23D-040 (10) TM ,
67 MILTON ST BP-2004-0054
GIS#: COMMONWEALTH OF MASSACHUSETTS
Ivlap:Block:23D-040 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0054
Project# JS-2004-0091
Est.Cost: $2600.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 15550.92 Owner: HANNIGAN WILLIAM&PAGE STACEY
Zoning:URB Applicant: HANNIGAN WILLIAM & PAGE STACEY
AT: 67 MILTON ST
Applicant Address: Phone: Insurance:
67 MILTON ST (413) 586-8158 ()
FLORENCEMA01062 ISSUED ON:7/17/03 0:00:00
TO PERFORM THE FOLLOWING WORK:ERECT 10 X12 SHED
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 THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 7/17/03 0:00:00 1938 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
r
File#BP-2004-0054
APPLICANT/CONTACT PERSON HANNIGAN WILLIAM&PAGE STACEY
ADDRESS/PHONE 67 MILTON ST (413)586-8158()
PROPERTY LOCATION 67 MILTON ST
MAP 23D PARCEL 040 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Fee Paid /9 31? —
Typeof Construction: ERECT 10 X12 SHED
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 RMATION 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 Stieet C 'ssion
40/
. .004e.# ,. ...p..ii,,, —2//2/6/3
Signature ofTtrilding OffticiaT 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.
4.Zs •
, y ..,r '- Pi'..iC f r7 dill iiii; ,t"i=, .' Jai'' >:,
City of Northampton 8,0..f0P ( 4-filQ
Building Department 6 .`! t �',sr, :a 44,(1ttF .
212 Main Street S I1
. , �e1 tft�ae
Room 100 i --�rt.t®a1 , :1,
ampton, MA 01060 T aSet nt iit �� :. "\::11kE `
(� E it, 7.1240 Fax 413-587.1272 Plo /Site' 1PP zi ' ° r,
Other°§pats ,.x „a"�, - , ! .` ",w ' '
APOVEA1*I 'PAO T, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
1 --
DES OF BUILDING I lA DtCIll S
S T NOATW, FORMATION
1.1 Property Address:Y This section to be completed by office
`0/ "1.t i V V` �-k" Map 2 ) `
Lot 710 Unit
,FILDlleile—e ] 4 8 Zone Overlay District
1 ElmSt..District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
5c L 1 ►c c,7 Hit - Flo M'
Name nnt) CJ Current Mailing Address:
Telephone
ignature
2.2 Authorized Agent:
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 ZCc,QCD! (a) Building Permit Fee
2. Electrical (b) stimated Total Cost of
n d e- _ Construction from (6)
3. Plumbing rl.dvv Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection rAO
6. Total = (1 + 2 + 3 + 4 + 5) ✓42-Cc, cc) . Check Number .1935--
_
tir
This Section For Official Use Only
Building Permit Number: s Date Issued:
Signature: _
Building Commissioner/Inspector of Buildings Date
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
Building Department
Lot Size 1Zl I bI114./ 5Qt'►'te
Frontage _
Setbacks Front / C)O
Side L: ` i R: L: LfSi R: 7 D
Rear 1-f
Building Height %.VIC4tier pew"(
Bldg. Square Footage % 1
Open Space Footage 2
(Lot area minus bldg&paved I /✓'' 1111 •C)
parking)
#of Parking Spaces I ,
Fil
l:
(volume&Location) nr0 ' ( n6n
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 obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are Mere any proposed changes to or additions of signs intended for the property ?YES
No
�/
IF YES, describe size, type and location:
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. Pr' Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
(- h e }C
Brief Description of Proposed Work: (OQ(.I Shy be r ac-ed OVl i)t-Ope-
Alteration of existing bedroom Yes -"No Adding new bedroom Yes v No
Attached Narrative 0 Renovating unfinished basement 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. 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 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
, 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
e as Owner/Authorized Agent
hereby declare that the tatemEtn s 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 0 ner/A nt Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : -
License Number
Address Expiration Date
Signature Telephone
', Registered Homecliiipro—eme i Contractor id t R?
_..,� ,�,��,, � ., .�..__��,.'�.,,- 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 0 No 0
11. ''Home Owncr Dt'empt 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 building permit.
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) 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.
The undersigned"homeowner"certifies and .:•urn-. ,onsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and LocaA
'int Laws a a State of Massachusetts General Laws Annotated.
Homeowner Signature ' akiis
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'jam DEPARTMENT OP LtUILDFNC INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, — —
— — ---- —
(Ii ix c nsccirmittec)
with a principal place of businessiresidence at:
--- — --- — (phone :;
(strcct/city/statePrip) —
do hereby certify, under the pains and penalties of perjury, that.
•
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
- (Insurance Company) (Policy Number) (Expiration Date)
X// I am a sole proprietor, general contractor or omeowne circle one) and have hired
t contractors listed below who have the following, woe er's compensation no!1c es:
"--27:„ c....2._.. ..e.,,,y4.11 .._,
(Name of Contractor) (Insurance Company/'Policy Number) (Ex;':vatic,'_Date)
1
(Name of Contractor) (1.nsurance Company/Policy Number) (Exc r:tiolt Date)
(Name of Contractor) (Insurance. Company/Policy Number) . .x,.:rntion Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach ad-!itimal 1h:ct if etc,-c-s,—v i—'",-:S-K:r It:or. ,:xtainicr::all cent act,(.)
( ) I all( a Sole proprietor and have no one working for me.
( ) I am a home owner nerforimng all the work Myself.
NOTE:plenae be awa a that(~'.tile harcowinr. 3 WNiru CZ:;pIay p�se:IS to e.)cr.aiftauncc,cut==:..t:e_:•-et Cr;:pair,":i.ell:.:..oiling c:
not mc"than throo unit(in winch the ho:r+JN- -rrri -u<K co the v:.L'o lla appurtenant thatt0 c.-t n. Gcn rally c. :t:_nta•::0 t`
cclploy3 undo the twrkcr's ccl;c :atim Act(t31.152,za I(5)),application by a hot:uolt-w fora licnu«Irra:i::::ray t^:'.:n c:r.
legal rtatua of an ernployet under tit,'Worrcc.'a Comp.:motion Act
I unct=t nd thnt a cop - .; rtatcrl:oel may be forwarded to the Department oxtment of Industrial Accident.1'Olroo of br uran_o for the
coverage veriGcatioo •.•that fail, to:xure coverage ur4cr section 25A of MOt.152 can lead to the imposition of c:mihsl pct.-allies
coosisting of a of i p to S 1,500.a• and:«irnpri.oconcilt of up to on-yt r and civil peru!tics in thc form of a Step\','cri Ordc tr.d a
firm o(S 100 t a it)gain:.(me:.
lifjrogllerFor dcputn uxatal .o onlY -- - ----- i
Permit Nttmtx r
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DEPARTMENT OF BUILDING INSPECTIONS , _; i= /_
INSPECTOR 212 Main Street • Municipal Building '`
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as Lis/her construction supc: .'isor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends 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
home owner."
The building department for the City of Northampton wants any 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)t
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a 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
a)-C,C (J understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date I(I
Address of work +1 I
location �� I y�., i 1 t-rAi SA-
Flo I\4
............... . ,
MORTGAGE LOAN INSPECTION
D , 3I -
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I JUL 1 6 2003
DEPT OF BUILDING INSPECTIONS
NORTHAMPTON,MA 01060
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I hereby report that the premises shown on this plan is not located within a Flood
Hazard Area as shown on Department of H.U.D. Federal Insurance Administration Maps,
Community Nu 250167 0002A
• • Identi.ficati. 1 Dal — -
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TO TILE SOCIETY MORTGAGE CORP. OWNER'
ELIZABETH & JULIA GROSS
AND THE TICOR TITLE INS. CO.-ONLY LOCATION'
To the best of my knowledge, informa_ 67 MILTON ST. NORTHAMPTON
tion and belief, I hereby report that I ' ALMER HUNTLEY,JR.& ASSOCIATES, INC.
have examined the premises and that this
inspection plat shows the improvement or SURVEYORS - ENGINEERS - LANDSCAPE ARCHITECTS
improvements as located on the premises de- 30 INDUSTRIAL DRIVE EAST P.O. BOX 568
scribed, that the improvement or improve- NORTHAMPTON, MASSACHUSETTS 01060
meats are entirely within lot lines , and _
that there are no encroachments upon the SCALE'
premises described by the improvement or ,,, =" •.. . "_ //o
improvements of any adjoining premises , '
' except as indicated. I further report that :' mow DATE'
there are no easements .of record affecting W. vi Z
• the tract shown hereon, except as noted. J y 990
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THIS PLAT IS FOR IDENTIFICATION PURPOSES .ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY