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29-295 . . to Quick Open Space Calculations Coverages coverage existing Lot area existing proposed house existing 1020 15905 1980 2430 patio existing 0' shed existing Open Space 13925 13475 drive existing 96 total 1980 Open % 87.6% 84.7% new 450"' new new 27 Pencasal Drive total 2430 26 Fr uio:IF'SCLi I �11- ID2 i 0=2—IL=1 1ptsc- 0 FIRE ALARM SYSTEM INSPECTION AND TEST REPORT Customer Name Date CrSAC. NORZ AMMt� C7Mwvitia lnstaliption Address Customer No. 29*4 FLEASErIT City State Zip Town No. NOR-M NIA DEVICE COMMENTS M�nusl Stations Heat Detectors Photo Smoke r Sprinkler Supervision Audible Signals Z Visible Signals t r CONTROL PANEL MFG 0k.0 X _ MODEL NX- 1 SERIALN N/A Battery- Voltage Charging Current b -L A HVAC Shutdown Operative WIN Remote Connection `F�i _ Elevator Capture Operation Remote Annunciator _ Auxiliary Function St(t�D� COMMENTS: MSCO certifies that the system and auxiliary equipment have been checked out And perform as noted in this report. AM Da (p, •il•e 51Rn.lure� Tills: ry GO�IOTef'f Rcprocnt•II•e Signs-lure Tllics In6ustrial Residential Security Co. alarm wstern inspecton and test report Date Customers Name Installation .-Nddress 1� State My\ zip ti Device 1 I 1 i)L I U� L4 Conti-ole Panel NIFG -1)IN') Serial;- Battery talle I Cha-u'llnu Current HVAC Shutdown Operative l_o_ Remote Connection—:114 Remote Annunclatov Elevator Capture Operation ii Iav Ru_Ic I on :tae of Butter, "Avera,ze 7-10 year life V) Comments 11,-o. Ccii L 6es that the systcm and awslfiavv _qlliplllellt h31C been check-ed out and ocrformas noted in the report above. Title c-N V-i V_ Title. h1��5 FIRE lECH IIIC F'AGE 01 Irk , • iQ I Lu I SA- V, errs ME T=OLONM MC. 57 York Street P.O. Box 8 WEST SPRINGFIELD, MA 01090 ` ! .c (413) 736-8111 (413)731-8000 FAX(413)746.9570 �'... PURCHASE ORDER NO P ONE ,� OgTE I i kq NAME ADDRESS G t I rrlbi #1/ 7 S ( n�Y L t� ` .. _ a Q { -� DESCRIPTION PRICE AMOUNT i s TAX REOFIVED BV , TOTAL s 13 M r All clairfis and returned floods MUST he accompanied by this bill. 90331 Thank You C x0kDEQ-$AfEOUAQD em-"Z-7277 • aiI4 of Xurt4 amptnn DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �� t�� Northampton, MA 01060 P R10D1C IN T'I;C"'PION APPLICATION FOR REQUIRED INSPECTION Application Sent: 4/1/2009 PREMISE NAME: Community Substance Abuse Clinic PREMISE ADDRESS: 299 PLEASANT ST OWNER(S)OF RECORD: Community Substance Abuse Clinic OWNER ADDRESS: 628 Center Street CHICOPEE, MA 01013 TELEPHONE NO: TYPE OF BUSINESS: Commercial Building USE GROUP: B . .......... . INSPECTION FEE: $ 150.00 C RETURN BY 4/14/2009 Please complete and return this application, along with a check made payable to the City of Northampton for the amount of the inspection fee listed above. Send it to the Department of Building Inspections, 212 Main Street, Northampton, MA 01060. We will contact you to arrange a time to inspect your property. If this information is not correct, or if you no longer own this property, please note any changes at the bottom or on the back of this form and return it to the building department. Feel free to contact us if you have any questions. We can be reached at(413) 587-1240. Thank you. Applicant name: Applicant Title: R a�iw Telephone: / —d O Sr Preferred inspection time/date: /? bVa- GG/r) 6 Atl -- Comments: Map/Plot: 32C- 143 Northampton, MAPro4ertyDetail Page 2 of 2 Brick Trim: 0 X 0 Lower I 1 st Story 13rd Stone Trim: 0 X 0 lBasementilOne Story Frame Remodeling Data: 10pen Frame Porch Year Remodeled: 0 Kitchen Remodeled (Y/N): Bath Remodeled (Y/N): Yes Land Data Outbuilding Info Square Foot Type Utilities Type Feet Value no Prime information Site Fl 5,905 86,420 T e Year Size 1 Size2 Grd ( yp Q��00F RSl � 1990 �1 80 �C Acreage Type Street/Road Type Acres Value no L no information ormation Sales Info Permit Info Date Type I Price Validity 06/25/2008 Land+ Bldg 192,500 Date Permit # Price Purp 08/15/2003 Land +Bldg 153,500 no information 07/01/1997 Land +Bldg 102,000 http://www.northamptonassessor.us/noho/propertydetail.php?map_no=29 -295-001&pageca... 4/6/2009 Northampton, MAPropertyDetail Page 1 of2 City of Northampton, MA: Residential Property Record. G New Search Property-Type Classification Code Reference Card 1 of 1 Parcel - Location - Zoning - Assessment Map-Block-Lot: 29 -295-001 Zoning: Assessm Location: 27 PENCASAL DR Neigborhood: 1 Land: #Living Units: 1 Deed Book: 7391 Buildin Class: R-101 Deed Page: 3!L__Jl Total: Dwelling Information F Building Sketch Style: Ranch Year Built: 1970 Story Height: 1 Attic: None Basement: Full Total Rooms: 5 Bedrooms: 3 Full Baths: 1 Half Baths: 0 Exterior Walls: Alum/Vinyl 40 Unfinished Area: 0 5 Ground Floor Area: 960 OFP i2 24 1 Fr}B 24 Total Living Area: 960 so S sso Finished Basement Living 0 X 0 5 Area: Basement Recreation Area: 0 X 0 40 Woodburning Fireplace 0/0 Stacks/Openings: Metal Fireplace 0/0 Stacks/Openings: Heat/Central A/C: Basic Heating System: Electric Fuel Type: Electric Quality Grade: C Physical Condition: Average Interior/Exterior: Same Condition/Desirability/Utility: AV Addition Information: Vacant/Dwell/Oby Status: Dwelling Additional Features: http://www.northamptonassessor.us/noho/propertydetail.php?map_no=29 -295-001&pageca... 4/6/2009 s � • J J, h d o SO c4 b � v } d � 10 / a a Fyt G tT © ` p b° � � o 3 j n fry i � 0 lcilll!�)11111 v o o� C n o 4 � s X k S � , � r k k 0 s HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines"Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor,to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required)and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing&gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections.Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home own r/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location ,27 P h ca.sc i D FIor�Kcc. /��SS, �l0(oZ _ A*- , The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ` Boston, MA 02111 n www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeZibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.F-1 I 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.❑Electrical.repairs or additions 3.0 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 12.7 Roof repairs insurance required.] t c. 152, §1(4),and we have no b /_ employees. [No workers' 13.� Other�t,� aC�. d'CCI�G 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 name 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: ���� Date: Phone#: Official use only. 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#: e a SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable GK Name of License Holder: License Number Address Expiration Date Signature Telephone 9,.Rectisteredf.Home.Imoroiuemerrt"Confracfor � ,µ. - .' ;' Not Applicable OR", Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§.26C(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...... ❑ I1 ��33orrie„�w>ae>r;�z � ia> 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 Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature J ' s SECTIOL4 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors I] Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [Be Siding[O] Other[O] Brief Description of Propo1 work: - j/6""? o Alteration of existing bedroom Yes ✓No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or additiorH td:;existliici hausFnit,.co zlete`tF he foCFdv�rfiiq: 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. Masscheck 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. 1. 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 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 l 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. Print Name DateSat O A ^ 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 Frontage Setbacks Front Side Rear 30 Building Height Bldg.Square Footage % Open Space Footage (Lot area minus bldg&paved % 619 ilvlq of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? �� �� NO ��/ DON7KNOYV �_� YES v�� |F YES, date iszue& IF YES: Was the permit recorded at the Registry ofDeeds? � NO _� DOwlxwu '�� -� vv |FYES' enter Book Page | and/or Document#| | ' L_-_________� �---------� `----------'—^ B. Does the site contain a brook, body of water orwetlands? NO »~�\ DONT KNOW 0 YES IF YES, has a permit been ur need tobe obtained from the Conservation Commission? Needstobeobtained »r - « Obtained �-� Date |ssued' � | �~� ' ' L_-___-____—� C. Du any signs exist on the property?y� YES �_� NO IF YES, describe size, type and location: NO D. Are there any pm������ora��ns�d�sir�d��r� p��? YES 0 � IF YES, describe size type and location: ' E. Will the construction activity disturb(clearing, gradingexcavation,ur filling)over 1 acre nrish part ofa common plan that will disturb over 1 acre? YES ��K ) NO �,� �� IF YES, then a Northampton Storm Water Management Permit from the DPW im required. ~�� '^~' 960 - City of Northampton Building Department partment Cr� CtlETeuva�'e� F� 212 Main Street e r� e �� �IabilEf � IS�' Room 100 ellFtastft � � Nortfiampton, MA 01060 Tetsa �ct�iaPparts� � �� piione 413j 587=1240 Fax 413-587-1272 f � APPLICATION TO CONST�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- Map- � Lot �'/ Unit 27 RVXCA5C. D{ Flo r2hc-e— MA 0 t o(p 2 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: GO%C%.\ K n o n 14"1"60 Z 1 tie h c�a�� U c Flore nc e � O ICxo Name(Print Current Mailing Address: i Telephone Sign ure 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 com feted by ermit applicant 1. Building !Q� (a).Building Permit Fee 2. Electrical J (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) Q Check Number ' This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date v File#BP-2009-0809 APPLICANT/CONTACT PERSON RENAUD BRIAN D&ELIZABETH F C/O GARY J HICKS ADDRESS/PHONE 27 PENCASAL DR FLORENCE (413)341-3529() PROPERTY LOCATION 27 PENCASAL DR MAP 29 PARCEL 295 001 ZONE URA(100)//WSP 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: CONSTRUCT 450 SQ FT DECK New Construction Non Structural interior renovations Addition to Existinp, 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 INFO ATION PRESENTED: ppprroved Additional permits required(see below) 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 69 /10 /, g 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. M 1 At BP-2009-0809 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2009-0809 Project# JS-2009-001206 Est. Cost: $2500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 15899.40 Owner: RENAUD BRIAN D&ELIZABETH F C/O GARY J HICKS Zoning:UFA(100)//WSP Applicant: RENAUD BRIAN D & ELIZABETH F C/O GARY J HICKS AT. 27 PENCASAL DR Applicant Address: Phone: Insurance: 27 PENCASAL DR (413)341-3529 O FLORENCEMA01062 ISSUED ON:411312009 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 450 SQ FT 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: 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: FeeType: Date Paid: Amount: Building 4/13/2009 0:00:00 $50.002055 e 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo