24D-307 (8) 18 HILLSIDE RD BP-2019-1258
GIS a: COMMONWEALTH OF MASSACHUSETTS
Meg:Block:24D-307 CITY OF NORTHAMPTON
Lot,-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Cateeorv�ADDITION BUILDING PERMIT
Permit a BP-2019-1258
Proiect a JS-2019-002036
Est,Cost 54142500
Fee: 5269.00 PERMISSION IS HEREBY GRANTED TO:
Cong.Class: COntraCtpr: L(cenae:
Use Grouo: DANIEL HATHAWAY 081793
Lot Swim ft.): 1257.28 Owner: BROWN HENRY
Zonine: URA(100y Applicant: DANIEL HATHAWAY
AT: 18 HILLSIDE RD
Applicant Address: Phone: Insurance:
2 OLD GOSHEN RD (413) 695-2937 0
WILLIAMSBURGMA01096 ISSUED ON.5/1"019 0:00:00
TO PERFORM THE FOLLOWING WORK.-ADD 3 SEASON PORCH, NEW DOOR
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 q Foundation:
DrNeway Final;
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimneyt
Rougb: 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 ofOccupancySlena ure:
FeeTYpe: Date Paid: Amount:
Building S/1520190:00:00 $269.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
FileX BP•2019.1258
APPLICANT/CONTACT PERSON DANIEL HATHAWAY ` \/
ADDRESS/PHONE 2 OLD GOSHEN RD WILLIAMSBURG (413)695-2937 Q C
PROPERTY LOCATION 18 HILLSIDE RD
MAP 24D PARCEL 307 001 ZONE URAf 100U
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled our
Fee Paid
TypeofConstruction: ADD 3 SEASON P0JGJ4rKW DOOR
New Construction
Non Structural interior renovations
Addition to Existinp,
Accessory Structure
Building Plans Included: '
Owner/Statement or License 081793
3 sets of Plans/Plot Plan
THE LLOWING 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
/�e
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.
•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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Depadnferd use only
City of Northa pto Smarr Pa -
��.> Building Depa m MAY 8 mC - way Pemtit
212 Main St at ewer/ optic vailabilily
Room 1 �j[y� water ell ilabiltty
Northampton, DIIJOrrI,^`BUII°I,r,qc,gµ,p, ye of tmcmnil Plans
phone 413587-1240 Fax 4 -
Olher Specify.
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMA710N ll4 n h D
1.1 Property Address: This sactil m be completed by office
Map .24/D tat 307 Unit
zone Overlsy Dblrkt
Elm St.Dletrict CB daelel
SECTION 2-PROPERTY OW NERSH I P/AUTH ORQEOAGdNT
2./ Owner
�of Record:
'
Name(R� A
TeWpl Meiling AtlEroBe:
1 rekrpltana
Bigatura
2.2 Au[horb,ed Agent.
Name(Rir,V Cumin WHIM rmw;
Sig.w. TeypW.
SECTION 2-ESfYATED CONSTRUCTION COSTS
Itam Estim led Cost(Dollars)m be Official Use Only
complabedbypennitapplicant
1. Building 7p/2 5 (a)Building Pennh Fee
2 Electrical •J7-00 0 (b)Estimated Total Cell of
Construction from 6
3. Plumbing Building Parme Fee 1{�f
4. Wchanical(HVAC) '(a
5.Fire Protacbm
6. Total=(1 +2+3+4+5) Check Number
This Seetbn For Official Use Only
Building Pemit Num r Date
Issued:
5C -7n
-)S-20in
Building Commssioner/Inspector of BWtlmgs lDay
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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Section 4. ZONING All Information Wrst Be completed.Permit can Be Denied Due To Incomplete Information
Existing Propowd Required by Zoning
Tbis wlumb in be fifth in by
nulla.[)b,ae mem
Lot Size
Fmnta e L
Setbacks Front
Side 1, R: _ L 1. R.___
Rear
Building Height �f.G
Bldg. Square Footage
Open Space F.Mge
(Id—ininns bldg a'uM
hie u [
#of Parking Spaces
Fill:
.ager atacauoa
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO < DONT KNOW O YES O
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 19L DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Iswed:
C. Do any signs exist on the property? YES O NO I,
IF YES,describe size,type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. Wil the construction acEvity dist rb(deanng,gradinitVEon,or filling)over 1 am or is h part of a common plan
that will disturb overt acre? YES O NO
IF YES,then a Northampton Stone Water Management Permit from the DPW is required.
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SECTION S DESCRIPTION OF PROPOSED WORK(check all aoollcalb
Naw House ❑ Addition Replecemerd Windows Alteretbn(s) ❑ Rooling ❑
M Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [[3 Siding[0l OtherjQ
�BY% 7
Desorption of Proposed *00 A ftLE seMiN AAAA,iy&j Dor�
rk-
Allembon of existing bedroom_Yes X No Adding new bedroom Yes v No
Attached Narrative Renovating unfinished basement _Yes No
Plans Attached Roll -Smmt
et.N Newhouse and or addidan to eftlina housina.complete the following
a. Use of Wilding: One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a ganga attodbd?
d. Proposed Square footage of new cosbuction. 2 JO Dimensions I
e. Number of stores?
t. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Massrheck Energy Compliance form attached?
h. Type of construction IDDJ10
I. Is construction within 100 R.of wetlands?_Yes I/No, Is construction within 100 yr. floodplain_YesNo
j. Depth of basement or cellar floor below finished grade 'rJco
IL Will building conlorm W the Building and Zoning regulations? r/ Yes No
1. Septic Tank_ CihSewer Private well City ,Mer Supply_
SECTIONTa-OWNER AUT14ORIZAT10N-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, N/Lr &lead as Oveer of time imbed
property ...
hereby authorize 1}7t0�f�tN�'y
to act on my behalf in all relsBve to sugnrtzed by is building permit application.
a X99
s Mure aawsr Date
I, DAwtO, �'r177/'A4nly!'t/ as Avner/Authorized
Agent hereby declare that the statements d information on the foregoing application are tree and accurate,to the best of my knowledge
and belief.
Signed under the pais and penalties of perjury.
j
a OanerlApeof Data
SECTION B-CONSTRUCTION SERVICES
8.1 Licensed ConstrucWn
Supervisor: Not Applimble ❑
NaneolLicmummHoldi Aft,&, ! L /li'S ' Vte Inp
S
— tAYnN N
2 a�Llj_/,ul�'>•v dO� ry lGL IAvMs8V2G � ' /i, 2iso
EWkatlon Dela
6q5 2y37
Sipetere TeNphona
S.Reoiatared Noma Imoroverrent Comractor,. Not Applimbte ❑
AAW e, 4*pfpq44 /146,70
Commnv Noma Registration Number
S)#04c- /2ca v
Add.. Eipiration Data
Telephoie
SECTION 10.WORKERS'COMPENSATION.INSURANCE AFFIDAVIT(M.G.L.c.152,.§25go))
Workers Compensation Insurance affidavit must be connpteted and submitted vnth this application.Failure to provide IN affidavit vdll msil[
in the denial of tte issuanca of tin building permit.
Signed Affidavit Attecled Yes.._.. No...... ❑
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City of Northampton
I Haasachunattn
l fbZP2 a S OF F.S U,: Z InU1FIOlia b'
212 !Wn atbm, " lain 010 Bu11G]nq �..
ea[Cl,aryCm' EA 01060
AFFIDAVIT
Home Improvement Caotnctor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors perforating improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor mast be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconsfrudw, alteration,renovation,repair,modamiza ori. coirverslon,
lmprovemera,removal,demoldan,or construct/On Ofan addition to arty pe-existing ow mr-occip ed budding cMISMng
at least one but rat more than fourdwelling unds....or to structures which are adjacent to such residence orbudding"be
done by registered contractors.
Note:Lfthe homeowner has contraccred with a corporation or LLC,that entity must be registered
Type of Work: "IM/dN Est Cost 10'//01) d
Address of Work: /a N'I U.S/bG gd-w Qf AV, 0 tV
Dale of Permit Application: ,S. S•
1 hereby certfy thm:
Registration is not required for the following ressno(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
Building out owneroccupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBMITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property
Date Ower Name and Signature
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City of Northampton
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Massachusetts Residential Building Code
Section 110.R5.1.2
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.
Section 110.R5.1.3.1
Any homeowner perforating work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s)
for hire to do such work, then such homeowner shall act as supervisor.
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 thejob 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.
City of Northampton
0Nasaachua tts
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DSF1aIIM+dT OF aU1WD INFFdOTiOHa
212 1 n et[aet •l m cip 1 a 11 9
PorHmp[m, M 01060
Debris 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.
The debris from construction work being performed at:
19 #y'510f 90AW
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location(of facility)
Or will be disposed of in a tlumpster onsite rented or teased from:
(Company Name and Address)
� .A 5- 5,101
Signature of Permit Applican Zilfner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth ofMassachusens
Department of IndustriWelecidessis
I Congress Street,Suite 100
Boston,MA 02114-2017
wwrvmassgov/dia
WV.cke.' Cmnp.s.mkc.Insurance Allbbuit:Buflders/Contmciors/Eleaticians/Plumbcrs.
TO BE FILED WITHTHE PERMITTING AUTHORITY.
Aooli ant Information ^../ tePlease Print Lcaibly
Name lBuanewlrdrev�
gongnIJIf
dividusll: Ytm U'YCM'Nwe�l./
Address:—7 OW 4 95#t7g XAV
City/State/Zip: C&a1*r:5AdX4 Jt 0104 phonc ii: q13 b9s 2937
Araya,an emp.ywf(Beck the appropride hoc 'type of project(required):
1.❑lamaempbym wah employee ftWl ud/w pert�hml' 7. ❑New constructors
L.�Iamneole proplietmwpeMacM1ip aM Mvememployee working farmein E. ❑Remodeling
my epuiny.INa woken'amp.itay.required]
3.❑Ian ahamwwnv doing all wokmyaelf.Mo wokae'comp.vummmrequimd]' 9. ❑Demolition
3.❑1 am a M1mnarxnar aM will be hying conmaas b mMuct ill wwkoemy PraPalY. 1 wJl 10❑Building 8ddtllOn
my Nal.11 umtrxlua citlla hn'e wwkas'congmfaYm vlelmrltcor aeeok 11.0DCCtrlcal repans MBddlnMs
pr�pri,:mn x,a /2.❑PI tubing repairsor additions
5�lamageail 4mnacrm and l w.e hire,t am aub mnVamon lisld an ac EEEW thea 13.[]Roof Ira
rnea am..mo-:lm.nm'e empin>...v,na nave wokmcomp.hammce.l �
6.❑N'e am a empormimand iia oRcers hone caemiaoi Neir right ofexemption pn M41,c. 14.❑0ther
152 k1141,and we hwe no emplayax.INo wokencomp.Imunncc regPhcdl
+any apphmnl IMI.'vhccb Mix n I moor oho fill ore the vu'tim nelnw vM1owirig aarwarW:n'camPemilion polity reformation
'Humuowmn who xuimil Nia afiidavil inNralbe Ney nn:Min6 all wok avd Nim M1ve emai4 v'anaevhan amt aubmit a new atiidavil imliuting auM1.
mCnlmaNn Nal chin Nieaox mhnemplov alhcyinal.M1m)iide leu Newne afderelywnvumh Band aisle wheNer or mil Nnxc mtilica have
emPloyma. IIIM:wbunnncmn'have emPlo\'u.,Iraq neral lure iJc Ndr wor4�s'mmD.ry.liw numnv.
I an an empkg•er char u providing nmrken'ooart envadon insurance for an,empinreev. /telae'is the pdie:f undjob stir
informatkm.
Inser.CornpanV Name
Policy 0 or Self-ms.Lic.q: Expiration Dale:
Job Site Address: City/Statdzip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure W secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1.500.00
and/or oat-year impratemsern,as well as civil penalties at the farm of a STOP WORK ORDER and a fire of up to$250.00 a
day against the violator.A ropy of this smtrnrent may be forwarded to the Ottice of Investigations of the DIA for insurance
coverage verification.
I do krreby ander the pains and prnallies n/perjury that the inJnmulian inteided dbme is true and n,rrear.
Si
Phone k: 3 '15 2,93Z
(1JJioiu/um ails'. llo nm write in Ihiv urea,In Ar ormrpleted by city sen Innen r Jjicia(
City or Town: PermitiLkensc h
Issuing Authority(circle one):
I. Board of Health 2 Building Department 3. Cit,down Clerk J. Electrical Inspector 5.Plumbing Inspector
G. Other
Contact Person: Phone W
• � 11:' llq..'C ^.a.: .41) :1'0.;: .C:., Y�Iri i'al•t 1
_NOTE_
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
IV
I NOTE:
r SUBJECT TO EASEMENTS AND
RIGHTS OF WAYS OF RECORD.
�O P
0
BOJ Q` I5,3 221':
BOOK 8865, PAGE 225 �.
22.T* PLAN BK. 42, PG. 15
111'4Y NOTE:
/18 $ PROPERTY LINES SHOWN ARE APPROXIMATE,
A FULL FIELD SURVEY IS REOUIRED TO
ACCURATELY DETERMINE THEIR LOCATION.
IYIQSIDE 26S 74't
ROAD
TO: FLORENCE SAVINGS BANK AND
FIRST AMERICAN TITLE INSURANCE COMPANY -NOTE-
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
1 HEREBY REPORT THAT 1 HAVE EXAMINED THE PREMISES AND BASED ON EXISTING AND DOES NOT CONSTITUTE A PROPERTY SURVEY
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON Ma
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, -MORTGAGE LOAN INSPECTION PLAT-
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN aunNL NORTHAMPTON, MASSACHUSETTS
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR IgR PREPARED FOR
COMMUNITY /250167 gwJ3
BOYD T. HEHN & ANNE T. TALLENT
SURVEYOR ?� .� 1'P F. r � HAROLD 1"=4 7,
AND ASSOCIAATES. INC.13
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS