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03-033 Windows venting: Wood Frame:Double Pane with Low -E: 31 0.350 11 Wall East Rachel, Bath, Guest BR: Wood Frame, 24" o .c.: 440 19.0 0.0 23 Windows venting: Wood Frame:Double Pane with Low -E: 49 0.350 17 Wall, North Garage, bath: Wood Frame, 24" o .c.: 241 19.0 0.0 14 Wall, E -W upper SL area: Wood Frame, 24" o .c.: 300 19.0 0.0 18 Full Basement: Solid Concrete or Masonry: 570 11.0 0.0 37 Crawl space min. backfill: Solid Concrete or Masonry: 252 0.0 12.0 18 Crawl Space max. backfill: Solid Concrete or Masonry: 370 0.0 12.0 23 Floor over Main Entry: All -Wood Joist/Truss:Over Outside Air: 122 40.0 0.0 3 Compliance Statement: Statement of Compliance: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheck Version 3.7 Release la and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. � / 1.%'6 .-- L ; 1 - -- / icl - t , L 47 / re C r %i /G/ U 6 Build /Designer Company Name Dat Robinson Residence Page 2 of 2 ' Permit # Permit Date ci. REScheck Software Version 3.7 Release la Comp Cert Project Title: Robinson Residence Report Date: 01/06/06 Energy Code: Massachusetts Energy Code Location: Northampton, Massachusetts Construction Type: 1 or 2 Family, Detached Heating Type: Other (Non - Electric Resistance) Glazing Area Percentage: 19% Heating Degree Days: 6404 Construction Site: Owner /Agent: ,designer /Contractor: 563 Coles Meadow Road Steve & Heidi Robinson ` Mark Gelotte Northampton, MA 01060 599 Coles Meadow Road // Mark O. Gelotte Architect Northampton, MA 01060 70 Elm Street 586 -2327 Hatfield, MA 01038 247 -9624 Compliance: Passes Maximum UA: 641 Your Home UA: 610 - -> 4.8 % Better Than Code (UA) Gross Cavity Cont. Glazing UA Assembly Area or R -Value R -Value or Door Perimeter U- Factor Ceiling, Rachel, Bath: Flat Ceiling or Scissor Truss: 343 40.0 0.0 10 Ceiling,M. Bath: Flat Ceiling or Scissor Truss: 123 40.0 0.0 4 Ceiling, Kitchen: Flat Ceiling or Scissor Truss: 210 40.0 0.0 6 Ceiling, Dining: Flat Ceiling or Scissor Truss: 330 40.0 0.0 10 Ceiling, Guest & Recreation: Flat Ceiling or Scissor Truss: 960 40.0 0.0 28 Ceiling, M BR: Cathedral Ceiling (no attic): i 237 38.0 0.0 6 Ceiling, Kitchen Counter Seating: Cathedral Ceiling (no attic): 250 38.0 0.0 7 Ceiling, LR: Cathedral Ceiling (no attic): 485 38.0 0.0 13 Kitchen SL's (4): Wood Frame:Double Pane with Low -E: 7 0.380 3 Wall, North, MBR, Rec, Guest: Wood Fram9, 24" o .c.: 795 19.0 0.0 42 Windows venting: Wood Frame:Double Pate with Low -E: 50 0.350 18 Windows, fixed: Wood Frame:Double Pane with Low -E: 32 0.320 10 Wall, North, recessed entry: Wood Frame, 24" o .c.: 230 19.0 0.0 10 Windows, venting: Wood Frame:Double Pane with Low -E: 12 0.350 4 Entry door, sidelight: Glass: 28 0.260 7 Door, Garage to Entry: Solid: 21 0.150 3 Wall, West, MBR, Bath: Wood Frame, 24" o .c.: 246 19.0 0.0 11 Windows, MBath: Wood Frame:Double Pane with Low -E: 18 0.350 6 Door, French: Glass: 43 0.330 14 Wall, West, Kitchen, LR: Wood Frame, 24" o .c.: 356 19.0 0.0 13 Windows, venting: Wood Frame:Double Pane with Low -E: 134 0.350 47 Wall, South, Kitchen, LR, Dining: Wood Frame, 24" o .c.: 342 19.0 0.0 13 Windows, venting: Wood Frame:Double Pane with Low -E: 75 0.350 26 Windows, fixed: Wood Frame:Double Pane with Low -E: 40 0.320 13 Wall, East, LR, Dining: Wood Frame, 24" o .c.: 585 19.0 0.0 21 Windows venting: Wood Frame:Double Pane with Low -E: 38 0.350 13 Windows fixed: Wood Frame:Double Pane with Low -E: 26 0.320 8 French doors: Glass: 172 0.330 57 Wall South Rachel. Guest BR. Rec: Wood Frame. 24" o .c.: 424 19.0 0.0 23 Robinson Residence Page 1 of 2 SECTION 8- CONSTRLJCTION SERVICES f 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : \J' S (Wet License Number 05 M uk tv- ,6 sr. 0- D&.t/ (-4- / 4143 T 1.17- Address 4 Expiration Date ( 7-4 - '76f9C;z4'`f Signat - Telephone Rei ete"W-10 a pr enfe ontracto 4" 1 Not Applicable l Company Name Registration Number - — — Address Expiration 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 tP- No ❑ ;`o'er .e 9'= sa 8! O` P l 'I The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts - as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature i.: SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House Er Addition ❑ ;: Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [0] Other [0] Brief Description of Proposed 07 w 382 UCL Sit W AC 6(TQ j Work: /✓ �� -T u�rnvrC�- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa f ewlhousean . " r,: di on #cLextsbn io — *m - e compietelt e o i in : a. Use of building : One Family ✓ Two Family Other b. Number of rooms in each family unit: •-• Number of Bathrooms 3 % 1 c. Is there a garage attached? ! g 4 / d. Proposed Square footage of new construction. 7 Dimensions 5 /AO e. Number of stories? 2- f. Method of heating? et/ON—Me - tier mg. Fireplaces or Woodstoves F P Number of each 1 g. Energy Conservation Compliance. Li g S Masscheck Energy Compliance form attached? 1 1E5 h. Type of construction 6' 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 7 k. Will building conform to the Building and Zoning regulations? ' Yes No . 1. Septic Tank &- ---- City Sewer Private well ✓ City water Supply SECTION 7a - OWNER ` AUTHORIZATION - TO BE CO WHEN OWNERS- AGENT "OR CONTRACTOR "APPLIES'FOR ,�#UILDING.`PERMIT 1, 5+e pile.' (b Ai 4 , as Owner of the subject property hereby authorize �f n L 'I'"' `✓`'F to act on my be If, in all atters relative t•- or4c authorized by this building permit application. Signature of Owner Date - Z.-/ / 0 0 1 ' (14' )/LK `/ 41 4)0‹ , as Owner /Authorized Agent he eb declare th t he statements and information on the foregoing application are true and accurate, to the best of my knowledge and beli- . Signed under the pains and penalties of perjury. ■ , ..)A• X < ,1-L4) 2zNC.6 Print Name ., el , Signature of • er /Agen Date . s Section 4. ZONING All Informatibit Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 7 S /a 77 SW) 000 { Frontage (/5 I ` i 1 f`).c ; Setbacks Front jocOD a Side L /ZD{ R :'/`/ ? L :3 R:7 : 7- Rear 513 ! i ' ) Building Height , _ _ _ I _ i Bldg. Square Footage 888 i 1 i% 7 ( 1 I i Open Space Footage L % / (Lot area minus bldg & paved 0 401 13 1 k____ parking) # of Parking Spaces I s r Fill: ' € Oyd pit,�l�; / c K- 1 i (volume fic Location) ! i ZL b t1CIS S P7c-- A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page; and /or Document #' B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: ! 6j /Z e (6.3 C. Do any signs exist on the property? YES 0 NO er . , , IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: 1 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of t ortl?am ton �� ' �, 2 i xer-44.A.4 Building Departlnenl 212 Main Street '" ielJ -, 1 Northampton, MA 01060 6 '� � �� phone 413 - 587 -1240 Fax 13 -�- 4272 - 1 _. � ;',..-4;:: 4 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This s ection to be compieted byoffice 'J k GwL/f S 1/4 Ei9DDGJ �UR� p, : ;dot s uni# 2 onex • =Ovefa) District E p Dl4,4 ., , A.. CI Disfn _ SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: / 1 _Ste e h e i , p ' ) i i v , 4 / f ' -O . , 6 u x / a . S" . t.�E -A-r1i - i r ✓ ii?? -// 2 j Name (Pri tt) — Current Mailing Address: t ' ig" ''' - ' (----7L/ / / Telephone Signature 2.2 Authorized Agent: f ._ 1rS 4 ,06e e 5 Maui,' -4, U c►' "ya vit.6- o/ 37 Name (Print) Ai Current Mailing Address: / 1 �L. liti 'S - ZG� - ?0 9y ( Z G . +S ° S G '�J Si Telephone SEC • , - ESTIMATED'CONSTRUCTION,OOSTS Item - . Estimated Cost (Dollars) to be Official Use Only completed by permit applicant , O D O (a) Building Permit Fee 1. Building �5 D 2. Electrical -(b} Estimated Total Cost of 6- !_ 3d 600 Construction from (6) i 3. Plumbing Building Permit Fee 3 006 7 ? ,-. g � 4. Mechanical (HVAC) - 5. Fire Protection ?j 0 � a e O 6. Total= (1 +2 +3 +4 +5) 1/4 A/ Check Number 93 .6S - This Section For Official Use Only Building Permit Number ` - Date = lssaed: Signature: r 1 Building Commissioner /Inspector of Buildings Date zsc-ts 4 ilQ.e.( pi,1-‘45 File # BP- 2006 -0804 APPLICANT /CONTACT PERSON JAMES LAWRENCE ADDRESS/PHONE 85 MOUNTAIN ST HAYDENVILLE (413) 268 -7099 PROPERTY LOCATION 555 COLES MEADOW RD MAP 03 PARCEL 033 001 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid ,q Building Paid Permit Filled out � � #/ /,61 i 96 Tvpeof Construction: CONSTRUCT 2 STORY SFH W /ATT GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 010092 f 3 sets of Plans / Plot Plan r r THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 F. eeds 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 J„, „ -3 -4I Signature oBui ding Offi41.1 / 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. BPd 7 07A-6 • 55 LES MEOOW e(1132d' M (7` BP- 2006 -0804 GIS #: COMMONWEALTH OF MASSACHUSETTS 03 - CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit # BP- 2006 -0804 Project # JS- 2006 -1232 Est. Cost: $540000.00 Fee: $1985.95 PERMISSION IS HEREBY GRANTED TO: Const. Class: 5B Contractor: License: Use Group: R4 JAMES LAWRENCE 010092 Lot Size(sq. ft.): Owner: ROBINSON STEPHEN & HEIDI Zoning: RR Applicant: JAMES LAWRENCE AT: 555 COLES MEADOW RD Applicant Address: Phone: i' � Insurance: 85 MOUNTAIN ST (413) 268 -7099 HAYDENVILLEMA01039 ISSUED ON:4/4/2006 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 2 STORY SFH W /ATT GARAGE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Metgt : Footings: Rough: Rough: Juse # Foundation: / t riveway Final: Final: Final: ' Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: / Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 4/4/2006 0:00:00 $1985.953365 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo . #6, , , : * C!iztp of �d"orttia.mptnn $ :, jt 4 " ' = DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 FAX THIS TO: 413 - 587 -1272 REQUEST FOR PERMISSION TO VIEW RECORDS OR HAVE COPIES OF DOCUMENTS MADE *PLEASE KEEP THESE DOCUMENTS IN CHRONOLOGICAL ORDER* DATE: la' MAP: Q 3 ou I BLOCK: FILE ADDRESS: ccC 6 l." k`AD na71 1b NAME: J,Q y S c S V EIU < ADDRESS: -- ) 1 ( ' ✓W R12Z'7Y it e E 'T 7--e P1'44 V 7110 4 I PHONE #: 5dij - 3>>7 UNDER MASS GENERAL LAWS WE HAVE THE RIGHT TO MEET THE ABOVE REQUEST WITHIN TEN (10) DAYS OF THE ABOVE LISTED DATE. 1 CI REScheck Software Version 4.0.1 ,,,,e Comp Cert Report Date: 02/28/09 Data filename: C: \Program Files \Check \REScheck \Weimeyer Energy analysis.rck Energy Code: Massachusetts Energy Code Location: Northampton, Massachusetts Construction Type: 1 or 2 Family, Detached Heating Type: Other (Non - Electric Resistance) Glazing Area Percentage: 22% Heating Degree Days: 6404 Construction Site: Owner /Agent: Designer/Contractor: 555 Coles Mesdow Rd Charles Weimeyer James Lawrence Northampton, MA 01060 West Street Lawrence Design and Construction Hatfield, MA 85 Mountain Street 413 559 -9660 Haydenville, MA 01039 413 - 268 -7099 jcl @crocker.com om rariCG Passes , , Ma imUm,, tb 861 ,: - Yout,J t seta * 21,8 : Batter Than Coda OA Gross Cavity Cont. Glazing U A Assembly Area or R -Value R -Value or Door Perimeter U- Factor Ceiling 1: Flat Ceiling or Scissor Truss: 2110 35.0 17,0 44 Skylight 1: Wood Frame:Double Pane with Low -E: 17 0.280 5 Ceiling 2: Cathedral Ceiling (no attic): 1700 35.0 7.0 41 Wall 1: Wood Frame, 16" o.c.: 3654 19.0 7.0 168 Basement Wall 1: Solid Concrete or Masonry: 2160 13.0 5.0 47 Wall height: 8.0' Depth below grade: 7.0' Insulation depth: 8.0' Window 1: Wood Frame:Doubie Pane with Low -E: 934 0.290 271 Door 1: Glass: 130 0.290 38 Door 2: Solid: 56 0.150 8 Boiler 1: Other (Except Gas -Fired Steam): 92 AFUE Air Conditioner 1: Electric Central Air: 14 SEER Compliance Statement: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheck Version 4.0.1 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as s. :cified in Sections 780CMR 1310 and J4.4. (2 (f."(.„t ■./454.1 k' 5 4.g t Al ci£ - gas, , C 41/47 K z7/o - , e - Title Signature Date Page 1 of 1 o a:HM^e,. o ' CITY OF NORTHAMPTON, MASSACHUSETTS �'�' "`�"� DEPARTMENT OF PUBLIC WORKS M Ot1 125 Locust Street a � �� r:S_ Nor thampton, MA 01060 413 -587 -1570 ext 117 Fax 413 - 587 -1583 Joseph Thomas Highway Superintendent January 20, 2006 Driveway at 155 Coles Meadow Rd. must have a culvert installed prior to construction of the driveway. The culvert and drainage ditch will become the homeowner's responsibility to maintain, repair and replace if needed. Size of culvert will be determined by the Highway Superintendent. Signature of owner ,,�'�/ G�(ur' Please call if you have any Questions Joe Thomas 413 -587 -1570 ext 117 Pg.1 /1, C: \Documents and Settings\jthomas\My Documents \Driveway culverts and ditches\Driveway culvert155 coles meadow.doc ENFORM 3 SHEET OF / CALCULATION WORK SHEET NORTHAMPTON D.P.W. ENGINEERING DIVISION PROJECT NAME : 9 ei:6k3. mci' CONTRACT 5,00 (POD R64,0/4/6 Qc ' oe) 701 ( x . 10 / Al, ( /e- /Af 7, - P ? ctie. re'g ` — 6 ± ♦ 2 ' /7/PE • PREPARED BY DATE REVIEWED BY DATE i�' r (• <1G a/11 f "l9-06 Sent: Friday, March 24, 2006 12:27 PM To: Bruce Young Subject: 555 cole meadow rd Bruce, I still have a house application for this address with a hold on it until there was a site inspection by Cons Com....where does this stand? Tony 2 q �3 J Jam. *fit ,tr�r YJ f AM1p �4tr E1 ?.t 3 , t4 n rt 4� 1k tl, f • Anthony Patillo From: Bruce Young Sent: Tuesday, March 28, 2006 11:35 AM To: Anthony Patillo Subject: RE: 555 cole meadow rd Tony, The contractors are working on the site, but there are no sediment and erosion controls at 555 Coles Meadow Road. Further, they will need to remove the sediment that has already accumulated on the road, and because of the steep driveway they will need to purchase a roll of sediment sock or straw wattle to place across the bottom of the driveway when they leave the site and during rain events. Bruce Bruce W. Young Land Use and Conservation Planner City of Northampton, Office of Planning and Development 210 Main Street, City Hall, Room 11 Northampton, MA 01060 (413) 587-1263 / fax (413) 587 -1264 www.NorthamptonMA.gov Original Message From: Anthony Patillo Sent: Tuesday, March 28, 2006 7:54 AM To: Bruce Young Subject: RE: 555 cole meadow rd Bruce, what was the verdict on 555 cote meadow? T Original Message From: Bruce Young Sent: Friday, March 24, 2006 1:05 PM To: Anthony Patillo Subject: RE: 555 cole meadow rd Tony, I will take a look at the site today while out in the field. Bruce Bruce W. Young Land Use and Conservation Planner City of Northampton, Office of Planning and Development 210 Main Street, City Hall, Room 11 Northampton, MA 01060 (413) 587 -1263 / fax (413) 587 -1264 www.NorthamptonMA.gov Original Message From: Anthony Patillo 1 No. 0 776 -tJ/ THE COMMONWEALTH OF MASSACHUSETTS FEEOr6O 1\brir BOARD OF HEALTH G /33 7 DISPOSAL SYSTEM CONSTRUCTION PERMIT '>' 2/6 Permission is hereby 1Of ranted to Construct ( Repair ( ) pgrade ( ) Abandon ( ) an individual sewage disposal system at Ctteet,Qi .J• as described in the application for Disposal System Construction Permit No. i4 0/ , dated u1 t4 /9d Provided: Construction shall be completed within three years of the date of this permit. All local conditions m, st be met. II Date / 3/ � a.f b Board of Health IA r .40162' .; ..,: ° FORM 2 - DSCP DEP APPROVED FORM 5/96 ER�1i�FS ��T J. MAT' 1'- r �•�•+ •�, �+°�•� ECTOR OF HEALTH FORM 1255 (REV 5/96) CH &W) HOBBS &WARREN TM PUBLISHERS - BOSTON • 1 VARIES �{ N 6 "PVC.PIPE, (/).4 - "x - "x6 "WYE REDUCER OR INCREASER w z IF NEEDED 6 "x6 "x6 " -90' 0 FERNCO PVC. TEE WYE a - COUPLING 6 "BEND (SIZE VARIES) EXIST SEWER SERV CE 1 * ./ (SIZE W.RIES) 6 "PVC.PIPE '� O �•I r 2 % MIN. SLOPE N PLAN w 6 "CAP EXIST GROUND H t� N OTE: FOR CLEANOUTS WHICH TERMINATE -- WIT1i1N PAVEMENT AREAS CONTRACTOR TO SUPPLY THE TOP OF A STANDARD WATER GATE HOX TO PROVIDE ACCESS AND TO PROTECT THE PIPE. REDUCE CLEANOUT PIPE SIZE FROM 6" 10 4" WITHIN 1HE GATE HOX TOP. CL _° v� 6 "PVC.PIPE, - VARIES ` REDUCER OR INCREASER IF NEEDED SEWER MAIN (SIZE VARIES) FERNCO COUPLING "x6 "WYE= r (SIZE VAR ES) 4110 6 "PVC.PIPE '� 2 % MIN. SLOPE - 6 "BEND 6 "x6 "x6 " -90' PVC. TEE WYE PROFILE EXIST SEWER SERVICE X (SIZE VARIES) TYPICAL 6 "PVC. SEWER SERVICE NOT TO SCALE Howard Laboratories 62 Main Street — Hatfield, MA 01038 Tel. (413) 247-5533 Fax (413) 247 -9599 WATER ANALYSIS REPORT Henshaw Well Drilling Invoice Number: 12362B Sample Location: Cotes Meadow Road Client: Jim Lawrence Sampled By: HWD Date Sampled: 01/09/06 Date Received: 01/10/06 Parameter Resr_rirs Limits Comments Total CDliform Bacteria 0 colonies / 100ml O colonies / 1OOm1 OK Color 51 PtCo Color Units 15 PtCo Color Units Iron 1.32 mg /I 0.3 mg /I Manganese 0.056 mg /I 0.05 mg /I Nitrate 0.09 mg /I 10 rng /i OK Nitrite 0.002 rng/1 1 mg /! OK pt1 7.55 pi 1 Units 6.5 - 8.5 Ph Units OK Sodium 3 rn9JI 26 mg /I OK Conductivity 0.32 mSlcm No Standard No Standard Turbidity 27.3E NTU 5 NTU Chloride 133 mg /I 250 mg/1 OK Hardness 112 rng /i No Standard <50 soft >100 hard ND = None Detected Recommendations: This sample meets acceptable standards of potability. The parameters with an asterisk vvhich are over the limit should go down after a few weeks as the water and materials floating in the well settle. Analyst: SL Date: 01/11/00 MA Certification: MA -00851 Massachusetts Department of Environmental Management Office of Water Resources TYPE OR PRINT ONLY Well Completion Report 1. WELL LOCATION 1 GPS (OPTIONAL) LATITUDE LONGITUDE DATUM Address at Well Location:: > 6' (....\\.(::—..":. ,°= = ..\+''A N9. ' A Property Owner /Client: `. , -� i.:"4.\----‘ ' ; �?- Subdivision Name: Mailing Address: `t., t"' �. t,' , $'t. u.--, Cityfi own: M, 4 ,v`. City/Town: -� x.` Assessors Map Assessors Lot #: NOTE: Assessors Map and Lot # mandatory if no street address available Board of Health permit obtained: Yes ❑ Not Required CI Permit Number Date Issued 2. WORK P ERFORMED 3 P ROPOSED USE 4. DRILLING METHOD EJ New Well ❑ Abandon Ll Domestic ❑ Irrigation ❑ Cable ❑ Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal IXI Air Hammer ❑ Direct Push ❑ Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud Rotary ❑ Other 5- WELL LOG Water Unconsolidated Consolidated 6, SITE SKETCH (Use permanent landmarks with distances) ., Rock Type Bearing ci s �. 12 m 1, _a,' Other YP From (ft) To (ft) Zones (3 (7) c5 m Ma Description _ 3 'ZI (ICI .. -� - , , r c i 7. WELL CONSTRUCTION 8. CASING Total Depth Drilled .,- ,`°4. From (ft) To (ft) Casing Type and Material Size I.D. (in) Well Seal Type Date Complete . =d \ -` ":4 \A 1 •:�, :.. \ 1 t t , ,g 4 _, ` y e 9. SCREEN From (ft) To (ft) Slot Size Screen Type arid Material Screen Diameter 10. FILTER PACK / GROUT / ABANDONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION Developed? W Yes ❑ No From (ft) To (ft) Material Description Purpose Fracture Enhancement? ❑ Yes NI No Method 1 _) „....._ 1 1 ,_.,......,_.,..,......_...,,,_..........._,___ L . Disinfected? Yes No 12 WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 13. STATIC WATER LEVEL (ALL WELLS) Yield Time Pumped D,awdown to Timer °Rco ver Penovervi to a Dep h Below r Date Method (GPM) (hrs & min) (Ft. BGS) (hrs &Tar (Ft. BGS1 i _n Date Measured Ground Surface iFT) ? l — ' 14. PERMANENT PUMP (IF AVAILABLE) 15. NAME/ADDRESS OF PUMP INSTALLATION COMPANY Pump Description { - � �_xt�� Horsepower _..� � �;�.- k.,- .. ,r,,;, r,d �f , , , f t, i s Pump Intake Depth : Otti, I (ft) Nominal Pump Capacity /C r__ (gpm) ;.F 1 r - - `r. r° ' 16. COMMENTS 17. WELL DRILLER'S STATEMENT This well was drilled, altered, and /or abandoned under my supervision, according to applicable rules and regulations, and this report is complete and correct to the best of my knowledge. Driller: __ I., ; >' --' . -- , - Supervising Driller Signature: ,A,..--,4,,,,, Registration #: \ ‘'- \\ • \t .O 0 o o o G is) 1 / /o a 1m o Q DENNIS L. AND LINDA L. FUNK BOOK 3820, PAGE 35 \` rn SEE: PLAN BOOK150, PAGE 35 \\ v - dwelling w w ,4, ..:1- r 5 ` ptiR - w ' I n r h P t e N. �R�� N� ' p l�G� • o e5 t� o � ea - . pN ` 30 01 ca FZ r- t\or o`oo t`' fioUd • 'a 11 o , .. oqe�ert 114'4 cl Qp p Fj ° 09r edge o P #565 ti5 P� 5 .-- .. , 00. `� LP`s � U� V v 0 CO E S ) /1,0 b4 A 5 h. � R \Jul) An We6k/CZ.. • OM' 0 9 y 1- L.1 I- (.cc(P A bC ) 5 zwz a,Cn0 Z E ZY ,6 vAziJf /tc( Li 803,2 -J LL. E5. n (n O.4 .{ Permit No. D17-06 Conditions: Driveway Permit In lieu of plan approved by City Engineer I agree to the following added conditions: 1. I will contact the Department of Public Works and have an inspector check and approve the graded gravel base prior to paving to insure compliance with slope and location; 2. I further agree that if in the inspections any of the permit conditions are not met that I will at no expense to the City remove and replace the driveway as directed by the City Engineer. By: 7 �� Petitioner Jim Lawrence Note: The Public Works Department recommends that you provide a plan showing the proposed driveway with grades and location in the future to avoid possible expense which you will incur by not getting approval of actual plans in advance. cc: Building Inspector Permit No. D17-06 CITY OF NORTHAMPTON, MA DRIVEWAY PERMIT Date: 12/30/05 FEE: $25.00 CHECK #: THE BOARD OF PUBLIC WORKS Driveway must be staked and house & lot number posted The undersigned respectfully petitions your honorable body for: Permission to install a driveway at 555 Coles Meadow Road Fifteen (15) foot maximum width at the street line. Gutter drainage not to be disturbed. All drainage shall be directed off the driveway surface to adjacent land and not on the existing roadway. Driveway surface to be paved as soon as possible if the grade of the proposed driveway exceeds 3% or more. Homeowners will be held responsible for any cost to the City of Northampton in the event of a washout of this driveway. B (,,- Jim Lawrence Telephone #: 626 -4865 Proposed Location Inspected By: oQ- ` l / e:4 Gravel Base Grade Inspected By: Final Approval THE BOARD OF PUBLIC WORKS voted that petition be granted. George Andrikidis Director of Public Works (SUBJECT TO ATTACHED CONDITION 1 & 2) cc: Building Inspector o ¢5M/1MP7o f . w . (Crt 7 of XItrt1 mpht1"It Z - # ° /. $ �-�-�f , i r j ' ji'il assuelmusetip — ? ,_ , ,. DEPARTMENT OF BUILDING INSPECTIONS - - , I NSPECTOR 212 Main Street • Municipal Building — Northampton, MA 01060 ,M e HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supc ,'isor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he /she resides or intends to be, a one or fwo 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 oven construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and fegulations. 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 r 1 44 4 / p i .. - • ' P it igO - • 6 3 f 45 QTii.13 of Yarilizaiiip toil . , . . e l • 3 a • di n s r 1 1 Is ' -----..- • I T ___.. -1----- DEPARTMENT OP DUI LIDDO INSPECTIONS \ --- . 212 Main Street_ ' i\funicipal Building • . Northampion, Mass. 010G0 --, WORKER'S COM:PENSA:110-N MST...TRANCE AFFIDAVIT ' . _114,14 $ 41-63gEet)( _ __ (lice-permittee) %vit.') a principal plac e. of business/residence at: & 114a. iLi 5": /AM Og.....A/1/tL.a.k MA Or 03 (phoncioq13—Z4s-7 I (s do hereby certify, under the pains and penalties of per Lhai • . . (1-rani an employer providing die followinz kvorkcr's compensation coverage nor my employees working on this job: • /4-S6,t-reo En4/4 J7/45 7705. g€ ' -. 1.34 - OD e;b1D 12 VZO 10 p (1 Co') - (Policy Ntumlacr) (E.:9imtion D) • ( ) I am a sole proprietor, general contractor or homeowner (cii one) and have hired the corm Listed below wbo have the follovvioR worker's comoensanon policies: (Namc of Con2raczor) (Insuranc-- Companr?olicy Numbz7) (Expirardon IDntc) _ (Name of Cono (stsuranc: CompanyiPoLic Numb-r) (E). Date) . . .. - • .-. . - (Name of Conz (Lnsui co milanyfPolicy Nurelx_r) (E Datc) . - - • • - - (Name of C.ontrac (Insurat= Company/Policy Numlyz_r) (EA7piraion D) . (sx.ada z.6.3.,1 sbc,if n•o=1..i2-y to inchl& in.forroc pc-tainting to .11 - --, ( ) 1 - am -a sole proprietor and have no one worming for me. ( ) I am.a home owner perfornaing all the work myself. No-r-E-. pi, I. ......, d,. wIn.:1c boco=owocra wlao =ploy pc-locu to cin r-.;---t.--- =-::-.--_ ,.:c-loo c rcpcir s•-ork. on • th...c.1.11,-.1c of op( room 1 .1r= 1 Sor. =hi in which the boc:co.-oo. raid.= or oo the crou.ocla x.p.purtcc= tbc-cLo •.-c ooc c--a.—.11y cocid---od to bc ■=i2;:31oycrs uoL:cr. tbc wth c=p.......ztioo Act (GO. 5 2....= 1(5)). ttopiioo by • bomcoo-ren f= r. Li=.3c cc- pc-Inet tr.ny cvid=occ tbc logsl ctv.c.3.c of r_zt tr.:Cploy.c coder d.e Utt crical. Cotap.a.st Ad.. 1 tundcrzu.o4 that a copy of chi, ctaccoona many b. fo..4 to the Dcpertmccd of Apo:down' am.. .11.0‘..0. co th.... • �v-a .. "="i•GC: 603 and 11 =4 C to 4•CO-Irt ' COVCni .. 0 s ' 34CGOCI 25A of Mal_ 152 can 1=3 to the inloositico O(1 poszitics coosaing or • ritx or up to S 1 S00.00 androt ix:Elva or up to occ )..-=r r_ncl civil pco•I in 64 roan of • Stop Work Ortic- and • I= or 5 100.00 • thy isaiost coc. A A --------- z z i , Pcrnait Number m ___ Lot : -__. i — sitpaa :Prof Liccns=f1pc rmitt= Date __ - .. • , HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he /she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two -year period shall not be considered a home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour). a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure.the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home 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 �, ----, Office of Investigations 600 Washington Street Boston, MA 02111 www.inass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers Applicant Information I , . , Please Print Legibly Name ( Business /Organization/Individual): �4>~na S -�1C�I r�1 <ic Address: 6(.4..,0 J i • City/State /Zip: 4 Oii Lit c.i/ 1444 6 6 f 5 Phone #: L(1' - 2. b - 701 Are you an employer? Check the appropriate box: Type of project (required): 1. gam a employer with 4. I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. Q'2Qew construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. fl Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance. required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 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' 13.0 Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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: .4 SS °C Ewt ncv 4 fidtS Z • S e 0. Policy # or Self-ins. Lic. #: (.JC c-• 5 6 0 o 3 CAI o Z00 $ Expiration Date: Q g / Z E D !Lop 7 Job Site Address: 5 e 04./ s 'V1 f or c.) ed. City /State /Zip: 16c)4 4-WhO i A-) Cl l l 4, 6 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 u the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 3/ 3 el` Phone #: f t 3 - Llo - 70 i 5 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 #: r SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : S 1 '\7 7 CR License Number 5 M614,0.A.-: 4.0) STi tD&JS)uE Ojd35 !o0 9L Address Expiration Date A,e �/�-2 G 6- 7605 /21/. /Zoe? Sig - Telephone 9. Registered HomeiImprovement Contractor ti„ ,,... ... , _r , , .,. Not Applicable ❑ Company Name Registration Number Address Expiration 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 build ing permit. Signed Affidavit Attached Yes E / No ❑ 11. -.Home OW itt:i emptior' The current exemption for "homeowners" was extended to include Owner occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two - year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature Y � SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House Addition ❑ Replacement Windows Alteration(s) n Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [EJ Siding [0] Other [O] Brief Description of Proposed Work:��w P €Q,14 cr ( �P -Lo- 0S-E<it ro N 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 addition to' existing housing, coniplete.the following: 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? Z " f. Method of heating? 4 tKDft.J 412 Fireplaces or Woodstoves ` Number of each 1 g. Energy Conservation Compliance. f Masscheck Energy Compliance form attached? h. Type of construction GA X14 Fns i. Is construction within 100 ft. of wetlands? _ Yes V No. Is construction within 100 yr. floodplain Yes No // 1 If j. Depth of basement or cellar floor below finished grade (D k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank r✓ City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 614 `L S L . J r M s t i #e- , as Owner of the subject property d hereby authorize d ittAk i` S iLetic to act on my behalf, in all matters relative to work authorized by this building permit application. . U..-- Signatu a of Owner Date , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner /Agent Date e T Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: '__. Rear Building Height Bldg. Square Footage Open Space Footage ° (Lot area minus bldg & paved parking) # of Parking Spaces - -- – —` Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW , , YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and /or Document #; 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 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 IF YES, describe size, type and location 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. a Department use only City of Northampton Statu4ibf Pew Building Department CtrbGuf/Drevvaaetmrt 212 Main Street werfse3#rcAvailab�tt €fir Room 100 1 ieriitife Avail tilty Northampton, MA 01060 Tw ets ofstrr/c iaF tans phone 413- 587 -1240 Fax 413- 587 -1272 PfotfSite Pians ;,;�' Oute S . v APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION Thie section to be completed by office 1.1 Property Address: l , �S S got/E. 114E4Oo1.) R d Map Lot Unit i' AR 2br LUQ9 Overlay District Elm St. District 4 CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: l�1QQL S GJE //G11 k�(l2/•t/ rLl�[d•c/� e,�, esi ST f r - 6/c[,D Name (Print) Current Mailing Address: doom rk L/ ' Telephone Si. ature 2.2 Authorized Agent: ■JetaRNS 1 8 t /H&c 4/r Anti g. bliftrne4),(44" Name (Print) , Current Mailing Address: / 3 -ZGS- 70 5' Signature i rr Telephone SECTION - STIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 1 7 1 0 d ado 2. Electrical (b) Estimated Total Cost of ✓? °5, D a o Construction from (6) 3. Plumbing O 0 Building Permit Fee 3 4. Mechanical (HVAC) 5. Fire Protection ?J' .5, d v 6. Total = (1 + 2 + 3 + 4 + 5) 3 D v v d a Check Number 3O "!4j 11; 5 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 4 File # BP- 2009 -0726 APPLICANT /CONTACT PERSON JAMES LAWRENCE ADDRESS/PHONE 85 MOUNTAIN ST HAYDENVILLE (413) 268 -7099 PROPERTY LOCATION 555 COLES MEADOW RD MAP 03 PARCEL 033 001 ZONE RR(100) / /RI /WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �j Fee Paid a U T f 30 6 Typeof Construction: CONSTRUCT 2 STORY SFH W /ATT GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 010092 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 Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay �; <,..�..., O 3 l d /0) 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 Office of Planning & Development for more information.