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a native perennial grass mixture. Any stabilization materials such as jute netting shall be
firmly anchored to prevent them from being washed from slopes by rain or flooding.
Preference should be given to biodegradable materials.
10. All disturbed areas shall be graded, loamed and seeded, or stabilized with erosion control
blankets or netting, and a covering of straw mulch prior to November 30, of each year. No
disturbed areas or stockpiled materials will be left unprotected or without erosion control
after this date.
11. No disposal of soils or other materials shall be allowed within: a 100 -year floodplain; 40
feet of the 100 -year floodplain elevation; any wetland; or any area within 100 -feet of a
wetland, unless such areas are specifically approved by the Commission, in accordance
with 310 CMR 10.00, and City of Northampton Ordinances - Chapter 337.
SAR
A� Lac- ` 5 '61- IZ 3
"ATTACHMENT A"
1. Prior to the initiation of any work, the applicant /owner shall submit a letter of
understanding to the Commission stating that he /she has received, read, understands and
shall comply with these conditions. The applicant, and, his or her contractor, foreman
and/or construction manager shall sign the letter of understanding.
2. Prior to the initiation of any work, the applicant shall install silt fence, straw bales, or other
erosion control acceptable to the Commission along the treeline from the edge of the
roadway to the rear of the house.
3. Prior to the start of any site work, excavation or construction, a pre - construction conference
shall be held on the site, between the contractor conducting the work, the site /project
engineer, the applicant, and a member or agent of the Conservation Commission, in order
to ensure that the requirements of this Determination are understood by all parties. Prior to
the pre - construction meeting, all erosion control devices must be installed.
4. All required permits must be obtained from applicable federal, state and local agencies and
departments prior to the start of any project.
5. A copy of these conditions and associated plans shall remain on site during all construction
and /or building activities. The project manager and all equipment operators shall be
familiar with the approved plans, and shall be informed of their location on the site. This
location shall be accessible to all contractors whenever work is occurring on site.
6. All revised plans shall be approved by the Conservation Commission and incorporated into
the permit by reference and shall be followed during the course of construction.
7. The areas of construction shall remain in a stable condition at the close of each construction
day. Erosion control measures shall be inspected at this time, and maintained or reinforced
as necessary. All such devices shall be inspected, cleaned or replaced during construction
and shall remain in place until such time as stabilization of all areas that may impact
resource areas is permanent. These devices shall also be inspected to assure that the
maximum control has been provided. Any entrapped silt shall be removed to an area
outside the buffer zone and resource areas, and maintained or reinforced as necessary.
Erosion controls shall be inspected after every rainfall to assure that maximum control has
been provided.
8. An adequate stockpile of erosion control materials shall be on site at all times for
emergency or routine replacement and shall include materials to repair or replace silt
fences, straw bales, erosion control blankets, riprap, filter berms or other devices planned
for use during construction.
9. Soils exposed for periods greater than two months shall be stabilized with erosion control
blankets and netting, a covering of straw mulch, or a temporary cover of rye or other grass
to prevent erosion and sedimentation. Drainage ditches shall be stabilized and seeded with
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
IIVPi4 Fo 2 — D etermination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, 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 appropriate Department of Environmental
Protection Regional Office (see http: / /www. mass. qov /dep /about/region.findvour.htm) to issue a
Superseding Determination of Applicability. The request must be made by certified mail or hand delivery
to the Department, with the appropriate filing fee and Fee Transmittal Form (see Request for
Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7) within ten business 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 to the applicant if he /she is not the
appellant. The request shall state clearly and concisely the objections to the Determination which is being
appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the
Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has
no appellate jurisdiction.
wpaform2.doc • Determination of Applicability • rev. 10/6/04 Page 5 of 5
Lik Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
(0 5. The area described in the Request is subject to protection under the Act. Since the work
described therein meets the requirements for the following exemption, as specified in the Act and
the regulations, no Notice of Intent is required:
3(0 C A T [D•oa ( )
Exempt Activity (site applicable statuatory/regulatory provisions)
❑ 6. The area and /or work described in the Request is not subject to review and approval by:
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
Name Ordinance or Bylaw Citation
C. Authorization
This Determination is issued to the applicant and delivered as follows:
❑ by hand delivery on a by certified mail, return receipt requested on
Idyl) b i .:=DI f
This Determination is valid for three years from the date of issuance (except Determinations for
Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not
relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances,
bylaws, or regulations.
This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to
the appropriate DEP Regional Office (see http: / /www. mass. gov /dep /about/region.findyour.htm) and the
property owner (if different from the applicant).
Sig nat res: , i
O.► - `
. it
i
? i -
A li si a s a bi t
D at
wpaform2.doc • Determination of Applicability • rev. 10/6/04 Page 4 of 5
iiiii,
„......i Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 6. The following area and /or work, if any, is subject to a municipal ordinance or bylaw but not
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s)
and document(s), which includes all or part of the work described in the Request, the applicant
must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more
information about the scope of alternatives requirements):
❑ Alternatives limited to the lot on which the project is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.
❑ Alternatives limited to the original parcel on which the project is located, the subdivided
parcels, any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the
Department is requested to issue a Superseding Determination of Applicability, work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request is post- marked for certified mail or hand delivered to the Department. Work may then proceed
at the owner's risk only upon notice to the Department and to the Conservation Commission.
Requirements for requests for Superseding Determinations are listed at the end of this document.
❑ 1. The area described in the Request is not an area subject to protection under the Act or the
Buffer Zone.
® 2. The work described in the Request is within an area subject to protection under the Act, but will
not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a
Notice of Intent, Stl3ec.+ -fo Cev d h6As i h ktetC ,+ A-•
❑ 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but
will not alter an Area subject to protection under the Act. Therefore, said work does not require
the filing of a Notice of Intent, subject to the following conditions (if any).
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent,
unless and until said work alters an Area subject to protection under the Act.
wpaform2.doc • Determination of Applicability • rev. 10/6/04 Page 3 of 5
L 1
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Fo 2 — D etermination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
The following Determination(s) is /are applicable to the proposed site and /or project relative to the Wetlands
Protection Act and regulations:
Positive Determination
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) or Order of
Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received
from the issuing authority (i.e., Conservation Commission or the Department of Environmental Protection).
❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act.
Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent.
❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are
confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are
binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding
such boundaries for as long as this Determination is valid.
❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination,
regardless of whether such boundaries are contained on the plans attached to this Determination or
to the Request for Determination.
❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to
protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work
requires the filing of a Notice of Intent.
❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will
alter an Area subject to protection under the Act. Therefore, said work requires the filing of a
Notice of Intent or ANRAD Simplified Review (if work is limited to the Buffer Zone).
❑ 5. The area and /or work described on referenced plan(s) and document(s) is subject to review
and approval by:
Name of Municipality
Pursuant to the following municipal wetland ordinance or bylaw:
Name Ordinance or Bylaw Citation
wpaform2.doc • Determination of Applicability • rev. 10/6/04 Page 2 of 5
L 1 Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important:
When filling out From:
forms on the Northampton
computer, use Conservation Commission
only the tab
key to move To: Applicant Property Owner (if different from applicant):
your cursor -
do not use the Roger D. Benoit
return key. Name Name
942 Park Hill Road
14_4 __: Mailing Address Mailing Address
Florence MA 01062
City/Town State Zip Code City/Town State Zip Code
I� �I 1. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents:
Diagram of 942 Park Hill Road Property July 22, 2011
Title Date
Title Date
Title Date
2. Date Request Filed:
July 22, 2011
B. Determination
Pursuant to the authority of M.G.L. c. 131, § 40, the Conservation Commission considered your
Request for Determination of Applicability, with its supporting documentation, and made the following
Determination.
Project Description (if applicable):
Construction of a 25 x 18 foot storage shed within the riverfront area to Hannum Brook, on an area of
existing lawn. Project includes 6" crush stone base and shed installation.
Project Location:
942 Park Hill Road Northampton
Street Address City/Town
49 19
Assessors Map /Plat Number Parcel /Lot Number
wpaform2.doc • Determination of Applicability • rev. 10/6/04 Page 1 of 5
/'` ` I , �, � - PL ANNING AND DEVELOPMENT • CITY OF NORTHAMPTON
to l4 H planning • conservation • zoning • northampton GIS • historic • community preservation • central business architecture
Q : i;i• Sarah I. LaValley, Conservation, Preservation, & Land Use Planner • slavalley@NorthamptonMA.gov • 413 - 587 -1263
^-ice
September 8, 2011
Roger D. Benoit
942 Park Hill Road
Florence MA, 01062
RE: Determination of Applicability, 942 Park Hill Road
Dear Mr. Benoit:
Enclosed please find the original signed version of the above - referenced document for your files. This
Determination is the permit from the Conservation Commission to construct a shed on your property as
proposed. It is valid for three years.
A copy has been provided to the Department of Environmental Protection as required. Please read the
conditions carefully, they contain provisions that
Please feel free to contact me with any questions or concerns.
Thank you,
i
& ) f ( i 1 , if
Sarah LaValley
Conservation, Preservation and Land Use Planner
City Hall • 210 Main Street, Room 11 • Northampton, MA 01060 • www.NorthamptonMa.gov • Fax 413 - 587 -1264
original printed on recycled paper
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. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
This column reserved
for use by the Building
Department
EXISTING PROPOSED REQTRREA Y
Lot Size
Frontage
Setbacks Front
Side L: R: L: 124110 L R:
Rear
Building Height
Building Square Footage
% Open Space: (lot area
minus building & paved
parking
# of Parking Spaces
# of Loading Docks
Fill:
(volume & location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: 6<0 1 Applicant's Signature( .. e '
4
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning
requirements and obtain all required permits from the Board of Health, Conservation Commission,
Historic and Architectural Boards, Department of Public Works and other applicable permit granting
authorities.
W:\Documents\FORMSI original \Building- tnspector\Zoning- Permit - Application- passive.doc 8/4/2004
ttt,L+CIVCLJ
'jM22 2 U11
File No.
a.
• ,.a m r .......;� "� r ate. n 3 x, Offtc*
Please type or print all information and return this form to the Building
Inspector's Office with the $15 filing fee (check or money order) payable to the
City ofNorthampton
1. Name of Applicant: i9GG�9& L) 8ZrAirn /7
Address: 99 i',0 k /Pa. Telephone: gi..? ;,73
2. Owner of Property:
Address: Telephone:
3. Status of Applicant:
Owne r V Contract Purchaser Lessee Other (explain)
4. Job Location:
r1 t� t '�3�: t .s+,+, ' s"� .:.. E+y P 'y y �r�a .r.�. ' �5 -' �- ws a'�zr�iS 5 ( �, '%
L�a r �. �.x,
? 14t: Iil +6,+4 4 . � � tr4
5. Existing Use of Structure /Property:
6. Description of Proposed Use /Work/Project/Occupation: (Use additional sheets if necessary):
�} C /0 Po r2 T / ` T 6€ u 1 /G /7 7 ��
7. Attached Plans: Sketch Plan Site Plan 1.-- Plans
8. Has a Special Permit /Variance /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 DONT KNOW YES
IF YES: enter Book Page and /or Document #
9.Does the site contain a brook, body of water or wetlands? NO DONT 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)
W:\ Documents\ FORMS\ original\Building - Inspector\ Zoning - Permit - Application- passive.doc 8/4/2004
File # MP- 2011 -0102 5A 1-{ A CLE 'f
APPLICANT /CONTACT PERSON BENOIT ROGER D & ROSALIE D C 8 3 °° Z. G
ADDRESS/PHONE 942 PARK HILL RD (413) 586 -4019 0
PROPERTY LOCATION 942 PARK HILL RD { g 1µ
MAP 49 PARCEL 019 001 ZONE SR(100) //WP/WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING F FILLED OUT i
Fee Paid •
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - 21 X 19 CAR[PRT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRE SSENTED:
Approved V Additional permits required (see below) A(S° S �� � 'KS) ; 411C;A:w1 5 PLANNING BOARD PERMIT REQUIRED UNDER : § (< �) �U Ll 1J c'�
(5 A K, 1_oA b )
Intermediate Project : Site Plan AND /OR Special Permit with Site Plan '(L l uJ
Major Project: Site Plan AND /OR Special Permit with Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: § A LSD CHAT
Finding Special Peiuut Variance* C ( ll`t h'
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
‘72.3111
Signature of Building fficial
Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of
Planning & Development for more information.
File # MP- 2011 -0102
APPLICANT /CONTACT PERSON BENOIT ROGER D & ROSALIE D
ADDRESS/PHONE 942 PARK HILL RD (413) 586 -4019 0
PROPERTY LOCATION 942 PARK HILL RD
MAP 49 PARCEL 019 001 ZONE SR(100) //WP/WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING F • ' FILLED OUT N2) t
ee ' aid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - 21 X 19 CARPORT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER : §
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
1 Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of
Planning & Development for more information.
-.�
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CarSense Automotive �� � �
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Your Automotive Answer
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Available Upon Request ‘ 20 Year warranty. -
6 FI.Legs
DOUBLE CARPORT
x
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REGULAR SINGLE BOW "SB" BUILDING SECTION A-FRAME SINGLE BOW "5B" BUILDING SECTION , DRAWING NOT 12T HRU30
__.
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(SCALE NTS) (SCALE. NTS) DATE: 2/15/2011
1 , :
,,,-- PEAK BRACE 2 1/2' SO. TUT PROJECT NUMDER
BE -PEAK BRACE
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1, 2.41.6 UP TO , O-0' TALL I i 1 2 i /2'X I BGA. CHANNEL -----"'
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,,,,______--_____ ._______ (22' THRU 30' BLOCS .; . 1 XtiS 44 ..''
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BOW SCHEDULE (TOP 4 COLUMN MEMBERS GAUGE ANC) SPACING) I A ENGINEE
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1i , . MASSACHUSETT.
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1 15'-0" TO 5-0" F - -. _. ._ . ._ _ -- i - - -. _� I
P 14GA 5.8.036" i 464. 0.8. 0 34" 1 ■ 46A. D.O. 0 36" $ 4GA 5 "8. 030' 1 4GA D.B. 0 30' i AGA" 0.8. 0 347
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PEAK BRACE SCHEDULE ' ''
■
_ ..-- WIDTH ' SIZE ` LENGTH } i r i 4. r
5.5. = SINGLE BOW
' D B. = DOUBLE BOW C 12 2 I1 ? "X k 8GA. CHANNEL 1 2'- j ' f j �, l
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_...- ._.. ' 24 -26 ` 2 1/2"X 1 4GA. 50. TUBE i 14' -0' 1 _ _ _
I -30 2 { 12 "X 1 4GA. 5Q. TUBE 16' 0 y DATE SIGNED: 2/15/2011
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ilN
(STATE Of NAASSCt-IU i C
SETTS) ,
1
AS PER DESIGN CRITERIA CHANDER P. NANGIA RE. Carports Inc.
i 7423 HOLLOW RIDGE DR. . t
HOUSTON, TX 77095 . 170 Holly Springs Rd. ,
Mr, Any, NC 27030
.... 14103497-3397
......
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DRAWING NO.:
1 2THRU30
------
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. DRAWING TITLE
I
DESIGN NOTES DESIGN CRITEKIA DRAVviNG INDEy,
- COVER SHEET 1
ALL CONSTRUCTION Sr■ALL DE PROVIDED, IN PREVAILING CODE i5C 200‘-09 i 50CA 90 ,
COVER 5 ' 1
ACCORDANCE wtrri 150 2000 , 0511A, A5C USE GROUP it (CARPORTS, BARNS; ,,' ■-• _ .._ _
ASC¢7.05. AWSD ; 1 CODES ANC ALL APPLICADi r DWING ‘./ELOCITy 90 TO I 20 MEI F 2 . FLOOR PLAN : ,.., tiEET NO..
1 OF 9
LOCAL REQUIREMENT!) (5EE SCHEDULE) . .
2 SHELTER BASE CONNECTIONS SHALL DE PROVIDED ROOF DEAD LOAD 2. 0 PSF 3 REGuLAK, AFRAME BLDG. SECTIONS
' ---------------- — ' - ---...--t - - 4
‘-'
AS SHOWN ON SHEET 9 1 ROOF LIVE LOAD AS PER GROUND SNOW i
3 ALL MATERIALS IDENTIFIED BY MANUFACTURER. MIN 20 P5F / MAX.-70 P5F 3A SCHEDULES
NAME MAY BE SUBSTITUTED WITH MATERIAL EQUAL
\ i
OR EXCEEDING ORIGINAL GROuND SNOW LOAD 20 TO 80 f'SF 4 . SIDE ELEVATIONS .
I
CHANDER I° N.\ ,
4 ALL SHOP CONNECTIONS SHALL DE WELDED (SEE SCHEDULE; 4 NOLA A■
CONNECTIONS. IMPORTANCE FAC1OR - SNOW 0 CN .8 '
- SECTL DETAt.- 'L . 4
5 ALL FIELD CONNECTIONS SHALL DE WIND 0 87 - -1 crirRAL 1
TEKS #12 (Ii4 SEISMIC . 0 END WALL DF.TAIiS ? 1 .
I 2S034 CJ ct
6 STEEL SHEATHING SHALL 5E 290A CORRuGATEC
GAD, OR PAINTED STEEL . MAIN Rt43 3ilv SEISMIC DESIGN CATEGORY C - )PEN#NG Dr:AL:
(FY O..
4tA.51) OR E0
ALL STRUCTURAL LIOPT GAUGE TUBING AND LOAD DOMSINA AN-D OFOC
T , IONS t; ' ' T 0; :14
T 11' ' ‘.
CHANNELS SHALL DE GRADE SD STEEL DL+LL. 0 6DL+wl. .
5 STUCTURAL TUBE 152 I.I2'x2 : /5.• - : 4GA. IS DL+O 750.-C 75A .9
EOUIvA.LAN r TO TS2 I t4Ine2 /4' - 20A
S STRUCTURAL TUBE 152 1 /4-x2 /4 - 1 2;„ r .E ri T CONTAINED IN THESE DRAwiNGS ARE THE SOLE LICENSE E_XPIR c 4 .13(:) 1 2/>_ 1 1_
,
SHOULD DE ACCEPTED IN LIEU OF TS2 ii,4`,42 , /4" : PROPER' OF A A A Et4GINCElie4G ANY 14E1 yloN iN p•AFgy 08 — ...
,
' - I 40A FOR IT IS A BETTER. STRUCTURAL 7U5iniC, „ _ wHoLE wiTHouT THE wwrres PEFURSEAON OF
, DATE SIGNED 2/15/2011
A A A ENGINEERING tS PROMOTED '
, .
City of Northampton -
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS m
212 Main Street • Municipal Building Or% A@
Northampton, MA 01060 J',1
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 backfilt 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 in : - tions are made
i� understand the above.
(H • m.r /resident's signature requesting exemption)
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 .
,; ' Office of Investigations '
�= 600 Washington Street
,�- q Boston, MA 02111
www. mass gov /dia
W Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers
Applicant Information Please Print Legibly
Name (Business /Organization/Individual) 4 9 /yo.
Address: i _ e42. i/ /� ,. _ ✓/- - ` ...0
City /State /ZipY j __ ; , Phone #: / - , _ —G 4"
Are you an employer? Check the appropriate box: Type of pr 'ect (required):
1. ❑ I am a employer with 4. VAI I am a general contractor and I
employees (full and/or part-time).* have hired the sub contractors 6. ew construction
2. 11.1 I am a sole proprietor or partner- ors listed on the attached sheet. 7. ❑ Remodeling
These sub-contractors have
ship and have no employees 8. 111 Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. n We are a corporation and its 10.0 Electrical repairs or additions
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. ❑ Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13. ❑ Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the 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 c rtify under the pains and penalties of perjury that the information provided above is true and correct.
Si Date: /6 ..1/
Signatur ��' 9__ &i���
Phone #: i1 /J -- `��� - l P
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):
Z. Board of H 7, B D 3, City/Tnwn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other •
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed C struction Supervisor: Not Applicable ❑
Name of License Holde ..
License Number
Address Expir. Date
Signature Telephone
9`g. =Re ist re ed.HomeJm rovement Con rbµ' v' ` • Not Applicable ❑
Company Name Registration Number
Address Expira Date
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 ❑ No ❑
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, Sta nd Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
c e�
r
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House n Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n
Or Doors D
Accessory Bldg Demolition 0 New Signs [ID] Decks [EJ Siding [II] Other [D]
Brief Description of Proposed Co HST R 19 x z l CA11'L,f'o elt
Work:
Alteration of existing bedroom Yes 13 No Adding new bedroom Yes K No
Attached Narrative Renovating unfinished basement Yes . No
Plans Attached Roll - Sheet
Ga.�
IfilewU.housez:and or additi n`to existing, ousinq,;comp el te.the.follow :
a. Use of building : One Famil Two Family Other
b. Number of rooms in each fame unit: Number of Bathrooms
c. Is there a garage attached? ..____."`- - ----..„,
d. Proposed Square footage of new construe- . Dimensions
e. Number of stories?
f. Method of heating? replaces or Woodstoves Number of each '
g. Energy Conservation Compliance. Massc - k Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction ithin 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 Ta OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT-OR CONTRACTORIAPPLIES FORBUILDING PERMITt
I , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized b •u]]21' ermit application.
Signature of Owner Date
Ow thorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the est of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print ■ . le o
/ .� e/e ei -? 9 / /f //I
,, • gnatur f Owner /Agent Date
Section 4. ZONING Ali Information Must Be Completed. Permit Can Be Denied Due To Inc plete Information
Existing Proposed Requir d b y l o / 1
This co to be fin bst i
Build' Deptutment rj /f
Lot Size I
Frontage
I
Setbacks Front I j I
Side L:1 _' R:' L: E R: i 1
Rear = I I `
Building Height I i
Bldg. Square Footage i 1 j 1 % # I !
Open Space Footage
(Lot area minus bldg & paved , t F
parking)
# of Parking Spaces
Fill: f� ? 3
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:,
IF YES: Was the permit recorded at the Registry of Deeds? 1
NO 0 DONT KNOW 0 YES 0
S
; \
IF YES: enter Book 1 I Pager I and /or Document #d
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued: € j
C. Do any signs exist on the property? YES 0 NO 0
f
IF YES, describe size, type and location: 1 !
i
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
i
IF YES, describe size, type and location
I'
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan /
that will disturb over 1 acre? YES 0 NO 0 1
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
G . -� a L w . �, �" i .4F4-, Deioartinemt;useonly -� ':: +. � V 0 -
9 ity of Northampton S tate of Pe m�t� .44* � g V
ilding Department C ®zCgf/Dri a yf rrTilt ; .
ef.Q 1 a + 12 Main Street ew ed e l a a lablllty� ��
Room 100 Vtl to elt �e)lab�lt t � � ,x4,4 %
• - - : mpton, MA 01060 wo u al ra
,.-
w ,►�' • ne 413 587 -1240 Fax 413 587 -1272 t ,101/S1 eta =
bitier St2ebi a1= a* au., , . sy O i, ;`a
r,
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
P SECTION 1 - SITE INFORMATION
t This section to be completed by office
c ,, ;'"::: ..: - i,,,'pE'Ll'.44,:Ki....- T 'E 1.1 Property Address:
r
�CZ •�L'C�t ' 6; Map L " Unit ' £
?� /d 5 a ° a y sss
n
2
�. e9 /4("1.-- +zone � . ' ��=. �"" ; � Overlay District .,',-,,,,"!...,,,,':!.,"",-• � `` '
girn st_Distnc . . CB'D s trict '‘ .
SECTION 2 - PROPERTY OW_ NERSHIP /AUTHORIZED: AGENT
2.1 Owner of Record:
Na (Print) Q Current Mailing Address: _
J� - % / /V GAL //4- d I /, f . — eta . -' ./ /7
r // — ® Telephone
Signat
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 permit applicant
1. Building "(a)' Building` Permit Fee
2. Electrical (b)Es #IrnatedTotal east of
Construction from (6) . -
3. Plumbing Building Permit F ee'
4. Mechanical (HVAC)
5. Fire Protection
--- 6. Total = (1 + 2 + 3 + 4 + 5) -' / • 7 3 3 - % 2 Check'Number
This' Section For Official Use Only -
Building Permit Number: Date
" Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP-2012-0250 VA
P
W °-1
APPLICANT /CONTACT PERSON BENOIT ROGER D & ROSALIE D
ADDRESS /PHONE 942 PARK HILL RD FLORENCE (413) 586 -4019 Q s W
P
PROPERTY LOCATION 942 PARK HILL RD 9/4,/ C � / (fl,,evi6 LED �'�
MAP 49 PARCEL 019 001 ZONE SR(100) //WP /WSP II THIS SECTION FOR OFFICIAL USE ONLY: t A ocitor4146 WitittS
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE pd AP _,I
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out j?, 3_ 29 i 79, 70
Fee Paid
Typeof Construction: CONSTRUCT 21 X 19 CARLPRT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ATION PRESENTED:
Approved 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
^
is . . D
. e 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.
942 PARK HILL RD BP- 2012 -0250
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 49 - 019 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit # BP- 2012 -0250
Project # JS- 2011- 001732
Est. Cost: $1733.00
Fee: $79.80 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 30274.20 Owner: BENOIT ROGER D & ROSALIE D
Zoning: SR(100) //WP/WSP II Applicant: BENOIT ROGER D & ROSALIE D
AT: 942 PARK HILL RD
Applicant Address: Phone: Insurance:
942 PARK HILL RD (413) 586 -4019 0
FLORENCEMA01062 ISSUED ON: 9/22/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 21 X 19 CAR[PRT
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 9/22/2011 0:00:00 $79.80
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
No
5Nr?