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23D-132 (10) 73 HINCKLEY ST BP-2001-0070 GIS#: COMMONWEALTH OF MASSACHUSETTS /lap:Block:23D- 132 CITY OF NORTHAMPTON sot:-001 Permit: Building Category:Deck Addition BUILDING PERMIT Permit# BP-2001-0070 Project# JS-2001-0117 Est. Cost: $3500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot Size(sq.ft.): 24480.72 Owner: ROOSA DOUGLAS F&DIANE E FABI Zoning: URB Applicant: ROOSA DOUGLAS F & DIANE E FABI AT: 73 HINCKLEY ST Applicant Address: Phone: Insurance: 73 HINCKLEY ST (413) 586-9384 () FLORENCEMA01062 ISSUED ON:7/20/00 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 32 X 16 DECK & 10 X 12 SCREENED PORCH & INSTALL ACCESS DOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET ispector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: Fee Type: Receipt No: Date Paid: Check No: Amount: iilding 7/20/00 0:00:00 1161 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2001-0070 APPLICANT/CONTACT PERSON ROOSA DOUGLAS F&DIANE E FABI ADDRESS/PHONE 73 HINCKLEY ST (413)586-9384() PROPERTY LOCATION 73 HINCKLEY ST MAP 23D PARCEL 132 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 //b/ — Typeof Construction: CONSTRUCT 32 X 16 DECK& 10 X 12 SCREENED PORCH&INSTALL ACCESS DOOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan TH FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS 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 Commissi Permit from CB Architecture Committee �' - LoOO Signature of Building Offici 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. , • _,... Department use only City of Northampton Status of Permit: I.) - L._%_. BU#�Iding Department Curb Cut/Driveway Permit _ 9 2000 ;; J 12 Main Street Sewer/Septic Availability ROOM 100 Water/Well Availability______ thmpton, MA 01060 Two Sets of Structural Plans DE PT OF B F D�Par: @i 3-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office -7-3 \--60,3,•\Q_A\ 5- -. _ Map (2?-)0 Lot /3 Unit 0c���� Zone � Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of cord: �- '73 �i�K._‘‘S St- - -1() a ©1c�a N.me'kirCurrent Mailing Address: 5 // t� �►L�` M. Telephone Signature 2.2 Authoriz- . -nt: 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 $ 3 500 (a) Building Permit Fee 2. Electrical IJIJ (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) �5 Check Number ,/(pj�6 IIII This Section For Official Use Only Building Permit Number: P 0/70 Date Issued: signature: Building Commissioner/Inspector of Buildings Date • • M 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 of Li II 9 C*4 a O ! 5, �Frontage 1 (.0 Ck 5- -Setbacks Front a G s a 020 Side L:65 R: 3 3 L:9 0 R: iI b /V Rear 92, —7 G 1 U Building Height a0' A 35-- Bldg. Square Footage 1"y" °7 % 5 la, --- v 6� 4, 3 Open Space Footage q % (Lot area minus bldg&paved dot 7 i ) J 3 „(a)..1} ! 9 1 176 5 parking) #of Parking Spaces A Fill: (volume&Location) A. Has a Speci 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 bod of water or wetlands? NO 1/Y 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 there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: OECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House El Addition El Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors El Accessory Bldg. El Demolition❑ New Signs [ ] Decks V/ Siding [ ] Other [ ] Brief Description of Proposed Work:E3U-4l A ciec t: 4 �C.0.: , e- e0Cr-Sn 6•:k re—O( t LLnLe_• i r,e>\-(1,.\\ Alteration of existing bedroom Yes v No Adding new bedroom Yes 1/No Attached Narrative❑ Renovating unfinished basement Yes /' _No 4,l^Nke\CAle,.. Plans Attached Roll ❑ - Sheet❑ 641:3Mielt.:'`Ce::.:'°,-: itifttadditiolti.r : 1 hotrolg. colt 01N6the LOWirtRI 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? 0. 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 nou., t., c 1boS(� , as Owner/Authorized Agent hereby declare thakhe statements and information on the foregoing application are true and accurate, to the best of my knowledge and belie . Signed the pains and pe 'es of perjury. rint ame ,/ P r 7 191op Signature wner/ t v Date • SECTION 8-CONSTRUCTION SERVICES 1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature Telephone Not Applicable 0 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 -Mine . ,nP.gle ton 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"home e rtifies and a ..- - responsibility for compliance with the State Building Code,City of Northampton Ordinanc , State an Local .oning .ws and State of Massachusetts General Laws Annotated. Homeowner Signature ` " " v • • o4ttv.>tpo a `��� of Northampton •� / Etcsattchncclla o- DEPARTME1JT OP BUILDING INSPECTIONS — 212 Main Street ' Municipal Building Northampton, Mass. 01060 r''' WORKER'S COMPENSATION INSURANCE. ArFEDA..VVIT • (li ccuscdpermi ttcc) with a principal place of business/residence at: (phone'). (surcet/ci ty/StatrJzi p) 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 wort ng on this job: (Inner n Cocir,anv) • (Polio Number) (t xpirtion Daze) ( ) I am a sole proprietor, general contractor or homeowner(ci de one) and have hired the contractors fisted below who have the following worker's compensation policies: (Name of Contractor) (Insurance Comp yiPoiie; NumLY;) (rpirrt:on Date) at (Name of Contractor) (Ins-urancc Company/Polio' Number) (Ex—pir.:tion Daze) • (Name of Conn—actor) (Insurance Company/Policy Number) (Expiration Date) • (Name of Contractor) (Insurance Company/Policy Number) (Ex-piratioo Date) . (etucb adduce iJ exert ifnooes.ry to axlu&inform.6oc pertaining to..11 ceccr--corm) • ( ) I am a sole proprietor and have no one working for me. am.a home owner performing all the work myself. NOTE:pIGsc be ew-xrc that wl 1c homoowocn wbo employ pczons to do c•r c „m ccw^:e.1oo c repair work o-,dwelling of not tnoca than ti tmitr in which the Iwtnoowner rcida or co the groomed appuxtoL11m the sn LT oct bC Calp I o yc-3 under the wazi(ce3 c pc aatioo Aa(GLt 52s s 1(S)),nppli orioo by a bomeowna fox c licznae or ln.van rr_y cvidrnoe the Iegl ctxou of as oaployor under rho Workoet Cocnpoem.y;oa Ant. I uodart.nd that a copy of the.ctxtcmom may bo focomrded to tbo Dopartmcae of lohaveriel Aoodootd Otroo of Iseau•aeo for tho covos.Sc vcrif rzioo nrtd lh:i L-iiurc to soauc covcinge umda soczion 25A of MOL 152 ran la-d to the i,Trmitioa of criminal pcatlties cooiir..m oft floc of up to S I.500.00 ardor imprboacocni of up to one year end civil pmsltio to t'c form of,Stop Work Otdcr and a r 00.00.thy against tx . roe u.e only .01 Permit NuEubcr ,vcs r I 00 Map:: lit g Sipnal-un-of t i ., s.-rm;t -NOTE- THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER ES AND IS NOT TO 3E CONSTRUED AS AN ACCURATE 15 Ca re . T SURVEY AND IS NOT TO BE RECORDED. uTJJLI9 2000 DEPT OF BUILDING INSPECTIONS NORTHAMPTON,MA 01060 41 90' Q� ,`-'`� - y , I N IC�.00 ' 1 TO: FLORENCE SAVINGS BANK & LAWYERS TITLE INSURANCE CORPORATION I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL 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: £'4" --y..kTHIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY /tY aF ` —MORTGAGE LOAN INSPECTION PLAT— /�`�" 'icy RANDM1 V\ NORTHAMPTON, MASSACHUSETTS EER PREPARED FOR 350 `�' ESTATE OF LEROY V. TACY CW332 Of ESSO SCALE: ! "=40 ' JUNE 18 , 1992 �'� o_s.. • HAROLD L. EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS C. 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