11A-058 (6) 1)gxRBpnlFItb`4 RwcB'r.. BP-2002-0119
GIS 4: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit. Buildina
Cateeorv,shed BUILDING PERMIT
Permit# BP-2002-0119
Proiect# JS-2002-0174
Est.Cost: $500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class! - Contractor: License:
Use Group:
Lot Size(sq. fn: 616374.00 Owner: BRISSON PIERRE R&SUSAN H
zoning:URA Applicant: BRISSON PIERRE R & SUSAN H
AT: HAYDENVILLE RD - MEADOWCREST GOLF RANGE
,!MlicantAddress: Phone: Insurance:
151 SUGAR HILL RD (413)296-4475 0
WILLIAMSBURGMAO 1096 ISSUED ON:813/01 0:00:00
TO PERFORM THE FOLLOWINGWORKERECT (2) 8 X 12 SHEDS
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 q"` Foundation: -
Final Final:
Rough Frame:
Gas Fire Department FireplacetChimney:
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 8/3/01 0:00:00' ' 517 T 0"00
212 Main SneeS Phone(413)587-1340,Fax:(413)587-1272-- i- -
Building Commissioner-Anthony Patillo - -
File&BP-2002-0119
APPLICANT/CONTACT PERSON BRISSON PIERRE R&SUSAN H 5007U qg,p k
ADDRESS/PHONE 151 SUGAR HILL RD (413)296-4475() 1' �d—•
PROPERTY LOCATION HAYDENVILLE RD-MEADO WCREST GOLF RANGE
MAP I IA PARCEL 058 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvoeof Construction: ERECT(2)8 X 12 SHEDS
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
INF9RMATION PRESENTED:
)1 Approved—Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and Site Plan
ZONING BOARD PERMIT REQUIRED UNDER §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
_Other Permits Required:
Cub 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
24V
Signature of Build6igOfficia 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 grouting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
t�/R
E C Er Q Eof Northampton
iding Department JUL 3 1 2001 12 Main Street I .
Room 100
Orth mpton, MA 01060
DE o �BL�DONQDAffi3-5 71240 Fax 413 587 1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1- SITE INFORMATION
1.1 PropertyAddress: This,sedt' be compleked,bY'o fits, '..
/17wO or, b��t KAN6C' Map 4y x':
*01",I RL zontet ° 0 is
Lads to q 6/05,3 E rWk"lsbict " ~ CISstrict
SECTION 2 - PROPERTY..OWNERSHIP/AUTHORIZED AGENT
Ji
2.1 Owner of Record: v/a-
rlieaae t Sura ✓ Bi:JJd✓ /.57 S *0g'er7*jI Ad
Name(Prinp Currant MailiYng Address:
Y!3 d5L-s: 7r 0!094
Telephone
Signature
2.2 Au horize nt:
Name(Print) Current Mailing Address.
Signature Telephone
SECTION:3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars)to be Official Use Only
coin feted bv oermit applicant
1. Building ar EOO (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) t0` 6-00 Check Number i
This Section For Official Use Only
Building Permit Number. ZP-- /7 Date Issued:
Signature:
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
This column to be filled in by
Building Itep otmenl
Lot Sim 2 .f
Frontage
Setbacks Front
off. 4ill
Side L: ire' R: 3w, L R:
Rear ASAI 900
Building Height i
9 ?Ckt h1 i
Bldg. Square Footage %3Gff X41W
X
Open Space Footage %
(Lot area minus bldg&paved
mk'n
#of Puking 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: 3X5/SXS &,p4taMe.e�r dr ow-w
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No1X
IF YES, describe size, type and location:
FI 7 R
New House 0 P Addition 0 Replacement Windows Alteration(s) 0 Roofing El
Or Doors El I
Accessory Bldg. IQ D New Signs Decks Siding( Other
Brief Description of Proposed Work: 7VO ✓K/Z VK/ZS7Vq44_t 4MC&T
Alteration of existing bedroom—Yes—No Adding new bedroom—Yes — No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll U Sheet 0
itjj%W0%Y1§Mt0-&fflffg-
ISWIft
a. Use of building : One Family Twol'armly—Other
It. 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?
In, Type of construction—
i. Is construction within 100 fL of wetlands?—Yes —No. Is construction within 100 yr. floodplain—Yes—1
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
g
�e'bWNtRAfIrA
UORlZATION-�,TQPB1COMPLETED WHEN
SO T
OACTOR'APPLIESF6R'blifLDIkGPERMIT
T
as Owner of the subject proper
hereby authorize to act
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
5E t 1.0 ., l;t�TAQN�S�t2VItfE6 •.,�;�y:.
61 L' ed Construct' S er iso : Not Applicable Of
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTJQN 10-WORKERS'COMPENSATION INSURANC&AFFl DAVIT(M.G..L. c. 152, §25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affida
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)Dumb,
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 me 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-vear 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 an 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)ofthe Massachusetts General laws Annotated,you may be liable for person(
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 _
j fl (rtf� rt# 'Xt3rf4ttnt}tfntt _
9 a A.....4...t.'
DEPARTMENT OF 13UILDING INSPEOPIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licensee/permittee)
with a principal place of business/resideuce at:
(phoned)
(sneeUcity/sta7rJnp)
do hereby certify, under the pains and penalties of perjury, th rt
( ) I am an employer providing the following worker's compensation coverage for my
employees worlang on this job:
(Insurance Company) (Policy Number) (Fxpvatfon Date)
O 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) Q ur,,,r e Comt my/PoGry Number) (Expvndon Date)
(Name of Coun'aaer) (Inetminee Compauy/PoUcy Number) (Expimdoa Daze)
(Name of Conmactor) (rnsumrtce Company/Pobcy Number) (ExPirabon Date)
(Nance of Coo,rnctor) (Insurance CompwY/P6 Numbs) (l;xpirzuou Date)
t. ,,n+dlitia..l�vn if ne�.ry b'Jude iafmnaem pcmwvg e W mtracW:n)
O I am a sole proprietor and have no one working for me_
(� I am a home owner performing all the work myself.
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