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43-157 (2) File#BP-2016-1454 / I / APPLICANT/CONTACT PERSON RONALD HANNAH �y K / ADDRESS/PHONE 2 JOHN MASON ROAD SOUTHWICK (413)454-7804 I ' f& W re PROPERTY LOCATION 20 HAWTHORNE TER MAP 43 PARCEL 157 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid c,-#- (/5/ t33 Building Permit Filled out Fee Paid TyoeofConstruction: ADDITION OF 10X13 ENTRY&FRAME AND ROOF A 13X7 COVER OVER PATIO AREA New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 096240 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Permit DPW Storm Water Management Demolition Delay 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. �n *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Co n hiPlanning&Development for more information. hrfs Carry_ dteson -- C1i3 - 5-Ga Oso e'Uc+ranite, �. �1 - Ply City of Northampton Building Department + " .7" (�. - 212 Main Street t l Room 100 .: t tl. Q'`1 ,"'.' co Northampton, MA 01060 1 11 I phone 413-587-1240 Fax 413-587-1272 " f. a. ot eelI1 AP 1 ATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING�u �'SaL'ION 1 -SITE INFORMATION T 1.1 Property Address: 20 r'W.v}�{-tO12NB 1tR44cE This section to be completed by office FLorteNce a IAA Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Own of cord: T Co sl Star-.c Na- (P T Current Titters 01105 Telephone ignature 2.2 Authorized Anent: 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 2.41000 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Constmction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5 Fire Protection {/��L 6. Total=(1 +2+3+4+5) 2.11.000 Check Number (15/ " C]'3 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings 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 L.yg Act S Frontage L _.\2L.cz\ � , _ SgrtC Setbacks Front "" 1 Side Lt . R - L:_ R ._. [_ J Rear Building Height Bldg. Square Footage Open Space Footage % ._.. (Lot area minus bldg&paved parking) #of Parking Spaces _ -- -- - Fill: _ ( "..._._ _.._._.. (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO la DON'T 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 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0,.4 DONT KNOW O 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 a IF YES, describe size, type and location: '.. D. Are there any proposed changes to or additions of signs intended for the property? YES © NO 93) 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 Ma common plan that will disturb over 1 acre? YES O NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [M] Decks [p Siding[CI Other[0] Brief Description of Proposed r , f r Work:QTyp1}teti OF A. ICfl• 4,th eAt,Cc[QAM6 Prat QaaS. P lb x1 Geq at otima Pwrte AteA Alteration of existing bedroom Yes No Adding new bedroom Yes eV No Attached Narrative Renovating unfinished basement Yes X/ No Plans Attached Roll -Sheet sa. It Newhouse and&Addition to existina housing, comp1*te:t$e 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-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I I, ,e / J iS r art ,as Owner of the subject property I / n - / ,, /� here. aut •:ze ' 4J6 ✓/ecc.4 ror/ LL to - • ".eha taJYmatters relative to wwwt55rk authorized by this building permit application. -72-- a ure of O.. er \\ Date I, IWN11 ALD Haavywh 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. / ZIT:'pL/�7 MIJ h�JDMW.�1 Cr c. Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ° Not Applicabler� 0 G Name of License Holder: t'�ryy0�1.fl r.t l.iq� CS — lb2LD �1 1 rr�� 7 ` LicenseL� Number / TODu 1-WSC1.) p.s> a\CA2. 1� dO�lr 1� S % ss h 915tr Expiratidn Date gybes-t c J Signature Telephone 7g I 8.Reabtsred Home tmorovein.ntCont,actor. .D Not Applicable 0 Company Name Registration Number Address 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 ❑ 1 . -Home:Owner Exemption 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 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 City of Northampton Massachusetts s� e ( DEPARTMENT OF BUILDING INSPECTIONS P3 %g r 212 Main Street • Municipal Building S fCD Northampton, MA 01060 Fee Calculator for Residential Properties Location : 2.o \apvokhnrz t ecZ2¢Acs- rlOctant tz .M►. Square Footage Amount Basement @ .20 1ST Floor @ .50 \30 (05 0 2nd Floor @ .50 % Floors, Finish Attic, Garage @ .20 20 Deck / Porches @ .20 Total : 9j3 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 20 1-41vwkhneNa The debris will be transported by: b..D., ,e,./L� The debris will be received by: ty ,,,as Building permit number: \\ Name of Permit Applicant �.0.1/4,11 y t&N yrih Date Signature of Permit Applicant Northampton, MA : Residential Property Record Card Page 1 of 2 Northampton, MA : Residential Property Record Card [ Back to Search Results] [Start a New Search 31 Hely with Printing] Search For Properties Parcel ID Name Street Name bacon J HAWTHORNE TERR v Search Reset Parcel ID Card Map-Black-Lot Location Zoning State Class Acres 43-157-001 1 20 HAWTHORNE TERR 101-n/a 2.950 Owner Information Property Picture Bacon Robert 1&Andrea L [ No Picture Available] 20 Hawthorne Terr Florence MA 01062 Deed Information Book/Page: 9234/304 Sale Date: 2007/08/15 Dwelling Information Living Units: 1 Style: Col/Gam Story Height: 2 Exterior Wall: Frame Attic Living: Unfin Basement: Full Year Built: 1991 Ground Floor Area: 1694 Unfinished BSMT Area: 0 Fin BSMT Living: n/a Tot Living Area: 3502 Rec Room: 0 x 0 Tot Rooms: 9 Bedrooms: 4 Full Baths: 3 Half Baths: 0 Mas Fire Place 1/1 Frame Fire Place n/a Heating Type: Central Air Valuation Land: $139,600 Building: $531,600 Total: $571,200 Sales History Document No Date Price Type Validity n/a 2007/08/15 $699,900 Land + Bldg G n/a 2003/11/03 $690,000 Land + Bldg G Permit History Date Purpose Price 2008/05/23 18X36 POOL $30,000 2008/04/30 ADD GAR/SHOP/SH $43,000 Out Building Information Type Qty Year Sizel Size2 http://www.northampton.univers-ch.com/view_property_R.php?account_no=43+-157-001&... 6/8/2016 Northampton, MA : Residential Property Record Card Page 2 of 2 Pool-Gunite 1 2008 1 648 Garage-Wd/Cb 1 2010 1 600 Building Sketch DescriplpdArea A:UA/2Fr/B 1496 sqft B:1 Fr/B 162 sglt 1' C':1.5Fr/B 36 sglt 4 146 �E D:5Fr/FG 31:26 44 12 276sgft 26 13 13 E:.SrFr/EFP 113 12 104 sgft - 32 6 2 sglt 6 UA/2Fr/B .SFr/FG FG F:EF 6 0 104 1196 3 276 13 G 312 sgit 1910 44 41 8 H:OFP B 8 66 36 U 8 280 sgfl 4 OFP 206 spit Notice The information delivered through this on-line database is provided in the spirit of open access to government information and is intended as an enhanced service and convenience for citizens of Northampton, MA. The providers of this database'.CLT,Big Room Studios,and Northampton,MA assume no liability for any error or omission in the information provided here. Currently All Values Are Finalized For Fiscal Yr 2016. Comments regarding this service should be directed to:jsaraflnranorthamotonassessorus http://www.northampton.univers-c1t.com/view_property_R.php?account_no=43+-157-001&... 6/8/2016 PipMassachusetts Department of Public Safety ® Board Of Building Regulations and Standards" License: CS-006240 Construction Supervisor RONALD O HANNAH 1 JOHN MASON R SOUTHWICK MA 0 • N17 lk— Expiration: Commissioner 04/01!2OIS The Commonwealth of Massachusetts !jeerer Department of Industrial Accidents ' Office of Investigations U 1 Congress Street, Suite 100 €V14.-4 Boston,MA 02114-2017 www mnss.gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Elm Electrical / One Development & Construction Address:68 Union Street City/State/Zip:Westfield, MA 01085 Phone#:413-568-0905 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 150 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction ) listed on the attached sheet. 7. 9 Remodeling 2.❑ t am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. 9 Demolition working for me in any capacity. employees and have workers' 9 9 Building addition [No workers' comp.insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §I(4),and we have no employees. [No workers' 13.9 Other comp. insurance required.] *Any applicant that checks box dl must also till out the section below showing their workers'compensation policy information, h homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees, lithe sub-contractors have employees,they must provide their workers'Lump.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:MA Employers Insurance Policy#or Self-ins. Lie, #:MCC20020000842015A Expiration Date:2'1/2016 Job Site Address: 20 Hawthorne Terrace City/State/Zip: Northampton, MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido her the pa and rallies of perjury that the information provided above is true and correct $ienature: -V \ Date: (4414i phone#: m(5 - 4 C ut-"a-tS)-j 0 Official use only. Do not write In this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2,Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector b.Other Contact Person: Phone#: