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4 ya PLANNING AND DEVELOPMENT • CITY OF NORTHAMPTON
.4
- i �J Y ( punning • conservation • zoning • northmnpton C:1S • historic • conmiwiiih preservation • central business architecture
6 l {
t!L 1J_ . = 713 -551- 7.266
March 10, 2010
John Zieminski
8 Woodridge Circle
Hatfield MA, 01038
RE: Proposed deck, Map /Lot 35-302; 8o Woodland Drive
Dear Mr. Zieminski:
Thank you for contacting the Conservation Commission regarding the proposed deck extension on
Woodland Drive, within the 100 foot buffer zone. As described, the deck is between the 5o and loo foot
buffer zone, and is and is not subject to the Conservation Commission's jurisdiction, as a minor activity
under 310 CMR 10.o2(2)(b)1. Erosion and sedimentation controls are required during construction.
Please feel free to contact me with any questions or concerns.
Thank you,
I/
S a •ah LaValley
4
Conservation, Preserva •n and Land Use Planner
(-'itv Hall • 210 Main Street, Room "11 • Northampton, MA 01060 • wr-vw.NorthamptonMa.gov • Fax 413-587-1264
ori printed on 1 ea'ded Pape,
The Commonwealth of Massachusetts
Department of Industrial Accidents
—3- .. . ' Office of Investigations •
® 600 Washington Street
=. .0 Boston, MA 02111
.. . www.mass.gov /dia .
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business / Organization /Individual) : ` �J / f? // . ":2-/Z7 i' • 7 6x .s i6 4.
/
Address: p i-,f rJL f) V-e ..06 /. /e..c,- .
City /State/Zip: /7 "Y./5 Phone #: ,')- y7 �‘-.) -' 7
Are you an employer? Check the appropriate box: Type of project (required): /
4. I am a general contractor and I
1. I am a emplo er with / 6. 0 New construction
employee and/or part-time).* have hired the sub - contractors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship'.anal have. no "^ loyees These sub - contractors have. g. D.emoliuon
working for me in any capacity. employees and have workers' 9. _0 ceding addition
[No workers' comp-: insurance coop:.. . $
required.] 5. 0 We are a corporation and its 10.(] Electrical repairs or additions
- 3.0 I am -a omeo-wner -doingail- werk-- - - - - -- o c-- 312 - 3 zav e xer cised ir--• 11 -.0- Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t • c. 152, §1(4), and we have no • .
employees. [No workers' 13. ❑ Other
comp. ;;once required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit: indicating they are doing ail work and then hire outside contractors must submit a new affidavit indicating such
:Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub - contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information
Insurance Company Name: SG?Cr r77 1 /-'L,c> 6/6.7ies 2)--'5 (), -
Policy # or Self -ins. Lic. #: tj• - e . ) 6 eo it 6%? 0 6 ) t' Expiration Date: 2 7 3 A e'
Job Site Address g 1 ' 4 1 Ls/ /' 2),,/' City /State /Zip /
s -44- ,,L.
Attach a copy of the workers' compensation policy: declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under: Section "25A ofMGL c. 152 can lead to theamposition of criminal penalties ofa
fine up to $1 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a e
of up to $250.00 a day against the violator. L e advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby _certify under the pains and penalties of the vzfonnation. provided_above_ i.s true.andcorrect __ __-
Signature: • Date: Y / 2714
Phone #: `f ( 9 - ,). c-, 7 ' 1 v ✓ '?'.
• . Offcial use only. Do not wrzte in this area, to be — comp -led by city or town'offciaL
_ _City. or Town: Permit/License #
Issuing Authority (circle one):
_ I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other 4:
Contact Person: Phone #:
s
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : 'Z 2 /t" 4 `�-- /�-->" i "- r C / 7 SJ f'
License Number
�r ,�i�.��
g 1,}4,4, i.) /L / ljGi C - //e- ���" / /'", e -z-n ,7s4- O.i'v.T'Y 'a/ a I/t Z
Address n Date
{ Expiration
e �T — c�.-- 0,92/i 3l y� f �. '. 4 c x
S g ture Telephone
9.,, Registered. Home:• Improvement:Contractor: �, . , , , , i , a ... ..,, Not Applicable ❑
f dlhi li 2---0%" /3GC.1# yC f G G. L,zf fd,, :7
Company Name Registration Number
G - dam, 4 .' /1 //o
Address Expiration Date
Telephone 9 y 2 1 v "
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 ,lid No ❑
11 w' Hnme O;Wner T'xtmption'
_ - -- �.. The_curr-ent_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, von 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
ort amp on - r macs,- a d°` . : i • - • ,. .4 ° � -: -> . . - w . eneral�La - -ws- Annotated. _
Homeowner Signature
a
i
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size _ -737-4Tc----1 o 7 �; _.._.... ._..__ __,_M__., ___...__._._._
Frontage >__ __._ �'...� Y __. 7 . y _ ,__
Setbacks Front / >i 77.7 -"
Side LE R:77::';7! L . . ._ °. R lCS<a : i _..
Rear FEZ Liti, !
Building Height - °�F £ y Y ;
• Bldg. Square Footage p % J „� ;
• Open Space Footage %
(Lot area minus bldg & paved g 'ttej F ` *P1. 1 !
parking)
# of Parking Spaces i -- -` Y'
Fill: i ... � _..__...�. .. �._..._....�_,,.
(volume & Location) ,i2_,_ , - - —. -
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:, 1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book i 3 Pa and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
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 0 NO e
IF YES, describe size, type and location: t
"D. Are there_ any proposed changes to or a• •i ions o signs intense orthe property ? YES 0 NO 0
IF YES, describe size, type and location: 9
E. Will the construction activity disturb {clearing,.grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Permit from- the -DPW is- required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks blE1 Siding [p] Other [0]
Brief Description of Proposed / ISit-iGD PR13/7 AV / ,Z-'e /G, De G4 frAftl, CRA' "7Z' ! .e2 y rn ,/x," 1 6- /7
Work: iA 51"0 -‘-'20---'0) C.-cvc'] P /00/2 C',.//.
Alteration of existing bedroom Yes ; ,c_ No Adding new bedroom Yes No
Attached Narrative .Renovating unfinished basement Yes No
Plans Attached Roll (;Shee`
sa: If " New " l ouse'andot idditiciriii)` existiiici 41ousmq; complete the foil ow iiiia:
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. N '"' / /2 s42 &-. Dimensions 72 ' r ' -frr 3f `/ L— ki el 4- i36zY..
e. Number of stories?
f. Method of heating? 0 Fireplaces or Woodstoves ' Number of each
•
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction 1.-14'00 FY-0 n+s
5' — /? rT7rz L. 7— am '' r'= %'/-7- ' f beet -2. u.'.
1. 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 /L `'
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank A City Sewer Private well City water Supply
x
•
SECTION 7a- OWNER AUTHORIZATION TO BE COMPLETED WHEN ,
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, p /774 t;2 /!. r1 A" 1-c- /Lt?( , as Owner of the subject
property f
hereby authorize , ----/ e'G ` / 2 /.0 / .J5,1
to a n my beh in all matters relative to work authorized by this building permit application.
V ,7W-6 Yiti-a.' 6 1.- t__ L- / / / 6
Signature of Owner Date
1 ?j / // /Z r,.s 5 /G'/ , as-Gloomier/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 _
�� -1.----.../1.., ` l /L a
Signature o %-r /Agent ;` Date
City of Northampton StatusofPermit
Building Department
212 Main Street SewerjSticaabdty
f\FR 1 3 L013
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272 Pt/Sjte Es
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE1NFORMATION
This section to be completed by office
1.1 Property Address:
9 0 L....lb Cip L4 OE Map Lot
Unit
•.:' Overlay District
t.?*6 g/fr Q ( Le)
EltitStVistrict CB District
.SECTION .2 PROPERTY•OWNERSHIP/AUTHORIZED.AGENT
2.1 Owner of Record:
/7414‘ irrp t- /741-c e
Namefrint) Current Mailing Address:
Telephone 4./ 3 5 ._ s „ . 2 _ 3
Signature
2.2 Authorized Apent:
• 2% . /(2'' S iL/ 2- /1. AJ5/4/ 0 06 y e P6-0 C.1.&._ Az
Name (Print) Current Mailing Address:
3/t)
Signatur Telephone
SECTION.3.,!ESTIMATEICONSTROCTIOkCOSTS2
: .
Item Estimated Cost (Dollars) to be Official Use .Only
completed by permit applicant
1. Building .: Fee
z Electrical ,,. (b) , Eetimated:.176tal , COSt . of
/ 0 .,.,,;, from (.6)
3. Plumbing Building Permit Fee.
4. Mechanical (HVAC)
5. Fire Protection
6. Total - (1 2 + 3 + 4 + 5) Check Number
. ecii/V237
• 739ff
•.This:Sectio.ft:ForPffitial.tiree'.0nly
Date
.Building PeiTnit Number: . .
.Issued:
. . . . ,
Signature:
•BUilditigZommissioner/Inspector Date
File # BP- 2010 -0891
APPLICANT /CONTACT PERSON JOHN ZIEMINSKI
ADDRESS/PHONE 8 WOODRIDGE CIRC HATFIELD (413) 247 -9014
PROPERTY LOCATION 80 WOODLAND DR
MAP 35 PARCEL 302 001 ZONE SR(100) //WP /WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out � � 7 � � &/ /
Fee Paid a
Typeof Construction: DEMO & REBUILD 16 X 24 DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 017889
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED: 1 "-t-�
Approved Additional permits required (see below) AAA, l ` p��-
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 Permit DPW Storm Water Management
Demolition Delay
i,q,0
Signa re 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.
80 WOODLAND DR BP- 2010 -0891
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 - 302 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- 2010 -0891
Project# JS- 2010- 001319
Est. Cost: $18000.00
Fee: $118.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN ZIEMINSKI 017889
Lot Size(sq. ft.): 197762.40 Owner: MAURER STEPHEN C & PAMELA ERICKSON
on r g : SR( 1oe), /WPAV p ri Applicant: JOHN ZIEMINSKI
AT: 80 WU"UL I' L DR
Applicant Address: Phone: Insurance:
8 WOODRIDGE CIRC (413) 247 -9014 Workers
Compensation
HATFIELDMA01038 ' ISSUED ON :4/16/2010 0 :00 :00
TO PERFORM THE FOLLOWING WORK: DEMO & REBUILD 16 X 24 DECK
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: J �
Driveway Final:
Final: Final: 0 949
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Lough: ° off: Insulation:
Final: Smoke: Final: OK G [Lc 110 Lou ( S
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
0 A 404444
Certificate of Occupancy 5/71/0 (,.ogcSfc Signature:
FeeType: Date Paid: Amount:
B4ilding 4/16/2010 0:00:00 $118.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
• Building Commissioner - Anthony Patillo