45-042 (6) File#BP-2003-0717
APPLICANT/CONTACT PERSON FOURNIER FRANK N III
ADDRESS/PHONE 17 HARLOW AVE (413) 586-2831 ()
PROP E,tTY LOCATION 34,8 QLD SPRING-FIELD-RD
' MAP 4S P.lARCEL 042;,001'ZON°E r-SC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSE15 REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 6b i
Fee Paid
Typeof Construction: CONSTRUCT 1 1/2 STORY SFH 46 X 25
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
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: § � .L /04./�. 2 /3„J 9tl3
Finding / Special Permit j- Variance* y
A ' �1.4•"5 ''-
Received&Recorded at Registry of Deeds Proof Enclosed /ee- y/Sl/'/�
Other Permits Required: n-O 4"co /-o,C'vti"M .
i
Curb Cut from DPW Water Availability Sewer Availabilit}�'
tub
Septic Approval Board of Health Well Water Potability Board of Health
V Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Str t Commission
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's bu Iden 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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"B a v°x ux s: ''•pT epa e(t' f®(r` r °
t :A:K , `� ?'�% tot ,. i*t . :,
City of Northampton S atus of Per, tt� ; Y,t.4, ,x�`i. l .
# Tg"' i �7ry f.J t q� yF..n.+`s R 1Vz
• Building Department .Curb C�u"t/,® �u f� 1, -` �-s ,,� ' , .
• - . -212 Main Street `Sewer Se® tc�g�'atta® �� ' e. 1 1 t+
4.31
Room 100 Wa er/Well Aua ab tiyd �� � � :�N
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Northampton, MA 01060 T oiSets of Str cturaAi,-ansA .. 4 st-, t> 1
phone 413 587 1240 Fax 413 587 1 27 2 PIPIlo%S to lan`?�1 '- 4„, .0
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s 33i.Y aR r .(cf'ti S,K 44 _f +., ..4. . *,)0,, r44
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE iOR DEMOLISH A DONE OR TWO FAMILYLDWELLING
v?//2c• _ f /) 7
--- A) / ,-
-- 1 new c/y/'� ' -- /
SECTION 1 - SITE INFORMATION
>
'This section tobe completedbyoffie
Y1.1 Property Address', �Ma Lot , ( . m nUn
amp : ' La a Y a i m A i
1 c
Zoe ^Overry,--Distracref 0'r-I� lVll> c
Elm St'District . CB•District
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: }\
\' IV 1.---(1 r,):V\ 1 e_,\ 1 1 4 ,
11_4 ci c.,.._1 r,f.,c) : \I c•
Name(Print) , .7' Current Mailing Address:,
•
�7-- .�;- `" Telephone
Si ature
2.2 Authorized Agent:
Name(Print) Cur ent Mailing Address:
Signature Telephone P
SECTION:3 -'ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be 'Official Use Only
completed by permit applicant
1. Building ---IE l e (a) Building Permit Fee
2. Electrical /j - (b) Estimated Total Cost of
7T }�'�''� Construction'from (6) ..
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) I
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) _ -el,K 0 o6 I Check Number J 7 �Q gr
j This Section For Official Use Only
f
Burldrng Permit:Number: 'Vb'$-I- `� Date Issued:
Signature! .
Building Coryirni oner/Inspector of Buildings I Date.,. •
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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
E3uilding Department
Lot Size ;4) 0 i' '1O] X :-.2,
Frontage /e"� / 1 d /
Setbacks Front /O;/ gfer ; /C
Side L: i y R: . .h L: 6,
Rear 1
Building Height /C� "
Bldg. Square Footage J %
Open Space Footage
minus bldg&paved 403 'ail cf./
parking) ( ` y
#of Parking Spaces i.I /
,I
•
Fill:
(volume&Location) /V'// -
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 obtain d from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on thetroperty? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF•YES, describe size, type and location:
SECTION 5=.DESCRIP.TION.OF.P:ROPOSEDWORK(check=all applicable)
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New House A Addition 0 Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. 0 Demolition'1 New Signs [ ] Decks .j Siding[ ] Other [ )
Brief Description of Proposed Work:Lc;r\ •y-ti k/k- IyN,-A,;- rt, J.; �_L>3 L?S i5� t !1[I fs;�: f 1 �c-i i
k; c \C() 1r. F 1ecc� I c_v e t ,{
Aeration of existing;tedroom Yes ✓ No Adding nevi/ bedroom Yes f/ No
Attached Narrative❑ Renovating unfinished basement Yes a/No
j Plans Attacned Roll • Sheec
54 Jf.N"-040h-us 7a-fit delMdttioWitaaittin"g.•ho`usinvco rn p I e t elA Ile 4611 vufiig:
a. Use of building : One Family I Two Family Ot per _
b. Number of rooms in each family unit:_ `Z Number of 'athrooms 3
c. Is there a garage attached? c ,
J I , /
/
d. Proposed Square footage of new construction. Iy1 Dimensions ;c1 j -��/ 1 9 L� ��
e. Number of stories? q
f. Method of heating? ftcQC G HC;f- tkjyt Fireplaces or Woodstoves ' ( Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction /
i. Is construction within 100 ft. of wetlands? Yes ✓ No. Is construction within 100 yr. floodplain t�Yes _No
4-( n r)�
j. Depth of basement or cellar floor below finished grade (1 •-�>�`q •
\•=;v\ .1 t C{\1C72
k. Will building conform to the Building and Zoning regulations? _ t Yes �/ , No .
I. Septic Tank \,/ City Sewer Dri atn well
/ City water Supply,
SECTION 7a OWNAU ER THORIZATION - To-BE COMPLETED WHEN
OWNERS AGENT:OR•CONTRA'CTOR 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
IrLiN ` '''`�c! r.�''Y1< i i,r- y 3'{. 1. i�si.n�k.�;� 2 y^..�o fi 1.4zf�h��^� y}+a Y qp;;
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I, + `; Z V\k., • "'(tom� , t`— _ _, as Owner/.Authorized Agent
hereby declare that the statements and,jiiformation 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 '
� c_,
r Gam'-,r' i / �.-a��._ % — ..
Sig ture 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
t9 Regrs#ered FLbmeEamiir.ove`ment Contractor ,,,, ;p iblit ff„'_- tifii = Not'Applicable•
❑
Company Name Registration Number
I
. Address Expiration Date
Telephone
SECTION-10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT (iM.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 ❑
10.1 T_411tOl®won574- p e WOX0km1i`On
The current exemption for"homeowners" was extended to include Owner-occupied Dwellings of one(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 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.
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 buildinglpermit.
As acting Construction Supervisor your presence on 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) andiChapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusietts 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 responsibjlity for compliance with the State Building Code, City of
Northampton Ordinances, State and Locil Zoning Laws and St Ilte of Massachusetts General Laws Annotated.
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends Ito 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
home owner."
The building department for the City of Northamptonlwants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation/footings (before backfill)1
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and la final building inspection. The
building department requires these inspections before,the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing &gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner/resident's signature requesting exemption)
1 will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work location C id) s n cP P_c_19
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Perfect Balance • Two bedrooms and a versatile den, Plan AHP-9804
along with an easily accessible hall Bedrooms: 3+ Baths:2
• This home's handsome exterior strikes bath, round out the the main floor. Living Area:
the perfect balance between the old and •• Cherish the seclusion offered by the Upper floor sq.ft
the new.A beautiful stone chimney and spacious upper-floor master suite, Main floor (23-9-61,072 sq.ft.
two impressive window walls clearly which boasts a deluxe private bath,a
highlight this design. roomy walk-in closet and plenty of Total Living Area:
• Walk through the foyer into the open nearby attic storage. Basement 760 sq.ft. I, 4 ,
'is living and dining area. Here,you can • Growing families will appreciate the Tuck-under garage 312 sq.ft. Ie
marvel at the elegant fireplace or enjoy expansion opportunities offered by the Exterior Wall Framing: 2x4 or 2x6 ,
the spectacular views through two sets flexible basement. 1
Foundation Options: r
of tall windows. • Take full advantage of the roomy L.6 .f _
• The well-appointed kitchen boasts a wraparound deck,the perfect spot for Daylight basements $ ,
handy serving bar as well as a barbecuing,suntanning or late night Standard basement 4 ,
convenient laundry closet nearby. gazing at the stars. Crawlspace - fvI . ;
Slab fp } .
(All plans can be built with your choice of foundation and framing. P .,,tea
A generic conversion diagram is available.See order form.)
25'-4" BLUEPRINT PRICE CODE: A � `k -
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oPr.000es. ___ BEDRM-3 a BEDRM12 yr.!.c I Arne
6T R rA
11'x 10' c[. 11'x 14'
FUTURE 4�ROOM I__ MASTER SUITE
�ww. �FEN V
10'clg
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DEN/' I irn I ;
I --; O 0 IF BEDRM-4 I��rjsi�� o
-- In I IMP
9LIEr x 10' ° = [ ti;
GARAGE a1 1 O .. 16'-8'clg ---- p °PEN TO
e I KITCH. °ooio �' R.
12'X26' = • 11x9' f __ ,� ':
AVE. UP ® FOYERI� __
Ems__ I I,
UP L°�p�°
UTILITY DINING °�
y- RM. LIVING --_ �I
,. El(0 • 24'-4°X 14'Ave.
l
' 16.-10°vltd clg ___ s"
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DAYLIGHT BASEMENT _ n = DECK--�' UPPER FLOOR
MAIN-FL-00FI
4
ORER BLUEPRINTS ANYTME! FOR MORE DETAILS,SEE
CALL TOLL-FREE -888--314/6093 Plan AHP-9804 AT www.homeplans.comiPcaN 121
Plan copyright held by home designer/architect I I
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