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38C-057 (2) South Street / f , i I ee hell Dnveway I I I ,I 1 8 1/ ?" III _. { Sidewalk I, 1 1 1 1 From survey: I I Prop rty L e I, 99'-7 112' I I i , e I I II to u It o! h o /'� / _ NLL r � M I a- c. 7 a i s s° J I I I e . Driveway c — Elet Ire Gannet coon e - to house trot, overhead gyres oil street / �� —_ __ e j \_ _ s_8.. ., _ __ _ __ __ _ _ _ _ _______ _ ______ __ _ ____ _ _ ____ _ _ _ __ _ __ __ _ te 15_Q, 15._0. \ ,- 0 Zone URB Zone URB Side setback Side .setback o ,� � `c m _ Property Line i3 " CoP Site Plar 160 .1) Cr \ �� u r" -- P rr, o U) —I x u> _ ! _ - O n �� I II f Qp o n ca o x L ei 6 .1.1.11.1"""" )> v D JJ w Oi y IIIII Co o Cn °WT 03 1 esal rti Permit No. D07 - Conditions: Driveway Permit In lieu of plan approved by the City Engineer I agree to the following added conditions: 1. I will contact the Department of Public Works and have an inspector check and approve the graded gravel base prior to paving to insure compliance with slope and location; 2. I further agree that if in the inspections, any of the permit conditions are not met that I will at no expense to the City remove and replace the driveway as directed by the City Engineer. By: Petitioner Signature Name: Traci L. Olsen/Peter Olsen Address: 6 Gregory Lane, Florence, MA 978761 -3207 ( Traci ) Note: The Public Works Department recommends that you provide a plan showing the proposed driveway with grades and location in the future to avoid possible expense which you will incur by not getting approval of actual plans in advance. For Commercial and Industrial applicants, a plan showing the proposed driveway with grades, location and Planning Board permits are required. Cc: Building Inspector • Permit No. D07 - CITY OF NORTHAMPTON, MA DRIVEWAY PERMIT Date: 9/26/12 Check #: 472 FEE: $250.00 THE BOARD OF PUBLIC WORKS Driveway must be staked and house & lot number posted The undersigned respectfully petitions your honorable body for: A driveway approval Permission to install a driveway at: 380 South Street, Northampton, Ma 01060 Fifteen (15) foot maximum width at the street line. Gutter drainage not to be disturbed. All Drainage shall be directed off the driveway surface to adjacent land and not on the existing Roadwa . Driveway surface to be . aved as soon as , ossible if the * rade of the . ro , osed Driveway exceeds 3% or more. Homeowners will be held responsible for any cost to the City of Northampton in the event of a washout of this driveway. Code of Ordinances §350 -8 8 providing standards for private, individual driveways as amended by the City Council on October 15, 2009, must be followed. By: Traci L Olsen/Peter Olsen Telephone: 978- 761 -3207 is ature: Proposed Location Inspection By: '41 dmiticr4 ` fierinrizAfr to-ft-010,g. Gravel Base Grade Inspected By: Final Approval: THE BOARD OF PUBLIC WORKS voted that petition be granted. Edward S. Huntley, P.E. Director of Public Works Cc: Building Inspector (SUBJECT TO ATTACHED CONDITIONS 1 & 2) 693 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: 380 South Street, Northampton Inquiry Made By: Peter & Traci Olsen 413 - 834 -1972 ( Scott Laidlaw ) Date of Inquiry: 7/9/12 Reason for New construction hooking into City Utilities Request: Municipal Sewer Main in Front of Location: Yes X. No Municipal Storm Drain Available: 5'/2 deep Yes X. No Size of Sewer Main: �' Material: ( ` Age: Depth of Sewer Main: Eau l /,1 Size of Service Connection: l l Type of Service Connection: Tie -in to Sanitary Main Tie -in to Sanitary Stub X Comments: „Se �� a— o Z --36 /con S6 C C /N f , 1 i ' is i4.: 4 ' 6 !- V =C' i rz Note: If this availability 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. John all Sewer Department cc: Ned Huntley, Director DPW Louis Hasbrouck, Building Commissioner OTAIn.3, sue` n0 answ-ta y.e • D 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: 380 South Street, Northampton Inquiry Made By: Peter & Traci Olsen (413- 834 -1972 Scott Laidlaw) Date of Inquiry: 7/9/12 Number of Type of 'Sin Family)Apart. Type of Private X Units: 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: No X Size of Water Main: 6" Material: Cast Iron Age: Approximate Static Street Flow Test Conducted: Yes: No: X #1 Pressure: 115 si p If done attach results Size of Service Connection 1" 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. • ements of such in ationjhall be made with the Northampton Water Depat tinent with a minimum of 5 orking da s ffication./ • All vor sha 1 c rm..o hampton Water Department specifications. 1 � 6 David W. Sparks, Superintendent of Water Dept. Water Entry $200.00 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. l O Bk: 10866 Pg: 195 Zoning Board of Appeals Decision City of Northampton Hearing No.: ZBA- 2012 -0018 Date: February 10, 2012 Elizabeth Sliver votes to Grant MOTION MADE BY: SECONDED SY: VOTE COUNT: DECISION: Elizabeth Silver 1 Granted w/ Conditions MINUTES OF MEETING: Available in the Office of Planning & Development 1, Carolyn Misch, as agent to the Zoning Board of Appeals, certify that this is a true and accurate decision made by the Zoning Board Administrator and certify that a copy of this and all plans have been filed with the Board and the City Clerk on the date shown above. I certify that a copy of this decision has been mailed to the Owner and Applicant • CO Aa tifi The appeal period for residential findings granted by the Zoning Board of Appeals Zoning Administrator are thirty (30) days from the date of the decision. All appeals are heard by the full Zoning Board of Appeals. March 13, 2012 I, Wendy Mazza, City Clerk of the City of Northampton, hereby certify that the above Decision of the Northampton Zoning Board of Appeals Zoning Administrator was filed in the Office of the FEB 1 0 2012 City Clerk on February 10, 2012, that thirty days have elapsed ! since such filing and that no appeal has been filed in this L... --I matter. ,_ matter. I Attest: (.../Liendtt Grc City Clerk J City of Northampton GeoTMS® 2012 Des Laurlers Municipal Solutions, Inc. Pttu&, TEST: HAMPSHIRE, REGISTER PATRICIA A P Amp Bk: 10866 Pg: 194 Zoning Board of Appeals - Decision City of Northampton Hearing No.: ZBA -2012 -0018 Date: February 10, 2012 , ' APPLICATION TYPE: SUBMISSION DATE: Olin Residential Finding 2/10/2012 1 Applicant's Name: Owner's Name: Bk: 10866Pg: 194 Page: 1 of 2 NAME: NAME: Reoorded: 04/06/2012 02:25 PM ■ Peter Olsen, Ill DOUBLE DUCK LLC ADDRESS: ADDRESS: 6 Gregory Lane 384 SOUTH ST TOWN: STATE: ZIP CODE: TOWN: STATE: ZIP CODE: NORTHAMPTON MA 01060 NORTHAMPTON MA 01060 PHONE NO.: FAX NO.: PHONE NO.: FAX NO.: (413) 584 -3792 EMAIL ADDRESS: EMAIL ADDRESS: Site Information: Surveyor's Name: STREET NO.: SITE ZONING: COMPANY NAME: 1 SOUTH ST URB(1001/ i TOWN: ACTION TAKEN: ADDRESS: NORTHAMPTON MA 01060 Approved w/ Conditlons MAP: BLOCK LOT: MAP DATE: SECTION OF BYLAW: 38C 057 001 Chapt 350 -9.3 (1) (D): Pre- existing TOWN: STATE I ZIP CODE Book Page: Nonconforming Structures or Uses May be 7779 75 Changed, Extended or Altered with a PHONE NO.: FAX NO.: Finding from the Zoning Board of Appeals. EMAIL ADDRESS: • NATURE OF PROPOSED WORK 1 Construct new single family home HARDSHIP: I CONDITION OF APPROVAL: 1) Runoff may not be directed to abutting lots. 2). Curbing must be Installed for the entire frontage except fora maximum 15' wide opening for a residential driveway. All curbing must be installed in accordance with the DPW standards and must match what Is on South Street FINDINGS: The designated Zoning Administrator granted the Finding based on the materials and graphics submitted with the application. The Findings of the Board Administrator under Section 9.3 for construction of a new house on a pre - existing non - conforming lot with a non- conforming use were as follows: 1. The Administrator found that the change would not be substantially more detrimental to the neighborhood than the existing nonconforming use and lot The proposed single family house would bring the lot's use Into compliance by eliminating a non - conforming commercial use. The lot would come Into full compliance with respect to open space and setbacks. The existing non-conforming frontage and lot area would remain the same and is comparable to the single family house lots that abut this lot 2. The Administrator found that the home would not extend any closer to any front, side, or rear property boundary than the current zoning allows. 3. The Administrator also determined that the new construction would not create any new violation of other zoning provisions; and does not involve a sign. i COULD NOT DEROGATE BECAUSE: FILING DEADLINE: MAILING DATE: HEARING CONTINUED DATE: DECISION DRAFT BY: APPEAL DATE: 1/10/2012 2/4/2012 2/23/2012 REFERRALS IN DATE: HEARING DEADLINE DATE: HEARING CLOSE DATE: FINAL SIGNING BY APPEAL DEADUNE 1/28/2012 4/15/2012 2/9/2012 2/23/2012 3/11/2012 FIRST ADVERTISING DATE: HEARING DATE: VOTING DATE: DECISION DATE 1/26/2012 2/9/2012 2/9/2012 2110/2012 SECOND ADVERTISING DATE HEARING TIME 'VOTING DEADLINE DECISION DEADUNE: 2/2/2012 4 :05 PM 5/9/2012 5/9/2012 MEMBERS PRESENT: VOTE • GeoTMSO 2012 Des Lauriers Municipal Solutions, Inc. 1 ` o N to I I - -c a I I M rn H c '° 157 0 U S f0 2E C I ° m W E 0 3',) Dim (0 .oz 'ou_ a� 7' �t1 IoN I E cp.= ED' ou) E w T ( C a) t0 m Q ++ co C 2 1 0 m d E -o I L2( 1 Tn o N 0 0 m '� EO O � 86 m N N 2 I ,..0-. 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N L I 0 Truss Engineering Corporation (TEC) strictly adheres to the 'Standard Responsibilities in the Design of Metal Plate Connect &d Wood Trusses' as defined by TPI Chapter 2 (available upon request) regardless of any job specific SUBTOTAL specifications unless clearly defined otherwise in writing by TEC. This product list is Truss Engineering Corporation's INTERPRETATION of plans and drawings as supplied to us. No '� _ responsibility is taken or implied by TEC for the structural integrity of the structure below the trusses or the affects of TEC's product on the structure as a whole. The building owner /owner's agent is solely responsible for verifying all IA / / dimensions, geometry, loads and load requirements for accuracy and full compliance to construction documents and shall Ali WIDE LOAD A A D be responsible for notifying TEC immediately of any discrepancies. Truss Engineering Corporation is NOT responsible for ' ESCORT FEE field verification of dimensions or special conditions. The building owner /owner's agent is responsible for coordinating all construction details between trades. The truss installer shall follow all BCSI recommendations, construction document specifications as well as any site specific GRAND TOTAL requirements to ensure safe and proper installation. No loading shall be applied to trusses until properly and fully installed, including all sheathing, hangers, wall anchors, lateral web bracing (as shown on individual shop drawings), and permanent bracing (as required by the construction documents). Installation contractor shall refer to the individual truss ------------------+----------- shop drawings for all structural requirements of trusses, including but not limited to bearing locations and requirements, ply to ply nailing, lateral web bracing, and truss spacing. No trusses supplied by Truss Engineering Corporation may be cut, drilled, or altered in any way without first contacting TEC and receiving engineering documents allowing such. * ** THESE DRAWINGS HAVE BEEN REVIEWED AND ARE APPROVED AS AN ORDER * ** Approved By: Approval Date: PO #: Requested Delivery Date: CONTRACTOR QUOTE PRINTED ON 03/06/13 PAGE 2 QUOTE # Q1207269 DATE QUOTED:03 /06/13 1 1 { 181 GOODWIN ST VALID UNTIL: 04/03/13 ENGINEERING p BOX 51027 CORPORATION Job: PETER & TRACI OLSEN f�lrA.� ∎�Ar% INDIAN ORCHARD, MA 01151 KENT HICKS CONSTRUCTION MANUFACTURERS OF ROOF & FLOOR TRUSSES 380 SOUTH ST. Phone (413) 543 -1298 Fax (413) 543 -1847 Toll Free (800) 456 -0187 NORTHAMPTON, MA Quote To:r.k. Miles, Inc. Requested By: ANDY CLOGSTON 24 West St. West Hatfield, MA 01088 Quoted By: Brian Tetreault Attn:ANDY CLOGSTON Phone: (413) 247 -8300 SPECIAL INSTRUCTIONS: *DRAWINGS FOR PERMIT. *NOTE: SPAN TO DEPTH RATIO IS GREATER THAN 20 FOR ALL TRUSSES WITH SPANS OVER 20'. FLOOR MAY EXPERIENCE BOUNCE DESPITE DESIGN CRITERIA. FLOOR TRUSSES LOADING ITCLL -TCOL. -BCLL BCDL STRESS INCR INFORMATION 1 boioo,00iooioo FLOOR TRUSS SPACING: 16.0 IN. O.C. (TYP.) LAYOUTBRT 03/01/13 FLOOR 1 QTY I TRUSS ID I DEPTH BASE O/A END TYPE CANTILEVER STUB UNIT PROFILE PLY SPAN I WEIGHT SPAN LEFT 1 RIGHT LEFT RIGHT LEFT I RIGH I F2 00 -11 -14 20 -01 -10 20-01 -10 j 1 19 -09 -15 19 -09 -15 r 1 1 81 82 1 I M . N 1 20 F3 00 11 -14 04 -11 -08 04 -11 -08 1 18 F4 0011 -14 04 -06 -12 04 -06 -12 I II I I 1 FG1 0011 -14 19 -00 -08 19 -00 -08 II r 80 7 1 I I I I ll EmErzrzsep 1 FG2 00-11-14 19 -00 -12 i 19 -00 -12 r 86 I 1 FG3 00 -11 -14 11 -08 -04 11 -08 -04 r 47 ITEMS QTY ITEM CATEGORY I LENGTH NOTES FT -IN -16 28 TOPFLANG HGR 00 -00 -00 ITS3.56/11.88 SST TOP FLANGE 1 SPECIAL ORDER- STOCKED IN ENFIELD, CT I _ • CONTRACTOR QUOTE PRINTED ON: 03/06/13 PAGE 1 QUOTE # Q1207269 DATE QUOTED:03 /06/13 E N all: N � 181 GOODWIN ST VALID UNTIL: 04/03/13 ENGINEERING p BOX 51027 CORPORATION Job: PETER & TRACI OLSEN /I II rA..1►1G� . INDIAN ORCHARD, MA 01151 KENT HICKS CONSTRUCTION MANUFACTURERS OF ROOF & FLOOR TRUSSES 380 SOUTH ST. Phone (413) 543 -1298 Fax (413) 543 -1847 Toll Free (800) 456 -0187 NORTHAMPTON, MA Quote To:r.k. Miles, Inc. Requested By: ANDY CLOGSTON 24 West St. West Hatfield, MA 01088 Quoted By: Brian Tetreault Attn:ANDY CLOGSTON Phone: (413) 247 -8300 SPECIAL INSTRUCTIONS: *DRAWINGS FOR PERMIT. *NOTE: SPAN TO DEPTH RATIO IS GREATER THAN 20 FOR ALL TRUSSES WITH SPANS OVER 20'. FLOOR MAY EXPERIENCE BOUNCE DESPITE DESIGN CRITERIA. LOADING TCLL- TCOL- BCLL_BCD STRESS INCR ROOF TRUSS SPACING: IN. O.C. TYP. LAYOUTBRT 03/01/13 ROOF TRUSSES INFORMATION 50.0,20.0,0.0,10.0 1.15 ( ) QTY PITCH TYPE BASE O/A PROFILE I I LUMBER OVRHG / CANT I SHIPPING I UNIT PLY TOP BOT TRUSS ID SPAN SPAN TOP 1 BOT LEFT I RIGHT HEIGHT WEIGHT ATTIC 00 -00 -02 1 00 -00 -02 10 -05 -10 178 Ar it 3 10.00 0.00 Al 23 -08 -00 23 -08 -00 I2 X 6 2 X 6 01 -10 -00 01-10-00 1 10.001 0.00 ATTIC 23 -08 -00 2 X 612 X 6 10 1 - 0 0 04 -02 10 -05 -10 178 00 -00 -02 23-08-00 23-08 00 I 010410 i _ 0.00 ATTIC Al B ' 2 X 612 X 6 01 -10 -00 00 11 01 �! 10 -05 -10 178 '� 1 � 10.00 3, �- � 1 ATTIC 1 00-00-02_100-00-02 1 1 - - - - �[� 10.00 2 X 6101-10-00100-05-08 10-05 -10 182 3 00-00-02100-00-02 000 AID A1C 23 -08 -00 23 -OS -00 2 X 6 ATTIC 01 0 00 L 1 1 10.001 0.00' 23 -08 -00 23 -08 -00 2 X 612 X 6 10 -05 -10 182 ATTIC 1 100-00-02 1 ta 2 -10 -00 2 X 612 X 6 01 -10 -00 10 -05 -10 168 10.00 0.001 Al A1E 23 -08 -00 21 I ATTIC 21 -10 -00 1 ___ 1 10.001 0.00 Al F 23 -08 -00 j 00 -00 -02 t_ - - - 10 -05-10 140 1 -- 2 Ply1 10.00 0.00, A1G ' 23 -08 -00 21 -10 -00 1 , 01 -10 -00 10 -05 -10 168 a 2 X 6 2 X 6 00 -00 -02 100 -00 -02 L- ATTIC 1 -- � I 1 1 1 L I 1 GABLE a 2 10.00'' 0.00 T1GE 23 -08 -00 23 -08 -00 12 X 6 2 X 61 10 -05 -10 174 FLOOR TRUSSES LOADING TCLL- TCDL- BCLL -BCDL ' STRESS INCR INFORMATION 40.0,10.0,0.0,10.0 1.00 FLOOR TRUSS SPACING: 16.0 IN. O.C. (TYP.) LAYOUTBRT 03/01/13 FLOOR I QTY TRUSS ID I DEPTH I BASE I O/A END TYPE CANTILEVER STUB I - I UNIT I PROFILE PLY SPAN SPAN LEFT I RIGHT LEFT RIGHT LEFT RIGHT f i WEIGHT Il i F1 001114 1 19 -08 -08 19 -08 -08 1 % 81 I 1 F1A 00 -11 -14 19 -00 -08 19 -00 -08 78 1 2 F1 B� 00-11-14 116 -05 -00 16 -05 -00 r �1j 60 � F1C 00 -11 -14 15 -07 -00 - 58 15 -07 -00 r i T F2 00 -11 -14 21 -04 -05 21 -04 -05 r n, 87 z 1 F2A 00 -11 -14 I 21 -00 -11 21 -00 -11 1 1 86 1 1 F2B 00 -11 -14 85 20 -09 -00 20 -09 -00 � 1 F2C 00-11 -14 20 -05 -05 20 -05 -05 1 r 84 r $ : 1 .- a �$esariasrffs . _ 4F - .� -• - �� o CZ �., , °E' ' DEPARTMENT Or BUILDING � SPECTI ONS INSPECTOR 212 Main Street 0 Municipal Bulb - fin! .. a Northampton, MA 01060 s., o° s • • A w • LOCATION 3�6 ScM.`1"L.. Si SQUARE FOOTAGE AMOUNT BASEMENT @ : 20 0 - • 1 @ 30 L146' Z 'S.Z Sb 2ND FLR O. 30 : 3 4 1 Z "'°� l FLOORS, FINISH ATTIC, GARAGE @ 20' 35'1. D . • DECK/PORCHES @ :20 - 1-1, et `o TOTAL.. 4 .t- { 3i° • . . . . . . . • .. . • . . . • •• • . . . . . , . . . . • . • . . . . . • . . . • . . . . • • . • . . . _ . • • . . , • . . _. • • • . . • . • . . . . . , . • • . . . . • ________ _• ...... � A � CITY OF NORTHAMPTON, MASSACHUSETTS ;, ,. DEPARTMENT OF PUBLIC. WORKS 125 Locust Street 31 ". �0 - Northampton, MA 01060 413- 587 -1570 Fax 413 - 587 -1576 Edward S. Huntley, P.E. Director ASSIGNMENT OF HOUSE NUMBER Street: - South Street Assessors Map: 38C -057 House Number: 380 Date: June 7, 2012 Remarks: This number was assigned by the Engineering Department on June 7, 2012. The number assignment was requested by the owner, Peter Olsen, for permitting purposes for the construction of a new, single family dwelling on this vacant lot. P . I4 / I ames Laura"' .E. City Enginee cc: Central Dispatch Board of Health Water Division Tax Collector Sewer Division National Grid Streets Division Verizon Telephone Inspectors Comcast Assessors Columbia Gas of Massachusetts Police Department Post Office (Northampton) James Thompson (GIS Coordinator) Post Office (Easthampton) Registrar of Voters School Department Owner: Peter Olsen 6 Gregory Lane Florence, MA 01062 K:1House Numbers \South Street\#380 South Street.doc Date: 8/28/2012 Time: 12:34 PM To: 413 -296 -0123 Page: 02 ACCORD- DATE (MMIDD/TYY'n CERTIFICATE OF LIABILITY INSURANCE 8/28/2012 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 NAME: John Kubacki Cray -Dowd Insurance Agcy.,Inc. PHONE FAX 101 University Drive Suite A6 I No•Ext):413 -538 -7949 (AIC.No) :413- 536 -6020 IL Amherst MA 01002 ADDRESS: PRODUCER CUSTOMER ID 0: KENH I INSURERS) AFFORDING COVERAGE NAIC 0 INSURED INSURER A : Tr avelers 25679 Kent Hicks dba Kent Hicks Construction P.O. Box 57 INSURER B W. Chesterfield MA 01089 INSURERC: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1244881907 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 TYPE OF INSURANCE POLICY NUMBER ADOL SUER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDD/YYYY) (MMIDDIYYYY) GENERAL. LIABILITY EACH OCCURRENCE $ DAMAGE 10 RENTED $ COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) CLAIMS -MADE OCCUR MED EXP (Anyone person) $ PERSONAL B ADV INJURY $ GEN ERAL AGGREGATE $ GE N'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON -OWNED AUTOS $ UMBRELLA LAB _ OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE -_ $ RETENTION $ $ A WORKERS COMPENSATION 0565698713 4/5/2012 4/5/2013 X WGSTATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER Y f N ANY PROPRIETORIPARTNERIEXECUTIVE E . EACH ACCIDENT $100000 OFFICER/MEMBER EXCLUDED? Y NIA $100000 (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ It yes, describe under DESCRIPTION OF OPERATIONS below E . DISEASE- POLICY LIMIT S500000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) Workers Comp policy does not provide coverage for the sole proprietor, Kent Hicks. 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. City of Northampton Building Department 212 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 07 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts l Print Form . Department of Industrial Accidents 1 — 'x i Office of Investigations 4 i 1 , 1 Congress Street, Suite 100 ti ; , ' Boston, MA 02114 -2017 'gib `° '-r www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Kent Hicks Construction Co. Name ( Business /Organization/Individual): Address:PO Box 57, 634 Main Road City /State /Zip:West Chesterfield, MA 01084 Phone #:413- 296 -0123 Are you an employer? Check the appropriate box: Type of project (required): 1. Et I am a employer with L , 4. ❑ 1 am a general contractor and I 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. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. 11:1] Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. El I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box 41 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 information. Insurance Company Name: Travelers Policy # or Self -ins. Lic. #: 6B698713 UB Expiration Date: 04/05/13 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 $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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: I Date Phone #: 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 #: SECTION 8 - CONSTRUCTION SERVICES • 8.1 Licensed Construction S. Not Applicable ❑ Name of License Holder � / Supervisor: i C Z License Number /-/_2 - ,Z Ql F' Address Expiration Date k)ti/ 7 19 Z jc - 5 it Signatu Telephone -�- y/3 - 2 71 d/ 22 9. Register Home im rovement Contractor: /� Not Applicable ❑ / Zde.--r s Company Name Registration Number 1 a Ark ( S ./ 2 7— 2V- l Address // 'J Expiration Date k) 6 .s //4 t fYc/91ePt � /e Telephone��i J 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 1 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 3 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [CI] ief Description of Proposed / Work: /1 / ) A iz.. p Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family X Two Family Other b. Number of rooms in each family unit: Number of Bathrooms --I- C. Is there a garage attached? no d. Proposed Square footage of new construction. "7.2 / Dimensions / e. Number of stories? 9.-- / / f . Method of heating? I. A So C c' G c .c T/tr.,/ Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. ° 4 3 /t Masscheck Energy Compliance form attached? h. Type of construction 4.icoe .1 /A -rr r 1. Is construction within 100 ft. of wetlands? Yes 6/ 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? ✓ Yes No . I. Septic Tank City Sewer r/ Private well City water Supply f � SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i, - Vac( a cs Ol_`e,n `t dS-) , as Owner of the subject property 1/ c hereby authorize [I'� 4 * C to act o my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date e -1 / //e , 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 undue t pains and pe alties of perjury. /C L A i / f Print Name - /ice Signature f Owner /Agent Date 3 ~ / 3 .... 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 6 060 Frontage Setbacks Front Side L: 1 5 R: Rear w Building Height j7 W Bldg. Square Footage S71 % Open Space Footage % (Lot area minus bldg & paved 1 0 parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit/ Variance/ Finding ever been issued for / on the site? NO 0 DONT KNOW YES IF YES, date issued: IF YES Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q IF YES enter Book Page, and/ or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 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 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 ef IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exc ation, 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. Oeft�ar* j t i us Y t City of Northampton Status of P r Building Department Curb ut/Drv�� r } emilt 212 Main Street Sewer /Sip €feAvailbtlty Room 100 Wat Mlel � Northampton, MA 01060 T S of tructu al Piand j phone 413- 587 -1240 Fax 413- 587 -1272 PlooU tta Plans A ��' r Other,SpeCif APPLICATION TO CONSTRUCT, ALTER,.$ RENCT TE O DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION ' 2111,3 1.1 Property Address: ` This section to be completed by office '38o SC7(J ► Ct. — __` Lot Unit eGT1 1) 2 1 - C� �i NCRTHFM'fi ON, MA 01060 N oc - „ o � p � 0 , I� 11 A o b G O Zone Overlay D i s tr T P 1 I`w C Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: _ - e er t li 0 6 C.n C0..ul1� kAC Q , AAA Name Print) Cur ent Mailin ddress: R — �C 1 3 20 Te phone Signature • 2.2 Authorized Ape t: �D /// / 7:1,1,1/9 /e/16 ffle Name Pr Current Mailing Address: > ) Vt -- S — .—,/ e / S gnature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 2 / 73 Z‘ (a) Building Permit Fee 2. Electrical / (b) Estimated Total Cost of } 3 6 Construction from (6) <1 e g'� Building Permit Fee 3. Plumbing / 4. Mechanical (HVAC) 5. Fire Protection j GOO jj 6. Total= (1 +2 +3 +4 +5) / ��) j Check Number 551), 1 {3 S This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0811 APPLICANT /CONTACT PERSON KENT HICKS ADDRESS/PHONE P 0 BOX 57 WEST CHESTERFIELD (413) 329 -4788 Q PROPERTY LOCATION 380 SOUTH ST MAP 38C PARCEL 057 001 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 r/0 if ,5f, 1(. /� Fee Paid ` `7 Q `f l/ Typeof Construction: CONSTRUCT SINGLE FAMILY HOUSE 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 IN R MATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 3 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. 380 SOUTH ST BP- 2013 -0811 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38C - 057 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: New Single Family House BUILDING PERMIT Permit # BP- 2013 -0811 Project # JS- 2013- 001391 Est. Cost: $254095.00 Fee: $434.70 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KENT HICKS 66104 Lot Size(sq. ft.): 6011.28 Owner: OLSEN PETER & TRACI Zoning: URB(100)/ Applicant: KENT HICKS AT: 380 SOUTH ST Applicant Address: Phone: Insurance: P O BOX 57 (413) 329 -4788 0 WC WEST CHESTERFIELDMA01084 ISSUED ON:3/26/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT SINGLE FAMILY HOUSE 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 3/26/2013 0:00:00 $434.70 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner