17A-057 (3) 195 BRIDGE RD BP-2020-1239
GIS#: COMMONWEALTH OF MASSACHUSETTS
MW:Block: 17A-057 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2020-1239
Project# JS-2020-001554
Est.Cost: $15900.00
Fee: $104.00 PERMISSION IS HEREB Y GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sa.ft.): 8276.40 Owner: ROLLINSON JOHN &JANSON M. SMI 11
Zoning: URB(100) Applicant. ROLLINSON JOHN & JANSON M. SMITH
AT: 195 BRIDGE RD
Applicant Address: Phone: Insurance:
195 BRIDGE RD (413) 244-6335 0
FLORENCEMA01062 ISSUED ON.611812020 0:00:00
TO PERFORM THE FOLLOWING WORK.-BUILD INTERIOR STAIRWAY, RE-BUILD
PORCH, ADD BATHROOM
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# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY TE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS
Certificate of Occupancy signature:
FeeType: Date Paid: Amount:
Building 6/18/2020 0:00:00 $104.00
212 Main Street,Phoa(413)587-1240, Fax: (413)587-1272
Louis Hasbr uck—Building Commissioner
Ln C ✓ _.J
c� -
n 4
-U Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
E 212 Main Street Sewer/Septic Availability
° Room 100 Water/Well Availability
o Northampton, MA 01060 Two Sets of Structural Plans
'� -hone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
(1
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 se tion to be completed by office
�j
l ��� f�� Map Lot V/� ' Unit
J � 7` Zone Overlay District
Elm St.District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
h n iRy 1Ii nsog- ISS � � �aE.., �L�,e�e.icv
c� %o cob
ame(Print) Current Mailing Ad ss:
l
q12-.2 s
We, Tefepfione
S gnature
2.2 Authorized Agent:
S 19'►yle
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 -4 2SQp i 18qIL.J LA9v (a) Building Permit Fee
2. Electrical ,� (b) Estimated Total Cost of I!� //
Construction from 6
3. Plumbing ¢ �a Building Permit Fee
4. Mechanical (HVAC) Y, gq '
5. Fire Protection
6. Total = 0 + 2 + 3+4+ 5) `75'Q6 Check Number Q
/ This Section For Official Use Only
Building Permit Number: 16P'% Date
Date
Issued:
Signature: �' 12'4)440
Building Commissioner/Inspector of Buildings Date
SRO I Irnso✓� @ Coly,ca. n�f
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 Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
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 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO ?-Rr DON'T KNOW 0 YES C)
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO
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)
—7EJ
New House ❑ Addition EJReplacement Windows Alterations) Roofing
Or Doors I]
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[0]
Brief Description of Proposed // --__ ...1 ,,,,//,�,� � � ��//
Work: Int 1 0 OW l�)4./" - E.ZtJ�'l
Alteration of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes K 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
Massachusetts ��?7
� DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building vh �a
Northampton, MA 0106010
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....pr 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:
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):
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.
rotwithstanding 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
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building r..,
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:
MA(Please print hous tuber and street name)
Is to be disposed of at:
find
lease print a an(5bcation of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Sig at re 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.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le¢ibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone #:
Are you an employer?Check the appropriate box:
Type of project(required):
1.❑I am a employer with employees(full and/or part-time).* 7. ❑New Construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.❑I am a homeowner doing all work myself.[No workers'comp,insurance required.]r
10 E]Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.nWe are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
IL
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do certify under the pains and penalties of perjury N:rrt the information pio; ove is true and correct.
Signature: Date:
Phone#:
e a.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. ( its/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
RECEIVED
File No. e*P— -a-�S-l
ZONING PERMITAPPLICATION (§J O.4) j
Please type or print all information and return this fo m to the Building
Inspector's Office with the $30 filing fee (check or moneylore � at�l ��ie
!� TON,
I_
City ofNorthampton 01060
MA
1. Name of Applicant: � ky) 8 a 1 kl Y�.s ® �{otl'Z,SON-
Address: � 13i2.�cQ. � (vRP_✓1C� Telephone: 413-aLiq -6 33 s-
2. Owner of Property: �D�'l 11 �D tr1 sD►r1 G) r')AYA- SO
Address: t IS 13.8ij- jqk f Llrn�t,� 0(0 b a Telephone: 911-,24141- 633A`
3. Status of Applicant: Owner X Contract Purchaser Lessee Other (explain)
4. Job Location: ��,� /r7 �, 1T�. rZokr,✓
Parcel Id: Zoning Map# l�� Parcel# S District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: S �Ol�? ! �t^ fZe Si dceIC.'e"
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
� ®
iv � � rLs
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO X DONT KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
9.Does the site contain a brook, body of water or wetlands? NO X. DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , date issued:
(Form Continues On Other Side)
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
File# MP-2020-0051
APPLICANT/CONTACT PERSON ROLLINSON JOHN L& MARSHA S JANSON
ADDRESS/PHONE 195 BRIDGE RD
PROPERTY LOCATION 195 BRIDGE RD
MAP 17A PARCEL 057 001 ZONE URB000V
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA-REBUILD& ENLARGE PORCH TO INCLUDE ACCESS TO ATTIC LIVING
SPACE BY STAIRS
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
INF MATION 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
Pen-nit from Elm Street Commission Permit DPW Storm Water Management
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 the Office of
Planning&Development for more information.
-Ivv I t-
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
.y
J�
v
Zy ` v
0
I —
L
I -
TO: INFINITY MORTGAGE COMPANY &
LAWYERS TITLE INSURNACE CORPORATION
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY # 250167
, � . t\\�� _ -NOTE-
SURVEYOR: 6V4JC��� �-1- ANIONLY
S
D ES NOT CONSTITUTE AMORTGAGEAP ROPE
RTYESURVEY
1y, OF k4S -MORTGAGE LOAN INSPECTION PIAT_
NORTHAMPTON, MASSACHUSETTS
RAN PREPARED FOR
E. MARSHA Ic,. JANSON & JOHN L. ROLLINSON, JR.
0 135032 SCALE: 1 "--30 ' AUGUST 2 , 2002
S RV HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS R
Irz
svgs -----�.
ow
lg� �
gy o
1odo
i
_Zr
'741/� 6�� �� 3/y COX_
,7XI.2 f/Xfyre,,
i �
FT- HiF
■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■N■■■NN■ICS]■■1�1■
N■N■N■■t■■■■■■■■■■■NNNN■■N■ONNNNN■NEIL !►\a
on
■■■■■■■ ■ 1
MEN M1111101111
■ME MENEM NIEMEN 59F.0"WA 1111111H %,,%, 1N■■■■NONE\' ■■No ON M 011111111 AMWEEN11 moll
��
■NNNN■NON■■■■1��■■■■s�7��■■■■!.N■■N■■r�NrNEW
■NNN■■N■■c■ mom
NNN■NNNNN■ t■I�iiiiiEr■■E11■N■■I� r■ t�L■raEE1k,91111
mom■EONE■■l101111i7i>1,! .1lO■■I■1�■E■E■■r■■i!'70,15INEW l
NONE■■■■■NMEMO■f1liNYl�■■■■NN■■■■■■■■■l11�:��N■11
N■■■■■■■■■■■1■hs!!!'■���NJ■■N■NN■N■■N■ss: sOrII■11
NOONNON■■■Mal■mom
NN■�■■N■NN■N■NN■N■■\``E.■N!1
■NN■NEN■!_ - --_- - 0=00=51wimaz ZROWNWOUSHVINN■ FE
■■■■NN■■ 1111111111110- ' "11'I■■NSI■iii\�i`;V/1�!\NOON■�N■NN■■■■■N■■NNiIIII1
■EE■■N■■■1111111N■S
■ M � ■iEOiiEENNN■■■ONEE -= =n e
MOONS■EO`` A1`>:CINIM■■li■■■■II■■N■ommomm■■.■■■■■11
MOEN MORE 11111101
■■■SI■MINOR ■O■sN■E■m■■N■■■■NENN 1E11109111■■■■■i1
■■■S1■0111■■■■■■■■■■■ME■N■■■■■O1�r!!►1N1�Wi.01■■■■Eli
MNEME_. :::��� •
�NNNN■■NN■NNI�N■\NOON■■li.__�a■r\\i■INN■Moll
■OMNI]111■■NISMEMO N■■■ENEMINIM E■fflvsN■N■OM1 11110111E■NN11 ■N■NNE, N■■■IS■N■1MINIMM : MEMEE■E■■■■11
NN■ :191NL1mN■III IM ■NI!■■■■■1s-M.30 C�EEWRI■■■■■N1
No ,■■.... R■■►IP0•i■■S■■■=
■■E■BRAQW■N■■NN■ N,-N■ 11101_
■■■■Nri�li11�1111��7E■■NCAMMO■■1 IENE1\■NIM■■■■IEM■■■I
MW OMNI
mom NOON■/1:���u�u�cOi■■■■NIS■■■■■Iflt -OMNI
�►:�►�■■■1J■l1��■■OI
NMN■■■11!11■s,401M ONE■w■■■■■11sww1 NOON■■E■■■■q1
NOON■■11111■OE■IR■O■■■MEMO■■110101111■1101■N■■■■m■'�I
■■■NO■■■L!eaAmm■■■lemon■■I:r��i�Jll'.,11■O■■■■■SIs»
ON
■■■N■N1���1■N■N■■■1�����7■■■N■■N■/!!�i�!�!%11■■I■NSI■E1
■■■■■■ONO■■■■■■■►'! i��■'■■N■N■■iii WN/■■ MOONS
■O■■■■■ ._
N■■■ NE■■\ \O■■■■■■■■■\ ■J\s■■■ ■
■■■■■■■■■■■EN■■■■�■■■mom■■■■■■MEN■■■■NEON
■■■■■■■■■■E ■■■■■■N■■■O■NON■E■■■■NN■■NEON
NOON■■O■NN■ ■■■N■N■■■■■■■■■■N■■■■■■■E■■EN
■■■E■■E■■■NOON■NE■■■■■■■■■■■■■■■■■■■■■■■■
p
J V
CJ