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Issued By Northampton Conservatio Co lion
Signatures:
This Order must be signed by a majority of the Conservation Commission.
On this � x
day of c 1995, before me
personally appeared , to me known to be the
person described in and who executed the foregoing instrument and acknowledged
that he/she executed the same as his/her free act and deed.
Notary Public My c is ion expires
The applicant, the owner, any person aggrieved by this Order, any owner of land
abutting the land upon which the proposed work is to be done, or any ten
residents of the City or town in which such land is located, are hereby notified
of their *right to request the Department of Environmental Protection to issue a
Superseding Order, providing the request is made by certified mail or hand
delivery to the Department, with the appropriate filing fee and Fee Transmittal
Form as provided in 310 CMR 10.03(7) , within ten days from the date of issuance
of this determination. A copy of the request shall at the same time be sent by
certified mail or hand delivery to the Conservation Commission and the applicant.
"-Detach on dotted line and submit to the Northampton Conservation Commission prior _
to commencement of work. PLEASE NOTE--THIS IS NOT REQUIRED IF THE COMMISSI011 ).T:fi
ALREADY RECORDED THE ORDER, AS IS THEIR USUAL PRACTICE, UNLESS LAND IS RGISTkI;v
- IN LAND COURT.
. . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . .. . . . . . . . . . . . . . .. . . . . .. .. ... . . . . . .. . . . . . . .. .. .
To Northampton Conservation Commission: Please be advised that the Order of
Conditions for the project at,S�'Ct;Qr/�iQtR �� ° i1e Number 246- f has been
recorded at the Registry of Hampshire County and has been noted in the chain of
title of the affected property in accordance with General - condition 8 on .
19
If recorded land, the instrument rument number which identifies this transaction is
If registered land, the document number which identifies this transaction is
Signature Applicant
page 5-6 (memorex\wp\conscom\order.cc) _
25. If checked: ( j YES
An "As Built" plan shall be included with the project engineer's
certification, detailing the post-development conditions of the site:
26. Erosion control barrier shall be located to the limit-of-work line. In
ethe area surrounding the dirt path, erosion control `-barrier shall be
armored with hay bales in addition to•the silt fencings.
r**rtrt**,t,t,t*,t,r**,t,t,r�*,trt,r,t,r***,r,r,t,r,t,t***,t,t,r*,rrt*�,t*w**,r*,t***,►**,r*,r,r**,rw,tw,r*,t**,r***
page 5-5 (memorex\wp\conscom\order.cc)
r
17. Areas of construction shall remain in a stable condition at the close of
each construction day. Erosion controls shall be inspected at this time,
and maintained or reinforced to meet specifications in the plans and this
order;
18. All construction areas shall be restored to original condition or better
upon completion of the project, including replanting of vegetation;
19. The Commission and its agents shall have the right to enter and inspect
the property at any time for compliance with the conditions of this Order,
the Act, and Wetlands Protection Regulations: 310 CMR 10.00 and Chapter 24
of the City's Ordinances: "The Wetlands Protection Ordinance". They shall
have the 'right to request and receive any data or documentation that is
deemed necessary for evaluation of compliance.
20. This Order of Conditions shall apply to any successor in interest or
successor in control;
21. The contractor is as responsible as the applicant and property owner for
any violations of the Orders of Condition and penalties under the law,
while all activities regulated by this Order are being performed.
Pi"copy
oV tti"is Orcgri
cgnst-ru- a"cti�i'
equipmt n a oyes»+s aY $e�a is "gin rovddlpl'and ,
be ,infatrrheco� atioa th idt _ ... ...
This 1F"rdCAt ion,,,#shal* be es s S e:� aFrl44 cMtr c o whenever i we rk f:s
occurisigi . :
g g r r rm ea°f a on-site and in all;excavating
mA a nw or s npe=soM
.._.»
22. All required permits must be obtained from the Planning Board, Zoning
Board, Department of Public Works, and Building Inspector prior to the
start of projects involving fill within any wetland resource area;
23. The owner of the property described in this Order, must advise any
potential buyer of the property that any construction or alteration to
said property, including brush cutting or clearance, may require action by
the Northampton Conservation Commission.
Any instrument conveying any or all of the owners' interest in said
property or any portion thereof, shall contain similar language as
follows:
"This property may be subject to the Northampton Wetlands Protection
Ordinance, Wetlands Protection Act, an Order of Conditions, and/or
a Determination of Applicability from the Northampton Conservation
Commission";
24. Upon completion of the project, the Applicant shall submit a statement
that all work has been done in conformance with the provisions of the
Order of Conditions and request a Certificate of Compliance.
-� If checked: [ ) YES
Certification shall be by a Professional Engineer or by a Wetlands
Consultant who shall have been approved by the Commission:
page 5-4 (memorex\wp\conscom\order.cc)
9. A sign shall be displayed at the site not less than two square feet or
\..I 00,,.lo more than three square feet in size bearing the works, "Massachusetts
Department of Environmental Protection, File Number 246-381". f �
10. Where the Department of Environmental Protection is requested to make a
determination and to issue a Superseding Order, the Conservation
Commission shall be a party to all agency proceedings and hearings before
the Department.
11. Upon completion of the work described herein, the applicant shall
forthwith request in writing that a Certificate of Compliance be issued
stating that the work has been satisfactorily completedz .
12. The work shall conform to the following plans and special conditions:
PLANS TITLE DATED SIGNED & STAMPED BY:
Plan #1
Attachment 01 .
Attachment #2
Map #35
Contour Map - Easthampton, MA N4215-W7231-.5/7.5 - 1964 photorevised 1979
Exhibit 3
Estimated Habitat Map - 1993 edition
,Septic System Design - Project location - West Farms Road, Northampton - Plan
dated 3/27/95 - JOB # 50828 - Thermo Consulting Engineers
All Plans on File with Northampton Conservation Commission
Special Conditions:
13. The applicant shall notify the Commission, in writing, as to the date that
Ic the work will be commencing: on the' project. Said notification must be
received by the Commission no sooner than (10) days and no later than five
(5) days prior to the commencement of the approved activity;-
14. No area within the 100 year floodplain, any wetland, or area within 100
feet of a wetland or 40 feet of a 100 year floodplain, as defined in 310
CMR 10, and City of Northampton Ordinances - Chapter124, shall be
permissible disposal sites, unless such areas are,specifically approved by
the Commission;
15. Excavated material and topsoil stockpiles shall be located and stabilized
so as to minimize washing into wetland areas or waterways;
` 1
16. Adequate measures shall be taken to prevent erosion and siltation of all
disturbed areas, and shall be implemented prior to any construction.
Sedimentation and erosion control devices shall be placed according to
standards set in U.S.D.A. Soil Conservation Service, "Guidelines for Soil
and Water Conservation in Urbanized Areas of Massachusetts".
Placement of sedimentation and erosion control shall be directed at the
site by the project engineer in order to accomplish maximum control df
erosion to ensure that no eroded material's will enter wetland resource
areas.
Hay bales must be staked. Silt fencing must be installed in a dug trenc*
with sufficient porosity to allow detained water to pass through while
trapping suspended sediments;
page 5-3 (memorex\wp\conscom\order.cc) _
Therefore, the Northampton Conservation Commission hereby finds that the
following conditions are necessary, in accordance with the Performance Standards
set forth in the regulations, to protect those interests checked above. The
Conservation Commission orders that all work shall be performed in accordance
with said conditions and with the Notice of Intent referenced above. To the
extent that the following conditions modify or differ from the plans,
specifications or other proposals submitted with the Notice of Intent, the
conditions shall control.
General Conditions
1. Failure to comply with all conditions stated herein, and with all related
statutes and other regulatory measures, shall be deemed cause to revoke or
modify this Order.
2. The Order does not grant any property rights or any exclusive privileges;
it does not authorize any injury to private property or invasion of
private rights.
3. This Order does not relieve the permittee or any other person of the
necessity of complying with all other applicable federal, state or local
statutes, ordinances, by-laws or regulations.
4. The work authorized hereunder shall be completed within three years from
the date of this Order unless either of the following apply:
(a) the work is a maintenance dredging project as provided for in the
Act; or
(b) the time for completion has been extended to a specified date more
than three years, but less than five years, from the date of
issuance and both that date and the special circumstances warranting
the extended time period are set forth in this Order.
5. This Order may be extended by the issuing authority for one or more
periods of up to three years each upon application to the issuing
authority at least 30 days prior to the expiration date of the Order.
6• Any fill used in connection with this project shall be clean fill,
containing no trash, refuse,, rubbish or debris, including but not limited
to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires,
ashes, refrigerators, motor vehicles or parts of any of the foregoing.
The applicant is prohibited from using demolition materials, asphalt,
large chunks of concrete, tree stumps and limbs, and general refuse;
7. No work shall be undertaken until all administrative appeal periods from
this Order have elapsed or, if such an appeal has been filed, until all
proceedings, before the Department have been completed.
8. No work shall be undertaken until the Final order has been recorded in the
Registry of Deeds or the Land Court for the district in which the land is
located, within the chain of title of the affected property. In the case
of recorded land, the Final Order shall also be noted in the Registry's
Grantor Index under the name of the owner of the land upon which the
proposed work is to be done. In the case of registered land, the Final
Order shall also be noted on the Land Court Certificate of Title of the
owner of the land upon which the proposed work is to_be done. The
recording information shall be proposed work is to be done. The recording
information shall be submitted to the Commission on the form at the end of
this Order prior to commencement of the work. The Commission usually will
record the Order in the Registry of Deeds. It is the applicant's
responsibility to insure the Order is properly recorded.
page 5-2 (memorex\wp\conscom\order.cc)
Z717.20(
310CMR 10.99
Ww�
(To be provided by DEP)
Form 5 City/Town Northampton
Applicant Frederick R. Mailloux
commonvealth Map # 35 Parcel 1_.L5
of Massachusetts
Order of Condition's
Massachusetts Wetlands Protection Act
G.L. c. 131, 540
and the Northampton Wetlands Protection Ordinance
From Northampton Conservation Commission Issuing Authority To:
Frederick R. Mailloux Frederick R. Mailloux
Name of property owner Name of Applicant
78 Turkey Hill Road 78 Turkey Hill Road
Address Address
This Order is issued and delivered as follows:
[ ] by hand delivery to applicant or representative on (date)
by certified mail, return receipt requested on (date)
Project located in Northampton at So. east corner of West Farms & Rvan Roads
The property is recorded at the Registry of Hampshire County
Book 1874 Page 149
Certificate (if registered) NIA
The Notice of Intent for this project was filed on June 28, 1995 (date)
The public hearing was closed on 7�0� 1�g� (date)
Findings:
The Northampton Conservation Commission as reviewed the above-referenced Notice
of Intent and plans and has held a public hearing on the project. Based on the
information available to the Conservation Commission at this time, the Commission
has determined that the area on which the proposed work is to be done is
significant to the following interests in accordance with the Presumptions of
Significance set forth in the regulations for each Area Subject to Protection
Under the Act (check as appropriate) :
[ ] Public water supply [X] Flood Control [ ] Land containing
[ ] Private water supply shellfish
pp y [X] Storm damage prevention [ ] Fisheries
( ] Ground water supply [X] Prevention of pollution [ ] Protection of
Wildlife Habitat
Total Filing Fee Submitted 1 55.00 State Share $15.00
City Share S 40.00 (1/2 fee in excess of $25)
Total Refund Due $ City Portion $ State Portion $
(1/2 total) (1/2 total)
page 5-1 (memorex\wp\conscom\order.cc)
31
THE COMMONWEALTH 0 MA 3 USETTS
BOARD OF V M26
.......................OF...........NRKt........ .....I.................................................
Appliration for 111oposal Works Tonstrurtiolut M'
Application is hereby made for a Permit to Construct (X) or Repair an Individual Sewage Disposal
System at:
West Farms Road
......................... .......
Location-Address or Lot No.
F derick P
,,...IL
.Ad...rjLr.Qj..
.............. A....NAi11QMX.............. ...
Owner Address
.................................................. .........
ing-taRer Address
Type of Building Size Lot..40.40..........Sq. feet
U
Dwelling—No. of Bedrooms........ThTfM........................Expansion Attic Garbage Grinder (X
04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
0- Other fixtures .....................................................................................................................................................
< Design Flow........... ............................gallons per person per day. Total daily flow.......A§Q.............................gallons.
Septic Tank—Liquid capacity..15.Q.Q.gallons Length...1.011...Width......S;El;...Diameter................Depth.....4..X.t.
Disposal Trench—No.....3.............WidthX.ft.........Total LengthL50 £t.....Total leaching area.....9.00......sq.ft.
Seepage Pit No..................... Diameter.................... Depth below inlet....................Total leaching area.................sq.ft.
Z Other Distribution box ( .14 Dosing tank ( )
Percolation Test Results Performed by..11=t1ey..Assnciates........................... Date....5,1.18.184..................
Test Pit No. I......Zr:0..minutes per inch Depth of Test Pit...11)..ft..... Depth to ground watengre&tex..than 10ft
Test Pit No. 2................minutes per inch Depth of Test Pit...11.1 t..... Depth to ground water.greatex...than 10ft
.............................................................................................................................................................
0 Description of Soil.........TPI..zl;......Q..: 1Z!!..jarganic,..topsiAl...12!!...n..12.Q!!..1ay.ers..j3f...sand..anii..gravel
....... ...Qrgamic .._of.............
s.a..nd..a.n..d....Zp.y.
q.1...................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed...................................................................................... ........
�/...Ils
Date
ApplicationApproved By................................................................................................ .................... ..............
Date
Application Disapproved for the following reasons:.............................................................................................................
.....................................................................................................................................................................................................
Date
PermitNo...........................»._.............._ Issued...........................
Due
- - ------- -------------------- ------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Tnuftratr of Tompitattre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired,(
by...................................................................................... _71111-111-111*1-1--
TEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....11.......................................................................... Inspector........*...... ................. .......... ..........
............ .........
THE COMMONWEALTH OF MASSACHUSETTS
Ct BOARD OF H EA
...............OF
.. .... . ...........
0...../ **' "
N ..................
UisposuL Marko Tonshiglion Pgrutft
Permission is hereby granted........tp-r-j....4_0,ia-6��........ .. ............................................
to Construct or ReZdr an Individual S ja a DIS pWSystem
.......... ...... ('=1....................................................
at No........... ._X4... ..Z..5: r Street
as shown on the Tapli'cation for Disposal Works Construction Pe t N 1'9_.r7..St.... Dated..
.............. .........
mrd of e Health
DATE... ............................................... ---B
FORM 1255 A.M.SULKIN. BOSTON
C I T Y OF N 0 R T HAM P T O N, M A S S.
March 19 1997
THE BOARD OF PUBLIC WORKS
The undersigned respectfully petiition your honorable body for
Permission to install driveway at 18 West Farms Road
Fifteen (15) foot maximum width at the street line. Gutter drainage not to be
disturbed. All drainage shall be directed off the driveway surface to
adjacent land and not on the existing roadway. Driveway surface to be
paved if the grade of the proposed driveway exceeds 3% or more.
C
By:
.ter
"'Chris Finn 584,-4172
29 Hickory Drive, Florence
Proposed Location �,�,,
Inspected by: s 0 G�� J _�` 9 7
Gravel Base Grade
Inspected by:
Final Approval:
THE BOARD OF PUBLIC WORKS
Voted that petition be granted.
$25.00 Fee Paid �90�
Samuel B. Brindis, P.E. , Director of Public Works
(SUBJECT TO ATTACHED CONDITION 1 & 2)
Conditions: Driveway Permit
In lieu of plan approved by City Engineer
I agree to the following added conditions:
1) I will contact the Department of Public Works and have
an inspector check and approve the graded gravel base
prior to paving to insure compliance with slope and
location;
2) I further agree that if in the inspections any of the
permit conditions are not met that I will at no expense
to the City remove and replace the driveway as directed
by the City Engineer.
By. c
etitioner Chris Finn 584-4172
29 Hickory Rd. , Florence
NOTE: The Public Works Department recommends that you provide a
plan showing the proposed driveway with grades and location
in the future to avoid possible expense which you will incur
by not getting approval of actual plans in advance.
L4
NORTHAMPTON WATER DEPARTMENT
237 PROSPECT STREET
NORTHAMPTON, MA 01060
586-6950 Ext. 300
Subject: Municipal Water Availability
Location: 18 West Farms Road
Inquiry Made By: Chris Finn
Date of Inquiry: 03-20-97
Municipal Water Main in Front of Location: YES x NO
Size/Material/Age of Water Main: 8" CI 1930
Approximate Street Pressure: 52 PSI
Size of Service Connection: No Existing Service
Comments:
A corresponding "water entrance fee" shall be paid prior to making
any connection to the municipal water system. Arrangements of such
installation shall be made with the Northampton Water Department
with a minimum of 5 working days notification. All work shall
conform to Northampton Water Department specifications.
arles Borowski
Superintendent of Water
Enclosure: Letter to Frank Sienkiewicz from Sam Brindis, dated
June 14 , 1991.
cc: Samuel B. Brindis, Director, DPW
Peter McNulty, Jr. , Assistant Director, DPW
George Andrikidis, Assistant City Engineer
Anthony Patillo, Building Inspector
A: \WATER\Availab1. 50S
(!iz#y of Wort4amptou �
� �Iassachusctts ;a -
"5" , DEPARTMENT OF BUILDIT;G INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
Square Footage Amount
Basement @ .10 /,---00 /Zo,Cb
1st Floor @ .40 zU v
2nd Floor @ .20
1/2 Floors, Attic, Garage %10 3
Deck, Porches
D CC�c
TOTAL
= 2
r
r /11D� �
"I V;iL-
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO_
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This columm to be filled in
by the Building Department
Required
Existing Proposed By Zoning
v
Lot size s ' /9
S
Frontage
Setbacks G' 3c� �8D
- side L: 0 R: `)0 L: 12' R: C 2 O
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paced parking)
.pf Parking spaces
f Hof Loading Docks C ___---
Fill:
(vol-rime--& location,
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: C lV APPLICANT's SIGNATURE
NOTE: Issu no® of a zoning permit does not relieve an applicant's burden to comply witir,,,all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubtio Works and other appiiooble permit granting authorities.:..
,'. ` FILE #
File No. `y
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: R1 O 14 "0
Address: � �c `7 T�(� (-Ff� w�Telephone:
N 6L
2. Owner of Property: �"41CL4 t/ X
Address: /r7 8 Tu k y 14,Lt-- V Telephone: _S—?
3. Status of Applicant: Owner 'X, Contract Purchaser Lessee
Other(explain):
4. Job Location: Cc,2„c 2_ lb' 5'j -fi b m J. rISD
Parcel Id: Zoning Map# 3�� Parcel# District(s): �/P—/zl
(TO BE FILLED IN BY THE BUILDING DEPARTMENT
S. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plan Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special PermitiVariance/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#
9. 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:
(FORM CONTINUES ON OTHER SIDE)
t� n
FILE if
PANT/CONTACT PERSON:
ADDRESS/PHONE: -�4:
PROPERTY LOCATION:
MAP PARCEL: ZONE :"
THIS SECTION FOR-OFFICIAL USE ONLY:
PER UT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FTI 11'ED OUT
Fee Pnid
Riiilding Permit Filled n1vt
Fe
New Cringtrnrtinn
Additinn to Existing U
Building Plan, Trichided-
T.1q,.tQ of Plan's Plnt)Plnn
>/
Q
THE FOLLO ACTION�HAS BEEN TAKEN ON THIS AP ICATION:
)C Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
C n
Z
2
Signature of Building Wector Date
NOTE:Issunnoa of a zoning permit does not relieve an appiioant's burden to oomply with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
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NOTE:IN ORDER THAT THIS APPLICATION MAY BE ACCEPTED,THE DATA CALLED FOR BELOW MUST BE SO SET FORTH
THAT WE CAN DETERMINE FROM THE APPLICATION AND THE ACCOMPANYING PLANS WHAT THE EXISTING CONDI-
TIONS ARE AND WHAT THE FUTURE CONDITIONS WILL BE.
Plot Plane and Plans,must be filed with this application before a permit be granted.
MAR 24
Zone
APPLICANT NOT TO FILL IN SPACES ABOVE THIS LINE
Application for a Dwelling Permit
a Northampton,Mass. . . . . . . .A,: c /.& /. .!.Telephone No. . . . ..` .`f-:.�.�L
7b the Supt.of Buildings:
Application for a permit to build is hereby made according to the following:
. . . . . Lot, No. . 35 2
1. Location,Street and No. . . . . C0A_r�
_ �v2.K . .�C' . . . . . X . .. .�.0-�. . . . . . . .
2. Nearest cross street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Size of lot . . . . . . . .
3. Owner's name . . ." L21 c k-_
. . . .h`�t.�t.d.11. .?C . . Address . . . . �g. . . . .1. . . . . . . .Lf
4. Architect's name. . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . 2 g. . . .Ht c ka2y 0(e, N� }tv!�%
n . . . . . . . . . . . . . . . . . .
5. Builder's name . . . . .�I�ff.!i p . . . . .1.N N. . . . . . . . . . . Address . . x.�. . . . .". dt2�. . p . N(H r u L�
f
Mass.Construction Supervisor's License No. . . . -`'�. � .�". . . . . . . . . . Expiration Date . . . . .. ./. /• /. . . . . .
6. Use of Building:One-family . . . . . . . �. . . . . . . . . Two-family . . . . . . . . . . . . . . . . . . . . Other . . . .. . . . . . . . .
7. Number of rooms in each family unit: . . . . . . . . . . . . . . . . . . . . . . . Number of Bathrooms . . . . . . . . . . . . . . . . . . . . . . .
8. Is there a garage attached? . . . .YE_-.5' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Z �. . . . . . . .. . . . . . . Square footage . . . . c`I Q . r
9. Size of building . . . . . . . . . . . .�: . .�.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Number of stories . . . . . . . N
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Distance from finished grade to high point of roof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Type of construction . . . .. . . .W.Q g.�. . . . . . . . .. . .
. .s •�
__ . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Distance from building to street line in feet . . . .
14. Distance from building to side lot lines in feet:Left . . . . 12c, . . . . . . . . . . . . . . . Right . . . . . .JrO . . . . . . . . . . . . . .
15. Distance from building to rear lot line in feet . . . . . . .C G . . . . . . . .. . . . . .
16. Is a plot plan being filed with this application? . . . . . . . . .. . . . . . . . . .
17. Species of framing lumber:DF . . . . . . . . . . . . . . . . . . . . Spruce . . . . . . .K. . . . . . . .. Other . . . . . . . . . . . . . . . . . . . .
18. Are all structural conditions noted on drawings? . . . . . . . S. . . . . . . . . . . .
19. Nature of land upon which the structure will be erected:Natural ./ ' X . . . . . . • . . • Filled . . . . . . . . . . . .. . . . . . .
20. Depth of basement or cellar floor below finished grade . . . . . .7. . . . . .. . . . . . . . • . • • • . . . . . . • • I� • • • • • • . •
21. Material of foundation walls . . �o`. . ..E!? Cc . �,2��
Thickness in inches . .. . . . . . . . . . . . . . . . .
22. Type of roof:Flat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pitched . . . . . ? . . . . . . . . . . . . . . . . . . . .. . . . . . .
23. Material or roof covering . . . . S�' t?.L /. . . . ...I����. . .. .L -k f.f. . . . . .' .'. 1. . . . .` .. . . . . . . .. . . . . . .
24. Method of heating . . . . . . . . . . . . . . . . . ✓.�� . . . . . . . . . . . . . . . . . . . . . /. . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . .
25. Will the building conform to the Building and Zoning Ordinances? . . . . .. ./. .� 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26. Septic Tank? . . . . . . 7'1.. . . . . . . . . . . . . . . . . . . . . . . . . . . . City Sewer? .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .
27. Construction within 100 ft.of wetlands? . . . . . . . . . . O
. . . . . . . . . . . . . . . . .
28. Construction within 100 year flood plain? . . . . . . ./�/.C. . .
29. Estimated cost:Total$ . . . .9-5 (9)V• 6V. . . . . . . . . . . . . . . . . . . . . . -
No building or structure which is erected or altered,shall be used,in whole or in part,for any purpose until a certificate
of occupancy is issued by the Building Inspector.
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
'k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Signature of Contractor Signature of responsible applicant
WRITTEN DESCRIPTION OF WORK TO BE DONE
. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .