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25-026 (7) _ -..i epa men use"on City of Northamp)on Status of Permit: Building Department MAY - JgUM Cut.Driveway Permit 212 Main Street Sewer/Soptic Availability Room 100 WaterA1011 Availability EPT.OF 6UILDING 1 ''Js Northampton, MA 0106$ NORTHAA4PTnN O4,,0s of Structural Plans phone 413-587-1240 Fax 413-5877-11227 PlotlSite Flans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office ,"z 4( cd1-11lt �.� Map ty, Lot Unit �"J Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: / Q Name(Print) Current Mailing Address: 3Zo -71��z Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS -- \ i Item Estimated Cost(Dollars)to be Official Us my completed by permit applicant 1. Building -301 4 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Z/ J iJ d Construction from 6 - " 3. Plumbing 2 J U O Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection , o D 6. Total =(1 +2+3 +4 +5) -7 Check Number /t y This Section For Official Use Only Building Permit Number: 6P_C� Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 Size6 Frontage Setbacks Frontr�f F771/ o; Side L:� R:� L:U R: 0 Rear t ro l E:�:f 0 Building Height Fzl FE-7 Bldg. Square Footage M3% = % asp Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces 1 `I Fill: volume&Location)A. Has a Special Permit/Variance/Fin in ver been issued for/on the site? NO O DON'T KNOW YES O IF YES, date issued:F- IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW O YES O IF YES: enter Book I I Page[ and/or Document# B. Does the site contain a brook, body of water or wetlands? NOR— O Rf DON'T 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 Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YESO NO 'J�r IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, gradin exca ation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO A IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alterations) ❑ Roofing ❑ Or Doors I] Accessory Bldg. ❑ Demolition ❑ New Signs [EI] Decks [p Siding [p] Other[O] Brief Descripti n of Proposed 7 �_ Work: 9^/-A< C 4J �?` L �ted/ v r +A Alteration of existing bedroom Yes No Adding new bedroomes No Attached Narrative Renovating unfinished baser retlt Y Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following 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. Masscheck Energy Compliance form attached? h. 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 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 to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, 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 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: 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. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton r Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building v� ►` Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered Type of Work: Est. Cost: Address of Work: �� /�c , �* ��C /J) /(-.,- Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): Job under$1,000.00 Owner obtaining own permit(explain): 0zj/I e/ E-- Building not owner-occupied 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 RESPONSIBILITES 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 Owner Name and Signature City of Northampton r ' Massachusetts . _ DEPARTMENT OF BUILDING INSPECTIONS S1 1 212 Main Street •Municipal Building Northampton, MA 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: (Please print house number and street name) Is to be disposed of at: (Please print hame and location of fa ility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) (s Cv Signature of Permit Applicant or Owner 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. DAVID MELLO BOOK 13175, PAGE 132 DAVID W. MELANIE A. FOURNIER PLAN BOOK 31, PAGE 61A BOOK 6741, PAGE 318 PUN BOOK 178, PAGE 235 PARCELS 2 3 i NI 4.3' r ys.a' 1 1 L i OSED DAVID MELLO 1 oPG AGE BOOK 13175, PAGE 128 r a SEE: PLAN BOOK 31. PAGE 61A ,i PINKY HOTA SUBJECT TO AND TOGETHER WITH s,3 VINAYAK RAMANAN THE RIGHT TO USE A CESSPOOL % >< �yv. Z BOOK 11756, PAGE 206 a1 PLAN BOOK 176, PAGE 235 s }i �1 1 1 J 1 4 1 1 l / 1 1 1 1 ' 1 RIVERBANK ROAD "BUILDING PERMIT" PLAN OF LAND IN LOCUS NORTHAMPTON MASSACHUSETTS RICHARD H. WATLING BOOK 9M, PAGE 19 RICHARD WATLING PLAN BOOK 176, PAGE 235 LEGEND PARCEL 1 — SCALE: 1'-20' MARCH 22, 2019 HAROLD L EATON AND ASSOCIATM INC. o FOUND IRON PIN �� REGISTERED PROFESSIONAL LAND SURVEYORS • IRON PIN TO BE SET E. 23;5 RUSSELL STREET — HADLEY — MASSACHUSETTS x35032 413-584-7599 413-5&S-5978 fax 0 FOUND CONCRETE BOUND email — hlootonOool.com � ■ FOUND STONE BOUND A UNMARKED POINT 0, 20 40 60 I I IIII '! III, N 77, _,iT I I I I I i I Il,i! lllli li ! � i j j �I'I lil!,lil' Ili If I'l Ililil �'1 li I I Illi jl�f'�I,II. ESI I! I I I , 'II! II ; '! I i� III �,f �'I I I i IIII lii II ~IIII ', � �' � ! I !IIli�lllll W 5 I i r a a 0 SINCE 1940-- D m 3 Io r k MILES 413.247.8300 OS :U BUILDING MATERIALS SUPPLIER#- N r 3 v a i L21west st. -west hatf!eld, ma. - 01088 4 _ -- ----------------- i O O N CO N W � N CO MY u� OD 00------- ----- —1- 1-- - O T 6 b [ Q F- Y YY N N X i� N VJ � ..I S-v Ivy S•v S v t- i-v r � � y m w-ra - _ Z r ------------------------- N 1 m.. Existing House i b i Watling,Richard s ....a k Existing House Northampton,Ma. i 1st&second floor plan - _ � Nrerw Nv}a Nu�Er _ OiY NYw 0-Y o-rn hwo a Second Floor - _ _ A101 I � I. �I ) I I J Tra Lill IWI I ;1 I9 N V j �clI ly G C SINCE 1940 rkMILES y m 3 � 413.247.8300 QHC11.DING MATFR1ALS SUPPLIER N ° . � v oy a 21 west st. -west hatfield, ma. -01088 CDCDM ......,,m...... y... 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