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18C-045 (4) A'� i t� C.d fhd 1` <IPta1N M)1 1'tztVIAL! 1NVY".",,0RZ"1' WIA`rAlI X _ ac sfiiv'; 68 Hatfield Street, Northampton,_MA _ _ _ Date: 8/28/2014 Prof(-c,t V: LPAB-'14-62536 LP Audette Builders, 717 Northampton street, Holyoke, 0104.0-audla1950� mail.co -__ p Y �9 � INID- No sb.str>s D.tect�d PC r uir-it C OUnt AS-A!iSUmrd, no Sarff;le C11,-C u,)cidoMe Asbestos UJI-Arnosite Asbestos F- Friable: 14- Hon-mgeneous z 4 3. - blot Appli bl�; NF- Non-r-riable NS-Not Suspect pect X - Sample Location ..................... ........... ...................._..... ..._I.._.... .. ...................................... ......................._....... 1 CONO(d.,6ridi ifsrny: DA- Dafoa lad DE•-Deteriorated D Significant L'J ;mane IN - Intact I- - ExposedlUncovered 0- Other p .... .........,........ ......... ................ ...... e... ..... ....... _...... .__..... ........_........,.........._..........._...... .:�F,lA i= Ponfn zsia ACM, , �aSLetC resilient, t itr co4� �irq, a�t asphalt It roofing productS 1 11 other Nonfri ihla ACM, anc hiding C atr,gof,r I F4CM Friable, I:c;qul rted A�~be tos 1 _,.:,S3Y Bl +97_t �•. `_.._ .. o{�Ir`i"L$�l'�L. llAl LL. rsri�� t rd t5 ir.f Nmi be r 13 I d 1,11T�i011V YI E. LOCATION `!V r GstJ13 + t7�Vihtir i,f 3 , __._....._.W_,v...... _ _ _ _ °' fay ult Notes: H= Similar materials to those identified herein that are located in other rooms are homogeneous,where indicated, and no additional samples were collected in those locations if no sample number is listed. The following inaccessible areas were not inspected or sampled: Wall and floor utility chases (unknown to exist); Pipe Tunnels(unknown to exist);Air plenums above permanent plaster or metal ceilings; Below-ground or below-grade (buried areas, parking lot, slab damproofing, etc.); r All asbestos-containing material(both friable and non-friable) must be removed from a facility or facility component prior to demolition/renovation operations that will disturb Fthese materials. N/S or NS= Not Suspect as containing asbestos per judgement of Inspector. It is recommended, but not required, that samples of negative resilient flooring& mastics be further analyzed by I I destroying the interfering matrix materials and isolating any asbestos fibers that may be present and analyzed by Transmission Electron Microscopy(TEM). r I Refer to the attached Asbestos Laboratory Report from the independent analytical laboratory. !INSPECTOR: Stephen IN Niec MADLS Lic. No. A1072373 Management Planner: Lic. No.: AP073456 I t . � ___.._.____.b.-_-. w._E.S. -.-..W-___--__-E—R —.-5-..-._. _..-.__.._ �__.7_.____.e,M -- _-:.__. _+ 1 .N. _.._ _,. Lollected by:FORBES�WHEELER s 650 Dwight Street,#1337 ♦ Holyoke,MA 01041 Analysis by:CEI Labs 07 New Edition Court� Cary NC X7511 IT.413-22'1-8233 ♦ F:866-423-6355 NVLAP Code: 101763-0 ♦ MADLS Lic # AA0001681 Page 3 of 3 Forbes &i Wheeler tyL.S`I't�S-a �' 99i�IIf�E MATERIALS INVENTORY MATRIX �r�gi y.a 68 Hatfield Street Northampton, MA� _w Date: 8/28/2014 Project 1k. LPAB-14-62536 cli'nt W LP Audette Builders, 717 Northampton Street, Holyoke, MA 01040-audla1950 @gmail.com CH - Chi vsotila Asbosto:� � ND- No A sl)estos D=`tected..._._._..__4_�.PC Point Count._.�.._.._.._...._...r__.____..._... AS--Assumed, no sarnp)e __._._.y._. __._....___.._..._...._....:� Cf` _Croddc,lita Asbesloss APO -A+nosita Asbestos f'-Friable m1- Homogeneous .................... N ,w iVc r^•.+»l+,�blc� lvi - !for+-F'r+41l�l� U13-Not suspact ��- ;»rmple Location C t}ND G onal.re1ii : ..............................DA- Darnaged DF-- !Deteriorated SD- significant Damage IN- Intact L- Ex osed!Uncovered O- Other l t D .................. ......-.. .._........._................_............_............ ........................... ...........................! + t e rare,€4uis6 I= Plonailabl AUVI, p..,a lEings, gasket= rzsilient, 'loor covering, and asphaft roofing {product:, + ..._-_... _. __.... .... e.. ii All Olhar N nfn ihle.ACM, • xcILMUTAY t atC gin s l NACIM Friable Pegul ed A h no $ mtaa)M IY.{ r"$ i IA y_} ay y _Ii _e( I...� iY,.i'titQ9�1P1 r ) V 1 LI�F �'�6i.�1� y1 EVIA I G'+l) __,.._..�,.-_.._..-.__• lsa s i.l (l eil ..i vBJf jj 1`I l obi QrY t,+IND t srE. 9 r 01111jli.lt i!T 3 � i r1l lilt.. 13A Plaster ceiling - �Kitchen ceiling NA g NA NA_ ND _ _ I NAs NA 1�B Plaster ceiling Kitchen wall _ X j g LL_n. 2F Stairwell landing to.. _� X NA i H 13 Plaster ceiling/walls �__.__.�_.__.,.�._�.IVA Plaster ceiling H 13 Plaster residue/debris _ 2nd Floor throu.hout € NA NA H ND .,.-..__14. .._ �Floor+ng Paper,Fblack,_on wood + - �J NA _ z , NA NA H / ND _ II W Kitchen _x__ R _NA NA NA NDa _ ! )Flooring Paper, black, on wood Dininc� Room � _��w �� NA NA NA H / ND 159" Gray Floor Tiles/Black Mastic Kitchen X s3 SF DF I CH 3% Mastic NEG. 16 Tan Linoleum remnant Layer 1 Kitchen X NA NA NA ND under #18 i 17 y I Wail Panel Adhesive, brown Kitchen X NA I NA �NA ND 18 NA Red Linoleum Remnant Kitchen X - - A _ _ N'4 9 .� wNA ND 19 12: Floor Tiles, self stick D+n+ng�Room �� _NA ND 20 Floor Leveling Compound, white Dining Room X NA �NA NA ND �� F _..__. _ 21 9'" Red Floor Tiles/Black mastic 2nd Floor X_ 60 SF DF_ I CH 3% Mastic NEG. 22 9" Red Floor Tiles/Black mastic 2nd Floor �f X 0 60 SF� DE_w I CH 2% Mastic NEG., under carpet Z3 Linoleum, white _ _ 2nd Floor I X ��NA NA NA ND ti __P.____.s_ Attic Insulation (cellulose mix) 2nd Floor in wall cavities � X � ` - � �� _..�_�x�NA NA NA ND 2 5 Roof Shin .�.` ..,_.__ --.-._- Garage, exterior rear �__X_�. _NA _ NA __NA� ND 2 Rooming Felt underlayment behind 6 -.-. _._� _. _6 #25 _ Garage, exterior rear v� X� NA i NA NA ND IWindow Glazing, white, thick, inner Garage, inner side metal X NA NA NA mN� NDu� 27 side __..w __ windows 28 Sheetrocic ceilin 4..... _Q -` � `� `��'�i-'°��"��`'�"`� _ _ Garage ceilin �_4 X NA NA NA ND W- w_ NS Cement Chimney Patch Basement Page 2 of 3 Forbes Wheeler ASBESTOS-CONTAINING dtIM51-RIALS INVM`fORY N1A"fRIX cilrty 68 Hatfield Street, Northampton, MA _ _ __ _ —Bate 8/28/2014 I'r<�;cct a : LPAB�14 62536 _tl .� f,IiE.r�.t LP Audette Builders, 717 Northampton Street, Holyoke, MA 01040-audla1950 @gmail.com Ct! - Chrys,?tile Asbestos ND- No A_,bestos Detected PC Point Count AS-Assumed, no sample p Cr( f l:olltc Asbestos AJI-AYl,ltt Asbestos F- Friable 14- Horno\�eneous NA- Not A.iaplic�ible NF- Non-Friable NS-!'Jot.3Y.ispect X- Gariple Location tiF.�'\�✓. .. .......................:.................... ...,................................._......................................y_.,......_................._...__,.._.. CONE)(Condition).- DA- D rrnaged DE- Deteriorated `D `7i(Inificant Damage IN- Intact t - ExposedlUncovered 0- tDthar .................................. ..........................._...................._..._............... ..............,.................,......................,_.._........_ ........... tl EPA I - Nonfr iable ACNI, p:ackings, gaskets, resilient, floor coverincj, and asphalt roofing products 11= e.11 other Norift iable ACM, F,xcluding Category I r ACM Friable, Regulated Aszbestos sill$TE4 !"iL. -_�__�..._..___ �,iV11�ty�_ ErjA__ �-ab � IS 1 I LOCATION '�`fV �;t�ND p� 1 C0 il�h�.NNd ; �M,`, cat. R sul `.' IfY i�9rs�tier I l�t"4�C��.1!'J`IDNIT�1 . I r 01 Cement Siding Shingles Exterior X 13,440 SF IN II CH 15% 02A Window Caulk, storm to bottom Exterior, right side, outer bead X NA NA NA ND frame-outer 02B Window Caulk, storm to bottom o Exterior, inner bead X 192 LF DE � II �CH 3/o _ 12 ea 3x5 windows frame-inner �_ 03 Window Caulk, wood to brick Basement windows X24 LF �DE II iCH 3% ea 1x3 windows _ 04 Window Glaze, white, behind silicone Bsmnt window, outer/ext. window X �NA NA NA �ND 05 (Window Glaze, white, behind silicone Bsmnt window, inner window X NA NA NA ND 06 Asphalt Siding Shingles g. 6 WaferboardhYnd A/C & - XNA NA NA -ND 07 Siding paper, Tan �._._ 6Ext., behind wood clapboardsY X yv NA NA NA ND 08A �Roofinc7 Shingle/Adhesive Strip Exterior front porch @_ _ X m NA NA NA ND 088 Roofing Shingle/Adhesive Strip Exterior rear entry X NA NA NAp ND 09A Felt Paper underlayment under #08 Exterior front porch X NA NA NA ND 09B Felt Paper underla ment under #08 Exterior rear entry X NA NA NA ND 4v `Yy104_ Fiberglass batting Insulation paper, J Basement walls W X NA W NA NA ND M ......_ __ - - _ ._� _ _ _ _..____ ___.� __- -_�. ___. _ _ � _ ��__�_ _ _� ____ � _ _ _....__.. -..._ 11A Joint Compound w/sheetrock ceiling Basement X NA NA NA ND #12 _._,�s_.._._.._ - �_..._.._._.__.___ _ __ 118 Joint Compound w/sheetrock ceiling Kitchen ceilin X _ NA _ NA _ NA �ND�� 12A Sheetrock ceiling _ Basement _ NA NA NA ND 12B Sheetrocl< ceiling � �� Kitchen ceiling X �NA �NA� NA ND Page 1 of 3 Forbes Wheeler #68 Hatfield Street- audla1950 cr gznail.com- Gmail Yage 1 of L IA ore co:r,PGSe #68 Hatfield Street Inbo, -- - John Hall<jhaf @northamptonma.gov> Stared to me Important Larry,When you take the building down at this address and plug the house service,call 587-1570 ext.4330 and tell the secretary that you are ready to h: go there and inspect the cap.I will then E-Mail the Building Commissioner telling him that I have inspected the cap,and how it was capped,the date and Sent Mail John Hall Drafts(2) (City of Northampton E–mail is a public record except when i-- falls under one of the specific statutory anemptior 14 Junes Way 2014 Cutaway(2) Chase/Bank Amer._ Clicc here io R_enly or Fo-ard Fink&Perras(1) Fleury Lumber Invs. Florence Savings B._ 0.45 GB(2%)of 15 GB used ©2014 Google-Terms S Pnvacv Manage Hatfield ST(1) Hatfield St Invoic... Ins.Certificates KLM 5500 Lot 9 Old Harvest Lot 9Invoices(1) Lot 12 Old Harvest LPA CORP.(2) Misi.(7) Motor cycle New England Sucu... Orchard St Orchard St Invoic... River View Bus.(1) Riverview Rent Re... RK Miles Scuderi Travel f f 1-ittps://mail.google.com/mall/u/0/?tab=wm 12/12/2014 AS\\='; INSULATION & CONTRACTING; INC. ST-,T_ STREET BUILDIN IG #110 , P.O. BOX 376 33 5-nn LUDLOW, MA 01056 FAX (4 13) 583-5555 MASSACHUSETTS CERTEFI=D VVEE Octcber 21. 2014 Nlir. Larry Audette E-Mail- audla1950.gmail.com Dear Mr. Audette: `Ale are pleased to submit our proposal for the asbestos abatement project at 68 Hatfield Street, Northampton; MA. Pease note the following Terms and Conditions. PRICE . . . . . $ 7,500.00 THE CONTRACTOR AGREES TO THE FOLLOWING: 1. To remove approximately 216 linear feet of window caulking from fifteen 15j windows. 2. To remove approximately 68 square feet of VAT in whole using the heat gun process. 3. To remove approximately 2,240 square feet of exterior siding. 4. To remove the storm windows from the windows and leave them inside the building. 5. To pre-clean the work area prior to commencement of abatement activity. 6. To furnish all barricades, scaffolding, aerial lifts, and safety equipment necessary for the safe completion of the pro iect. 7. To undertake asbestos abatement operations in compliance with Federal, State and local regulations. 8. To file all required notifications with appropriate regulatory agencies. 9. To dispose of all asbestos waste at an approved landfill. 10.Forward copies to you of regulatory notifications and waste manifests. 11.To commence work during normal business hours, Monday-Friday. 12.To supply water as needed. Y 1 THE OWNER AGREES TO THE FOLLOWING: 1 . To supply electrical receptacles in all work areas. December 15,2014 Louis Hasbrouck, Building Inspector Municipal Office Annex 212 Main Street Northampton,Ma 01060 Dear Mr. Hasbrouck: The water service at 468 Hatfield Street has been disconnected from the city water supply and the water meter has been removed from the premises as of December 15, 2014. Please contact me if you have any questions. Sincer R. Nuttelman g Nu e uperinten4denttoftater Cc: Ned Huntley, Director of Public Works Jim Laurila, City Engineer DEMO LTR- 68 HATFIELD ST.,NORTHAMPTON, MA 01060 - aud1a1950 @gmail.e... Page 1 of 1 Mom corr,aosE DEMO LTR-68 HATFIELD ST.,NORTHAMPTON,MA 01060 - Estrella,AnnMarie<AnnMarie.Estrella @nationelgrid.com> Starred to me Important Sent Mail Drafts(3) 40 Sylvan Rd 14 Junes Way Waltham MA 02451 2014 Cutaway(2) December 22,2014 Chase/Bank Amer... Mr.Larry Audette Fink&Perras(1) LP Audette Builders Fleury Lumber invs. 717 Northampton St. Holyoke,MA 01040 Florence Savings B-- Hatfield ST(1) EMAIL. Hatfield St Invoic... RE: Service Removal for Building Demolition Ins.Certificates Dear Mr.Audette: KLM 5500 Lot 9 Old Harvest This letter is to confirm,per your request,National Grid has removed electrical service and meter as of December 22,2014 from 68 H: you have any questions or need further assistance,please feel free to contact me at __- Lot 9lnvoices(1) Lot 12 Old Harvest Sincerely, LPA CORP.(2) Mist.(7) AnnXarie r£strelTa Motor cycle New England Sucu_. Customer Fulfillment Orchard St FAX: PH: Orchard St invoic... zn•m_ ill- , i _ River View Bus.(1) Riverview Rent Re... Ref.WR418556579 RK Miles Scuderi Travel This a-mail,and any attachments are strictly confidential and intended for the addressee(s)only.The content may also contain legal,professional or othe r " 1-i@s://mail.google.comhnaiUu/0/?tab=wm 12/22/2014 A NiSource Company 995 Belmont Street Brockton, MA 02301 Date: March 23, 2015 To Whom It May Concern: The address listed below has had the gas service(s) disconnected and is now ready for demolition. ADDRESS : 68 Hatfield St TOWN : Northampton STATE : Massachusetts Sincerely, Maintenance Administrator Integration Center Columbia Gas Of Massachusetts 508-580-0100 Ext 1293 0 ipir ler vjELD FOR UNE, 1.51' FROM CORN -1 43'4Y 70,69' Gi 'ii } fiiii6l nZ 48092 sq. Fnot pl, HELD FOR UNC' FROM CORNER DOWN IPF 1, A PU8Uc way K rNNEI-Di N/F C, LS8Ei%U IISEII 7350332 PARCEL I 7 PLAN '070 18c-047 as"I r. N/F KEUNCTI I C. Lrj3r111 IN STY I CONCH GARAGE cbk,� OR hp ,AojOR C.RU OWSKI DEED 60MO2 yillir. ,u PLAN 32-2B oritiNF. FROM CORNER Gi 'ii } fiiii6l nZ 48092 sq. Fnot pl, HELD FOR UNC' FROM CORNER DOWN IPF 1, A PU8Uc way K rNNEI-Di N/F C, LS8Ei%U IISEII 7350332 PARCEL I 7 PLAN '070 18c-047 as"I r. N/F KEUNCTI I C. Lrj3r111 IN STY I CONCH GARAGE cbk,� OR hp City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: The debris will be transported by: � ct � ` The debris will be received by: f �� - .� e�l Building permit number: Name of Permit Applicant „ F Date Signature of Permit Applicant City of Northampton Massachusetts i. of DEPARTMENT OF BUILDING INSPECTIONS ✓? x,' CC` r 1 212 Main Street • Municipal Building b' Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 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 any 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 owner/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 The Commonwealth of Massachusetts Department of Industrial Accidents ` , t Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLibly Name (Business/Organization/Individual): d Addre'ss: 7r h%F t' Fi3r►s:r"%f� City/State/Zip: r %«�, i�r?, Phone#: //.,4 -�j 7-3 `'i Are you an employer? Check the appropriate box: Type of project (required): 1.❑ I am a employer with 4. I am a general contractor and I 6. F-1 New construction employees (full and/or part-time).* have hired the sub-contractors 2.F_] I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. , Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ 5. We are:a corporation and its 10.E] Electrical repairs or additions required.] 3.❑ 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 12.0 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. tHo meowners 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: 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 paz nd penalties of perjury that the information provided above is true and correct. Date: Signature. 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): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor: Not Applicable E Name of License Holder: License Number 3 7 7 t I Address Expiration Date .3 4�— ...------------ 9. Registered Home �6�; ment�Contiraicibr,".::-�'� Not Applicable E Company Name Registration Number 71 Address Expiration Date ".6" 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 of the building permit. Signed Affidavit Attached Yes....... F-- No...... E i,-,- :Ome...ownen: xem-p ion. 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 buildine 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,— SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors C] Accessory Bldg. ❑ Demolition New Signs [❑] Decks [C] Siding [❑] Other[❑] Brief Description of Proposed , Work: '/': f , /� °7t'— �i)�' r � 1�'� f✓ h�% i fit, %3�.s i f�,�?, "E2c:r 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 adtlition to existing.housing, complete th6 foi 'o"1nC 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. 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 as Owner of the subject property hereby authorize to act on my behalf, in all tters relative-to rk authorized by this building permit application. Signature of Owner Date , as Owner/Authorized . v, i !'s: � /. ./P �: .c Agenf hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed underthe pains and penalties of perjury. Print Name, r 'Signature of Owner/Agent Date ' Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning T�is column to be filled in by Building Department � Lot Size Frontage Rear L Building Height L Bldg.Square Footage % Open Space Footage % (Lot area minus bIdg&paved #of Parking Spaces t (volume&Location) -W A. Hasa Special Permit/Variance/Finding ever been issuedior/on the site? NO 0 DONTKNO� YES 0 !F YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? _� /-� �| NO t uu� xnKNOW ,cS IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water orwetlands? NO 0 DONTKNOY/ 0 YES 0 IF YES, has permit been or need to be obtained from the Conservation Commission? Needs to beobtained x-� Obtained �� ' Date Issued:�� C. Do any signsexist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or addition for the property YES �`� NO /�� IF YES, describe size' type and location: E Will the construction activity disturb(clearing, gradingexcavation,orfiUinQ)over 1 acre orioit part ofa common plan ' that will disturb over 1acre? YES NO KD IF YES,then a Northampton Storm Water Management Permit from the DPW is required. �L Department use only k F -City of Northampton Status,ofPermrt 5� r; '(Building Department Curb Cut/Drryeluay Permlt - , 212 Main Street Sew er/Se ptrcAvarfabrlrty { �.. w Room 100IVater/Vsfelkf�va3labdrty w Northampton, MA 01060 Twa Sefs of5trictu`rai Plans 6bone 413-587-1240 Fax 413-587-1272 yPlot/Srte Plans r ' 2. APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE O DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This secfio to be completed by office 1.1 Property Address: _P Zo ne Overlay District _EIin.St District CB Distract SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: a,f Name(Print) Current Mailing Address i Telephone 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 ermit applicant 1. Building .(a) Building Permit Fee 2. Electrical (b)Estimated Total'Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection be Num Check r < :` `' •~P 6. Total=(1 +2+3+4+5) Ch _ This Section For Official'Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/fnspector'of Buildings Date File 9 BP-2015-0882 -t APPLICANT/CONTACT PERSON L P AUDETTE BUILDERS INC ADDRESS/PHONE 171 LINCOLN ST HOLYOKE01040(413)539-9115 PROPERTY LOCATION 68 HATFIELD ST MAP 18C PARCEL 045 001 ZONE URB(100)/ 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: DEMOLISH SFH&GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 021237 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved 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 t Signature of Building Official Date L J 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.