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29-408 :. 7',4_,,. (,( - v_ _ '-( c.�' ,: ., � � J 2012 1!O4W1t1S ,sicL±. ii .• uaIiy is ft unda noon which we build. K VARIES A K VARIES CAR RIM ARCHIHI ARCHITECTURAL ASPHALT SHINGLES _ ------- „-- END VENT EACH SIDE SINGLE HUNG - ' -- ALUMINUM WINDOW n �� a �_� I SIDING VARIES: 'um W L sib"DURATEMP® —'��— um TEXTURE 1-11 ' OK HORIZONTAL OVER Vs"CDX .=_........7........ ... OVERHEAD DOOR 9'0"x 6'5" r__— I FRONT SIDE *shown with standard single door and standard windows ..--- 30 ASPHALT SHINGLES ('h"PLYWOO '�"CDX PLYWOOD ROOF SHEATHING GUSSETS BOTH ' SIDES 2 x4 RAFTERS 445.71 1'6"O.C. ALUM.DRIP EDGE �Cer l( 'f` . j t��ii I I��i ∎ �° ! I (2)2"x 4"TOP PLATE FINISHED SOFFIT ir ii" i and FASCIA I u; SIDING VARIES: '� I ¢ k�-- 'b"DURATEMP® I in TEXTURE 1-11 OR HORIZONTAL 1 I I 11 OVER'h"CDX 1 We BC PRESSURE TREATED 5-PLY PLYWOOD i'I I it 2"x 4"STUDS I 2,.x 4"PRESSURE TREATED 16"O.C. e f 4 ' OOR JOISTS 8"0.C. f 1 ; f I PRESSURE TREATED j 4"x 4"BEAMS k"a.�,�10'WIDE:5 BEAMS 1‘�(((=tl�l�it Wit=li t,t U,(�t(( .L6 .I,j ,(8 /(A.L ,CC�l.,t—�ll,jt lit( `12'WIDE:5 BEAMS SECTION 14'WIDE:7 BEAMS - --- KLOTER FARMS Nn i tc�A Design meets requirements Designed to resist wind gust of ___ LPL L. . www.KloterFarms.com of 2005 CT Building Code 120 MPH for 3 seconds Residential Section 301.5 Design wind force-34psf 860-871-1048 800-289-3463 Fax 860-871-1117 Floor will support 2000#load Design snow load-40 psf 216 West Road(Rte 83), Ellington,CT 06029 applied over 20 sq.in Design floor load-100 psf .0. .. •••4 = ,..., Z * OH G) rnZni -.a -a < = -, —I Cf) -r• /`■ "77, ..a. 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I , I , , , , --, 0 1 E . eD ft • Mt- Cf) I a 0 0 , , = " , ,..,) , ... i , , .i.. , .....i 0 (/) — l n--- * ril 7: m r < Q1 wro 1"" 2 2 m E. i. rti cr ' '- ,,' g tig , o ,=:. ,,•. a). , . 1..) — ' -C:1:'''''''7 ...''—....04' 7:Lr— tOrD —C/C ' :„,„',:i-4. t :U : '''''■_2'''.7--" -:i . t' ri c ' ' Il^ 7 11-2-: 3 .. : o cr 0 0 c (1) o •-■ i cl 1.V.f'''',:=,"'' aO3 F) co >, n) 0 u, ..,..- .... 0 ACo D CERTIFICATE OF LIABILITY INSURANCE 1oi TI/�OfYYYYI 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 1 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). (CONTACT PRODUCER NAM • C a r•1 • v Dowding, Moriarty & Dinock, Inc. F' _es....tia. tr960-875-2 23 iK. ft6 No,: . .375-0O P.O. Box 300 ADOESS: nowdinga%net n-Pt Rockville , C T 0 6 0 6 6 INSURERIS)AFFORDING COVERAGE I NAIC 0 INSURERA. PEERLESS INS CO I SNSURED INSURER B: '<LOTER FAR)'IS, INC. INSURER C: 216 WEST ROAD INsuREaD: ELLINGTON,CT. 06029 INSURER E: C INSURER F; ) , COVERAGES CERTIFICATE NUMBER: 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 •'' •:I::• POLICY EFF . POUCY EXP iLTR TYPE OF INSURANCE RISS MAD POLICY NUMBER IMWflOA YYYI I IMWDDJYYYYi I LIMITS GENERAL LIABILITY I EACH OCCURRENCE 4$1 .000.000 I DAMAGE T(RER1'ED A I X COMMERCIAL GENERAL UABIL1TY I PREMISES(Ea dgxrrencei $100,009 1 1CLJJMS-MADE I XIDC�IR CRP8083948 10/24'/1210 24/13.4EDExPtAnymeaer0oRl Is 5,000 PERSONAL&ADVINJURY s 1,000.000 GENERAL AGGREGATE $2,000,000 I PRODUCTS-COMP/OP AGG S 2,000,000 CEN'L AGGREGATE LIMIT APPLIES PER: ■ i I Prx cy' I 6: 71 Loc A s l AUTOMOBILELLADIUTY . t i I tEaacaNdentl I �I • 1 S ,7O0.00 A. {ANY AUTO i I /n j BODILY INJURY(Pot persoe) I S NLOVHVED f A9906944 10/' 4/121Cr _4/iy FT SCIEDULED BODILY INJURY(Pe(acidentl j S ` AUTOS H:711 NON-O 1 PROPERTY DAMAGE S AUTOS NED P HIRED AUTOS I .` AUTOS i wr ttcgtlttnll I j UMBRELLA LIAR ;OCG:JR I .1 S EACH OCCURRENCE is 5,000,000 f ExcsssuAB I 1cwMSMn0E( CU9907247 0/24/1110/24/1�Ar,,RECnTE Is 5,000,000 is i :DEC I ■RETENTIONS I I WORKERS COMPENSATION x WC STATU• ( 1OTH-I I AND EMPLOYERS WBtL71-Y I 4E.L EACH ACwiDENT 101 , `� A (!ANY PROPRIETOR/PARTNER/EXECUTNE IY/HI NIA v;C 9 i 7 3 6 3 3 10/24/1210/2 /4 13 OFFICER/SIEMBER EXCLUDED? EL CSEASE•BA EMPLOYER fl OO.000 I{mandatory In NH) 13500,000 I ESSCRIPmOON Of OPERATIONS boo*, E.L.DISEASE•POLICY UNIT 1 DES I RIPTION OF OPERATIONS/LOCATIONS/VEHICLES IAttach ACORD 101,Addlttonal Remarks Sehodul.,N mom.Pad Is required) 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. SPECIMEN AUTHORL ED REJ'RESENTATTJE 1 ED GIZA (.Z-Y e I. Ge. _ t?1588-2010 ACCORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD . - .. ......._ ..."-- --- ...--.. --- ii / / . (---'' ,- 1. 1\ 1 1 -___ (.1 I ; I \ (i...,./""---i t3* , ,...... I ,-----__. { IIII C-----5 I 1 r 1 i cpi ) I _ --------. . r 4. i:-- -........ -,.. cz....... I .........., -s, -3---- -...,..... ....„,.. ., - ....... ._ l' ..... - Ir...>1 ---.— • City of Northampton , TM 515 .�1 Massachusetts ' w ,��f tv ��fr DEPARTMENT OF BUILDING INSPECTIONS } ° 212 Main Street • Municipal Building ON ,11. 4 Northampton, MA 01060 �S� °yam.._ INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 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 any 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 inspect'. are made tC� I, I 4 ` est (9-,i _ understand the above. ( ome owner/ ident's sign re requesting exemption) I will call to schedu all required b ing inspections necessary for the building permit issued to me. Date / �o) ll C Address of work location S-1 PQ `1`(-t 11 An/ l f 4. -r C-_ .. The Commonwealth of Massachusetts Department of Industrial Accidents = Office of Investigations — - 600 Washington Street A411 * Boston,MA 02111 4 s* www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): WO 17,2 r P15 ,Trl C, Address: a-/(o LJ 4.)c74•Q City/State/Zip: � /6!y- �.. l�� C5 t`,�a a Phone#: �CJC> --ro ' 3�� , 3 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.CI 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. ❑ Building 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 12.0 Roof repairs insurance required.] t c. 152,§1(4),and we have no �, j / employees. [No workers' 13.® Other ,r i\gro I comp.insurance required.] *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. TContractors 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: Policy#or Self-ins.Lic.#: 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 $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 perjwy that the information provided above is true and correct. - - / �( � aftoree: 6.4 Date: de)[ 1. LS 41 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,! e. 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone -e_�stere+ orne m+roveme` . ontraetori a `.;a ff _d ` ;` - „°' � .,. ,:�, Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE A FFIDAVIT(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 ❑ e I :l ;° lentil tin 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 ee/L,/ 5 ( • J SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) d ■• f New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n Or Doors ED Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks f0 Siding[D] Other[0] t /tiefDescriPtionofProPose + // �/ e-�btC 3A(/ Y / /17 C r c,c'7�Z.� I!� 4c,e'C 1,..; it c°l Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet a? `r`e idt:ii aedZrladdition, 6 exis inc` '-iiiiiiiiiiiiaiiiiiiiiiet e hey:a l&wrng: 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 ft. of wetlands? 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? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a OWNER AUTHORIZATION .7Q BE COMPLETED,WHEN f..,x OWNERS AGENTOR CON?RACTOOPPLIES FOR BUILflIMG PERMIT w 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 If 15i 0 - , as Owner/Authorized Agent her y declare that the statementand 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. /4 1 6 e cT 0jeie Pfint N i �l-�' 5 a l3 Si at re of Owner/Ag nt Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information a Existing Proposed Required by'Loning This column to be filled in by Building Department � Lot Size I t H i �I ! i Frontage I Setbacks Front = IX+ 1 I Side L:' R:i I / L:1'1OR:! 1 ! ),....._11 Rear ind Building Height Bldg.Square Footage i I = °o = = ; t S Open Space Footage (Lot area minus bldg&paved i { II parking) #of Parking Spaces I i II t=l Fill: 9 `_ 1 _._. _._I .._.__.._.__ ______I 1 (volume&Location) i I` _! A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:■ t IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book I Pagel and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained l Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES l NO 0 IF YES, describe size, type and location: I F 1 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 Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. „,,'.a 7,..4 r$ii;,l$ f� r City of Northampton S r'ug ,Remal -. E,V` ":- -. Tv Building Departments t,.oNS 212 Main Street fP��p6C .r .�; Room 100 1 F% Northampton, MA 01060 Q phone 413-587-1240 Fax 413-587-1272 ,' 4� ' � � `� .4,-''---'i '.o'1 x , 1 _ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING S CTION 1-SITE INFORMATION Rei :; 7his section to be completed by office z 1.1 Property Address: / €t,k ' : z� 1 �� -I .. • t x s” '"' ` 6 9 � 1 'k,- �h.v 4+0,, Lotw s 6 4M,� ' s ^w a a r ' z ri ' t�a C�, �i I 'l A (�f "Zone `��4 -�'� Overlay Districfi -�°: ,t.a m St`District'a ...: CB District ' SEGTIONG2-PROPERTY OWNERSHIP%AUTHORIZED AGENT 2.1 Owner of Record: \ //'� y q // /� �_,Y-t * &r o 4 ra s- (--17\")'e--. Q 1 ICi _11-/1 { 1 L�c G 1- / • Na a(Pn t) Cyrrp ailingc rgs- ti i i b I L /f YY 3 `I ��JJ7 AI` k/ �„ �..' ii / Telephone :ign.ture i , 2.2 Authori d Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3 File#BP-2013-1057 APPLICANT/CONTACT PERSON ST ONGE ALBERT J ADDRESS/PHONE 89 SANDY HILL RD FLORENCE (f7 —11) / 2 v N t a J PROPERTY LOCATION 89 SANDY HILL RD /Li/3 575 L©ci 3 MAP 29 PARCEL 408 001 ZONE cats l411M1 AlAC°1AA) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 9 70 Fee Paid Typeof Construction: ERECT 12 X 24 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 103149 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 Ared, 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. 89 SANDY HILL RD BP-2013-1057 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-408 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: shed BUILDING PERMIT Permit# BP-2013-1057 Project# JS-2013-001748 Est. Cost: $8745.00 Fee: $57.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: OTER FARMS 103149 Lot Size(sq. ft.): 17206.20 Owner: ST ONGE ALBERT J Zoning: Applicant: ST ONGE ALBERT J AT: 89 SANDY HILL RD Applicant Address: Phone: Insurance: 89 SANDY HILL RD (413) 584-4198 0 WC FLORENCEMA01062 ISSUED ON:5/17/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:ERECT 12 X 24 SHED 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 5/17/2013 0:00:00 $57.60 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner