22B-111 (3) PLANNING AND DEVELOPMENT • CITY OF NORTHAMPTON
planning•conservation•zoning•northampton GIs•historic•community preservation•central busing atchltettui'e
i Sarah I.Lavalley,Conservation,Preservation,&Land Use Planner•slava11ey(9NorthamptonMA,gov.413.587.1293
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1
October 4,2012
Jeffrey D.Squire,RLA
Berkshire Design Group
4 Allen Place
Northampton,MA o1o6o
RE:Proposed Elks Lodge open pavilion,3-7 Spring Street,Map 22B-i11
Dear Jeff:
Thank you for contacting the Conservation Commission regarding the proposed open pavilion at the Elks
Lodge within the floodplain to the Mill River. As shown in the site plan(`Elks bodge'dated October:L
2012)and associated cover letter,the project will result in a loss of compensatory flood storage of 6.5
cubic feet,and is outside all other wetlands resource areas. The Northampton Conservation Commission
voted that projects impacting less than one cubic yard of bordering land subject to flooding do not"cause
an increase in or..,contribute incrementally to an increase in the horizontal extent and level
of flood waters during peak flows."
-As shown on the plan,the project does not require Conservation Commission review. This applies only to
the pavilion project referenced,and does not authorize or permit any other work within jurisdictional j
resource areas. If the scope of the project is changed to include additional flood storage loss or impacts to
additional resource areas or buffer zones,review under the Wetlands Protection Act and Northampton
Wetlands Ordinance may be required. j
Thank you,
S ah LaValley
City.Hall .e 210 Main Street,Room 11 •Northampton,MA 01060•www.NorthamptonMa.gov•Fax 413-587-1264
original printed on recycled paper
!F'
File#MP-2008-0069
APPLICANT/CONTACT PERSON MATT MURPHY
ADDRESS/PHONE 329 SOUTHAMPTON RD (413)237-4415 Q
PROPERTY LOCATION 17 SPRING ST
MAP 22B PARCEL 111 001 ZONE WP(100)/WSP(100)/SI(98)/URA(2)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA-OUTDOOR PAVILION W/2 BATHROOMS&KITCHEN
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
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
i
Intermediate Project: Site Plan AND/OR Special P Major Project:Project: Site Plan AND/OR pecial 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
—V!!1-0`P`ermit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
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 the Office of
Planning&Development for more information.
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The Commonwealth ofMassachusetts
Department of Industrial Accidents
Office of Investigations
�. a.
�-� 600 Washington Street r
- Boston, MA 02111
_ www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: eY'''a- kv�) Phone#: t--
Are you an employer?Check the a propriate box: Type of project(required):
I am a employer with 4. E] I am a general contractor and I
6. New construction
employees(full and/or part-time).* have hired the sub-contractors
2.El
am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
[No workers'comp.insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
�.❑ I am a homeowner doing all work
officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance 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 all 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 nacre of the sub-contractors 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: &(JS-k �ff4MA- ce_
Policy#or Self-ins.Lic.#: Or, 1�� Expiration Date::
Job Site Address: (� � i _ City/State/Zip:
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 of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be 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 certi under the pa i s an enalties of perjury that the information providde/d a o e is true and correct.
%r`
Sienature:''d'' � �—•' Date: 7
Phone#
Of use onl)i. Do not write in this area,to be completed by city or town officiaL
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
Contact Person: Phone#:
r
Version 1.7 Commercial Building Permit May 15,2000
.o
4
SECTION 10-;STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes No 0
SECTION 11 OWNER!AUTHORIZATION-TO BE:COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
f6ok � Z WW 7 w
£ ' , j l�uyT e�°
........ ,as Owner of the 7property
hereby authorize
to
act on my beh If, in 11,m rs r o work authorized by this building permit application
Signat re of Ow r Date
x
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 nd penalties of penury KK .
-._
Print Name
Signature of Owner/Ag nt Date
SECTION 12-CONSTRUCTION:SERVICES
10.1 Licensed Construction Supervisor. Not Applicable ❑
Name of License
7 License Nurriber
l�
Address ' Expiration ate
Signature Telephone
SECTION 13-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 � No
Version 1.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF EN
IOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
W
Registration Number
Address '^-
Expiration Date 1 01 na ure Telephone
9.2 Reo0tered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address R�istration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone I Expiration Date
9.3 General Contractor
Not Applicable El
Company Name
Responsible In Charge of Construction
Address 1
Sig ature Telephone
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTONZONING
Existing Proposed Required by Zoning .
This column to tie filled in by
Building Department
Lot Sizel( ' J'
Frontage _. ___ _ _..,_..... _ .....,. _... ..... .... ..
Setbacks Front
Side L:—.—
Rear _ c�Y
Building Height ia r
Bldg. Square Footage %
Open Space Footage _ _ % _ -
(Lot area minus bldg&paved
#of Parking Spaces
Fill: ejV.,o./ ,{ S��e
(volume&Location _, _ _..__ _, t U�il. f �.:,� :..... -
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page'-. and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES C
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued
C. Do any signs exist on the property? YES NO
f
IF YES, describe size, type and location: '!
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
IF YES, describe size, type and location:
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 2 Northampton Storm Water Management Permit from the DPW is required.
Version l.7 Commercial Building Permit May 15,2000
.o
SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 Y
CUBIC FEET OF ENCLOSED SPACE
i
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description Tnter a brief description here.
Of Proposed Work: r 1 11
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A El
A-4 ❑ A-5 ❑ 1 B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ i 2C ❑
H High Hazard ❑ - 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 1 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B
U Utility Specify:: :mot
M Mixed Use ❑ Specify:
S Special Use El Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING.RENOVATIONS ADDITIONS AND/OR CHANGE'IN USE
-
Existing Use Group.
------. ------ Proposed Use Group:
Existing Hazard Index 780 CMR 34) _. Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
1St .�..��.__.__........�
-_...
St �-._...,..,.
2nd 2nd
3 rd 3rd
41n 4m
Total Area(so Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public E] Private E] Zone Outside Flood Zone[:] Municipal ❑ On site disposal system[]
r
Version 1.7 Commercial Building Permit May 15,2000
Departure t use only
City of NorthamptonStaatuzl J�rrr#tt Sg A R s
Building Department Cuzb Out/D ueway Permit,RAN,
�g 212 Main Street 5ewertSepfacAvatla6cltt}r `
'ARK 10 ma Room 100 Wat&NNX aila, II, E `- a ry
Northampton, MA 01060 T>nraets aMiructrarlY?lais�
OPBUI 1w1NsPECTIOt hOn 413-587-1240 Fax 413-587-1272 Plot/Sited?{ans `
NORTHAMPTCNA AAA 01
___- other Specify .
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
_ _ w... ...._..__ __.._.
Map Lot Unit
Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
VO�G7H Nt�TV CCU U G C O/=61t-I-L NC i• .� 1
Name(Print)/ �� Z 't.Iti -{3w'Sr�L-jW Current Mailing A dress
Signature 6 Telephone
2.2 Authorized nt
Ac :
.,.
Name(Print) r� Current Madmg Address
i!in
Signature ./ � Telephone
SECTION'3'-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
_
completed by ermit applicant
1. Building (a) Building Permit'Fee
2. Electrical
(b).Estimated Total Cost of
Construction from 6 _ _._..._. .,.......
3. Plumbing Wp Building Permit Fee
4. Mechanical(HVAC) °•-°-
5. Fire Protection
6. Tota -J1,at 3+4 5) L4 7 Number
This Section For Official Use Only
on
Building Permit Number Date
Issued
_ _Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2013-0928 'I OY
APPLICANT/CONTACT PERSON WALTER MAREK III �I Ow
ADDRESS/PHONE 73 SOUTHAMPTON RD WESTHAMPTON (413)527-7667()
PROPERTY LOCATION 17 SPRING ST —) E 1J s
MAP 22B PARCEL 111 001 ZONE WP(100)/WSP(100)/SI(98)/URA(2)/
0
THIS SECTION FOR OFFICIAL USE ONLY: �tP Y
PERMIT APPLICATION CHECKLIST 0 (�S�
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid '
Building Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT 40 X 80 PAVILLION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure i "
Building Plans Included:
Owner/Statement or License 055201
3 sets of Plans/Plot Plan Aod /nz�
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION P ENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§ �O ,1 , TA l(, 0 f lA Se -5r;0 Cr
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
j �.
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.