15B-049 til
PENDING APPROVAL
�9 .�°?. CITY OF NORTHAMPTON,MASSACHUSETTS 259 CHESTERFIELD ROAD
• d Al. DEPARTMENT OF PUBLIC WORKS 2013 083
`-- 125 Locust Street Trench Permit Number:
� = �, ` € Northampton,MA 01060
413-587-1570 Date Approved: /?
--- Fax 413-587-1576 Expiration Date: — —
(for City Use Only)
EXCAVATION/TRENCH PERMIT
Pursuant to G.L.c. 82A and 520 CMR 14.00 et seq. (as amended)
This permit must be fully completed prior to consideration. Submit completed form with permit fee to
Northampton Department of Public Works, 125 Locust Street,Northampton,MA 01060.
This permit is issued under the provisions of M.G.L. c. 82A, 520 CMR 14.00 and applicable sections of the
Revised Ordinances of the City of Northampton, including,but not limited to,Section 285-21.
Fee:$250 Check#: 5013 Date Issued: 5/8/13
Name of Applicant Primary Phone#
PATRICK MELNIK 584-6750
e
Street Address Emergency Phone#
259 CHESTERFIELD ROAD 537-0219
City/Town State Zip Email
NORTHAMPTON MA 01060
Name of Excavator Primary Phone#
RANDY BAKER 348-6991
Street Address Emergency Phone#
149 BRIDGE ROAD
City/Town State Zip Email
NORTHAMPTON MA 01060
Name of Property Owner(s) Primary Phone#
PATRICK&ALICE MELNIK 584-6750
Street Address Emergency Phone#
311 CHESTERFIELD ROAD
City/Town State Zip Email
- NORTHAMPTON MA 01060
Insurance Certificate# Policy Expiration Date
ON FILE _/_/3
Name&Contact Information of Insurer 1S
ON FILE
Dig Safe# .
2013-190-2081
-D 2L-J Pa.l/4,Excavation Trench Permit n } �'\
C �,
•
To be completed when approved permit is picked up.
By signing below, the applicant acknowledges and agrees to all the conditions of approval stated below
and validates this permit.
Applicant Date
For City Use--Do not write in this section
Department Approvals/Comment Other Referenced Permits
Water �`. ci— /13 E�r O
Sewer /J , f
/ 3/73
Streets Fl-``J ' _
Condition of road: ,�= 2
Road last paved: C q'g 7
Conditions of Approval
• ❑ Control Density Fill Required ❑ Refer to Engineering for plans
❑ Must install clean-out(See Attached) ❑ Subject to 5-yr.pavement moratorium
❑ Other requirements(See Attached) ❑ Water/Sewer/Drain Entry Permit
Fee
❑ $250 Permit Application Fee received(Check payable to the City of Northampton)
❑ Fee Waived. Reason:
Permit Approval
6g510.4 /13
Director of Public Works Date
Pg.1 ono
City of Northampton
City of Northampton
31yy1
House
Cheste
eW;Rd
s
204 'A* 196
220
212 s
ett
236
228
7/26/13 City of Northampton Mail-259 Chesterfield Rd
i .....vra,.. ..,.... .._
cv, #.4. 4?- ..r.
259 Chesterfield Rd
Louis Hasbrouck <Hasbrouck @northamptonma.gov> Fri, Jul 26, 2013 at 8:58 AM
To: Sarah LaValley <slavalley @northamptonma.gov>
Cc: Carolyn Misch <cmisch @northamptonma.gov>
Sarah,
I've got a permit application for a new house at 259 Chesterfield Rd. Are you all set with any cons corn concerns
for that property? I don't think there's a problem; you reviewed the septic and it doesn't look like the house is any
closer to the possible wetlands at the northwest part of the property. Let me know. Thanks.
Louis Hasbrouck
Building Commissioner
City of Northampton
Town of Williamsburg
(413) 587-1240 office
(413) 587-1272 fax
https://mai I.g oog I e.com/mail/ca/u/0/?ui=2&i k=ec5f19a57e&vi ew pt&search=sent&th=1401b0f3cfa0b96e 1/1
JUL-1a-2013' 1a:13121 FROM: TO:14133846T89 F'.1 2
2013-07-08 ,)00: P 313
Howard Laboratories
62 Main Street- Hatfield, MA 01038 Tel, (41.3) 247-5533 Fax (413) 247-9599
WATER ANALYSIS REPORT
Invoice Number: 16385
Hershaw Well Drilling Sample Location: 259 Chesterfield Rd Leeds, MA
Client: Pat Melnlck Sampled by: ilenshaw Well Drilling
Date Sampled: 7-2-13
Date Received: 7-2-13
Parameter Sample Result Ma DEV/EPA Maximum Comments
Contaminant Limit (MCL)
Total Coliforrn Bacterial Absent Absent OK
E. cobf Absent Absent OK
§ Microbiology Certification #: M-00851 for Total Coliform & E. col/(SM 9223B-Colliertg)
Additional Water Quality Parameters
Parameter Sample Result Detection Limit MA DEP/EPA MCL Comments
Color 117 MO Color Units 1 PtCo Color Units 15 PtCo Color Units rt
Iron 0.52 mg/L 0.01 mg/L 0.3 mg/L
Manganese 0.061 mg/L 0.001 mg/L 0.05 mg/L
Nitrate 1.1 mg/L 0.1 mg/L 10 mg/L OK
Nitrite 0.019 mg/L 0.001 mg/L 1 mg/L OK
pH 6.8 pH Units No Limit 6.5 -8.5 pH Units OK
Sodium 1 mg/L 1 mg/L 20 mg/L OK
Conductivity 0,2 mS/cm No Limit No Standard NO Standard
Turbidity 9.99 NTU 0.5 NTU No Standard No Standard
Chloride 6.4 mg/L 0.1 mg/L 750 mg/L OK
<50 soft
Hardness 105 mg/L No Limit No Standard >100 hard
Parameters marked with an asterisk are above acceptable MCL. Please refer to the
attached sheet for more information. Most of the parameters that are over the limit should
decline to below MCL after a Few weeks as the water and materials floating in the well settle.
Analyst: TS Date: 7-2-13
' ;t025C1
JUN-11-2013 08:46 FROM:NORTHAMPTON HEALTH D 4135871221 TO:914135846789 P. 1/1
•
City of Northampton
BOARD OF HEALTH
PERMIT NUMBER; zot - O t FEE $50
CHECK#Q ct5 q
CASH------'
This is to certify that �(,� �LJJ 1 1L-
NAME
Z i' cti e i4 . ii .ubs OtogS
ADDRESS
Is Hereby Granted a Permit *o Install an
Individual Private Drinking Well:
LOCATION: 501 C - 1ci.4 1)--cl
DATE: ikAar i V , 20 1
:4 ,v- caaAi
This license 1, granted in conformity with s and ordinances relating
thereto and expires CO i i p t 14 unless sooner suspended
or revoked. 1
I
F
gag.-rrtA tp,_ CITY OF NORTHAMPTON, MASSACHUSETTS
1- DEPARTMENT OF PUBLIC WORKS
o--11 . 125 Locust Street
•� � li Northampton, MA 01060
413-587-1570
Fax 413-587-1576
Edward S. Huntley, P.E.
Director
ASSIGNMENT OF HOUSE NUMBER
Street: Chesterfield Road
Assessors Map: Map 15B, Lot 49
House Number: 259
Date: April 29,2013
Remarks: Address assigned to a new building lot on Chesterfield Road as shown on an
ANR plan entitled Remaining Land of Patrick J. Melnik&Alice E. Melnik
Trustees or Melnik Family Trust surveyed by Richard J. Labarge & Son dated
April 25, 2013 and endorsed by the Planning Board on April 29, 2013. The
number assignment was requested by the owner for permitting purposes for the
construction of a single family dwelling.
i i III,
4, es L;uf a, 9I .
I ity Engi •er
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(Joy Winnie)
Applicant/Owner: Patrick J. and Alice E. Melnik
311 Chesterfield Road
Leeds,MA 01053
K:\House Numbers\Chesterfield Road\#259 Chesterfield Road.doc
Commonwealth of Massachusetts ‘720/3
City/Town of Florence Number __
Application for Disposal System /50
= Construction Permit
Fee
Form 1A
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site
sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and
not to place th0:system in operation until a Certificate ofCompliance has been issued by this Board
iof Health. j• A
-, r
Signature Date t I
Application Approved By:
Name Date
gectifr4 spc /c'1
Application Disapproved for the following reasons:
PfrT
1L7,
t5formia.cloc•06/03 Application for Disposal System Construction Permit•Page 3 of 3
BOARD OF HEALTH
CITY OFNORTHAMPTON
ya sf.a •�
DONNA C.SALLOW, CHAIR ;47 i I &•SUZANNE SMITH,M.D. MASSACHUSETTS 01060
JOANNE LEVIN, M.D. j,(16
OFFICE OF THE
b �e1
Benjamin Wood, MPH, Director �-
Daniel Wasiuk,Health Inspector BOARD OF HEALTH
Edmund Smith, Health Inspector 212 MAIN STREET
Patricia Abbott, RN,Public Health Nurse (413)587—1214 NORTHAMPTON,MA 01060
Heather McBride,Clerk FAX(413)587-1221
Onsite Septic System Construction Permit: Conservation Commission Review
NOTE: As of 1/1/11, Septic System Permits will not be issued by the Northampton Health Department
until we receive this form signed by the Northampton Conservation Commission Staff Member.
The Conservation Commission can be reached by contacting:
0 Sarah LaValley, Conservation, Preservation and Land Use Planner
SLaValley@northamptonma.gov
587-1263
Office of Planning& Development
210 Main Street, Rm. 11,City Hall
Northampton, MA 01060
A .Property Owner: f'c� �►c-K `N► r' Address: v9 desier-Weid !
Engineer: f jrY° ct.. Aviv/s Cu sY�vc D�z
V
(C3ci) reatil4
to 7servation Commi on Conservation, Preservation and Land Use Planner
Date: 67q/13
U$( W1 d W`' 91A. y Wfus--s-1 - ThC \k th
(SUBJECT TO ATTACHED CONDITIONS 1 & 2)
Permit No. D26-13
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: Patrick Melnik Sr.
Address: 311 Chesterfield Road
Leeds, MA 01053
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
L.
fr
0
Permit No. D26-13
CITY OF NORTHAMPTON, MA
DRIVEWAY PERMIT
Date: 5/2/13
Check#: So/''
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 new Curb Cut
Permission to install a driveway at: 259 Chesterfield Road
Fifteen (15) foot maximum width from street line to property line. Gutter drainage not to be
disturbed. All drainage shall be directed off the driveway surface to adjacent land and not on the
existing roadway. The first one hundred(100) feet of the driveway surface shall be paved as
soon as possible if the grade of the proposed driveway exceeds 3% at any point in the first one
hundred (100) feet. Homeowners will be held responsible for any costs to the City of
Northampton in the event of a washout of this driveway. City is not responsible for culverts
installed under driveways in City layout. Code of Ordinances §350-8.8 providing standards for
private, individual driveways as most recently amended, must be followed.
By: Patrick Melnik Sr
Telephone: 4 584-6750
_lature: ,
winivh
Proposed By: A 4,A[a /:1,�1- /t it • s` '- ' -13
P
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
\.,
o
I c N
I d N " _
J M
ni o �-,
li o
—LS'90l _ �o
–J---,fS'9ZC M„11,65.00 5 — ---- ------- "r---I?
l
r
NI_h
III
1'I
a- I
I
5 01'9'22"E --
r------- 265.72' /
.,,in Q
/ I o
of x W a aw ~1 _
N U
Q
n
Z�I - a _
' d L :: z U
j
/ 1
265.72' --`
N 01'50'26"W
1 d
ors
b
\ I
li 1
Z
/ n
i
L",
o
L r ' =
m 1 O • •
I: 1
p
_ E
ti ��
I
0_ 3; s r
I -
_
iJ
°
G N
I
I
0___ ,Z3901. _ Ir
.1
to
1 i
1
I
I I
it
// nl
5 01'49'22"E -- —:�
■ ._------ 265.72'
J
3a
A
' ' =
k l •
m
-I- :<1 o NI
gl Q. a
r o
` z
\ \ , o
\
m
I'x 255.]2'
--------- V 01'50'26"N
—
/ \;.�� ICI _ III
d
y a
Feel free to call if you have any questions. My telephone number is 587-1240 and office hours are Monday
through Friday, 8:30 am to 4:30 pm, excepting we close for walk-ins at 12:00 noon on Wednesdays. My email
address is: cmiller @northamptonma.gov
Thank you f. yo .r cooperation o these matters.
Chuck Miller
City of Northampton
Assistant Commissioner and Zoning Enforcement
25. Dryer duct transition is limited to 8'of aluminum flex, must be exposed, and the proper UL listing.780
CMR M1502.4.3
26. Dryer duct maximum equivalent length is 25' less 5' per 90°elbow or per manufacturer's specs.780
CMR M1502.4.4.1, no screwed connections.
27. Markup air is required for any exhaust hood of 400 CFM or more. 780 CMR M1503.4
28. Fireplaces require all combustion air be provided from the exterior and below the firebox, duct work
maintaining 1" clearance for 5'from the duct outlet for all fireplaces and airtight doors. 2009 IECC
402.4.3
29. Fire and draft stopping shall be completed before rough inspection.Typical locations, top(ceiling)and
bottom (floor) plates, soffits, and every 10'within enclosed cavities. 780 CMR R302.
30. Ignition barriers in place before final. 780 CMR R316.
31. Dwelling/Garage fire separation.An attached garage (within 3' of main structure) is required to have%2"
drywall on the garage side of the separation wall and if there is a finished space above the garage all
walls must have%" drywall and the ceiling 5/8" drywall. 780 CMR R302.6
32. Energy aspects shall comply with the stretch energy code. 780 CMR Appendix 115AA or 2009 IECC.
a. An initial HERS evaluation is required including insulation levels anticipated.
b. A final HERS evaluation confirming code requirements have been met including duct testing.
c. A signed copy of the Thermal Bypass Checklist.
d. Energy information including mechanical equipment posted on the electric panel.
e. Remodeling and Additions can be completed in accordance with IECC 2009 with Energy Star
Windows and the Thermal Bypass Checklist. Duct blast testing when practicable.
f. All band joist insulation must be enclosed within an air tight cavity,which you must create.
33. Vapor retarders.Although these are still in the code have exceptions, one must understand that there is
a difference between a vapor retarder or barrier and an air barrier. An air barrier is intended to stop air
flow(convection)a vapor retarder or barrier is intended to stop molecular moisture transfer(diffusion).
A vapor retarder or barrier is effective even if there are some holes or gaps, however an air barrier has
to be absolute and complete. If air can leak through an electrical device or through a crack it follows the
path of least resistance and carries 99%of the moisture in a structure.This is evident every time one
exposes fiberglass insulation and finds black insulation,which is dirt filter out of the air moving through
the insulation. 780 CMR R601.2 for vapor retarders and Table N1102.4.2 for air sealing requirements.
34. Unvented attic assemblies. Hot roofs are allowed, but have specific requirements 780 CMR R806.4.
35. Deck ledgers and post must be appropriately attached, bolts or lags. 780 CMR R502.2.2.1 Note:ThruLoks
are engineered for post attachment supporting a railing. Lateral attachment is required for each deck
per section 502.2.2.3.
36. Smoke and CO detectors as required. 780 CMR R314 and R315.
a. Smokes in each bedroom,within 10'of a bedroom door, and at the bottom of a stair leading to
a finished floor above.
b. CO within 10' of bedroom doors, at each level,for every 1500 sqft, (plumbing code in the
mechanical room) Except if there are no fossil burning fuels.
c. Heat detector in attached garage, and other large unfinished unconditioned spaces.
37. Closets beneath stair which have doors must be drywalled with%". 780 CMR R302.7
38. If there is mechanical equipment or a combustible roof, 30 sqft of space, and 30" measured from top of
ceiling joist to bottom of rafters an attic access of minimum RO of 22"x 30" is required to be located in
an accessible place. It must be insulated,gasketed, and secured in place.
Relevant items must be submitted to the building department for approvals before inspections and or
Certificates of Occupancy can be issued.
12. A complete window and header schedule is required. 780 CMR Table R502.5 for header sizing and
number of jack studs required.
13. All framing materials which are not code prescriptive must have stamped engineering.
a. LVLs
b. I-joist and or Floor Truss
c. Roof truss
14. A braced wall plan identifying appropriate braced wall areas where required (R301.1) and braced wall
method being used. 780 CMR 602.10.
a. Garage corners and large corner window/door layout may require special solutions.
b. All corners must be appropriately attached to the foundation.
c. When using PFH (R602.10.3.3) or PFG (R602.10.3.4)the nailing requirement is 4" and 3"
respectively using 8d common nails or galvanized box nails. NOT PNEUMATIC NAILS
15. When nailing sheathing make sure your pneumatic nailers' pressure is properly set. Nails set too deep
perforate the sheathing weakening it and contribute to building damage in high wind events.
16. Ceiling heights minimum 7'for habitable spaces, 6'8"for bathrooms includes tub/shower area if a
shower head is used, 6'8"for basements, 6'4" at beams/ducts. 780 CMR R305.1. MA amended
17. Hazardous glazing locations, within 24" of a door, or within 60" of a stair, or across from hot tubs,spas,
bathtubs within 60" if not 60" above the walking surface, and other locations.780 CMR R308.4
18. Windows over 72" above grade with the opening less than 24 above the finished floor shall meet the 4"
sphere rule.Order restrictors.780 CMR R612.2
19. Egress and emergency escape requirements shall be strictly met.
a. Basements, habitable attics, and all sleeping rooms require emergency escape.780 CMR R310
b. Windows within 44" of floor, DH 3.3 sqft min window size, Casement 20"x41" exception 5 sqft
at 1st floor. Minimum clear opening 20"x24" or 24"x20". 780 CMR R310.1.1
c. Two doors remote as possible at the normal level of travel, opening measured from the face of
the slab to the stop with door at 90 degrees, one 32" and one 28" minimum 78" high. 780 CMR
R311.2
d. Landing at each door 36"out and the width of the door minimum 36", maximum step 7%" from
the top of the threshold and only in-swinging doors. 780 CMR R311.3
20. Stairs have critical standards, make sure you know the floor finishes when planning. Minimum tread 9",
maximum riser 81/4", maximum overall variance for the run is 3/8",4" sphere rule on risers except where
the total rise is 30" or less 780 CMR R311.7.4.3 Exception,4 3/8" on balustrade, 6" in the triangle.
Graspable rail 13/4" minimum and 2" maximum rail, height minimum 34" maximum 38", required for 4 or
more risers. Landing to landing constitutes a new run. Minimum 6'8" ceiling height from nosing. Rails
must be continuous and returned to the wall if not to newel post.780 CMR R311.7.
21. Guards 36" minimum height above walking surface, a bench is a walking surface, required for more than
30" above floor or grade within 36",4" sphere rule.780 CMR R312.1.
22. Educate the plumber and electrician about maximum notch and hole sizes, and placement. 780 CMR
R502.8 and R602.6. In bearing studs holes not larger than 40%of a stud no closer than 5/8 to the edge,
In interior non-bearing studs holes not larger than 60%of a stud no closer than 5/8 to the edge, or holes
in joist are a maximum 1/3 the depth not closer than 2"from the top or bottom or to any other hole.
Notches are different.
23. Drilling or notching of more than 50%of the wall plate width of an exterior wall or load bearing partition
requires a 16 GA 1 W' strap across the area and 6" beyond each side with 8- 10nd nails. 780 CMR
R602.6.1
24. Dryer ducts must terminate outside of the building, have a backdraft damper, cannot include a screen,
and require 3' clearance from windows. 780 CMR M1502.3
City of Northampton
'` `' Massachusetts �5 cff
ff il:*---A 1
p * G
` DEPARTMENT OF BUILDING INSPECTIONS �" 11
`„ t_C .,
' § 212 Main Street • Municipal Building OE. C "
". w Northampton, MA 01060 ss II VO
INSPECTOR
Ed Jazab June 30, 2013
9 Shepherds Hollow
Leeds, MA 01053
Subject Location: 259 Chesterfield Road, Florence, MA
Map Block: 15B-049
Mr.Jazab,
Your building permit application and plans dated 7-30-12 have been approved as drawn and per this memo.
All work must meet all applicable codes whether noted or not included within this memo.
Please follow up on the following items:
These items will need to be accomplished as the project moves forward and before rough inspections;
1. Engineering on all non-prescriptive items, LVL, I-joist, and truss.
2. HERS initial and final ratings, duct blast results, and a signed Thermal Bypass Checklist.
3. A smoke/CO per code.
4. Thermal barrier between exterior slab and wood frame.
5. Lateral attachment is required for each deck per section 502.2.2.3 (state is pushing these)
6. If the basement is not conditioned space the walls around the stair and the door leading to the
basement should be insulated, however HERS allows for tradeoffs.
As of August 4th 2011 the 8th Edition MA code is the 2009 IRC with MA amendments.
In the following are some generic requirements which seem to be problematic.
This is not intended to be comprehensive, nor is it a substitute for purchasing and reading the MA codes.
Read only international codes are available on line at http://publicecodes.cvberregs.com/icod/one
must also consider the MA amendments to these codes which can be found at www.mass.gov/dps/bbrs.
The current relevant building codes are:
2009 IBC, 2009 IEBC, 2009 IMC, 2009 IRC, 2009 IECC,AA115, MA amendments.
1. Structures shall conform to 780 CMR 8th Edition 1 and 2 family building codes with MA amendments.
2. Grading plan for structures being constructed required. 780 CMR R401.3 for drainage requirements.
3. A basement drainage system is required in all basements 780 CMR R405.2.3. except those in group
soils (table R405.1)
4. Foundations that retain earth and enclose interior space require damp proofing 780 CMR R406.1.
5. Through wall form ties must be removed from both faces and patched with hydraulic cement.780 CMR
R406.2 of amendments.
6. Foundation anchor bolts must be%" and be embedded a minimum of 7" into the concrete. 10" bolts!
780 CMR R403.1.6
7. CMU foundations require 3/8" parging before damp proofing. 780 CMR R406.1 see exceptions.
8. Emergency escape is required out of every basement whether habitable or not. 780 CMR R310.1
9. Ceiling joist are intended to prevent spread,once raised above the wall plate they become rafters ties
and may require up sizing of rafters and increased nailing for example with a 4" slope 8-16nd common
are required at each connection. 780 CMR R802.3.1. When there is neither of these a structural ridge is
required with a load path to the foundation.
10. Steel straps over the ridge or 1x4 minimum collar ties are required 4'OC in the upper 1/3rd 780 CMR
R802.3.1
11. Ridge boards must be the full depth of the cut. 780 CMR R802.3.
.0 . (.Z�1 Qf NQZtltantptilit �—
Nom ••` !8 A58ALhII8ttf3 I'M —'
__ z
' '" DEPARTMENT OF BUILDING INSPECTIONS 4 _
INSPECTOR 212 Main Street • Municipal Building 7`Q,N—
5
Northampton,MA 01060
LOCATION 025 9 � � i
SQUARE FOOTAGE AMOUNT
BASEMENT @ .20 3 50 9.90
1 FLOOR 50 13 5 o tp�7
2ND FLR @.30 •
i0Lk0 31 �
IA FLOORS, FINISH ATTIC,GARAGE @.20 1 0 0 1 Li 0
DECK/PORCHES @ .20 2 6 L1 3 v
TOTAL. , C 0
.p1 .. The Commonwealth of Massachusetts
Y` �,-�:—... Department of Industrial Accidents
_ ,_..
),E: Office of Investigations
M E.:AM
nu ; w, 1 Congress Street, Suite 100
" = 1,= Boston, MA 02114-2017 trir
all C
Iwwwww
v0
wwx.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Edward Jazab
Address:9 Shepherds Hollow
City/State/Zip: Leeds Ma. 01053 Phone #:413-222-4910
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. n I am a general contractor and I 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
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. ❑ Building addition
[No workers' comp. insurance comp. insurance.t
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
employees. [No workers' 13.❑ Other
comp. insurance required.]
*My 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
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 cergv u r the pains and penalties of perjury that the information provided above is true and correct.
Signature: �` Date: 1 .2-.7-- \ 2 0 G Phone#: 4'3 22 - LO 10
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 Supervisor: Not Applicable ❑
Name of License Holder: IL✓ T424 4 cs n'A -050D 9 9
License Number
9 s AlE/LtAiff /JolLD 1-1 D )J t3' oy /02 1 ZO1L\
Address Expiration Date
q4)\'\\,.,6\ .,,,., Li 13 -* ja4._ q1 ) 0
Signature 1" Telephone
9.Re, stered Home Im•rovement Contractor Not Applicable ❑
Company Name Registration Number
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 A 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 0 Addition ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[0]
Brief Description of Proposed ni
Work: Construct new single family home �:w"`
relf2'
Alteration of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes x 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: 6 Number of Bathrooms 2
c. Is there a garage attached? yes
48' r
d. Proposed Square footage of new construction. 2000 Dimensions X
e. Number of stories? 2
f. Method of heating? geothermal Fireplaces or Woodstoves yes Number of each 1
g. Energy Conservation Compliance. yes Masscheck Energy Compliance form attached? Yes
h. Type of construction Wood frame
i. Is construction within 100 ft.of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade L✓A 4.4( 0 iT 6Os ''L`' 0
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank A City Sewer Private well \ City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
f0Ar R►c4 T , , t #"li
i, , as Owner of the subject
property 11
hereby authorize
L.✓n,,,J 74z4b
to act on my beha all matters relative to work authorized by this building ermit application.
. 7 r a) I.7
Signature of O ate
/'�Ot,e-(H , .. .41 Eta h , 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 under ie pains and penalties of perjury.
fA aljk 1' „, ,,/lk
Print Name '
td) 1.
�
Signature of Own: 'gent to
4
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 80,000 80,000_
Frontage 300 300.
Setbacks Front 40 40
Side L: 175 R: 75 L: 175 R:75
Rear 190 190
Building Height 0 35
Bldg. Square Footage J % 2000> 3%
Open Space Footage )(M•n',
(Lot area minus bldg&paved /d UV; 97%
parking)
J
#of Parking Spaces 0 2
Fill: U U
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 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 (3 DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?—/VDT'
` D i //1°211
Needs to be obtained 0 Obtained c)4 , Date Issued: 06/01/2013
54,444 4,1441 `JAI 4tt.JJ ,or rite lekt)0'+l rt rgerIc to 0��.
o,,rrt.�t v l.• I/t-
C. Do any signs exist on the property? YES NO t• f "t •
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,excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
fkq
it of Northampton status of,Permit:
Buil s ing Department Curb Cut/Drive"Permit
2.Q\3 21' Main Street Sewer/Septic Availability,'
•oom 100 WaterVell Availability
�oiNGha pton, MA 01060 Two Sets of Structural Plans
pEFTNA J�' �` ° -587-1240 Fax 413-587-1272 Plot/Si#e Plans
Other.Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: //� /� Q
�\ei t lT'�/'f"7 -t /l�/ Map /_513 Lot `_( Unit
S ni,.A U , OS-? Zone Overlay District
S Y� — 4 i ot•/t) Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Patrick J.Melnik and Alice E. Melnik,Trustees 311 Chesterfield Road,Leeds,Ma. 01053
Name(Print) Current Mailing Address:
413-5841155
Telephone
Signature
2.2 Authorized Agent: u 4 9 f isie'4.•415/ f pill / v✓ L11
Name(Print) Current Mailing Address:
Li`? — aa� 4 9JD
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 120,000 (a) Building Permit Fee
2. Electrical 15,000 (b)Estimated Total Cost of
Construction from(6)
3. Plumbing 15,000 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection 20,000 )) r,
6. Total=(1 +2+3+4+5) 170,000 Check Number ..9 7 � Yd JC
. V
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0058 MC •
APPLICANT/CONTACT PERSON ED JAZAB 0 v' ,,
ADDRESS/PHONE 9 SHEPHERDS HOLLOW LEEDS (413)222-4910 O I eft c Otte
PROPERTY LOCATION 259 CHESTERFIELD RD M `�rcA
MAP 15B PARCEL 049 001 ZONE OD
GO03
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ��f (ij�
Fee Paid �.J 7 /, �j'� '
Typeof Construction: CONSTRUCT SFH W/ATT GARAGE/DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 050099 ✓�IN f&e *'rc 1ir<�
3 sets of Plans Plot Plan
THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I FO 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
e lition 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.
259 CHESTERFIELD RD BP-2014-0058
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 15B-049 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-2014-0058
Project# JS-2014-000134
Est.Cost: $170000.00
Fee: $1440.20 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ED JAZAB 050099
Lot Size(sq.ft.): Owner: MELNIK PATRICK J&ALICE E
Zoning: Applicant: ED JAZAB
AT: 259 CHESTERFIELD RD
Applicant Address: Phone: Insurance:
9 SHEPHERDS HOLLOW (413) 222-4910 ()
LEEDSMA01053 ISSUED ON:7/31/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT SFH W/ATT GARAGE/DECK
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 7/31/2013 0:00:00 $1440.20
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner