Loading...
30B-120 (5) 36. A request for Certificate of Compliance shall be accompanied by a comparison of invasive species occurrence on the site with baseline invasive species conditions during the growing season prior to mitigation. Tnvasivefspecies occurrence shall be seventy -five reduced following mitigation. 37. Further alteration within the mitigated.area is prohibited, except as may be required to maintain the area in its restored or mitigated condition. 41713811 ECAMPBBIBB1 =TER MARIANNE L. DOiw8Q8 ' :t•' • • • • { • • 28. Soils exposed for periods greater than two monthsshall be stabilized with erosion control blankets and netting, a covering of straw mulch, dea temporary cover of rye or other grass to prevent erosion and sedimentation. Drai`age ditches shall be stabilized and seeded with a native perennial grass mixture. AO stabilization materials such as jute netting shall be firmly anchored to prevent thern'from being washed from slopes by rain or flooding. Preference should be given to biodegradable materials. 29. 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. 30. 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 24 31. Ongoing conditions that shall not expire with the;` of a Certificate of Compliance are as follows: 34, 37 32. Upon completion of the work covered by this Orden, the applicant shall submit a written • request for a Certificate of Compliance. The wr ttOn request shall specify any ways that the completed project differs from the plans refeiericed in the Order. . • • 33. . The owner of the property described in this Ordermust advise any potential buyer of the property that any construction or alteration to said property, including brush cutting or clearance, may require approval by the Northampton Conservation Commission. Any instrument conveying any or all of the owners'' interest in said property or any portion thereof, shall contain language similar to tie'fdllowing: r "i" +tIF "This property is subject to the Northattipton Wetlands Protection Ordinance and /or Wetlands Protection.A.c't. Any construction or . maintenance work performed on this p;gperty requires an Order of • Conditions, and/or a Determination of Applicabi from the Northampton • Conservation Commission. � •, r�F's 34. Rain barrels to catch roof runoff will be installedat; ends of gutter downspouts, and will be shown to be in good working order priottbthe issuance of a certificate of compliance, and shall continue to be maintained ;following the certificate. 35. Prior to requesting the issuance of the Certificateof Compliance, the applicant shall demonstrate that improvements and mitigation in accordance with the NOT plan has been successfully completed for at least two growing'seasons. Unsuccessful plantings shall be replaced prior to the issuance of a Certificate. • • • "ATTACHMENT A" 20. 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 Orders. The applicant, and, his or her contractor, foreman and /or construction manager shall sign the letter of understanding. 21. Prior to the initiation of any work, the applicant shall submit to the Commission a sequencing plan for construction, and erosion and. sedimentation control-installation. • 22. Prior to the start of any site work, excavation or construction, a pre - construction conference shall be held on the site, between tine contractor conducting the work, the site /project engineer, the applicant, and a member agent of the Conservation Commission, in order to ensure that the requirements of this Order are understood by all • parties. Prior to the pre - construction meeting, all erosion control devices must be installed. 23. All required permits must be obtained from federal, „state and municipal agencies and departments prior to the start of any project. 24. A copy of this Order and associated plans shall remain on site during all construction and /or building activities. The project manager a Cl 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. ti. 25. All revised plans, referenced within this Order of Conditions, shall be approved by the Conservation Commission and incorporated into the permit by reference and shall be followed during the course of construction. 26. 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 inplace until such time as stabilization of • all areas that may impact resource areas is pennarent 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 anctresource areas, and maintained or reinforced as necessary. Erosion controls shall besjnspected after every rainfall to assure that maximum control has been provided. 27. • An adequate stockpile of erosion control materialsshall 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 befms or other devices planned for use during construction. ii • • Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246 - 0637 WPA Form 5 - Order of Conditions eDEP Transaction #:286360 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Iown:NORTITAMPTON • E. Signatures /.� This Order is valid for three years from the date of issuance, unless otherwise specified 1 (cg'r 43 D h � according to General Condition #4. If this is an Amended Order of Conditions, the Amended 1. Da of Original Order Order expires on the same date as the original Order of Conditions. (� Please indicate the number of members who will sign this form. This Order must be signed by 2. Number of Signers a majority of the Conservation Commission. The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A copy also must be mailed or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office, if not filing electronically, and the property owner, if different from applicant. • Signatures: E by hand delivery on IV by certified mail, retum receipt requested, on 0 /90/0 - Date Date F. Appeals The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject to this Order, 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 MassDEP Regional Office to issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and a completed Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Order. 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 Any appellants seeking to appeal the Department's Superseding Order associated with this appeal will be required to demonstrate prior participation in the review of this project. Previous participation in the permit proceeding means the submission of written information to the Conservation Commission prior to the close of the public hearing, requesting a Superseding Order, or providing written information ■ to the Department prior to issuance of a Superseding Order. The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act (M.G.L. c. 131, § 40), and is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Departrnent has no appellate jurisdiction. Page 9 of 10 * ELECTRONIC COPY r i r . • • Massachusetts Department of Environmental Protection Provided by MassDEP: \- 'ti - -• --. Bureau of Resource Protection - Wetland MassDEP File #:246 - 0637 V -_, WPA Form 5 - Order of Condition eoEP Transaction #:286360 City/Town:NORTHAM PTON t Massachusetts Wetlands Protection Act M.G.L. c. 131, § D. Findings Under Municipal Wetlands Bylaw or Ordinance 1 . Is a municipal wetlands bylaw or ordinance applicable? F Yes r No 2. The Conservation Commission hereby a. r DENIES the proposed work which cannot be conditioned to meet the standards set forth in a municipal ordinance or • bylaw specifically: 1. Municipal Ordinance or Bylaw 2. Citation Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order or Conditions is issued. b. F APPROVES the proposed work, subject to the following additional condition's. 1. Municipal Ordinance or Bylaw 2. CitationCHAPTER 337 OF THE NORTHAMPTON CODE OF REGULATIONS The Commission orders that all work shall be performed in accordance with'the following conditions and with the Notice of 3. Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the conditions shall control The special conditions relating to municipal ordinance or bylaw are as follows: PLEASE SEE 'ATTACHMENT A' • • • • Page 8 of 10 * ELECTRONIC COPY . • . . , Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands - ).,..., MassDEP File #:246-0637 eDEP Transaction #:286360 WPA Form 5 - Order of Conditions L ' Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 1 City/Town:NORTHAMPTON Page 7 of I I * ELECTRONIC COPY • Massachusetts Department of Environmental P>f•otection Provided by MassDEP: \ ` Bureau of Resource Protection - Wetlands MassDEP File #:246 - 0637 WPA Form 5 - Order of Conditions eDEP Transaction #:286360 City/Town:NORTHAMPTON • ( Massachusetts Wetlands Protection Act M.G L. c. 131, §40 responsibility for BMP maintenance. Prior to requesting a Certificate ofCompliance, or Partial Certificate of Compliance, the responsible party (defined in General Condition 19(e)) shall execute and submit to the issuing authority an Operation and Maintenance Compliance Statement ( "O &M Statement) for the Stormwater BMPs identifying the party responsible for implementing the stormwater BMP Operation and Maintenance Plan ( "O&M Plan ") and ceitifying the following 1.) the O&M Plan is complete and will be implemented upon receipt of the Certificate of Compliance, and ii.) the future responsible parties shall be notified in wilting of their ongoing legal responsibility to operate and maintain the stomnwater management BMPs and implement the Stormwater Pollution Prevention Plan. d) Post - construction pollution prevention and source control shall be implemented in accordance with the long -term pollution prevention plan section of the approved Stormwater Report and, if applicable, the Stormwater Pollution Prevention Plan required by the National Pollution Discharge Elimination System Multi- Sector General Permit. e) Unless and until another party accepts responsibility, the landowner, or owner of any drainage easement, assumes responsibility for maintaining each BMP. To overcome this presumption, the landowner of the property must submit to the issuing authority a legally binding agreement of record, acceptable to the issuing authority, evidencing that another entity has accepted responsibility for maintaining the BMP, and that the proposed responsible party shall be treated as a permittee for purposes of implementing the requirements of Conditions 18(f) through 18(k) with respect to that BMP. Any failure of the proposed responsible party to implement the requirements of Conditions: 18(0 through 18(k) with respect to that BMP shall be a violation of the Order of Conditions or Certificate of Compliance. In the case of stormwater BMPs that are serving more than one lot, the legally binding agreement shall also identify the lots that will be serviced by the stormwater BMPs. A plan and • easement deed that grants the responsible party access to perform the required operation and maintenance must be submitted along with the legally binding agreement. f) The responsible party shall operate and•maintain all stonnwater BMPs in 'accordance With the design plans, the O &M Plan, and the requirements of the Massachusetts Stormwater Handbook: ' • • g) The responsible party shall: 1. Maintain an operation and maintenance log for the last three (3) consecutive calendar years of inspections, repairs, maintenance and/or replacement of the stonmwater management system or any part thereof, and disposal (for disposal the log shall indicate the type of material and the disposal location); 2. Make the maintenance log available to MassDEP and the Conservation Commission ( "Commission ") upon request, and . 3. Allow members and agents of the MassDEP and the Commission to enter and inspect the site to evaluate and ensure that the responsible party is in compliance with the requirements for each BMP established in the O &M Plan approved by the issuing authority. h) All sediment or other contaminants removed from stormwater BMPs shall be disposed of in accordance with all applicable federal, state, and local laws and regulations. i) Illicit discharges to the stormwater management system as defined in.310 CMR 1 are prohibited. • j) The stomnwater management system approved in the Order of Conditions shall not be changed without the prior written approval of the issuing authority. k) Areas designated as qualifying pervious areas for the purpose of the hnipact Site Design Credit (as defined in the MassDEP Stomnwater Handbook, Volume 3, Chapter 1, Low Impact Development Site Design Credits) shall not be altered without the prior written approval of the issuing authority. I) Access for maintenance, repair, and/or replacement of BMPs shall' not be withheld. Any fencing constructed around stomnwater BMPs shall include access gates and shall be at least si* inches above grade to allow for wildlife passage. Special Conditions: • Page 6 of 10 * ELECTRONIC COPY • • _ l • Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246 -0637 � WPA Form 5 - Order of Conditions eDEP Transaction #:286360 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Ciry/iown:NORTHAMPTON 10. A sign shall be displayed at the site not less then two square feet or more than three square feet in size beating the words, " Massachusetts Department of Environmental Protection" [or 'MassDEP"] "File Number : "246 -0637 11. Where the Department of Environmental Protection is requested to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before Mass DEP. 12. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Forum 8A) to the Conservation Commission. • 13. The work shall conform to the plans and special conditions referenced in this order. 14. Any change to the plans identified in Condition #13 above shall require the applicant to inquire of the Conservation Commission in wilting whether the change is significant enough to require the filing of anew Notice of Intent. 15. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that evaluation. . • 16. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and • to any contractor or other person performing work conditioned by this Order. 17. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. • 18. All sedimentation baniers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or water• body. During construction, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or darnage prevention controls it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. • NOTICE OF STOMRWATER CONTROL AND MAINTENANCE REQUIMENTS • 19. All work associated with this Order is (1) E is not (2) P subject to the Massachusetts Stonnwater Policy Standards. If the work is subject to Stonnwater Standards, then the project is subject to the following conditions a) All work, including site preparation, land disturbance, construction and redevelopment, shall be implemented in accordance with the construction period pollution prevention and erosion and sedimentation control plan and, if applicable, the Stonnwater Pollution Prevention Plan required by the National PollutionDischarge Elimination System Construction General Permit as required by Stonnwater Condition 8. Construction period erosion, sedimentation and pollution control measures and best management practices (BM Ps) shall remain in place until the site. is fully stabilized. b) No stonnwater runoff may be discharged to the post- construction stomiwater BMPs unless and until a Registered Professional Engineer provides a Certification that i. all constnrction period BMPs have been removed or will be removed by a date certain specified in the Certification. For any construction period BMPs intended to be converted to post construction operation for stormwater attenuation, recharge, and/or treatment, the conversion is allowed by the MassDEP Stomiwater . Handbook BMP specifications and that the BMP has been properly cleaned or prepared for post construction operation, including removal of all construction period sediment trapped in inlet and outlet control structures; ii. as -built final construction BMP plans are included, signed and stamped by a Registered Professional. Engineer, certifying the site is fully stabilized; iii. • any illicit discharges to the stomiwater management system have been removed, as per the requirements of Stonnwater Standard 10; iv. all post - construction stonnwater BMPs are installed in accordance with the plans (including all planting plans) approved by the issuing authority, and have been inspected to ensure that they are not damaged and that they are in proper working condition; v. any vegetation associated with post - construction BMPs is suitably established to withstand erosion. c) The landowner is responsible for BMP maintenance until the issuing authority is notified that another panty has legally assumed • Page 5 of 10 * ELECTRONIC COPY • • • • • • • Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246 - 0637 �,.. WPA Form 5 - Order of Conditions eDEP Transaction #:286360 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 • 21. fl Land Subject to Coastal Storm Flowage . a. square feet b. square feet 22. F Restoration/Enhancement (For Approvals Only) , If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has been entered in Section B.2.b or B.3.h above, please entered the additional amount here. 1800 23. r Streams Crossing(s) If the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings. a. number of new stream crossings b. number of replacement stream crossings C. General Conditions Under Massachusetts. Wetlands Protection Act • The following conditions are only applicable to Approved projects • 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. • 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. • 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: • a. the work is a maintenance dredging project as provided for in the Act; or b. the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years, the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the 'issuing authority at least 30 days prior to the expiration date of the Order. 6. If this Order constitutes an Amended Order of Conditions, this Amended Order of Conditions does not exceed the issuance date of the original Final Order of Conditions. 7. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refirse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe; tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 8. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 9. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. in the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of the registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall be submitted to this Conservation Commission on the form at the end of this Order, which font must be stamped by the Registry of Deeds, prior to the commencement of work.. Page 4 of 10 * ELECTRONIC COPY • • Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246 -0637 V. WPA Form 5 - Order of Conditions eDEP Transaction #186360 , Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 CitylTown:NORTHAMPTON Cubic Feed Flood Storage e. cubic feet . f. cubic feet g. cubic feet h. cubic feet 8. E isolated Land Subject to Flooding a. square feet b. square feet Cubic Feed Flood S torage c. cubic feet d. cubic feet e. cubic feet f. cubic feet 9. F Riverfront Area 686 686 a. total sq. feet b. total sq. feet Sq ft within 100 ft 0 0 c. square feet d. square feet e. square feet f. square feet Sq ft between 100 -200ft 686 686 • g. square feet h. square feet i. square feet j. square feet Coastal Resource Area Impacts: Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement 10. E Designated Port Areas Indicate sire under Land Under the Ocean, below 11. I Land Under the Ocean a. square feet b. square feet c. c/y dredged d. c/y dredged 12. I Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below 13. E Coastal Beaches a. square feet b. square feet c. c!y nourishmt d. c/y nourishmt. 14. E Coastal Dunes a. square feet b. square feet c. c/y nourishmt. d. c/y nourishmt. 15. E Coastal Banks a. linear feet b.. I inear feet 16. I Rocky Intertidal Shores a. square feet b. square feet 17. E Salt Marshes a. square feet b. square feet c. square feet d. square feet 18. E Land Under Salt Ponds a. square feet b. square feet c. c/y dredged d. c/y dredged 19. E Land Containing Shellfish a. square feet b. square feet c. square feet d. square feet ' Indicate size under Coastal Banks, inland Bank, Land Under the 20. r Fish Runs Ocean, and/or inland Land Under Waterbodies and Waterways, above c. c/y dredged d. c/y dredged Page 3 of 10 * ELECTRONIC COPY • Massachusetts Department of Environmental Protection Provided by MassDEP: ^ - - --- Bureau of Resource Protection - Wetlands MassDEP File #:246 - 0637 �:. WPA Form 5 - Order of Conditions eDEP Transaction #:286360 i Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Town:NORTHAMPTON Response to DEP New England Karro Frost 1/22/10 NA Comments Environmental B.Findings 1.Findings pursuant to the Massachusetts Wetlands Protection Act Following the review of the the above- referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply: a. F Public Water Supply b. P Land Containing Shellfish c. F Prevention of Pollution d. F Private Water Supply e. F Fisheries f. F Protection of Wildlife Habitat g. F Ground Water Supply h. F Storm Damage Prevention i. F Flood Control 2.Commission hereby finds the project, as proposed, is: , ; Approvedsubject to: a. F The following conditions which are necessary in accordance with the performance standards set forth in the wetlands regulations. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall control. Denied because: b. (— The proposed work cannot be conditioned to meet the pefommance standards set forth in the wetland regulations. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect the Aces interests of the Act, and a final Order of Conditions is issued. A description of the performance standards which the proposed work cannot meet is attached to this Order. c. r The infomnation submitted by the applicant is not sufficient to describe the site, the work or the effect of thework on the inter cats identified in the Wetlands Protection Act. Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued. A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). Inland Resource Area Impacts:(select for Approvals): • 3. E Buffer Zone Impacts: Shortest distance between limit of project disturbance and Bank or a. linear feet Bordering Vegetated Weltand boundary • Resource Area Proposed Permitted Proposed Permitted Alteration • Alteration Replacement Replacement • 4. E Bank • a. linear feet b. linear feet c. linear feet d. linear feet 5. E Bordering Vegetated Wetland a. square feet b. square feet c. square feet d. square feet 6. r Land under Waterbodies and Waterways a. square feet b. square feet c. square feet d. square feet e. c/y.dredged f. c/y dredged 7. E Bordering Land Subject to Flooding a. square feet b. square feet c. square feet d. square feet ' Page 2 of 10 * ELECTRONIC COPY • • gilt NI1 „ , Bk: 10098Pg: 311 Page: 1 of 12 Reoorded: 02/09/2010 01:00 PM • • • • Massachusetts Department of Environmental Protection Provided by MassDEP: `� -- Bureau of Resource Protection - Wetlands MassDEP File #:246 - 0637 • WPA Form 5 - Order of Conditions eDEP Transaction #:286360 City/Town:NORTHAMPTON 4 . Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A.General Information • 1: Conservation Commission NORTHAMPTON 2. Issuance a. F OOC b. E Amended OOC 3. Applicant Details a. First Name HEATHER b. Last Name WARK c. Organization d. Mailing Address 56 OLD STAGE ROAD e. City/Town HATFIELD f. State MA g. Zip Code 01038 4. Property Owner • a. First Name JOAN b. Last Name • WEIGELE c. Organization d. Mailing Address 145 VERNON STREET e. Cityffown NORTHAMPTON f. State MA g. Zip Code 01060 5. Project Location • a.Street Address 145 VERNON STREET b.City/Town NORTHAMPTON c. Zip Code 01060 c. Assessors Map/Plat Number 30B d. Parcel /Lot# 120 e. Latitude 42.31934N f. Longitude 72.65333W (e.g. 42.355767) (e.g. 71.060996) 6.Property recorded at the .Registry of Deed for: a. County b. Certificate • c. Book d. Page HAMPSHIRE 8724 210 7.Dates a. Date NOI Filed 12/30/2009 b. Date Public Hearing Closed 1/28/2010 c. Date Of Issuance 1/29/2010 8.Final Approved Plans and Other Documents a. Plan Title: b. Plan Prepared by: c. Plan Signed/Stamped by: d. Revised Final Date: e. Scale: • WARK RESIDENCE • TWO -STORY .INTEGRITY HSBF 12/18/09 1 " =15' ADDITION - NOTICE OF INTENT NEW ENGLAND 1/22/10 1"-=20' OVERALL PLAN ENVIRONMENTAL jj O Page 1 of 11 * ELECTRONIC COPY 1'1 1 .� ' I) \Ia..achu.ctt. - Ucltartmcnt or Puhlic'arct� I.,,ristructJon 0), B u lrtl of Building Re�2 tti,rn. nd Standard. License: CS 66104 Restricted to: 00 KENT S HICKS PO BOX 119 1 WORTHINGTON, MA 01098 Expiration: 1/12/2012 uI111111 Tr #: 15958 Eyite IP OP / 4 i - '.v 2T Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 120757 Type: Individual Expiration: 2/28/2012 Tr# 292223 KENT S HICKS KENT HICKS - - - -- -- —_ __ - -- -- - - - - -- - - - - -- PO BOX 119 -- — — WORTHINGTON, MA 01098 — — Update Address and return card. Mark reason for change. El Address [I Renewal P1 Employment L1 Lost Card DPS -CAI Ca 50M- 04/04- G101216 0 3 {oo m7nvnafea/ 1X r . /474.14 , 4 ee s Office of Consumer Affairs & Business Regulation License or registration valid for individul use only before the expiration date. If found return to HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 120757 10 Park Plaza - Suite 5170 Expiration: 2/28/2012 Tr# 292223 Boston, MA 02116 Type: Individual KENT S HICKS KENT HICKS 187 RIDGE RD. WORTHINGTON, MA 01098 Undersecretary Not valid without signature ' r The Commonwealth of Massachusetts � ! _ ' Department of Industrial Accidents ,� 7-7 Office of Investigations ! E 1 "i - 600 Washington Street ' ~ - Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information L li�� Please Print Legibly Name ( Business /Organization/Individual): K h i � !` Address: ! ' 0. *ea x ') City /State /Zip: G✓ i 7 4/;,/z.< / Phone #: V/ .3 2 1 ®, 0 -' 3 Are you an employer? Check the appropriate box: Type of project (required): 1. 0 I am a employer with / 4. ❑ I am a general contractor and 1 employees (full and/or part- time).* have hired the sub - contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in aci employees and have workers' g any capacity. 9. Q$uilding 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. ❑ 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. 1' 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. 7 Insurance Company Name: � r '� A 7e. 5 /� i — 4 G G Policy # or Self -ins. Lic. #: Z. Z 1 7 2 // 7 Expiration Date: 1-7 6S ° -2 en .-- d Job Site Address: / 1 . e ., S /.. City /State /Zip: ��� i'�, „ i'` nr6eo 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 un er thepai s andpenalties of perjury that the information provided above is true and correct. 7,1 Signature: Date: OT_ 1 / w Phone #: ' 3 r 2 "7 4 , 4) l 3 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 #: f ' • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Su ervisor: [� Not Applicable ❑ Name of License Holder : Construction F / r �C /J ` 4:C /1) I ,hh License Number Pe® '7 > 7Z -2a / 2-- Address Expiration Date Signature Telephone /1/ ��� - - e/7 -3 9. Registered Home Improvement Contractor: Not Applicable ❑ w-,As /z© ) 7 Company Name Registration Number f, 9, £ '2 Address // �j Expiration Date Wt f �E f rG� Telephone -03-29Z- z o/ _ 2 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 -near 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 C] Addition Replacement Windows Alteration(s) ©r Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [p Siding [0] Other [0] Brief Description of � Proposed / Work: fir -1 y- .. Y r 1`" n ,/,,t; e , to= 7 / �. /l ' a A Alteration of existing bedroom Yes /--- No Adding new bedroo — Yes No Attached Narrative Renovating unfinished basement Yes — No Plans Attached Roll - Sheet 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 unit: 7 Number of Bathrooms ` c. Is there a garage attached? iv b l d. Proposed Square footage of new construction. 6 d / Dimensions 2 >e 2 e. Number of stories? f. Method of heating? Z L, S Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction r /o.,GA*G iG 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" - - r ' k. Will building conform to the Building and Zoning regulations? f Yes No . I. Septic Tank City Sewer 17 Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, _ y W c -✓- ki vv IA , as Owner of the subject property hereby authorize x V. -Pc -'In i Hi C k S to act on my behalf, in all matters relative to work authorized by this building p- rmi)' application. Signature of Owner Date 1, e ,�, T / -' t /b , 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 and r the pains and penalties of perjury. Print Name Y- Z--P /7,4-- _— Signature 6f Owner /Agent Date • r 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 / ‘2/ /2 Frontage 9 r 2? J Setbacks Front Side Lit) ; R> jr L:/')R:/t'? Rear /w 42 2 Building Height Bldg. Square Footage /;6 ©3 U % /C 79% Open Space Footage o (Lot area minus bldg & paved parking) it of Parking Spaces ' Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Er DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q 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 ® DONT KNOW ® YES er 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 ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® 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 ® NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • , r Department use only C of Northampton Status of Permit: (. U� Buil 'ng Department Curb Cut/Driveway Permit 12 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413- 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans 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 Map Lot Unit j J/ Zone Overlay District P/s (� t b c S f - !(/ /, JA-14- Elm St. District CB District r � SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: / ( L HZ. ldVt e t 6 C( e 1 % VO ∎kit v` M t\ o i O3 Name (Print) Curre ailing Addres III . 5 WAf kitilAck -(14 L''J 1 v� e'J t1 ( (CI v„, A Telephone Signature 2.2 Authorized Agent: _ Name (P nt) Current Mailing Address: Si ature 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 ;',. c Poi/ 1044: Dom 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 7123, �U - 6. Total = (1 + 2 + 3 + 4 + 5) / e 496 Check Number /t221 / This Section For Official Use Only / Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0997 APPLICANT /CONTACT PERSON KENT HICKS ADDRESS /PHONE P 0 BOX 57 WEST CHESTERFIELD (413) 329 -4788 Q PROPERTY LOCATION 145 VERNON ST MAP 30B PARCEL 120 001 ZONE RR/URA(100) / /FFR/WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid /d c ) er"l Typeof Construction: FOUNDATION FOR REAR ADDITION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 66104 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IIWMATION PRESENTED: rr Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER: § -:? CL ili j fr .! r.T - ` UC Intermediate Project: Site Plan AND /OR Special Permit With Site Plan cam ?( Major Project: Site Plan AND /OR Special Permit With Site Plan h-1 r ZONING BOARD PERMIT REQUIRED UNDER: § f 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 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. - I 1 145 VERNON ST BP- 2010 -0997 GIS #: COMMONWEALTH OF MASSACHUSETTS 30B 120 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0997 Project # JS- 2010 - 001464 Est. Cost: $18000.00 Fee: $134.40 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KENT HICKS 66104 Lot Size(sq. ft): 16465.68 Owner: WARK HEATHER & WILLIAM WHITCOMB Zoning: RR/URA(100) //FFR/WP Applicant: KENT HICKS AT: 145 VERNON ST Applicant Address: Phone: Insurance: P O BOX 57 (413) 329 -4788 0 WC WEST CHESTERFIELDMA01084 ISSUED ON:5/13/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: FOUNDATION FOR REAR ADDITION 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 5/13/2010 0:00:00 $134.40 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo i ZNSPEC ION , P ICA 1K75FS ONLY AND DOFS CO A 1 .__.t1Y. : __ET 1 14 41 RI vse . 4 5r'+``� v • F • j . .i a ii ). . i _ ...-............._.., i . , ■ 1. • f k.,,, . •1 • G,ARR E • Si I U . 1 1 1 . - i / • ' 1 2fz slaty 1 � • W i wl> , ;; NoisE L ` . I 1 i ti / • ii 0 Vi • 1 • .1' lE sou_ R C E ODgi t[ORTCA06 SERVICES CORP. ANDTIIE •• '1 I,AWt6R6 TITLE INS. CORP. -ONLX To tits hest of sry kormici e. information am:11 4ef, i hereby report dot 1Imr* usmieal the poacher asd that tiw iosponion pia -Moog d lmpvowrutotor improemast Wiesned on the premises dnrn'6ed, that ibe imp.erement or imp•e•ematn era entirety 'whistler Rom that time ere no essamisnsrte span the premiss &frothed by the iassmm enl or improvements of sny edp»Sers passim, and tint thus sot: sip nttna afsaord Antos the !rest sbavo hereon, uotpt as rbo,rn. 1 friths repots des Sim rentio4 intro on stir plan is nM looted "id11n s Shod Haul Arm u shown on i • Stikirietet of N.U.D Moil lmsmnesAdroinistramion M pq 250167 OQOSA Htiltidation DM APR3L + ■ • j 1 y • • HUNTLEY , (1- o wxEx =In C. EIKE 1. d ALMTiR IIUNTLAY, JIG dr ASSOCIATES. INC. a i%401 t Surveyors • E4t atera • Landscape AISIIII[CL! `,� s2 Loa N 143 VERNON ST, EXTENS trOITUAHPTON 701sdwtrYal ArirePas! . "- = r �Gr Noilhamprtw, MA 01061 ° /3 - 44-7 ' ((- ! .' f_ S3 • + mire 013134144i (at (413) Sd6•51134 - JOE NO. DATE • } SCALE i 1• • • t - - ,T.a+N, rr+.,�.. r� r nom.. � I W.' �� y " $~ �, .. " fi t Y�, -/•. } I D . --el' ., . or, ---..i.: —; 0 . ',;: ' , . :.: 7 1 -- . --,, :- , , ,...-... ;.. . 4 '. • * - ' : ' ' Z ' 4 ' 16: :4•4 0 , ".■ ... 1 ; : " ; ' .. ', .1 ; {-?/1,.. / . C I ; • 0 .3*. ° - ' cam ; A ,k v ..? tR e : • Oil • • J 1241 ,41 : • ®.d d4 --- 96E• '` £ :.• 6 61. } t _ i . : ' � ' •�.j •V;....� .nom 1 Sy l ►►11 VV _':� • ti 1 ' {`: f t 0 _ ` _ 4 . , : -•,..;----• , . : : • • • • "••-•---- - • ._....,_.- .--- I.- , ••-.�.. ..s 4 rr.r. w...-+.r � » .<..i..a :........+ai.' w..+yr I — si. . - -,1 ,,,,,- ...."-... «11-77-- 71... 77 - V.J. i' , Plan 11. Add addition to rear of house. There is a small extension currently on the back of the house (126 square feet) which would be replaced by a larger extension (390 square feet, or 15x26), for a total increase of 264 square feet. This would be a two -story addition. New open space calculation: 1821 / 16485 = 11%. ! it'l `z4 j= i ? 1 ra I G x ,� Nww ix-r i 10 a _ J <-^ Z3 ---_ . i? 73-- \ \< I y 1 ,..) 1 \ f'''''''' \ ./". \fry" rs= r Do a ny signs exist on the property? YES NO v I F YES, describe size, type and location: Are there any proposed changes to or additions of signs intended for the property? YES NO L— IF YES, describe size, type and location: 11. Will the construction activity di (clearing, ading, excavation, or over 1 re or is it part of a common plan of development that will disturb over 1 ac re gr ? YES fitting) NO IF YES, then a Northampton Storm Wate sturb Managem Permit from the DPW is requ ired. 12. ALL INFORMATION MU ST BE COMPLETED, or PERMIT CA BE DENIED DUE TO LACK OF INFORMATION This colum reserv for use by th e Build Depa rtmen t EXIS TING PROPOSED ItE{ Y = =NINA B i6 is , .SCE i ; ....„"„..,_,,, ,,,,__,..,,„_„......_,.„,,,..,._, ,. _ Lot size ( Frontage / (� Setbacks Front / �-F Side L: ( - R: Z 3 ' L : R: L. R. Rear '� - 1� Spa - Building Height Square Footage Building S ua %O pen Space: (lot area sf, /613- / 4 >c minus building a paved j' } 7'� -I, i '' parking # of Park Spaces # of Loading Docks Fill: (volume i3 location) M 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Date: 7/ ��r' Applicant- 's-:� //,,.1' NOTE: Issu o a zoning permit doe! not relieve an applicants bu to comply wi all zon requirements and ob all required permits from the Board of rden Health, Conservat Co mm i ssion, Historic and Architectural Boards, Departme of Public Works and other applica p ermit granting authorities. W:\I)octunents \FORMS \original\Buil ding- Inspector\Zoning- Permit- APPlicatian- passive.doc 8/4 2004 2009 ° : File No. 41, 97 ~ � t r . ,L - iri �� r- 1 ry 0VO '.. Please;type or pritaZll ' ormation and return this form to the Building Inspeetnr's Office wit a 15 filing fee (check or money order) payable to the City of Northampton 1. Name of Applicant: 4,4 % ' F-G il)IV : CUI J' o so r U / 974-I Address: 7' L VII as" G , 0 /0 6 0 Telephone: 'Lit 3 °CI - 06 go 2. Owner of Property: JO Address: Al /i / Telephone: fb g,v r/44- 3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) Pvrzc t 5J-!K 4. Job Location: / t/N &V J > � x MtAu 4' lr 4 4kr { M , - v ei a S S y # x,. as u 1 w x S' � a i ha 8 t _ t � a �c, �. #- ' 9 - i ff ` �.{.� a • } � ..� �.: �__. .... ilia ..._ # xr... _E' . _. .... .. . ' , . ., - ., ... _ .. , 5. Existing Use of Structure /Property: /' HI 6 L ', J U L 2 2 2009 6. Description of Proposed Use /Work/Project /Occupation: (Use additional sheets # nec pt �, r. „ 1 >+ c ; 0liS QING Rl" r'C '1 S F i t3z4.F 7.5. 7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed 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 1� IF YES, has a permit been or- need- to-'be- obtained - "'from- the - Conservation- Commission? Needs to be obtained i Obtained , date issued: (Form Continues On Other Side) W:\Documents\ FORMS \original\ Building - Inspector\ Zoning- Permit - Application- passive.doc 8/4 /2004 r File # MP- 2010 -0007 RCA"( 0 C APPLICANT /CONTACT PERSON MATTHEW SKELTON ADDRESS/PHONE 71 DRYADS GREEN (413) 584 -0680 0 PROPERTY °' i -= •• g 3. . i ,. 5 :: Ax ; 0, SL 4' ' p ' , fi; ; THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filed out Fee Paid Typeof Construction: ADD ADDITION TO REAR OF HOUSE 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 F LLOWING 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 Co ' sion Permit DPW Storm Water Ma • gement L Z 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.