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35-302 (3)
b4 t PLANNING AND DEVELOPMENT • CITY OF NORTHAMPTON � , � planning • conservation •zoning • northampton C15 • historic • community preservation • central business architecture �l {.l 3 -x.,87 -1266 March 10, 2010 John Zieminski 8 Woodridge Circle Hatfield MA, 01038 RE: Proposed deck, Map /Lot 35 -302; 8o Woodland Drive Dear Mr. Zieminski: Thank you for contacting the Conservation Commission regarding the proposed deck extension on Woodland Drive, within the loo foot buffer zone. As described, the deck is between the 50 and loo foot buffer zone, and is and is not subject to the Conservation Commission's jurisdiction, as a minor activity under 310 CMR 10.o2(2)(b)1. Erosion and sedimentation controls are required during construction. Please feel free to contact me with any questions or concerns. Thank you, 6 v Sa •ah LaValley Conservation, Prese n and Land Use Planner cit 1 la11 • 27.0 Main Street, Room 11 • Northampton, MA 01060 • www.Northempton.N1a.gov • Fax 413- 587-1264 o printed on receded paper e AillIllNIMIIIIIIIIIIIIIIIIIIr I ;4-ilgri „,—, ....2 e. ' 4 , , c 1 ,o 0_4 S''ti, ,3 7 Pe .7 <- r-f,g 2 . , 4) el \-__ ___---- -9 ri i'',. 1 .S7e-- ell I ...v e ; ,,,,,# 3,-- -.?- •,;) .,/ / CN , 3 .le—lf,l.."r- 7 ' N 1 C\ k.., i • r,,,t, - t= 1, ,.. s _ — - r < . -.-------.----.------- ,::::. F. . , ,,,,,,,,.. / -17,,;-*: c 4 7c, - ,/ _ :? ,,,,,,:, t? ' 2 (5:9( (er'S Alli NW .4111 7H1114.1.1 rt-j/r\ • .Y2rAteivi 741 , rd / %-.1 19(Z. . . 1 - 1 i I 1 ( 1 . 1 I 1 1 , i i ,., ro 0 1 i - - 1 , f roreCc 4 ,„.? N7soile .„.„. .., • N -- -----It%?7 7. iy- ,.,. 3 1 9c2 , g ( "J. :7.1 ( )'' C(.'P/S -/— ' KY e...N1 7 ---xmoiPti ') 4 7 = 4 1/ g; Nlassachusctts - Department of Public Safety )1 Board of Building Regulations and Standards Construction Supervisor License License: CS 17889 Restricted to: 00 JOHN H ZIEMINSKI ,� 8 WOODRIDGE CIRCLE 48 HATFIELD MA 01038, tlod G - �-'�- — Expiration: 2/25 /2012 ('ui inissiuner Tr#: 15199 gk 6arnirrcoacwecd of , Board of Building Regulations and Standards " WNW- HOME IMPROVEMENT CONTRACTOR ==off► 7'; _ Registration: 100133 Expiration: 6 /9/2010 Tr# 267949 Type: DBA JOHN H. ZIEMINSKI BUILDER/CONTR. John Zieminski 8tra:-DF3 HATFIELD, MA 01038 Administrator ,.." IDiJI * (i) .,. ,. ..... , ,S'i; --". 7 / ,... , /.,. ta (A ,, ./- / 97, /70 s f 7 /' /7 --,, ... --... $ - , , / 7 i / t • ____ ..._ __ _ ..7 ----,:-.--..- ----, ■ . ./ --- . , „...„.„..,, , .. WE It AND , . 277 276 . . ' ., ,,■, _ ! . i ,\;i, ..,\\ _ 120.00' 276 . - --..„.. , .... ARE_ A I . . 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If' il . , - '''''' „. --------------------- O , ,-`. ..::', O \ O ,, '''\, IP . • " .4 i w • OP • 1.4 ...- .-->"; FR _______ \ - 7 , -;, ' -----.. ---- , t , \ , t 7 \ tr V .------- ,,. , ..,,, \ (I ,.._,,,,,-- ..., ,,,,- ,'•- \ / ...„-- - ...------- ..,...- ..,..., ' \ ,,,./ 7/7 P/i? , / , '' .,.. .p ,,. -, \ , 7 ,,, 7 „. ,/ \ / / r / So ./ The Commonwealth of Massachusetts Department of Industrial Accidents 1= E Office of Investigations a ® -� ,� � � 600 Washington Street z °= Boston, MA 02111 „- . www.mass.gov /dia -Workers' Compensation Insurance Affidavit: Builders/ Con tractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): J 2 ' f+)•■.S !y - l L -' i ....(9 Address: e C-t) ;9 d d i 1 ,6p-- C' l t` City /State/Zip: / - 7e1 11 it /.9 /0,lb' Phone. #: q f 3 / 3 i io Are you an employer? Check the appropriate box: Type of project (required): / 1.21 1 am a employer with / 4.. 0 I am a general contractor and I have hired the sub - contractors 6. 0 New construction employees (full and/or part- time). * 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling shin and have no en loyees These sub - contractors have 8. 0 Demolition • working for in an ca _ act employees and have workers' Y P tY 9 . Z_Butiding addition [No workers' comp. insurance con p, inszu--anc . _ - required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions ] ers]aave LC ed_thi er _ _ _i-1 Plumbing r i 3. � I- am- a•�orneo-wner -dsine --all- work--- o - - - - - -- ,� ❑ �rs 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 5 it Re..• 1)4/E (' comp. insurance required.) . /,'"2 . *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. , t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such :Contractors that check this box must attached an additional sheet showing the name of the sub = contractors and state whether or not those entities have employees. If the sub-contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation Insurance Company Name: /) 7C ` e( 07Th b Pb l. Y6 Policy # or Self-ins. Lic. #: I4.. . SC S C) & OC) V0/2- P C' Expiration Date: 7/. Job Site Address 0 C 170L G`Y7 -.0 1)/' City / State /Zip :' / 2'7L!E c i /e../‘ - ._ 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 ne of up to $250.00 a day agau?st the violator. £ e advised that a copy of tuts statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby_certrfy under the pains and penalf%Ps ofperjury that the information . provided _abov -e_is_true_andcorrect__- _ Si • .. ture: �'is. .. ■-111 Date 3 22-- . / 0 Phone #: 1 3 ti e• G' i 7 — Official use only. DO not write in this area, to be completed by city Or town o ciaL City or. Town: Permit/license # _ —_ Issuing Authority (circle one): - -I_ Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction S Supervisor: / Not Applicable ❑ Name of License Holder : G(1 E"r _ 2 /C J/ ,4 t 60- (S • C. License Number 3 on /2- i » 6C CFK /7 yi'f «2© � ©. t� / 7 ��5 Address Expiration Date 2- /2, S" Sign Telephone &.. Req" i` steredHome .:tmprcivetrientOontractor... `;`.. :,, Not Applicable ❑ /I, `2 / E- / 22/'3 Company Name Registration Number s4 ' /, 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 IX No ❑ .r5,»I, �� 7 >r 11 4kTn e wn MXtll pti C. _ _. _The_cun nt exemption for "homeo v_ners "was extended to include Owner 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 ofland 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 art ampton ar.tna ces;- a e .n. .. .-- tts- �"renera1Laws.- Annotated. Homeowner Signature ,, 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 h . /1 /.=ZS _ Building Department Lot Size ......_.. _/q 7..„... _Z ' ' ..._..• 5 ? 5 : v ' Frontage 5 _._.M _...__,., L__ Setbacks Front -- • Side L:'...—.2 J R: L __. _.I R _..__.? mm <d Rear 0 Building Height f 2 'I Bldg. Square Footage t ° "; 1 % [ Open Space Footage _ % -- - -- (Lot area minus bldg & paved _ ' parking). �s 0 # of Parking Spaces 1„..._ 9 ' • —_.H a Fill: 1 d (volume & Location) - -- '. --- , _____ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW e YES 0 IF YES, date issued:! IF YES: Was the permit recorded at the Registry of Deeds? NO 0 D ONT KNOW ® YES 0 — 7. IF YES: enter Book i Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained I , Date Issued C. Do any signs exist on the property? YES 0 NO 0 IF YES; describe size, type and location: Y. -- ' ` ire ere anany proposed' clianges to or -a • • i ions o signs inten • e 1 for the property ? YES 0 NO IF YES, describe size, type and location: s. 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. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding [I=1] Other [p] Brief Description of Proposed Work: /3-0D I Ux //c 5tf-U Pet; P Trilatc 77) G3 7 Si Pi/ 14r ^ - "M"Son:97udeli Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative . Renovating unfinished basement Yes No Plans Attached Roll heel) sa :tf.New:hoUSee.and..vr.�ctcl IOn to eXistinq Fiorismcj corriptete the.f ttowireq: a. Use of building : One Family ) Two Family Other b. Number of rooms in each family unit: r' Number of Bathrooms V c. Is there a garage attached? / d. Proposed Square footage of new construction. / U Dimensions / ' /U / e. Number of stories? f. Method of heating? 0,6 ri-' //>r Fireplaces or Woodstoves `-- Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction Lilo OD fieorowir i. Is construction within 100 ft. of wetlands? 2 Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? X Yes No . I. Septic Tank k City Sewer Private well City water Supply )C SECTION.7a - OWNER AU - i-bk ZAT10N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I , mil"? - < 1`7 , as Owner of the subject property hereby authorize G /7 r1 to act on my behalf, in all matters relative to work authorized by this building permit application. y !h hyt. L c Signature of Owner Date - 6 /'> -' , • 2- / ?=2 --71 s--cS /e/ , as- CumAer /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. Q J /V `2 /& '-i / /C"/ Print Name z. Z " 3 Signature Vner /Agent Date City of Northampton Status oflermlf " ��` Building Department rt3i�errriit�' 212 Main Street Se>rre5elicAuailatrl - ~ ' �:_� Room 100 ter/UUeli Northampton, MA 01060 olrtfuIPns� phone 413- 587 -1240 Fax 413- 587 -1272 't om . i � q ier Specifjt ; APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLI,S Of{A QNE OEi O FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office go i,JOOD L,17.Jt 1 f Lit Map Lot Unit �vZ x /`!!* 0/ t h' ... - 26ne OverlayDistrict Eliit District CB District .SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 8e.) ,mfr 62/44 Nary,' (Print)/ �. ) / Current Mailing Address: ) ILZ,C �. : Telephone (3 5 � 23 Signature 2.2 Authorized Agent: �J Ff a. 24x41 i e)Oiet 06 OI6.3Y Name (Print) Current Mailing Address: ecte._ 3 2_ i t 3 i�Cs Sign.: Telephone SECTION 3 •ESTIMA CONSTRUCTION': COSTS Item Estimated Cost (Dollars) to be • Official Use Only completed by permit applicant 1. Building (a) Building 'Permit Fee oeo 2. Electrical (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) p ev Check Number i % /p This Section ForOffcialUse Onip " Date Building Permit Number: • Issued: Signature: Building Comrnissioner /Inspectar.of Buildings Date l _ File # BP- 2010 -0831 APPLICANT /CONTACT PERSON JOHN ZIEMINSKI ADDRESS/PHONE 8 WOODRIDGE CIRC HATFIELD (413) 247 -9014 PROPERTY LOCATION 80 WOODLAND DR MAP 35 PARCEL 302 001 ZONE SR(100) //WP/WSP II 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 /�� ►�+�'�'"' Typeof Construction: CONSTRUCT 10 X 16 ATTACHED SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 017889 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: A, ° r t e W L./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 l 3/2.SI Signature o B�Official Date g g 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. 80 WOODLAND DR BP- 2010 -0831 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 - 302 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 -0831 Project # JS-2010-001228 Est. Cost: $4000.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN ZIEMINSKI 017889 Lot Size(sq. ft.): 197762.40 Owner: MAURER STEPHEN C & PAMELA ERICKSON Zoning: SR(100) //WP/WSP II Applicant: JOHN ZIEMINSKI AT: 80 WO ODLAND DR Applicant Address: � Phone: Insurance: 8 WOODRIDGE CIRC (413) 247 -9014 Workers Compensation HATFIELDMA01038 ISSUED ON:3/29/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 10 X 16 ATTACHED SHED FiC POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector r Underground: Service: Meter: - s Footings: Rough: Rough: House # Foundation: , Driveway Final: Final: , �l Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: OK S C hi I 0.2 Lelt4 r THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy C(V(Oc_- iiI Signature: ( p Y FeeTvpe: ate Paid: Amount: Building 3/29/2010 0:00:00 $60.00 212 Main Street, Phone (413) 587 - 1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo m