23D-137 (2) (
80 HINCKLEY ST BP-2002-0145
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D- 137 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: shed BUILDING PERMIT
Permit# BP-2002-01 45
Project# JS-2002-0236
Est.Cost: $2025.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 21 780.00 Owner: BLANCHARD ELSIE&ROGER
Zoning:URB Applicant: BLANCHARD ELSIE & ROGER
AT: 80 HINCKLEY ST
Applicant Address: Phone: Insurance:
80 HINCKLEY ST (413) 585-9807 ()
FLORENCEMA01 062 ISSUED ON:8/24/01 0:00:00
TO PERFORM THE FOLLOWING WORK:ERECT 25 X 30 STORAGE SHED
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector 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:
Building 8/24/01 0:00:00 1229 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2002-0145
APPLICANT/CONTACT PERSON BLANCHARD ELSIE&ROGER
ADDRESS/PHONE 80 HINCKLEY ST (413)585-9807 Q
PROPERTY LOCATION 80 HINCKLEY ST
MAP 23D PARCEL 137 001 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 g09Q . 7[�-
/ �' d-
Typeof Construction: ERECT 25 X 30 STORAGE 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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and 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
s411 P /44,71/-
Signature of Building‘0"icial 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.
r
Department use only
if Northampton• Status of Permit:
tong Department Curb Cut/Driveway Permit
2001
1 AEG $ 1 . Main Street Sewer/Septic Availability
oom 100 Water/Well Availability _
pEP10fonp7FL�, �+gP;CCaNWtha 240 Fax41ton, MA 060 Two Sets of 3 587 1272 Plot/Site Plans Structural Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address:�QiiiiNcidrut Sr
Map c>93 Lot / 3 7 Unit
� Zone Overlay District
/1. 6Krii R I'e nil 1141:
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
rt (I0&E lR !3111/ZA/9i?
D(rint) � Current Mailing Address:
�1 Telephro e ��Js. c�g07
Signature `f
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
2. Electrical (b) Estimated Total Cost of
AY/ Construction from (6)
3. Plumbing Building Permit Fee
NA
4. Mechanical (HVAC) �/
5. Fire Protection pd
6. Total = (1 + 2 + 3 + 4 + 5) a02�' JO Check Number / 9
This Section For Official Use Only
Building Permit Number: SPOg-146-
Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
IP
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
�J�/ Building Department
Lot Size / hag. ,f721 '/ O o c2 1) 7TO I, 6776
Frontage 7 S
Setbacks Front
A lur�
Side L: R: L:t 9 R:
Rear
t� ►
Building Height p I C
Bldg. Square Footage % 750 3z=.
%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 V 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 V
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-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition 0 Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. 'Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
0
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
s if New 1ictrse ar door ddition to xisltng fo §ing,.cot plete he 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 l
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, t�1�.. * `7Si� /,¢NC , as Owner of the subject proper
hereby authorize to act
my behalf, in all atters elative to work authorized by this building permit application.
2 - .� LPL le °e._
Signure of caner Date Q
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.
P(6't d `1— t 1E Z fi5►dJL4 ilk iZt
Print Name
Si nature of 0 ner/Agent Date Fr/did/
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Reilsteretl : 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 affid�
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 0 No 0
ome-Owner Exemption
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(
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
N. hampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
,'.omeowner Signature �.
;4 ,' ' •
4II pT0 .
.N f g (art of k. ar4Iiamphi,1 ' -*,�U
4 is/ _ ( lassacansctts' __:v _=
DEPARTMENT OP BUILDING INSPECTIONS 4
212 Main Street ' Municipal Building
Northampton, Mass. 01060 rr'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
,,../ (1►censeelpermi tt ee)
with a principal place of business/residence at: •
t2 • yy�`(phone#) ceR gg'S79.D 7
(atttxt/city/ rip)
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:
(Policy Number) (Expiration 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 compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
•
•
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if n :•ry to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one worldng for me.
' I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do maintr+,sconstruction or repair work on a dwelling of
not more than throe units in which the homeowner rides or oa the grounds appurtenant thereto arc not generally considered to be
employers under the wotiot's compensation Ad(GL152,ss 1(5)),application by a homeowner far a license or permit may evidence the
legal status of an employee under the Worker's Compensation Act.
•
I underhand that a copy of this statement may be forwarded to the Departs:at of Industrial Accident?Ofoo of Iasuraooe for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties •
re+osistiug of a fine of up to S I,500.00 and/or imprison of up to one year and civil penalties in the form of a Stop Work Order and a
firm of S100.00 a day against tnc. •
For departmental use only
? Permit Number
i.ag-„4-r Map# Lot#
Signature ofI.icy-nc.,./PP-rn:itt, Late
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AUG 2 3 2001 ,J ITEM MATERIAL
BOTTOM RAILS TO 6X6
DEPT OF BUILDING INSPECTIONS FLOOR JOISTS TD 2X6
NORTHAMPTON,MA 01060 BLOCKING TD 2X6
PLYWOOD FLOOR 3/4" PLYWOOD
BOTTOM PLATES 2X4
WALL STUDS 2X4
TOP PLATES 2X4
2ND FLR JOISTS 2X8
RAFTERS 2X4
malt RIDGE BOARDS 2X6
mina SUPPORT POSTS 4X4
Raj BASE TRIM TD 2X8
SIDING TD TRIM TD 1X6
SAVE TRIM TD 1X6
mom
DOOR TRIM TD 1X4
IXROOF SHEATHING 1/2" PLYWOOD
DOOR
Liu WINDOWS
NAILS
Immo FRAMING 16D
<lc FLOORING 10D
ROOFING 10D
TRIM 1 2D FINISH
1
2 SHINGLES 1 1/2"
ROOF FELT 30# FELT
SHINGLES 3 BDLS / SOR
DRIP EDGE BENT AL
BASE FLASHING BENT AL
JOINT FLASHING BENT AL
.-1.? t
/....e_iiit:xitzi
to >> �
•
Roger A Blanchard
80 Hinckley St.
Northampton. Ma. 01062
To Whom It May Concern:
Revision of material list for storage shed: concrete footing will consist of twelve 4' x 10" concrete
columns,with 5/8"threaded rod tie down bolts. Floor joists will be upgraded to 2"x8"s.
Sincerely,
zja.Lt_
£ L44
;:.--jr
and Elsie Blanc and
IHECEPY
AUG 242001
DEPT OF BUILDING INSPECTIONS
NORTKAMPTON,MA 01060