37 -046 188 Rocky Hill Road Accessory Apt zpa 2013File # BP·2014·0639
APPLICANT/CONTACT PERSON ALAMED KYLE
ADDRESSIPHONE 188 ROCKY HILL RD FLORENCE (413) 923-8724 0
PROPERTY LOCATION 188 ROCKY HILL RD
MAP 37 PARCEL 046 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TypeofConstruction: APARTMENT IN DET GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets ofPlans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATIOl'l! P]Hl:SENTED:
__Approved _V_AAcldditional 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: §
FindingO--______ Special Permit. __=~· _________ Variance*
___.Received & Recorded at Registry ofDeeds ProofEnclosed._____
__Other Permits Required:
___Curb Cut from DPW ___Water Availability ___.Sewer Availability
___Septic Approval Board ofHealth ____Well Water Potability Board ofHealth
__---'Permit from Conservation Commission ___P.ermit from CB Architecture Committee
___.Permit from Elm Street Commission ___.Permit DPW Storm Water Management
__---'Demolition Delay
J~.~
Signature ofBuilding Official
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 ofMGL 40A. Contact Office of
Planning & Development for more infonnation.
of Northampton
ilding Department
212 Main Street
Room 100
MA 01060
-1240 Fax413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
JSB ~oc..~~ ~I\ tlt~
fJo<"'er1CJ... MGt
0'0(0 t..
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
"'~/e, (Jlt:\rJ e.J.
Name ( flnt)
~f-~==Signature
Telephone
2.2 Authorized Agent:
Name (Print)
Signature
Current Mailing Address:
Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Official Use Only Item
DateBuilding Permit Number:, __________~__ Issued:,___________________
Signature: _______---,.___________
Building Commissionerllnspector of Buildings
Date'
This Section For Official Use Onl
(a) Building Permit Fee 1. Building
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)
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
Fronta e
Setbacks Front
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
arkin
# 0 f Parkin S aces
Fill:
volume & Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW €) YES 0
IF YES, date
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW ® YES 0
IF YES: enter Book [ pagel!..,____....! and/or Document #I
B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
o o
C. Do any signs exist on the property? YES NO (l)o
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 ()DNO
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 of a common plan
that will disturb over 1 acre? YES 0 NO {)
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
____
SECTION 5-DESCRIPTION OF PROPOSED WORK (check all applicable)
RoofingAlteration(s)Replacement WindowsAddition 0 0New House 00 Or Doors D
New Signs [0] other [1&'IJDemolition 0Accessory Bldg. 0
Brief Description of Proposed
Work: ("1 q..~Ql.je.. Ct,5 W·e..\\\V'\~
NoAlteration of existing bedroom ___Yes p. No Adding new bedroom Yes X
Attached Narrative Renovating unfinished basement Yes $. No
Plans Attached Roll -Sheet
Two Family ____Other _____a. Use of building : One Family
b. Number of rooms in each family unit: ______ Number of Bathrooms,______
c. Is there a garage attached?
d.
e.
f.
g.
h.
__Yes __Noi.
j.
k.
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, _--;____________________________________' as Owner of the subject
property
hereby authorize toactonmybeha~lf,li~n~a~lI~m=a~tt~e~~~re~la~t~iv=e·~~w=o~rk~a=u~t~h~on~·z=e~d~b~y~t~hT-is~b~u~iI~d~in~g~p~e~rm~it~a~p~p~lic~a7,ti~o~n.----------------
Date
I, ,as Owner/Authorized
Agent h.ereby 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
Date
Proposed Square footage of new co '_________ Dim sions _______________
Number of stories?
Method of heating? _____ Number of each ___
Energy Conservation Compliance.
Type of construction _______
Is construction within 100 ft. of wetlands? ___
Depth of basement or cellar floor below finis
Will building conform to the Building a, Zoning regulations?
_
Yes ___No.
SECTION 8 -CONSTRUCTION SERVICES 1
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
~Q:'''''''""TC''~'i'''='c'';;, 1..I"'"",iO.:lmDI "~i) if1ii;;",; Not Applicable 0
Registration Number Compan)! tlame
Expiration Date Address
Telephone
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6» I
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 ...... 0
The current exemption for "homeowners" was extended to include Owner-occupied Dwellings ofone (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 ofland 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 shaD not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shaD 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 ofthe work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability ofEmployers to
Employees for injuries not resulting in Death) ofthe 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 ofMassachusetts General Laws Annotated.
Homoowner Signature ~~
1
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