
Bmld}ng Penni/Filled out
("fee Paid t 50.00 623
Ta e. Constmcti.r: Install M- !I Chimne
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owned Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQILNIATION 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 Commission
!gnomic of Buil ing 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.
Depann5eniusevnly
_
I_^ c' ortgampton ---"., «` 9 : a-
�UlJ1ll C IE U L'1ppu I g Department r .1Cle Sa's
t.ialn Street € rt Tabtr �€` n "
APR 1 9 2CC� om 900 1 Y
ori pton, MA 01060 rr = ? +
phone 41387-1240 Fax 413-587-1272 °� 4 -c 'e"$;FL--
APPLICATION TO LUNb I RUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1•SITE INFORMATION
1.1
PropertyAtltlress: Birk", Thrssectionto_becompletedbyoffice
11 1p61t&LL / Treu ( Tdatr T. .tot UoT
Flores I /v(,4 V I Ulc Zoite `-Dyed 'Dusrrict.',-
EfmSG Dlshtcf _ CB.Dlsbict' - .
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-111C010.5 LIMO c7PPMI Har+lam Ily RIACL Florence MA 0104-a<
Name(Print) Current Mailin Address:
- / "11„.L2 j7 - le hn " .�R'1- r34�]t`•
lF-�— (C✓y Telephone
S' nature
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 --19C 2 a 50 -(a)Building Permit Fee
2. Electrical 'y(b)Estimated Total Cost of
ConstructionTrom(6)
3. Plumbing Building Permit Fee
4. Mechanical(H-VAC) I II
5.Fire Protection 1// arC)i:c11`u -flet' Pry -er4r),
6. Total=(1 +2+3+4+5) - 1-1„.3.4,, ,561 Check Number
This Section For Official Use Only
at
e
Building Permit Number. < Issu
Ded:
Signature:
Building Commissioner/Inspector of Buildings Date
Se„" q ,SJR- `vt f i,•cDL. cc71 t46J 151 re'iaat March 31
HO ' l; q, Coned, and 4(ki614fe+n rIctr'; nor 64412 eA's4 t
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Cotter? room
Required by Zoning r
This ding to be filled In by
® Buildingby Zoning
Department
Setbacks Front
Side 111111111
Rear
lanifigialMINSIIMMINIIMMIll
Open Space Footage
not area minus bldg&paved ®®
IIMIMII
artlm,)
--
ballalIMMSMONI
A. Has a Special Permit/Variance/Finding ever been Issued for/on the site?
NO 0,R� DONT KNOW 0 YES 0 ,
IF YES, date issued:+
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES Q_
IF YES: enter Book Page and/or Document MI
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T 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 Q , Date Issued:
C. Do any signs exist on the property? YES Q NO 9
W YES, describe size, type and location: i
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0
IF YES, describe size, type and location: '
E. WM the constnrction activity disturb(clearing,grading,excavation,or tiring)over I acre or is a part of a common pian
that will disturb over I acre? YES Q ,. NO (Qj
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Q Addition Q_; Replacement Windows Alteration(s) ® Roofing Pi
l
Sr Doors O _
Accessory Bldg. Q Demolition Q New Signs t0] Decks [p Siding[p] Other(C)
Brief Descripfion f Proposed
Work: Ittt`} �n r1.,imno �vr wood .s'love— Chivlei +o 7 yr i h} u? 4ltt"upc, La1 ; raved
Alteration of existing bedroom Yes No Adding new bedroom Yes XNo wl,G. aha.
Narrative Renovating unfinished basement Yes —X No Too of- c
Plans Attached Roll -Sheet
cufth eSit7atii",1h+ raga'of o e" t5`tti�`-a'Y" r rp"' bl7171T Wier_. e a ImhRn i
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 stores?
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 Ta-OWNERAUTHORPJITWN-TBE tOMPLETD WHEN
OWNERS AGENTORCONTRACTORAPPLUES FORBUILDINGAERMIT
as Owner of the subject
Property
hereby authorize _
to not nn my behalf, in all matters relative to work authorized by this building permit application.
immimimmumiSigneture 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 Name
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8,1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder:
License Number
Address Expiation Date ...
Signalise Telephones _
de" ,= HLLTel c. T,):.T r;."ey't*' rplgh,.uas> -rctitD n w4 . . ..._ Not Applicable 0
Company Name Registration lumber — -
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE;CFFIDAVtf Mat,c.152,8250(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 0
rw vTmd sr5hr.fliT3THT301553";81:34.eiFirrta
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 750, 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 fans
structures.A person who constructs more than one borne in a two-vegr 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 mast be liable for person(s)
you hire to perform work for you under this pernriL
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
f4118(
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pSlWlpy.
Lam _ )�sa (fif-2 of Northampton _
• ,,seri. %(ai(
f • t&. .try nc.ua _ — r=
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DEPARTMENT OP BUILDING INSPECTIONS
212 Main Strcct ' h2unicipal Building
NorLhamp ton, Mass- 01060
wORJQR'S COp'N'ENSATION ENS—TWANG?. Af1..diAva
•
(Ii eos.:J)A„wirtc)
with a principal place of busioessfresidence at
(phom_:)
(s2iUdty/naintnp)
do hereby certify, under thepans and penalties of perjury, u12I
( ) I am an employer providing the followine worker's colnocns_non cove age For my
employees wor'.dng on this job.
•
(L^sannc Comp-my) - (Policy Nmnba) te~rpimt on Dam)
( ) I am a sole proorittor, general coolrcor or homeowner(d cie one) and have hired
the conte actors Listed below who have the foJowine. workers cope_canon pobcies_
(Name o;Co*.•ictor) (tnnirank Company/Policy N1mi.c:) 10'.pL-aco,r.Datc)
(Name of Coocnop (Ls,trznc CompamnPouicr Numt r) (E:.piradon Dalt)
(Name of Cov^znor)c (Insureno Company/Policy Numbs) (Ervinuon Date)
(Name of Coon-actor) (Insuranc Comcany/Poucy Numyi) (E piatioo Daje)
(.cath mrml ec nam&--t-u clew&:eru-m.scc pev:.as to at c, cera)
•
) I am a sole proprietor and have no one wornng for me.
( ) I ama home owner performing all the work myself.
Nom: ..Mc�s...:].b®mwu-,.M coley vcaon:u,u
wrnt =o,iw.t be of
eMcy unc`a. wxe..aactho faU«wwo aa,.6a,.by boc/r. wax-.rye Lamm
�lo.ma nfc a4 't:,e� cks�(GL�ISs[(S)1�Iimriw M.Eoae.m rmeEeca Fm^cya•d-v-Ite
'.i 1cpl r2220.22 qmy.,Boa.r ae Works'. _.c A4
I undcwd aa,orgy of dam=lemma cry b. uo pilj.,,m.:11 of tmtond omo.of linin roc m.
m'7-''rcifciw=Ad uu Li]t c to occur.ltovnza,m'3c acioa 25A of MOL I52 at taz m ux r.•,m o(cimical p-"ir°
oxacn or a Gane of up to S1300.0]n'« s of up to oncd.O pad-Jo in&(of.StoO Work-Orli=uta
fu o(SIDO.00 e2y,.7S220c
For dap.�.�-d uc my
Pcrmil Numbs
Map= Lot.1
Signature or Licrrmcmuuc Lace __ J
'4SnANPTC �
9
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•y- DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Mtun.Street O Municipal Building
Northampton;MA OlOCO
to
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 trvojary
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 bmtdifg department for t1t City of Northampton wants any persons)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 fegulations. 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-TT
i, JeA r\Iter i-ai- r ft4' understand the above.
(Rome owner/resident's kignature requesting exemption)
I will call to schedule ail required building inspections necessary fin [he building permit
issued-tome.
Date 3//L!!A)(0
Address of work
location .,.�1 i q -sicitu girth rou/ ..
F1. ' UIO&
4 OLDE HADLEIGHpyg y� A
HEARTH &HOME CENTER,INC -PROPOSAL
OSAL
• 119 Witlirnansett St. Rte.33 .r (ra r' �,+,�S
SOUTH HADLEY, MA 01075 l� = 1S
D y p4 or / Pokes
(413) 538-9845 FAX (413) 538-8753 _,.'! i 9 + �I_,
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j.
MA CS UC. #009989 MA 1418 Lie. #120184 APR 1
ALAN CTOUPSiS
..nrl .„
/
To: i tiE�S OF owe w` t<.IJNS (li) U4.(jd
moNE Dna.
12105
We hereby submit specificaeoax and estimates foe
reP:vjec,f3 1110,-).A1., -ece,a ,_ pfrv.t,t_ntezec ,gte_orte-n-teer-ae-044,rAi
- - 1 /241 3c
s to
- sf
vii 3( .,t Ink(' ?/
k......)
,�� (T U ccs <_ X07
7 12-
N - agnate k .r a gas unit the customer Is responsible for paying the plumber or gas company! ping and connection of the gas to 7 TS
tt this quote is Tor a wood or coal unit,the customer is responsible for obtaining a wood stove installation or building permit from the local building inspector's
office and for the final safety inspection upon job completion.
WE PRO' *SE hereby o Burnish material an/abo -eomple a in accord- Ce. �yi e spe
lbe(
cdcuGr She sum of
/�9�j
Jail a -....:-..da-- y Ir... �I"' elzddlars IS "f'V '--, ),
Payable as follows'. _ l' _ 1:e^""
(r�/� CL.,.
/Jr' / e
l
Allmaterial g d b pe.:Oed.All work be completed workmanlike Authorized /A -- /
tl e standard P .Any I deviationfrombon -pec act- signature V G
liiiiih according
involving ll he executed onli upon writtend and will become an
charge d avre Uie estimate_All ag g. n accidents s NOTE: This proposal -be withdrawn 9
et delay.bcyoral mit.on.ro..0 r to carry fire tornado.and other ,5sm} are. by us if not accepted within <__days.
Our workers are fully covered by Workmen§Compensation insurance
`ACCEPTANCE OF PROPOSAL- The prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized
to do the work as specified. Payment will be made as outlined above.
Signature Dale Signature
r
L ` 1.7=^I I it
Anthony Patillo A"r,n 1 9 Ajf116, 2006
Northampton Building Inspector)
Mr. Patillo,
The Design Review Board of Rocky Hill Co-housing has carefully reviewed the
recent request by Tom and Jennifer Hartley of 119 Black Birch Trail to have a
wood stove and chimney professionally installed by Olde Hadleigh Hearth and
Home in South Hadley, MA. Wefeel favorably towards their request and
hope you are able to issue a building permit to the Hartleys for this installation.
Sincerely,
Pc (a
Donna Cohn
Randy Sailer
Betsey Wolfson
�, .
U APR 1 "w^o
April 2006
As immediate neighbors, we hereby-state thaf-we-do not have any
objections to Jennifer and Tom's plans to install a woodstove and
chimney at 119 Black Birch Trail.
Signed //Print Date
'Stan it: l�a. rain ,Mc�v S L j S +40(9
GiJeff f cf ch 'yr