31A-334 BP-2024-0543
17 HARRISON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31 A-334-001 CITY OF NORTHAMPTON
Permit: Demo
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-0543 PERMISSION IS HEREBY GRANTED TO:
Project# DEMO GARAGE 2024 Contractor: License:
Est.Cost: 7500 56922
Const.Class: Exp.Date: 05/02/2025
Use Group: Owner: S. WETSTEIN, RENEE
Lot Size (sq.ft.)
Zoning: Applicant: HERMAN DIETZ
Applicant Address hone: Insurance:
76 GUNN RD (413)626-3169
SOUTHAMPTON, MA 01073
ISSUED ON: 05/08/2024
TO PERFORM THE FOLLOWING WORK:
DEMO GARAGE AND FOUNDATION
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 4/2.
Fees Paid: $30.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
File #BP-2024-0543
APPLICANT/CONTACT PERSON:WETSTEIN, RENEE S. f.��� A G
32 LAUREL ST LONGMEADOW, MA 01 106 fz LlvlS Ti
PROPERTY LOCATION 17 HARRISON AVE
MAP:LOT 31A-334-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $30.00
Type of Construction: DEMO GARAGE AND FOUNDATION
New Construction
Non Structura 1 Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION
PRESENTED:
/pproved Additional permits required(see below) For all projects that need additional reviews ri*s+=��k,0
as checked below,please see the Office of Planning& Susta inability Permit Daee or scan here -
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
7:rz
Signature of Building Official Date �Z /
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.
fi �j' C-
k•Li,;
The Commonwealth of Massachusetts -,
Board of Building Regulations and/Stan.Irds44 ' • FOR
` 1YUNICIPALITY
4).
Massachusetts State Building Cod 780 MR 2°24. ,(JSE
nr.,,
Building Permit Application To Construct, Repa'r-,�genogt +j `• e olish a Revisci( Mar 2011
One-or Two-Family Dwelling • _, - !-12 i niN INspEcr� !
This Section For Official Use Only _-=°j06o j
Building 33Permit Number: a�J,�y S(/ 3 Date Applied:
``4)163 - ems 5-8z zai
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro erty Address: Vsexors Map& Parcel Nu b
/7 HA/wsv� v>E s�
1.1 a Is this an accepted street?yes '( no Map Number Parcel Number
1.3 Zoning Informati : 1.4 ro er imensions: 7 g oe I
v R 8 Kesfd>v?� �a7
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required �Prrovided Required Proved _ Required Prove
/C ' /YVA" /5 ' /VA 2 d ' /C/ /9
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public k Private 0 Zone: — Check eckeFlood Zone?if ye� MunicipaK On site disposal system 0
Ch
SECTION 2: PROPERTYJ OWNERSHIP' /l Owner'of Recor �B �G//1✓ l�/V Alec), cAi, 4U d//d6
�A U,�?�/G7'Z�/1t'.�vct 7T7 q' d
Name(Print) City,Sttaate,/LIP
3A Laa,,e 1S't- '/�3IpdZ• .9, - dewi•1&Jieyt 4 / 7/1•0* l •Cc/M
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
- New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition , Accessory Bldg. 0 Number of Units Other 0 Specify: - /
Brief encryption of Proposed�Work2: Az/Lj oaf__ Q/�./'A47 L. ,i,A4/71 V
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building D c A?d $ 7 coo-- 1. Building Permit Fee: $312,±4ndicate how fee is determined:
Standard City/Town Application Fee
2.Electrical S
0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ —
Suppression) Total All Fees: S 30
Check No.2(R Check Amount: Cash Amount:
6.Total Project Cost: $ 75-00
Paid in Full 0 Outstanding Balance Due:
i
ASBESTOS REMOVAL
All residential, commercial and institutional buildings are subject to Massachusetts Department of
Environmental Protection (MassDEP) asbestos regulations at 310 CMR 7.15. Therefore, owners
and/or operators (e.g. building owners, renovation and demolition contractors, plumbing and heating
contractors, flooring contractors, etc.) need to determine al asbestos containing materials (ACMs),
both friable and non-friable, that are present at the site, and whether or not those materials will be
impacted by the proposed work, prior to conducting any renovation or demolition activity.
Examples of commonly found ACMs include, but are not limited to, heating system insulation, floor
tile and vinyl sheet flooring, mastics, wallboard, joint compound, decorative plasters, window glazing,
asbestos containing siding and roofing materials and fireproofing materials.
Failure to identify and remove all ACMs prior to its being impacted by renovation or demolition
activities, can result in significant penalty exposure, and higher clean-up, decontamination, disposal
and monitoring costs.
A DOS certified asbestos consultant must be contracted to determine if asbestos is present and
whether removal/repair is necessary. If the building is a state owned facility, contact DCAM and DOS.
DOS provides a list of licensed asbestos abatement contractors and consultants. You may wish to
inquire if a contractor has any history of violations. Only DoS licensed and DOS certified asbestos
abatement contractors and consultants may be hired to perform asbestos related work in
Massachusetts.
Received by: /9,4!//,!3 12( A/64"
Print Name Title
(126< '/may
igna re Date
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
/fec/)c,Jk p/ 'Z..- License Number Expiration 4 ate
Name of CSL Holder V
�j List CSL Type(see below)
'14
N . Type Description
d Str ecti
{/ LA
�� 1 1 y^ Q.� 6�3 U Unrestricted(Buildings up to 35,000 cu. ft.)
—Ye) ���]]] ///�ll V VOA— R Restricted 1 R2 Family Dwelling
City/Town,State,Z M Masonry
RC Roofing Covering
WS Window and Siding
(�j / L SF Solid Fuel Burning Appliances
J `3'604'3I C�C�j /AVCAl Q72CGf'�!STc. I1GAec r" I Insulation
elephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State, ZIP Telephone
SECTION 6: 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 0
SECTION 7a: OWNER AU HORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PE IT
I,as Owner of the sub' ct property,hereby authorize Pt/ L D f 6 /
1 L VI/twit/
to act on m eh all matters re t e to work aphorized by this building permit application.
5---/
P . er's ame(trre \ ate
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby a t under the pains and penalties of perjury that all of the information
contained in this a i tion is true cc to to the best of my knowdge and understanding.
‘ DM 40 pit-fzi
6- r-7/a-y
Print er's o uthorized Agent's ame(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics, decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Department of Industrial Accidents
I
k-
::11I Congress Street,Suite 100
:_ Boston, MA 02114-2017
y www.mass.gov/dia
11oilers'Compensation Insurance Affidavit:Buildersr('ontractorsfElectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information _ Please Print Leeihls
Name(Husincss organtzation'lndividual): 194 /40 �/ J- _-_--_
Address: 32 lawei e
City/State/Zip: a /l'1a id w/44-4/10 hone 0: 4/1/3 ' 6,26 'F 3
5-2
Are you an employer!Check appropriate boa:
Type of project(required):
1.0 I ain a employer with employees(full andbr pan-time).* 7. 0 New construction
2 fl 1 am a sole proprietor or partnership and have no cork/eel working for me in 8. Q Remodeling
any capacity.[No workers'camp.insurance required.)
3 am a homeowner doing all work myself.[No workers'comp.insurance requinal_]' 9. Demolition
4.0 I am a homeowner and will be hiring contractors in conduct all wuek on my property. I will 1013 Building addition
erasure that all cortrainors either have markers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors with no employees_
12.0 Plumbing repairs or additions
5.0I am a general contractor and I have hired the cub-contractors listed ut the attached sheet. 130 Roof repairs
'these subcontractors have employees and have workers'comp.insurance.. _
6.0 We are a corporation and ita officers have ezenised their right of exemption per k4Gt_e. 14.0Other
152,§114),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks boa al 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 cheek this box must attached an additional sheet showing the name of the sub-contra tors and state v.hcihcr or not those entities have
employees. If the sub-contractors have employees.they must provide their workers'sump.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: CitylState&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 MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00
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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify unde pains a penalties of perjury that the information provided a ove is true and correct
Signature: Date: C "/A v
ram'7 l3 6 Q'). /c
Phone#: ` .t* ` r.3 Cal
official use only. Do not write in this area.to be completed by city or town official
('it, or Town: Permit/License b
Issuing Authorith (circle one):
1. Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('ontact Person: Phone#:
BUILDING DEPARTMENT
DEMOLITION PERMIT SIGN-OFF SHEET
Date: 3/ /ol y
Address: /7 ! "t/Sd/U A ve Building Use: f 4 pAi L
Owner:D4V ThE / -411. " -Phone: L//3 . 616 • 3p.
Owner's Address: 3.2 LA U✓I / 1 &vy/ tfedch/i, I/11
UTILITY CUT OFF
(Signature of Authorized Representative of Utility Department required)
As required by the Massachusetts State Building Code (780 CMR), a permit to demolish shall not
be issued until a release from the utilities is obtained, stating that their respective service
connections and appurtenant equipment have been removed or sealed and plugged in a safe
manner. / n �/
Eversource (Gas) N/� ,�/ O fig -SG4t'LthZ 716 9' "
Sina ure w Title
National Grid (Electric) / V/A �/ ��� �G "C ��� " - 4//41.9 e
" /� ,/ Signature Title
DPW (Water) IV0 tij4 _�'-l/Y��l/ G�7� 6-4/47
/]l Signature Title DPW (Sewer) i ►' 1- X14) .SC -S1✓%if/k Vb
/ Signature '/ Title
DPW (Storm water) /WA A/O J ]?/✓%11 IJ- cG/v/ 4-/ c.
ignatuuree /� Title
DPW (Tree Warden) /�- /1� - �� 60/4-/ U� Ld r
Signature Tit'le_eti
DPW Director ���if/v "- U�^�'/
Signature Title
f� �,'`I� S cVJ
Historic Comm. Review �C� l��CJ1�lG /�eGf �
Signature Title
Health Department � 74i416 �ZA11 £vh��Jv C m) 00
Signature Title
City of Northampton
*/' Massachusetts
•
W;R { �' DEPARTMENT OF BUILDING INSPECTIONS 9f it
s..
` yr ti.� 212 Main Street • Municipal Building J`... :C"•�
•�y Northampton, MA 01060 rg�74.• ,,0
APPLICATION FOR DEMOLITION PERMIT
Attached are the forms required for a Demolition permit. Please fill out all of the attached forms and
submit them to the Building Department with the appropriate fee. Please make checks out to the City
of Northampton. (Cash not accepted)
Please be advised that disconnect signatures from the following departments must be submitted with
the application:
1. Eversource (Gas division)
2. National Grid (Electric division)
3. Northampton Department of Public Works - Water
4. Northampton Department of Public Works — Sewer
5. Northampton Department of Public Works — Storm water Management
6. Northampton Department of Public Works — Tree Warden
7. Northampton Historical Commission Review (if built prior to 1945)
*Proof of extermination is required to be submitted to the Health Department for all Commercial
demolitions and all abandoned residential properties. (Extermination may be required at the Health
Inspector's discretion if evidence of rodents exists).
Other required documents:
• Massachusetts Construction Supervisors License
• Copy of Workers Comp Affidavit
• Asbestos abatement report
A Demolition Permit will not be issued, and no demolition is to commence until ALL required
documents are submitted to the Building Department.
For further questions or information, please contact this department @ (413) 587-1240
City of Northampton
•
Massachusetts 4,S�5 -
DEPARTMENT OF BUILDING INSPECTIONS o"
x
, *►' 212 Main Strout • Municipal Building %)". Qa
Northampton, Mx 01060
Z4-iJ
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, 3 e (insert full Iegal name), born_(insert
month, day, year),hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. 1 am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns 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 home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualifij for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pal d penalti perjury on this 2N day of / 1(4 y , 20)./
ei
(Sign re)
JI rf•
CITY OF NORTHAMPTON PERMIT DECISION
DATES PROJECT INFORMATION
Submitted 9/27/2023 Owner David Dietz & 32 Laurel Street MA 01106
Name/Address Renee Wetstein Longmeadow
Hearing 10/30/2022 Applicant Name/ Same
Address (if
different)
Applicant Contact
Hearing Closed 10/30/2022 Site Address 17 Harrison Ave Northampton MA 01060
Decision 10/30/2023 Site Assessor Map 31D-101
ID
Zoning District Urban Residential B
Filed with Clerk 12/1/2023 Permit Type Certificate of Appropriateness
Appeal 12/20/2023 Project Description Garage Demolition
Deadline
Any person aggrieved by a determination of the Commission may,within 20 days after the filing of the notice of such
determination with the City Clerk,file a written request with the Commission for a de novo review by a person or persons
of competence and experience in such matters, designated by the Pioneer Valley Planning Commission.
Plan Sheets/Supporting Documents by Map ID:
1. Photos of garage to be demolished
BOARD MEMBER PRESENT FAVOR OPPOSED ABSTAIN/NO COUNT VOTE TALLY
(Favor-Opposed)
Martha Lyon,Chair •
✓ ✓ ❑
Barbara Blumenthal, ✓ ✓ ❑ ❑
Vice Chair
Dylan Gaffney ✓ ✓ ❑ ❑
Vacancy •
❑ ❑ ❑ ❑
Greg Dibrindisi •
❑ ❑ ❑ ❑
Vacancy •
❑ ❑ ❑ ❑
Steven Moga ✓ ✓ ❑ ❑ 4-0
pg. 1
WCITY OF NORTHAMPTON PERMIT DECISION
APPLICABLE CRITERIA/BOARD FINDINGS
ORDINANCE/REGULATION
(' 195 The Commission finds that demolition of the conforms to the performance standards of
l listoric District Design the Ordinance and Historic District Design Guidelines by considering compatibility with
Standards the existing parcel and the District.
I,Sarah LaValley,as agent to the Local Historic District Commission certify that this is an accurate and true decision
made by the Historical Commission and certify that a copy of this and all plans have been filed with the Board and the
City Clerk and that a copy of this decision has been provided to the Owner and Applicant.
pg. 2
CITY of NORTHIAMPTON `
_; ;,;� lit
PUBLIC HEALTH DEPARTMENT y`� �
�r Public Health Director-Me,+ridith O'Leary.RS
Municipal Building 212 Main Street-Northampton.MA 01060
�• ' Phone(4l3)$1 7•1214-Fat(4l3)N17-1221 Publicilealth
hitp.' nu northamptonmagov/24$/Healih Prevost.h�rNs.hmsct.
WITNESS OF EXTERMINATION
Date I j Icy Time
Property Owner: 0-1/;4\ <j-1
Property Address: :j4 Oh t. 6\.e
Exterminator: ' i�QLc.L-AJ - GI)] `1 11
Company: yt,�?Y, t.ryt o.i` „� �' t _
Company Address: l U C.A se
t.Z S . cS•t''�'�,� /cwt.. 4
RodenticideiChemicals Applied (
Reason for Extermination: ?er L b SQ..L <�-y ut'e cov....vjs
Comments: ,rtS LL( w��S�� e.� Cn/l c r'ti` I'&dc_+ %L_,A141,1
CL -Le [ L -
f 4-1vin_yw "-h , Q s, t,._ (.,ruL�,',,.•�
1 hereby certify,under the pains and penalties of p rjury,that Ito the best of my knowledge
and belief, have applied the above noted pesticide$n accordance with M.G.L.Chapter 132E
and any other applicable law or regulation.
eCity Water Li Well ❑Septic System
If applicable OYes 0 No
•
Board
'o/flf HeI h Representative Signa a of Extermin r
*Demolition best practices relating to fugitive dust and debris must be adhered to in accordance
with MGL Chapter 111,Section 122.
•
1
RULES AND REGULATIONS FOR EXTERMINATION FOR
RODENTS IN BUILDINGS TO BE DEMOLISHED
The Board of health has adopted the following Rules and Regulations to be conducted before
demolition of property:
I. A licensed and professional exterminator active in the business must be hired to perform
the extermination of the building(s)to be demolished.
2. The Board of Health must be notified of the date and time of the extermination so that a
Sanitarian can he present for inspecting and witnessing.
3, A fast acting rodent poison must first be used in sufficient quantity and bait stations
to be adequately accessible to the rodents.
48 hours after this baiting,an anti-coagulating type or other effective rodenticide
must be used and allowed to be present for 72 hours before demolition can
begin. This is a total five(5)day treatment.
The poison should be checked by the exterminator at sufficient intervals in order
to replace bait stations which are consumed. Sufficient data must be supplied to
the department on the rodenticide used to satisfy the Board of Health of its
effectiveness,
J• IA.P ,y'7 RA-/-6").(9 7ci_ a',t q uncl
Minuteman Pest Control Co.,Inc Service Inspection Report
90 Conz Street
Suite 102
Northampton,MA 01060 INVOICE #: 375482
413-586-1009 WORK DATE: 05/01/2024
Time In: 5/1/2024 11:29:00 AM
BILL-TO 149326 LOCATION 149326 Time Out: 5/1/2024 11:46:10 AM
Customer Signature
David Dietz David Dietz
17 Harrison Ave 17 Harrison Ave
Northampton,MA 01060-2910 Northampton,MA 01060-2910
Customer Unavailable to Sign
Phone: 413-626-9352 Phone: 413-626-9352 Teehnldan Signature
Becca Gullberg
License#: MA-48471/cat 41
MA-48471/cat 43
Purchase Order Terms Service Description Quantity Amount
None NET 30 rodent demo garage 1.00 250.00
Subtotal 250.00
Tax 0.00
Total Due: 0.00
Payment Date Method Reference Payment Amount Applied Amount
5/1/2024 Visa ************0385 S250.00 $250.00
GENERAL COMMENTS/INSTRUCTIONS
Please process payment method on file upon completion
Installed 4 weightedttanchored rodent stations to exterior perimeter of garage to fulfill demo requirements, per estimate instructions.
CONDITIONS/ OBSERVATIONS Reported Severity Responsibility Reviewed
None Noted.
PRODUCTS APPLICATION SUMMARY
Material Lot# EPA# A.I.%o A.I.Conc. Active Ingredient Finished Qty Undiluted Qty
Final Blox 12455-89 0.0050'., n/a Brodifaccum 32.0000 Each
Areas Applied: Exterior Foundation
Target Pests: Mice,Rats
PEST ACTIVITY #Areas #Devices Pest Totals
None Noted
DEVICE INSPECTION SUMMARY
Printed:05/02/2024 Page: 1/2
Minuteman Pest Control Co., Inc Service Inspection Report
90 Conz Street
Suite 102
Northampton, MA 01060 INVOICE #: 375482
413-586-1009 WORK DATE: 05/01/2024
AREA COMMENTS
None Noted.
DEVICE INSPECTION EXCEPTIONS
None Noted.
INSPECTION DETAIL
None Noted.
PRODUCTS APPLIED
Material A.I.% Finished Qty Application Equipment Application Rate Time
EPA# A.I.Concentration Undiluted Qty Application Method Sq/Cu/L Ft Lot#
Final Blox 0.0050% 32.0000 Each 11:44:40 AM
12455-89 n/a
Target Pests: Mice,Rats
Areas Applied: Exterior Foundation
Weather: 0°,0 MPH
Printed:05/02/2024 Page: 2/2
APPROVAL UNDER THE SUBDIVISION
CONTROL LAW NOT REQUIRED
PLANNING BOARD
NORTHAMPTON, MASSACHUSETTS
///" .1/
ALANA KACZMAREK
OtIa BOOK 12361, PAGE 318
TTA
FEWLxty. BOOKA101686, PAGE 95
s •
$Q/69 MU W N 54'41'47" E---
o / 5.1 T
DATE: J ?lot4}�Z N 54'41'47" E 146.54'—
N 54'49'0 E 71.97'
"PLANNING BOARD ENDORSEMENT UNDER THE ASSESSOR'S MAP 31A. PARCEL 0721
SUBDIVISION CONTROL LAW SHOULD NOT BE we;
o
CONSTRUED AS EITHER AN ENDORSEMENT OR
AN APPROVAL OF ZONING REQUIREMENTS" WI0 m
m.m FA to
�I> mom v r
l / rn
TRAVIS M. JOHNSON 1 I m o /
a; a
1 m m
JENNIFER COOK JOHNSON Z m R
BOOK 12473, PAGE 20 /
Olc�i
o o /222 ELM STREET a;
1LOT1
m
8,899f SQ. FT. 29.9_ , T
PORTION OF BOOK 10805, PAGE 22 /
fn
Zin
I
ASSESSOR'S MAP 31A, PARCEL 072 LOT 2
17,465f SQ. FT.
l ! /t4C I/S4'v A4te-- PORTION OF BOOK 10805, PAGE 22
---S 54'57'14" W 156.92'
— -S 54'57'14" W 78.08'
HARRISON AVENUE
LEGEND
O IRON PIN FOUND -----
• IRON PIN SET \ 4\
• FOUND STONE BOUND
"SUBDIVISION APPROVAL NOT REQUIRED"
PLAN OF LAND IN
NORTHAMPTON, MASSACHUSETTS
PREPARED FOR
`,H.,,,,„ RENEE S. WETSTEIN
I REPORT THAT THIS PLAN HAS BEEN PREPARED IN CONFORMITY (Rho&L SCALE 1"�20' AUGUST 31, 2022
WITH THE 1976 RULES AND REGULATIONS OF THE REGISTERS E HAROLD L. EATON AND ASSOCIATES, INC.
OF DEEDS OF THE COMMONWEALTH OF MASSACHUSETTS. REGISTERED PROFESSIONAL LAND SURVEYORS
`' �ssoas 235 RUSSELL STREET — HADLEY — MASSACHUSETTS
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