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38B-183 (4)
\/0 507d v Utility pole Fort Street Existing curb cut Existing curb cut -. �. -. 140„ 50, r 13,� ye.. won .m 0;r aaal G 23 (.......------ i 1 Front Set Back 20' -0" r 1 or."/„. 1 1 1 24 ■ 10 .,E > 35 ' _ 6 ., House Foot Print 2,595 G.S.F. i o q c m m It J r11 _ T ti cn O3 do a m cr) a 1 • - i - • Back Set Back 20 -0" 111 1 21,0" 1 I ! • 0 5' 10' 20' NI& 27 Fort Street Northampton, Mass Two curb cut driveway schematic 4 / 20 / 2012 Summit Ridge Design - j Josiah �Simpson r p ,' MUNICIPAL SEWER/ AVAILABILITY APPLICATION Northampton Streets Department 125 Locust Street Northampton, MA 01060 587 -1570 A Department of Public Works Trench Permit and Sewer Entry Permit shall be required prior to any construction or connection activity associated with this application. Location: 27 Fort Street, Northampton Inquiry Made By: Jim Locke 413 - 301 -3125 Date of Inquiry: 4/5/12 Reason for Building new house on this existing lot Request: Municipal Sewer Main in Front of Location: Yes X No Municipal Storm Drain Available: 5'/2 deep Yes No Size of Sewer Main: r i , ' Material: C LAY Age: / 89 O Depth of Sewer Main: , c - — T 7 - Size of Service Connection: L) Al iii r w"I . Type of Service Connection: Tie -in to Sanitary Main Tie -in to Sanitary Stub X. Comments: t / LC_ R ..1 =;er: (,vA/E % /NC' l C) Ex i S ,AJ& /�IJu ,56- V /('6' Note: If this availibility is for new construction, this form must be hand delivered to Building Inspector. A corresponding "sewer entrance fee" shall be paid prior to making any connection to the municipal sewer system. Arrangements of such installation shall be made with the Northampton Streets Department with a minimum of 5 working days notification. All work shall conform to Northampton Streets Department specifications. a . u) /f John Hall Sewer Department cc: Ned Huntley, Director DPW Louis Hasbrouck, Building Commissioner o MUNICIPAL WATER AVAILABILITY APPLICATION Northampton Water Department 237 Prospect St. Northampton, MA 01060 587 -1097 A Department of Public Works Trench Permit shall be required prior to any construction or connection activity associated with this application. Location: 27 Fort Street, Northampton ( Existing lot, putting up new house ) Inquiry Made By: Jim Locke 413 - 301 -3125 Date of Inquiry: 4/5/12 Number of Type of Single Family Apart. Type of Private X Units: 1 Unit(s): Multi- family Ownership: Condo Rental (Applicant to fill out the above) Municipal Water Main in Existing service to Front of Location? Yes: x No: site. __ Yes: x No Size of Water Main: 8" Material: Ductile Iron Age: 1978 Approximate Static Street Flow Test Conducted: Yes: No: X Pressure: 110 If done attach results Size of Service Connection 3/4" Suggested Meter Size: 5/8" Comments: The Water Department cannot guarantee adequate water pressure during peak demand times at elevations above 320 feet. • A corresponding water entrance fee shall be paid prior to making any connection to the municipal water system. • Arran ements of such install. • e all be made with the Northampton Water Department with a minimum o 5 w d not atio ' . • All rks all co ays • ! .rth ton Water Department specifications. i David W. Sparks, Superintendent of Water Dept. Water Entry$ N/A Meter $100.00 Radio $100.00 cc: Ned Huntley, Director cc: Louis Hasbrouck, Building Commissioner Note: If this availability is for a new construction, it must be hand delivered to the Building Inspector. RECEIVED 04/23/2012 08:49 4132680354 GOUGEON &LOCKE 4/23/2012 8:30 AM FROM: Berkshire Insurance Berkshire Insurance TO: 814132680354 PAGE: 001 OF 001 ACO CERTIFICATE OF LIABILITY INSURANCE Y) 4/23/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Maureen Cormier NAME: Berkshire Insurance Group, Inc. (n o, Extl; (413) 773 -9913 (AIC No): (413)774 -3372 117 Main St. An mcormier @berkshireinsurancegroup.com INSURER(S) AFFORDING COVERAGE NAIC • Greenfield MA 01301 INSURER A :NEM Insurance Company 14788 INSURED INSURER B Associated Employers Insurance Jeffrey Gougeon & James Locke INSURERC: dba Gougeon & Locke INSURER D : 26 South Street INSURERE: Williamsburg MA 01096 INSURERF: COVERAGES CERTIFICATE NUMBER:11GL ,WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 5O 000 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 50,000 CLAIMS -MADE I X OCCUR 8(5338015 6/1/2011 6/1/2012 MED EXP Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 5 i POLICY PI n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accitlentt �_ _ ANY AUTO BODILY INJURY (Per person) $ — ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ _ AUTOS — AUTOS HIRED AUTOS A UTOS IED (Per accident) GE _ � AUTOS ) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED 1 1 RETENTION $ $ B WORKERS COMPENSATION IT A T U -I I° R AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNERIEXECUTIVE I Y 1 N N E.L. EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? 09644012011 12/6/2011 12/6/2012 {Mandatory In NH) A 7CC50 E . DISEASE - EA EMPLOYEE $ 100,000 If yes. describe under DESCRIPTION OF OPERATIONS below E . DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Job site: 27 Fort St., Northampton, MA 01060 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Kiki Smith & Charles Cohn 226 Cooper Lane Shelburne, MA. 01370 AUTHORIZED REPRESENTATIVE Maureen Cormier /MPC ACORD 25 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �� y Not Applicable 0 J Name of License Holder : r r• L 6 e Yom^ 1 N q License Number 2 4 Sd U Nil sr toi i/fr t6 ,cry– t Z -5 - )3 Address Expiration Date te4 -� �-� - q 3 Z 3 1-4 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ l=0 U r'-el w - LC 1 017 2-12q Company Name Registration Number 5 � y k NA-0466 i/7& - /14,x-- b -I Z -- l 7-- Address Expiration Date Telephone 2 C - Z✓ 2-3 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 ❑ 11. - Home Owner Exemption 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) El Roofing 0 Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E] Siding [0] Other [It( Brief Descriptio of Proposed / •�+ Work: F 'it A. 4 P v l''t V l 'L. o I Alteration of existing bedroom Yes V No Adding new bedroom Yes No Attached Narrative 'j Renovating unfinished basement Yes No Plans Attached Roll Shee / 3 s ry 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family ✓ Two Family Other b. Number of rooms in each family 1. Number of Bathrooms 2 " 2- C. Is there a garage attached? l li..S d. Proposed Square footage of new construction. F / `./` ' 1 5 Dimensions Z 1 ZI X �� + ,012.- e. Number of stories? (Air f e"tvt- f. Method of heating? a/ /. iir _ ireplaces or oodstoves f Number of -- e }� a , ch g. Energy Conservation Compliance. WV 14; 1(.(, ' Masscheck Energy Compliance form attached? L4 2tZ i f 'it(t. h. Type of construction f dnAkt--- i. Is construction within 100 ft. of wetlands? Yes V Is construction within 100 yr. floodplain Yes V No j. Depth of basement or cellar floor below finished grade g f k. Will building conform to the Building and Zoning regulations? Yes No . , I. Septic Tank City Sewer ✓ Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT � O � R CONTRACTOR APPLIES FOR BUILDING PERMIT I, 0 ' /(' ! / e i21 (L H Si / ( (r , as Owner of the subject property hereby authorize to act on be If, in all matters relative to work authorized by this building permit application. _./(,, 1 81U,G02_ c --- ) b ,i( ),/ ( ,Cf (> 9 0 1, 2 --- Signatur Owner Date I, JA-144.'s Lp C , as Owner(Authorize ge ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. I Signed under the pains and penalties of perjury. js4/1 Ls Cif . Print Name ocre, 17-C/7-0 1 2/ Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information (� • R� Existin Pro Required by Zonit s e This column to be fine $ iC pQ n V t Building Department Lot Size VV t 6 11, /�� q`s fit' 0 Frontage Setbacks Front Side L: R: L: R: Rear Z ) Building Height Bldg. Square Footage % s5 (4 te, Open Space Footage % )&111 cs G�/ (Lot area minus bldg & paved o parking) # of Parking Spaces Fill: �1 (volume & Location) A. Has a Special Permit /Variance /Findin ver been issued for /on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Re • try of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO e 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: C. Do any signs exist on the property? YES 0 NO 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: E. Will the construction activity disturb (clearing, grading, ex vation, 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. Department use only ? -- b r i E C E (�� City of Northampton Status of Permit_ Building Department Curb Cut/Driveway Permit • as 2012 212 Main Street Sewer/SepticAvailability Room 100 Water/Well Availability N rthampton, MA 01060 Two Sets of Structural Plans DEPT. OF B INb NORTHAMPTON, MA 41- 587 -1240 Fax 413- 587 -1272 Plot/Site Plans P70 Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office L Cr. Map Lot Unit (N (f' r ftt af Zone Overlay District t / `, %fi -101/1 ij -4,1( Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHO AGENT 2.1 Owner of Record: ( f & , 4 (L (171 72 .-,'' &cLth(b4»tr Name (Pnpf) Current Mailing Address: ,� 0 VOW) � (� 1 N---- Tele phone 113 6 Signature 2.2 Authorized Agent: ,)y4.144 -S i cr--r- , cS '( & , UY . BLS I (42— Name (Print) Current Mailing Address: I t )4 `' /\!'Z' CA____ Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant )-(1.4 1. Building r (i 1 , 5 v'f? (a) Building Permit Fee 2. Electrical t (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection ��, 6. Total = (1 + 2 + 3 + 4 + 5) 0 r .S 0 • Check Number tram This Section For Official Use Only Building Permit Number: Date g Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0927 Ott/ • APPLICANT /CONTACT PERSON GOUGEON & LOCKE ADDRESS/PHONE 26 South Street WILLIAMSBURG (413) 268 -9323 '479det7v.r-41”1112Adj PROPERTY LOCATION 27 FORT ST MAP 38B PARCEL 183 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 1 ga e7 Typeof Construction: FOUNDATION ONLY - SFH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 001992 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF • PRESENTED: Approved Additional permits required (see below) GAT . ►� Q N , y 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 9 /- 7-- 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 Office of Planning & Development for more information. 27 FORT ST BP- 2012 -0927 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B - 183 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Zoning Permit BUILDING PERMIT Permit # BP- 2012 -0927 Project # JS- 2012- 001508 Est. Cost: $39500.00 Fee: $519.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GOUGEON & LOCKE 001992 Lot Size(sq. ft.): 14069.88 Owner: ANDREWS ROBERT G & BESSIE 0 C/O CHARLES M COHN Zoning: URB(100)/ Applicant: GOUGEON & LOCKE AT: 27 FORT ST Applicant Address: Phone: Insurance: 26 South Street (413) 268 -9323 Workers Compensation WILLIAMSBURGMA01096 - 9726 ISSUED ON:4/30/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: FOU N DATI ON ONLY - SFH 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 4/30/2012 0:00:00 $519.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner