23A-277 (3) •
4640000
BP-2001-0924
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: shed BUILDING PERMIT
Permit# BP-2001-0924
Project# JS-2001-1667
Est.Cost: $450.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Sjze(sp.B.1: 6490.44 Owner: DILTS MICHELLE
Zoning:URB Applicant: DILTS MICHELLE
AT: 6 MAPLE ST
Applicant Address: Phone: Insurance:
6 MAPLE ST (413) 586-6971 O
FLO R E N C E MA01062 ISSUED ON:5/18/01 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 8 X 8 SHED
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 5/18/01 0:00:00 8066 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2061-0924
APPLICANT/CONTACT PERSON DILTS MICHELLE
ADDRESS/PHONE 6 MAPLE ST (413)586.6971 0
PROPERTY LOCATION 6 MAPLE ST
MAP 23A PARCEL 277 ZONE I,1RB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out //
Fee Paid ((L6 dIP
Tvoeof Construction: INS ALL 8 X 8 SHED
New Ct r st action
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owne/Statement or License
3 sets of Plans/Plot Plan
THE F' LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented. r,,r7/- �jeir✓ '<Z,S/
Denied as presented: 6",e- Y/ J -
Special Permit and/or Site Plan Required under: § Be eA' /
PLANNING BOARD ZONING BOARD STET 6MK
_Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof(inclosed
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
err ./ - eaLS f
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.
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 4135: r �.
r+ FC gdkr ,
APPLICATION TO CONSTRUCT,ALTE*Li A R,RENOVATE OR DE irl N A ONE OR TWO FAMILY DWELLING
dM 15 2001
SECTIONS-SITE INFORMATION pErtT OF
BINDING INSP
INDlNGINSPCkIYtlS
1.1 E,roperty Address:
ar
G Maple Sk. sy
a
r lorence. Mft p161OZ
_ —il - aaa.
SECTION 2-PROPERTY OWNERSHIFUAUTHORIEp AGENT
2.1 of Retard:
Michelle. -hilts (a M4.o10 no--t41c
Name(Print) Current Mailing Address:
F Telephone
aignature
2 2 Autharizfd 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 *�YSo (a)Building Permit Fee'
2. Electrical (b)Estimated TotWfCottbf
Construction from(6)
3. Plumbing Building Pertnitte
4, Mechanics((HVAC)
5. Fire Protection
6. Total =(I +2+3+4+5) t 'St Check:Number 7/4 .{..J,
6 s.POc`j
T,hpis Section For Official Use Only
Building Permit Number: ?lag Date Issued:_.,_.,..
r
oignature
Building cmnmis Mner/Mspectoraf B .: Date:,;
Section 4.
r 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
Setbacks Front /C."-
Side L: R: L: R: y
Rear
Building Height '17
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 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 Book 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
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:
kTION 5- DESCRIPf ase P;a - e euri h
New House 0 Addition 0 Replacement Windows Alteration(s)❑ Roofing 0
Or Doors 0
Accessory Bldg. IIY Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: ...At \n . at _ a miL. ,a
r
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll o Sheet❑
37uT LrA{= ,.hY tt.L . .
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?
elk*. 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
SECTIQN 7a-OWNERAUTHORIZA{( -TO,`R[* PLETED WHEN
OWNERS AGENT OR:CONTRACTOR it LIES FOR GILDING 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 Name
Signature of Owner/Agent Date
•
•
iiilSECTION S-CONSTRUCTION.SERVICES
is . true on .,pervisor. Not Applicable 0
N me of Ceense Holder
License Number
Address Expiration Date
Signature Telephone
.„,,, k. ? , Not Applicable ❑
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.
,${fined Affidavit Attached Yes 0 No ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 10$,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 he,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 hopte 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 LocalZoning LawsandState of Massachusetts General Laws Annotated.
Homeowner Signature 1\AXE k., cs"S I_t�x—rte„_
f
s.
. . . '
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A^, a,_ ,��ti,*`e CAT of erfhamptartpi
itef llff Sansas4nvella' it .
wy. I DEPARTMENT OF BUILDING INSPECTIONS 34V'
212 Main Street • Municipal Building _
Northampton, Mass. 01060 IN
WORKER'S COMPENSATION INSURANCE AP`N'IDAV P
I, MitLelle.. T)i 143
(ticeusedpermittee)
with a principal place of business/residence at:
U, Mnplf S-1cj lone. cs rwa 01062 (phoned) g13,684497f
( tre<vaty/sra�Jrip)
do hereby certify, wider the pains and penalties of perjury, that:
i.vc ( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Iil
(Insurance Company) (Policy Numlxr) (Expiration Dare)
f, ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurance Compaay/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Polcy Number) (Expiation Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(math additiooal Med ifneowuy to include information prtruarriag w all ca mama)
( ) I am a sole proprietor and have no one working for me.
(WI am a home owner performing all the work myself.
NOTE:plcasete aware that while bao»samers wiw employ versant to do maimn'aor oxamuuoo or ncah WWII Me d.J4og of
not mete than t roeimas in whidadm hnm»nacramides or m dm Bounds apportemMtherdo nm nett gemadly uomidand to be
smpkoyae under Me works oam,.mwien Ad(61.152ss1(5)),application by a homeowner far•bathe or parva may evidence dm
1ep1 aluua afar avwleyer undwtbe Woha's Compsyfxon Act.
Iu_. .Gat a coy`If Mil amenemesay be faaaMed In the nmummt ofiaaaadd AntiMz&OSSoc of Manua forth.
coverage vuiflarioa and thetfailma three=coverage make section 55A of Wit 152 as bdmtha imposition ofaiwmd pmstia
m5.iaredafrac new toStatono0 anNmiagrIeseersofup to one}rxa ipW pemriia mtbe flim ofa SWp Watoademae
flim of$100.00 aday agaimt me.
Fa dqianvccsl wen* --
r (�() J .-� - , Permit Number `-
13
. t � Signature oftio-nw/permittec lite
ps.:. .�:; ,.�..,. —
MORTGAGE LOAN INSPECTION
R. , 1 F 2x01
h
DEPT OF BUILDING[NSPECTiONS *cS`
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NOfIIH4MP10tLMA 01060
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LOCUS REFERENCE
9m II
PT 'J'' BOOK 4485 PAGE 59
L'v0 PLAN 8801 55 PAGE 45
ry i OVP-Rw6ge
�� VT��1 TiE(
MAPLE STREET
TO. Florence Savings Bank
AND. Lawyers Title Ins. Corp.
OWNER: Richard Horton
Nicole Meunier
I hey repot that the p shown on this plan are LOCATION: 6 Maple Street
not located within a Flood Hazard Area as shown on the Northampton, Massachusetts
Pedal Emergency Manfgo:nmt Ageecy's Flood
Insurance Rate Map,
Community No. 250167 - 0001 A E. B. HOLMBERG &Associates
RHbotive Due April 3, 1978 LAND SURVEYORS
ea V Vkflfl..Cm nm' v•era♦t4mvw vA mMY AOALC