23D-064 (17) 40 NUTTING AVE BP-2004-0951
GIS#: COMMONWEALTH OF MASSACHUSETTS
mmENNIIIMar CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category: BUILDING PERMIT
Permit# BP-2004-0951
Project# JS-2004-1409
Est. Cost: $3800.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 12980.88 Owner: KAJKA JARED A
Zoning:URB Applicant: KAJKA JARED A
AT: 40 NUTTING AVE
Applicant Address: Phone: Insurance:
40 NUTTING AVE O 584-6440 O
FLORENCEMA01062 ISSUED ON:
TO PERFORM THE FOLLOWING WORK:ERECT 14 X 18 SHED & INSTALL PELLET STOVE
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 4/9/04 0:00:00 1312 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2004-0951
APPLICANT/CONTACT PERSON KAJKA JARED A
ADDRESS/PHONE 40 NUTTING AVE FLORENCE ��f 441/6
PROPERTY LOCATION 40 NUTTING AVE
MAP 23D PARCEL 064 001 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 /L9J e�
"-
Typeof Construction: ERECT 14 X 18 SHED&INSTALL PELLET STOVE
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
INFOVIATION 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
ZOO
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.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 --Plot/Site Plans
• other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
A,_,,, 20W4
SECTION 1-SITE INFORMATION DE?
T.42 This section to be completed by office * fy
1.1 Property Address: --t4
110 JU Jl//MQ7 bra Map tx�I/ Lot (p Unit
J • M
F// Zone �� Overlay District
Elm St.District CB District 44,uT
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
J rcc) JXp i iu Jtt,- J c f reit/cc-
Name(Print) Current Mailing dress:
!/0.1,0e/y
Kati Telephone
Signature
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 (a) Building Permit Fee
] ]d0,00
2. Electrical (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number � tj0►
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTI0I = D�SGRPT101 OFPROPOSED YVORKfcheck afl apalica67e) y
•
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 0
Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ] Siding[ ], Other [ ]
Brief Description of Proposed Work: /d it_U
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 • Sheet 0
6a Lf New ouse'randhor addifionIto` ezi ithytiousing eomp °e e.ttie eitIowl:ng:
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
SECTIOK 7�a1lYNERAUTHORIZATION TO BE COMPLETED WHEN
OWNEkSAGE( TO,tCONTR'ACTOR APPLIES,jFOR 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
, 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
4
('Signature of ner/Agent Date
•
`er 1a
.�1�"��� ,�slaaaacElnsrtts
zc-.9�_ DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal building
•
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE A + t-U)AAVIT
------------------- (liccrs.Jp+:rmittc-^.)
with a principal place of business/residence at:
(�honc�=)
----'-- -�. (SiTecl/C71}'r:>ir ~�71p) _—
do hereby certify; un(ter the pains and penalties of perjury, that: -
( ) I am an employer providing the followinc worker's compensation coverage for my
employees working on this job:
•
- ('insu anc Company) (Pone;Number) (E pinion Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensator, policies:
(Name of Contractor) (Insurance Cornpan ,Policy Number) ( xp:rr:t cn Date)
(Name of Contractor) (insurance Contpanv/Policy Number) (Expira tio'n Date)
(Name of Contractor) (Insurance Company/Polic Number) (Exc.. rc:ao:I Date)
(Name of Contractor) -- (Insurance Comra+,ylolicy Number) (Expiration Date)
(much additional sheet ifno-e-Sir:to inel'.dc i. ers:s:ioc,-- .;;era'.ell e:era.-..:-.)
( ) I am a sole proprietor and have no one workinr4 for me.
'`�' I am a home owner performing all the work Myself.�'NOTE:please be aware that while t•,ccrcownora�r o c -],loy]rase..:;n 6)17.aslI:aance,cs:�-rucim cr t dwelling of
not mere than three units in ui:id+::he hotnu rev-raid'-,or a:t`,t ..•:ems appurter_:rl thereto ere not calerally :o h.
employes us'kr the t nrkea ar: , im Act(GL152.:7a 1(5)).application by a homeowner for s teelsc cc p-rmi::: ...'croe the
legal statue of on employer under din Worker's Coaapernation A.ct.
1 understand that a copy of this ctatc n nuy bo forx•nrded to tho 1Y.tiort-sent of lod utri:J AaiLmta'Oirtw of Inrawur:e for dre
coverage vtti c?.z ooe and that failure to:40.3.rt cov rise under:action 75A of 1.MGL 152 can lead to the imposition of c�^i r l per allies
consisting of a fir,of up to S t-500.00 and'ty in ri,xa]ai of up to cram}Tar Phi civil peuhia in tr'c farm of a Ste;+Work Ord.er tr,d a
fire of 5100.00 a day tgaitrt m;
For depsruneztal use only
Permit Nunibur _ ___ __---
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Sinn[ of i.icer:;edi]crmittc+, r i;,:_ i F
-INUit-
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
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�_----7-- r�\-___�— —1,:, —,-:_c-- —77
TO: FLORENCE SAVINGS BANK &
FIRST AMERICAN TITLE INSURANCE COMPANY
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
-NOTE-
SURVEYOR: :. �.q THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
/-.�N OF ass -MORTGAGE LOAN INSPECTION PLAT-
P q°y NORTHAMPTON, MASSACHUSETTS
RANDALL Gjo'. PREPARED FOR
0 IE. N WENDY B . ORTIZ & JOANNE F. NADOLNY
(y� �o� SCALE: 1 "=40 ' SEPTEMBER 25 , 1997
suRVE HAROLD L. EATON AND ASSOCIATES, INC.
- REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSLI I S