16C-031 (4) D. Conditions for the filling in of any land area subject to the provision of this § 350 -10.4 of this
chapter, the following conditions shall govern:
(1) Provision shall be made for adequate temporary and permanent drainage of the site.
(2) Fills shall be limited to terrace fills which are not to exceed 10 feet at any one time nor
be within 10 feet of an adjacent property line or cut.
(3) Regrading of all or parts of the slopes resulting from such fill shall be carried out.
(4) At least six inches of topsoil shall be replaced over all filled or otherwise disturbed
surfaces seeded or sodded with a perennial cover crop, reseeded or resodded as
necessary to assure uniform growth and soil surface stabilization.
(5) Where any fill will have a depth of 10 feet or more and create a slope of more than one
vertical in two horizontal, there shall be a substantial fence enclosing the fill at least six
feet in height with suitable gates. Such fence shall be located 10 feet or more from the
edge of the fill.
(6) Filling of land area which falls within the superimposed Watershed Protection District is
prohibited.
(7) The planned filling in of any land area shall be consistent with any recreation,
conservation and open space plan as prepared by the City Planning Board.
(8) Documentation shall be submitted as to the effect of such filling -in activities on
drainage, both within the immediate area and sufficiently far downstream, as required
by Planning Board.
(9) Provisions shall be made such that the filling in of any land area shall not impair surface
drainage, constitute an erosion hazard nor act as a source of sedimentation to any
adjacent land or watercourse.
(10) Provisions shall be made such that the filling in of any land area does not impair the
safe and efficient operation of any on -site sewage disposal or drainage facilities nor
those located on adjacent properties.
(11) Provisions shall be made to reduce the area and duration of exposure of fill material(s)
and to reduce the velocity of runoff, both during and after the completion of the filling -in
activity in order to minimize the potential of soil erosion and siltation problems.
(12) Provisions shall be made for the adequate control of dust during filling -in operations.
(13) All disturbed fill areas shall be promptly seeded or sodded with a suitable ground cover
and supplemented with other suitable plantings as soon as the season permits.
(14) No final slopes shall exceed a slope of more than one foot vertical in two feet horizontal.
(15) No filling in of land shall cause or permit any soil, earth, sand, gravel, rock, stone loam,
or other fill material, or water or liquid to be deposited upon or to roll, flow or work upon
or over the premises of another without the express consent of the owner of such
premises so affected; nor shall any filling in of land cause or permit any soil, earth,
sand, gravel, rock, stone loan, or other fill material or water or liquid to be deposited, or
to roll, flow, or wash upon or over any public street, street improvement, road, sewer,
storm drain, water course, or right -of -way, or public property.
(16) Such other conditions as may be deemed necessary and reasonable shall be imposed
by the Planning Board in order to prevent damage to public or private property or any
sewer, storm drain, or watercourse, or to prevent the filling in of and from being
conducted in a manner hazardous to life or property, or in a manner likely to create a
nuisance.
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3
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
b understand the above.
ome owner /resident'ssignatu esting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date 7f
Address of work 3 3 � location
a iie Act aeoG
1
t . {s
_ The Conzmonwea %th of Massachusetts
--x Department of Fndustrial.4cciderts
O,jce of Investi`arions
600 Washington Street
Boston, v1_4 02111
www. mass.gov/dia
Workers' Compensation Insurance _Affidavit: Builders/ Contractors /EIectricians /Plumbers
ADs0 iicant Information Please Print Le2ibly
Nam e (Bu sin ess'Organization 'Individual):
—
Address:
City/State/Zip: Phone #:
I Are you an employer? Check the appropriate box:
Type of project (required):
I. n I am a emp
employees (full and/or part-time).*
I am a sole proprietor or partner-
loyer with
4. [I] I am a general contractor and I
have hired the sub - contractors 6. ❑ ew consutiction
Remodeling
2. r] listed on the attached sheet. ❑
ship and have no employees These sub - contractors have g- ❑Demolition
working for me in an capacity. employees and have workers'
v 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
r cored ] 5. ❑ We are a corporation and its I 0. ❑Elect )cal repairs or additions
3. am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions
myself. o workers' comp. right of exemption per MGL
12.❑ Roof repairs
insurance required_] c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
I comp. insurance required.]
Any applicant that checks box =1 must also fill out the section below showing their workers' compensation policy information.
Homeowner who submit this affidavit indicating they are doing all work and then hire outside contractors trust submit a new affidavit indicating such.
zContrctors that check this box must attached an additional sheet showir_ the name of the sub - contractor and state whether or not those entities have
errmloyees. If the sub - contractors have employees, they must provide their workers' cotta. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
iirf ni , ation.
Insurance Company :Vary e:
Policy 4 or Self-ins. Lic. 4: Expiration Date:
Job Site Address: • City /State /Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forxarded to the Office of
Investigations of the DLA for insurance coverage verification.
I do hereby terrify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone 4:
i
1 Official use only. Do not write in this area, to be completed by city or town officiaL
Citv or Town: Permit /License 4
Issuing Authority (circle one):
1. Board of Health '. Building Department 3. Ciry;Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
I
6. Other
Contact Person: Phone 4:
SECTION ION E - CONSTRUCTION SERVICES
8.1 Licensed Construction Suoer, sor: I Not Applicable ❑
Name of License Holder :
License Number
adaress Expiration Date
'Signature Telephone
I
1. Reaistered Home ImnrovernentConfractor „, w � _,•_, Not Applicable ❑
:omoanv Name Registration Number
ddress Expiration Date
Telephone
ECTION 1.0- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M GAL. c. 152,. § 25C(6)) I
'crkers Compensation Insurance affidavit must be completed and submitted with this application_ Failure to provide this affidavit will result
the denial of the issuance of the building permit •
aned Affidavit Attached Ye= ❑ No ❑
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
allow i individual for hi_ -,. d„ riot possess a license, provided t
and to aliuw such homeowner to engage an tilulvluual�LVi hire w does riot y SSeSS a I.,..n., d hat 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 -vear 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 Ordinance e and Local Zoning aws S e of Massachusetts General Laws Annotated.
Homeowner Signature "AL
.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House E Addition fl Replacement Windows I Alteration(s) C i Roofing Or Doors E I
Accessory Bldg. ❑ Demolition ❑ New Signs [DJ Decks [ Siding [p; Other fI�1'
Pa l
Brief Des of Propos- / �+ / �(� f j � / ,,/'
!
Work: i i - i. , 1) / -o v Fr- fl Of- hoar ( -heel. S'/Y/ t leir- deck kpaw
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes Nc
Plans Attached Roll - Sheet I
sa ' If New houses and oe ad to existing h complet the fotf
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?
f Method of heating? Fireplaces or Woodstoves Number of each
g- Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h- Type of construction
i. Is construction within 100 if cf wetlands? Yes No. 15 construction within 100 yr. floodpiain Yes No
j- Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No . I
I, .Septic Tank City Sewer Pnvate `:Jell City water Supply
ity' ( up y
SECTION 7a - OWNER AUTHORIZATION TO BE COMPLETE WHEN CONT
C
Wh ERS AGENT OR CONTRACTOR APPLIES: FOR B
FOt1ILDING PERMIT ii
I
I, as Owner of the subject
property hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I I /Of , as Owner/Authorized
Ageri"ereby declare that t e state ,eats and information on the foregoing application are true and accurate, tc the best of my knowledge
and belief.
I Sicnec under the pains and penalties of perjury.
A . 1 , K S" .. `' .c_ / ,f , `
I
Fnnt Name %/�-- G
g
C rAffreriAcent Cae
r f
1 Section 4. ZONING I All information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
1 Existing Proposed Required by Zoning
This column to be tilled in by
Building Department
LOT Size
Frontage .._._.._. .__. . - .__..._.._. _..._. ..._._
Setbacks Front
_
Sid L:'_...._..._ R: ,..._ _.; L ,...,_._ R_ _,._...__: _ .,._
Rear — D
Building Height
Bldg. Square Footage _... .. ._.... % _ _ _v _ .
Open Space Footage
(Lot area minus bldg & paved
„_______ 7 I
# 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 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES n
!F YES e Rnn Page and /or Document #
3. Does the site contain a brook, body of water or wetlands? NO V 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
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, excav on, or filling) over 1 acre or is it part of a wrnn pfan
that will disturb over 1 acre? YES 0 NO
1F YES, then a No Storm Water Management Paimit from the DPW is required.
Department use only
. iiy or Nortt arnpton of Pemtit:
: ‘1 - [ ' icy
lding Department Gurb Status Cut/Drnreway Permit
212 Main Street. 5e ver /Sep tic.Availabiiit
J U L 1 6 2008 ' Room 100 water AVanabUity
Nom amp MA 01060 587 122 Two Sets of Structural Pla
p 14- 58711240 Fax 413 7fl Flans
ho1�e 4
I
Oth Spe afy
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 I
rA 7 3 5pr( S Map Lot Unit
r 'Cvrent Zone Overlay District
Elni St District CB District
SECTION 2 - PROPERTY 01111NEr�SHIP /AUT r10RIZ1 =D AGENT
2.1 Owner of Record: �`
e (Print / Current M ai l in Addr ess: .
Telephone
nature
2.2 Authorized Agent:
Name (Pent) Current Mailing Address:
Signature Telephone
i
I SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be I Official Use Only
completed by permit applicant
1. Building 3//02,00°' UD
I (a) Building Pemtitfee
2. Electrical VZ2p , c3a (b) E Cost of
Constru ction Total from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) ,Z ;.OU . a � Check Number Z '
This Section For Official Use Only
Building Permit Number: IssuDate ed:
Signature:
Building; Gammisswner /InspeVtor.or tiuuomgs Date
File # BP- 2009 -0061
APPLICANT /CONTACT PERSON COTE - HOUGHTON DOROTHY & DAR
ADDRESS/PHONE 383 SPRING ST FLORENCE (413) 586 -5422 0
PROPERTY LOCATION 383 SPRING ST
MAP 16 PARCEL 031 001 ZONE SR
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 C5 J�J�
Typeof Construction: CONSTRUCT 2 LEVEL DECK & INSTALL ABOVE GROUND POOL
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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition D 7,7
Signature of Buil mg Official Dat-
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.
383 S g fit' BP- 2009 -0061
vIS #: COMMONWEALTH OF MASSACHUSETTS
map:B1*- 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- 2009 -0061
Proiect # JS- 2009 - 000077
Est. Cost: $2200.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 31319.64 Owner: COTE - HOUGHTON DOROTHY & DAR
Zoning: SR Applicant: COTE - HOUGHTON DOROTHY & DAR
AT: 383 SPRING ST
Applicant Address: Phone: Insurance:
383 SPRING ST (413) 586 -5422 0
FLORENCEMA01062 ISSUED ON:7/24/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 2 LEVEL DECK & INSTALL
ABOVE GROUND POOL
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 7/24/2008 0:00:00 $75.00548
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo