07-053 (3) POS BP-2003-1222
GIS#: COMMONWEALTH OF MASSACHUSETTS
etisa ; ` CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Ninth# BP-2003-1222
Project JS-2003-1893
Est.Cost: $1200 00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Grnnp: Homeowner as Contractor
Lot Size(sq. e.): 46609.20 Owner: STRYSKO EDWARD C&KATHLEEN M
Zooms:RR Applicant: STRYSKO EDWARD C & KATHLEEN M
AT: 400 NORTH FARMS RD
Applicant Address: Phone: Insurance:
400 NORTH FARMS RD (413) 585-9684 0
FLORENCEMA01062 ISSUED ON:718/03 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSfRUCT 14 X 12 DECK
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 Sienatpre:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 7/8/03 0:00:00 206 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2003-1222
APPLICANT/CONTACT PERSON STRYSKO EDWARD C&KATHLEEN M
ADDRESS/PHONE 400 NORTH FARMS RD (413)585-9684 O
PROPERTY LOCATION 400 NORTH FARMS RD
MAP 07 PARCEL 053 001 ZONE RR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �'/ �
Fee Paid Uo
TyoeofConstruction: CONSTRUCT 14 X 12 DECK
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
INFtyuv1ATION 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
��� 9//'e
Signature of Building £ficial 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.
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� Ct'ty ortharnpton S u �3ita <
ra) g �'�-F3✓1 ng'IDepartment Grr ad etj Air %
KI 2 I M&in Street
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U "II 2 North, p Qn MA 01060 T^ 3fiS et atrcas + ,
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e-47,1 •1210 fax 413.587-12 7 2 416;184, y � 4m,�'a-
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APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be comptet d bmjrbffice '
1.1 Properly Address r, n fsa=, 1
" I6) 7 q Map _ /�� . a.o[� - uT$' S2�t.,e .,
Zone, h2 r sf✓fi-' Overlay Dlstrtct4' e*. ,
Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
r wMe STR . 1 , 4100 M. trA2ntS .1 0-
R-vt (Prams - r.'rent tie Anjress
C
'
l �l(�S6fr5— 4 6 d-tl.
_ eie�hene
Signature
2.2 Authorized AgerLt;..._ _...._ __ _ _ _..........__.
Name Frint7 Current Mating Aod Rgs:
Signature o'eprqme
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Building
completed by permit anarlcr' be Official Use Only
(a) Building Period Fee
(b: . .b n,.ted Total Cost of
,.0ns:rococo from (61
3. Piumbmg _ ., —. — . Building Permit Fee .._
4. M /he t „' ('IVA")
5. hie Pro lectins
6. fetal r. t) . z t 3 % + 5) t 541946• aa Check Number.... 020 112 gry I — _
^7 This Section For Official Use Only
Building Permit Number: /P3 Date Issued:
Signature:
t 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
bits column to be Gllcd in by
Building Department
Lot Size O 74c4 I' 07 ,t-cd
qL--
Frontage f 0 1 /0 1
Setbacks Front �� $0 I/°
Side I._30 R: a7 L:SO R: L(3 dO
Rear P5-7 9-73-
1/45-6
9- JG
Building height i 6
Bldg. Square Footage ' '-� % t no-$�. a. I
Open Space Footage 9b �
(Lot area minus bldg Rpo.<d L44j 5-0 9,S:5- 44bRSY9b. 9S-I PO ,
parking)
it of Parking Spaces 6 L,
Fill: I "—
(volume&l catLon) No�C rtoNe= I
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 Bcok Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO LON'l 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 K_
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:
•
-z"6-.SES do . l'I �� el % .tP.ROPOSEDSWORkKche I Saptlll"ta"bl€)
rmn ra
e z-r-s^- ..q;;7{7: rs^.r< lath'.-4 nftgaZialiagOWS
New House 0 Addition 0 Replacement Windows Alteration(s) ❑ Roofing 0
Or Doors 0
Accessory Bldg. 0 DemolitionD New Signs [(] Decks r-' Siding[ ] Other [ ]
Brief Description of Proposed Work: la k I`(Sort L ECL( k&fie OF 14-00,(=—
Alteration of existing bedroom Yes 1- No Adding new bedroom Yes K No
Attached Narrative❑ Renovating unfinished basement Yes k No
Plans Attached Roll❑- Sheet(3
Ra ;ill e '4v F o e a d dtl itionit6'texistindrh"o Mifra°, dfffii [MIMIUl1 UMW :
a. Use of building : One Family r( Two Family Other
b. Number of rooms in each family unit: 7 Number of Bathrooms a_
c. Is there a garage attached? Yes
d. Proposed Square footage of new construction. I bis-
Dimensions id yt`/ I
e. Number of stories?
f. Method of heating? NA- Fireplaces or Woodstoves HA- Number of each Na
g Energy Conservation Compliance. I V* Mascheck Energy Compliance form attached?
h. Type of construction 1.)G01U FMIn&
i. Is construction within 100 ftof wetlands? Yes X No. Is construction within 100 yr. floodplain Yes x No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? f Yes No
I. Septic Tank Y City Sewer Private well City water Supply
SECTIOF a OWNEI(WAUT(hORIZATION -TO BE COMPLETED WHEN
dWNERSPCGESViCONTRACTOR APPLIES FOR BUILDING PERMIT
k L.OW,he0 v'Tjaper0 �'` , as Owner of the subject property
hereby authorize t'OWfVh wyrKO to act on
my behal , in all matters rela e to work authorized by this building permit application.
Signature of Owner r\-�' Date
a-,0 W/h2.0 STT27(-de0 , 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.
L:Dw//hkt% `ST11>tr1e
Print Name
lt-an( C 6Ada3
Signature of Owner/Agent Date
`S CTI 3 It3'- ,N t Q,�Crz d.ON SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: _____
License Number
Address Expiration Date
Signature Telephone
. t''eltatitilitt 1 Giitiatiaila. ;.-k- «« .<:-.T.} xse#T%•c I . . s . Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone
trs
SECTI0f7O-rWORKERS'.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 0 No ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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`—�,S `""""' Csd'W/✓\.
S
— '
ttett11
>ry,g Gill!, of mtIf
wxW DEPARTMENT OP LUIDINC INSPECTIONS •min
212 Main Street ' Municipal Building
Northampton, Mass. 01060 es'
WORKERS COMPENSATION INSURANCE AFFI_DAYTT
I,
(llrtu.Jls milfce)
with a principal place of business/residence at
fa zct/a s 'tip)
do herebya
cel- ify, ^r!Cr the paws and penalties of perjury_, !b,at -
() I an' an employer providing the following .corker's compensacoU coveri'n'g for my
employees wofiaug orchis job-
(Insurance Comp ny) (Policy Num1 r) (ExTiroon Date)
() Iain a sole proprietor, general contractor or homeowner(crele one) and have hired
the contractors listed below who have the follovrn't worker's compensation policies:
(Name of Contractor) (IDsurdnce Comoa;ry,Polie/Numtcr) (Lx :reuon Date)
tNattpt of Conn lclor) l(1nSurancc Com -rv/Policy Nui bcr) fitattpfatton Date)
(Name. of Con¢saor) (Insurancz Coutttanyttaoltcy NIIn lbe t) ,.2,C Date)
(Name of Contractor) (Insurance Company/Policy NumLJ) U^qz-Bron Dale)
() I dill a sole pioplie.or and have no one v::orking for me.
/N'n 1 van tome oo:ner performing all rte ' O: myself.
Nom, l i 6 Sic ie re .r _ - c.:ylay xsc.. ._..c.on — •ti
u uc Quoonlm enJt i nticab;he lo.•-co - ar 4 b m dn�� m.bv.-lallv mrc_�:larbbb be
m:52 o-
o aIFt eoan.ac Ioy- me. (t a uii(5)) 2. .by.h�n _I-en. P'n -_-C.vec 0_
lagal nssau of m...y.loyu Dour Ja Wu4al.Cwapen.rirna I.ct
I uodcnand,h+:a o.py ofthb.rest i any be forwrsded to rt 6pvumd'ofI«6ntid M,Emrie!ncv of bu..nz for Jm
coveragc vailicatiou nvl llufeilurc to',nut mvcndc but:cram 25A of MO-152 can larto the impxiticn ofc:_'_., ll-rat
ccmu[iny of 1 line of tip to S1,500.00 n.4'rr=rvisxn=ii of up to c-.:yr,r eei civil pubilliel n de form of e St.-,]Wort at er4 e
..m of SI00.W t thy eg.imt m-_
For ro only
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ma =r DEPARTMENT OF BUILDING INSPECTIONS i
INSPECTOR 212 Main Sired • Municipal Building sc�>/
Nonhumpion, MA 01060 ��i
e
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as i.is/her construction sup 1 .isor. 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 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 arc
made
I, Ea om-it�1---Ct*7(SIo 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 to(9-4(/
d3
Address of work H
location 1(00// v.Kiems Ak
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