23D-141 (3) 5ECEilVEn o2377-J4/
n, DEC 3 - 2001 ILdi /6 ikiyMer 51—
OENOPT BUILDING INSF'AP01060NS
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106 HINCKLEY ST BP-2002-0470
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D- 141 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: ADDITION BUILDING PERMIT
Permit# BP-2002.0470
Project# JS-2002-0715
Est. Cost: $8000.00
Fee: $52.80 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sq. ft.): 11717.64 Owner: HUANCA EUGENIO& ELIZABETH S
Zoning: URB Applicant: HUANCA EUGENIO & ELIZABETH S
AT: 106 HINCKLEY ST
Applicant Address: Phone: Insurance:
106 HINCKLEY ST (413) 584-4590 ()
FLORENCEMA01062 ISSUED ON:11/1/01 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 24 X 22 DET GARAGE
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 11/1/01 0:00:00 3523 $52.80
212 Main Street, Phone(413) 587-1240, Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2002-0470
APPLICANT/CONTACT PERSON HUANCA EUGENIO&ELIZABETH S
ADDRESS/PHONE 106 HINCKLEY ST (413)584-4590 Q
PROPERTY LOCATION 106 HINCKLEY ST
MAP 23D PARCEL 141 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out `3
Fee Paid itt�J/mod, 11-0
Typeof Construction: CONSTRUCT 24 X 22 DET GARAGE
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
INF 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 Co ' ion
////_crry
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.
w
Department use only
City of Northampton Status of Permit:
RD
tll I Department Curb Cut/Driveway Permit- 2i_2 ain Street Sewer/Septic Availability
R dm 100 Water/Well Availability
OCT 3 1 2Nrth ton, MA 01060 Two Sets of Structural Plans
phone 413-5 -1240 Fax 413-587-1272 Plot/Site Plans
D(P?or°JJILDINC OISPECTICNS Other Specify
APPLItAi ilkri 14h UCT,-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:
fi /17 �✓ G 1C sT--- Map C b Lot if Unit
�L t� C C Zone �j� Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: A-11 Ai v / ?.., I 1-1-7 AIG,KL C—y Sr—le- oRC-,ice--�i��
Name Print /
Current Mailing Address: di O 6,2_/
/1�,1^ 1 1 3 - y —its
•'! � �✓ 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
G
2. Electrical (b) Estimated Total Cost of
6 , ,
Construction from (6)
3. Plumbing f Building Permit Fee
4. Mechanical (HVAC) /
5. Fire Protection
6. Total = (1 + 2 + 3 +4 + 5) v v Check Number y ,23
This Section For Official Use Only
Building Permit Number: �> �( 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
47 Lot Size #940 ( /®1 I,6' 7-B 0 0
Frontage F 3 f 13. s 75"-
Setbacks Front g`1? GI Is
Side L: c R: 7O L: 3 R: 671
Rear SD S
U
Building Height
/:3 )-4) �o
Bldg. Square Footage 6.- -3
Open Space Footage
(Lot area minus bldg&paved ?t70/ ?0 e/SC1-0
5-6parking)
#of Parking Spaces
Fill:
(volume&Location)
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(here any proposed changes to or additions of signs intended for the property ?YES
No "
IF YES, describe size, type and location:
- w to �� �,<✓inf- a-rr-y Ft 4.,✓410t.- - � 6i+1—c.li 11- C—o 4or. s�
9
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
/ Or Doors El
Accessory Bldg. If Demolition❑ w igns [ ] Decks
[ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: ? a a y
Alteration of existing bedroom Yes ✓No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes 4.---110
Plans Attached Roll o - Sheet❑ }
]�3t.= .. :
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
LnUr v 9`
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
v a a t— > '' �"'�� � UY-
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.
r U c—r J //t!f—xl (A- A Z, 4-f7h-
Print Name l
1 v/j+/ 0/
Signature of Own r gent Date
•
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
m .r fl
��.« � � � i� , €c�s.tt�fi,..➢@ � v tlE f ,1,1&S",1.14 ��1 � iu313 "3,1 za. .I:.X•....t J ji ,a317K:W0i, 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 ofthe building permit.
Signed Affidavit Attached Yes Q' No ❑
1. Home 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(s)
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
Northampton Ordinances, State and Lo al Zoning Laws and State of Massachusetts General ws Annotated.
Homeowner Signature (/�yliLG��
0. &A HP2.
:° eMeots Oy
( j of No rtlytinpioi _ _g �►�� E�� _
9��ctt ` rB =v :aaa rinsetfa� (l
{9— DEPARTMENT OF BUILDING INSPECTIONS 4 __��=
• •
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 up'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
1,
(licensee/permittee)
with a principal place of business/residence at:
•
(phone#)
(btu eet/city/state/ap)
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) ::;<:,:,
( ) 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)
if
(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 ifne +.ry to include information pertaining to all eoatrndot)
( ) JAM. a sole proprietor and have no one working for me.
( a home owner performing all the work myself.
NOTE:please be aware the while l a *iwuera who employ persons to do rrea(nrrnarur,construction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto arc not Malty masidered to be
employers under the worker's giros ettat Act(GL152,s3 1(5)),application by a homeowner for a Gecase a permit may evidence the
legal status of an employer under the Worker's Compensation Act
I understand that a copy of this aaateme t may be forwarded ded to the Department of Industrial Acadeastr Office of Insurance for the
coverage verification and that failure to secure coverage tinder section 25A of MOL 152 can lead to the imposition of criminal penalties
ootuisti g of a fine of up to 51,500.00 andkor imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
firm of 5100.00 a day against me.
For departmental u.n only
�/ /v 1/0/ Permit Number
("11-41.1.4.. ..) Lot#
gnaturc of Licensee/Permittee
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—NU I L—
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.
ol
a—
TO: BANK UNITED OF TEXAS , F. S . B. &
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY
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 u 250167
SURVEYOR: • -NOTE-
THIS THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
/ `� OF M -MORTGAGE LOAN INSPECTION PLAT-
RM4AII \, NORTHAMPTON, MASSACHUSETTS
is 1 tZER PREPARED FOR
m3m032 EUGENIO & ELIZABETH S . HUANCA
SCALE: 1 "=30 ' FEBRUARY 25 , 1993
1,MO:� HAROLD L. EATON AND ASSOCIATES, INC.
�r-.. REGISTERED PROFESSIONAL LAND SURVEYORS
C.
.�-�r\ 235 RUSSELL STREET - HADLEY - MASSACHUSETTS