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Bk: 07508 Pg: 196
"ATTACHMENT A"
18. The owner of the property described in this Order must advise any potential buyer of the
property that any construction or alteration to said property, including brush cutting or
clearance,may require approval by the Northampton Conservation Commission.
Any instrument conveying any or all of the owners'interest in said property or any portion
thereof, shall contain language similar to the following:
"This property is subject to the Northampton Wetlands Protection
Ordinance and/or Wetlands Protection Act. Any construction or
maintenance work performed on this property requires an Order of
Conditions, and/or a Determination of Applicability from the Northampton
Conservation Commission.
19. A copy of this Order and associated plans shall remain on site during Al construction
and/or building activities. The project manager and all equipment operators shall be
familiar with the approved plans, and shall be informed of their location on the site.
This location shall be accessible to all contractors whenever wort: is occurring on
site.
20. All required permits must be obtained from the Army Corp of Engineers (Section 404,
Water Quality Certification), Planning Board, Zoning Board, Department of Public
Works, or Building Inspector prior to the start of projects involving fill within any
wetland resource area;
21. No disposal of soils or other materials shall be allowed within: a 100-year floodplain;40
feet of the 100-year floodplain elevation; any wetland; or any area within 100-feet of a
wetland, unless such areas are specifically approved by the Commission, in accordance
with 310 CMR 10.00, and City of Northampton Ordinances - Chapter 24;
22. All revised plans,referenced within this Order of Conditions, shall be approved by the
Conservation Commission and incorporated into this Order by reference and shall be
followed during the course of construction.
23. Ongoing conditions that shall not expire with the issuance of a Certi f icate of Compliance
areas follows: NA
24. Prior to the start of any site work, excavation or construction, a preconstruction
conference shall be held on the site, bet,,veen the contractor conducting the work, the
site/project engineer, the applicant, and a member or agent of the Conservation
Commission, in order to ensure that the requirements of this Order arc understood by all
parties. Prior to the pre-construction meeting, all erosion control devit:es must be
installed, also.
Bk: 07508 Pg: 195
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 246-527
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
D. Recording Information (cont.)
Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission.
- --------------------------------------------------I--------------------------------------------------
To:
Conservation Commission
Please be advised that the Order of Conditions for the Project at:
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
County Book Page
for-
Property Owner __ —_.--------_--- .
and has been noted in the chain of title of the affected property in:
Book ---- - ..
Page
In accordance with the Order of Conditions issued on:
Data _. .-_... _. .�... ——
If recorded land, the instrument number identifying this transaction is:
Instrument Number — —If registered land, the document number identifying this transaction is:
Document Number
Signature of Applicant
wpafortn5.don•rev.12/15106
Pape 7 or 7
Bk: 07508 Pg: 194
Massachusetts Department of Environmental Protection
- DEP File Number.
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions 246-527
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Appeals
The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject
to this Order,or any ten residents of the city or town in which such land is located, are hereby notified of
their right to request the appropriate DEP Regional Office to issue a Superseding Order of Conditions.
The request must be made by certified mail or hand delivery to the Department, with the appropriate filing
fee and a completed Appendix E. Request of Departmental Action Fee Transmittal Form, as provided in
310 CMR 10.03(7)within ten business days from the date of issuance of this Order.A copy of the request
shall at the same time be sent by certified mail or hand delivery to the Cnnsprvation Commission and to
the applicant, if he/she is not the appellant.
The request shall state clearly and concisely the objections to the Order which is being appealed and how
the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands
Protection Act, (M.G.L. c. 131, §40)and is inconsistent with the wetlands regulations (310 CMR 10.00).
To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts
Wetlands Protection Act or regulations, the Department has no appellate jurisdiction.
D. Recording Information
This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in
which the land is located,within the chain of title of the affected property. In the case of recorded land,the
Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land
subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court
Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information
on Page 7 of Form 5 shall be submitted to the Conservation Commission listed below.
Conservation Commission
Wpe(orm5.doc-rev.12116100 Pepe 6 of 7
Bk: 07508 Pg: 193
Massachusetts Department of Environmental Protection DEP File Number.
Bureau of Resource Protection -Wetlands
WPA Form 5 - Order of Conditions Provided by DEP
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings (cont.)
Additional conditions relating to municipal ordinance or bylaw:
This Order is valid for three years, unless otherwise specified as a special condition pursuant to General
Conditions#4, from the date of issuance.
16 SeRieimbcr 2003
}ate
This Order must be signed by a majority of the Conservation Commission.The Order must be mailed by
certified mail (return receipt requested)or hand delivered to the applicant.A copy also must be mailed or
hand delivered at the same time to the appropriate Department of Environmental Protection Regional
Office(see Appendix A)and the property owner(if different from applicant).
Signatures:
ilk lot
On this 281"day Of August, 2003
Day Month and Year
before me personally appeared
the above-named
to me known to be the person described in and who executed the foregoing instru ~ Qrr
acknowledged that he/she executed the same as his/her free act and deed.
Nota
Public7 rQTy Cbmmissid, es
This Order is issued to the applicant as follows:
❑ by hand delivery on by certified mail, return receipt requested,on
Date Date
wparorm5.doc.ray.12115100 Page 5 of 7
Bk: 07508 Pg: 192
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands QEP Fite Number:
WPA Form 5 - Order of Conditions 246-527
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by QEP
B. Findings (cont.)
15. This Order of Conditions shall apply to any successor in interest or successor in control of the
property subject to this Order and to any contractor or other person performing work conditioned by
this Order.
16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland,
the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden
stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a
Certificate of Compliance has been issued by the Conservation Commission.
17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully
stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or
water body. During construction, the applicant or his/her designee shall inspect the erosion controls
on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately
control any erosion problems that occur at the site and shall also immediately notify the Conservation
Commission, which reserves the right to require additional erosion and/or damage prevention controls
it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of
work line has been approved by this Order.
Additional Conditions:
See"Attachment A'
Findings as to municipal bylaw or ordinance
Furthermore, the hereby finds (check one that applies):
Conservation Commission
❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
Municipal Ordinance or Bylaw Citation
Therefore,work on this project may not go forward unless and until a revised Notice of Intent is
submitted which provides measures which are adequate to meet these standards, and a final Order of
Conditions is issued.
❑ that the following additional conditions are necessary to comply with a municipal ordinance or bylaw,
specifically:
Municipal Ordinance or Bylaw Citation
The Commission orders that all work shall be performed in accordance with the said additional
conditions and with the Notice of Intent referenced above. To the extent that the following conditions
modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent,
the conditions shall control.
ftatorrn5.doc•rev.12/15100 Pegs 4 a 7
Elk: 07508 Pg: 191
Massachusetts Department of Environmental Protection
• DEP File Number.
Bureau of Resource Protection Wetlands
WPA Form 5 - Order of Conditions 246-527
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
B. Findings (cont.)
4. The work authorized hereunder shall be completed within three years from the date of this Order
unless either of the following apply:
a. the work is a maintenance dredging project as provided for in the Act; or
b, the time for completion has been extended to a specified date more than three years, but less
than five years, from the date of issuance. If this Order is intended to be valid for more than three
years, the extension date and the special circumstances warranting the extended time period are
set forth as a special condition in this Order.
5. This Order may be extended by the issuing authority for one or more periods of up to three years each
upon application to the issuing authority at least 30 days prior to the expiration date of the Order.
6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse,
rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard,
pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing.
7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such
an appeal has been taken, until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Order has become final and then has been recorded in the
Registry of Deeds or the Land Court for the district in which the land is located,within the chain of title
of the affected property. In the case of recorded land, the Final Order shall also be noted in the
Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to
be done. In the case of the registered land, the Final Order shall also be noted on the Land Court
Certificate of Title of the owner of the land upon which the proposed work is done. The recording
information shall be submitted to this Conservation Commission on the form at the end of this Order,
which form must be stamped by the Registry of Deeds, prior to the commencement of work.
9. A sign shall be displayed at the site not less then two square feet or more than three square feet in
size bearing the words,
"Massachusetts Department of Environmental Protection" [or, "MA DEP']
"File Number 246-527 "
10. Where the Department of Environmental Protection is requested to issue a Superseding Order,the
Conservation Commission shall be a party to all agency proceedings and hearings before DEP.
11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of
Compliance(WPA Form 8A) to the Conservation Commission.
12. The work shall conform to the plans and special conditions referenced in this order.
13. Any change to the plans identified in Condition#12 above shall require the applicant to inquire of the
Conservation Commission in writing whether the change is significant enough to require the filing of a
new Notice of Intent.
14. The Agent or members of the Conservation Commission and the Department of Environmental
Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours
to evaluate compliance with the conditions stated in this Order, and may require the submittal of any
data deemed necessary by the Conservation Commission or Department for that evaluation.
Wpalorns.aoc•rev.12115/00 Papa 3 or 7
l3k: 07508 Pg: 190
Massachusetts Department of Environmental Protection
Bureau ofIResource Protection - Wetlands DEP File Number:
WPA Form 5 -, Order of Conditions 246-527
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
B. Findings
Findings pursuant to the Massachusetts Wetlands Protection Act:
Following the review of the above-referenced Notice of Intent and basea on the information provided in
this application and presented at the public hearing, this Commission finds that the areas in which work is
proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply:
® Public Water Supply ❑ Land Containing Shellfish ® Prevention of Pollution
® Private Water Supply ❑ Fisheries ® Protection of Wildlife Habitat
® Groundwater Supply ® Storm Damage Prevention N Flood Control
Furthermore,this Commission hereby finds the project,as proposed, is: (check one of the following boxes)
Approved subject to:
® the following conditions which are necessary, in accordance with the performance standards set forth
in the wetlands regulations, to protect those interests checked above. This Commission orders that all
work shall be performed in accordance with the Notice of Intent referenced above,the following
General Conditions, and any other special conditions attached to this Order. To the extent that the
following conditions modify or differ from the plans, specifications, or other proposals submitted with
the Notice of Intent, these conditions shall control.
Denied because:
❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland
regulations to protect those interests checked above. Therefore, work on this project may not go
forward unless and until a new Notice of Intent is submitted which provides measures which are
adequate to protect these interests, and a final Order of Conditions is issued.
❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect
of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this project
may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient
information and includes measures which are adequate to protect the Act's interests, and a final
Order of Conditions is issued.A description of the specific information which is lacking and why it is
necessary is attached to this Order as per 310 CMR 10.05(6)(c).
General Conditions (only applicable to approved projects)
1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory
measures, shall be deemed cause to revoke or modify this Order.
2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any
injury to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying with all
other applicable federal, state, or local statutes, ordinances, bylaws, or regulations.
fteform&doc-rev.1211 WOO Page 2 or 7
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number.
WPA Form 5 - order of Conditions 246-527
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. General Information
Important: From: 1
When filling
out forms on Northampton _ Bk:7608Pg: 189 Pago: 1 of 9
the computer, Conservation Commission Recorded: 10/03/2003 02:32 PM
use only the
tab key to This issuance if for(check one):
move your
cursor-do ® Order of Conditions
not use the
return key. ❑ Amended Order of Conditions
VQ To: Applicant: Property Owner(if different from applicant):
,lames Dimas _
Name Name
r 75 Pomeroy Terrace
Mailing Address Mailing Address
Northampton MA 01060
City/Town State Zip Code CityiTown state Zip Code
1. Project Location:
Northampton
Street Address City/Town
36 155
Assessors MapiPiat Number Parcel/Lot Number
2. Property recorded at the Registry of Deeds for:
Hampshire
County Book Page
Certificate(if registered land)
3. Dates:
May 15, 2003 August 28, 2003 _ September 17,2003
Date Notice of Intent Filed Date Public Hearing Closed Date of Issuance
4. Final Approved Plans and Other Documents(attach additional plan references as needed):
"Sketch of Land in Northampton, Massachusetts Prepared for James _Dimas" 6111/03
Title Date
Title Date
Title Date
5. Final Plans and Documents Signed and Stamped by:
Paul Lussier, Registered Professional Land Surveyor
Name
6. Total Fee:
$125.00
(from Appendix B:Wetland Fee Transmittal Form)
WpafoM%5.doc•rev.12!15100 Pape 1 of 7
ENERGY CONSERVATION APPLICATION FORM FOR
LOW-RISE'RESIDENTIAL NEW CONSTRUCTION and ADDITIONS
780 CMR Appendix J
Applicant Name: tS DI.-tos, Site Address: 30q(X)vs+h p" Fc�
Applicant Address: ZYp rim r-5-t- 5q� City/Town: rc o r in Ge
//o r K., 1 Use Group:
O 1 a G 0 Date of Application: Ob
Applicant Phone: -sly 0 Applicant Signature:
Compliance Path(check one):
❑ Prescriptive Package(Limited to 1-or 2-family wood frame buildings heated with fossil fuels only)
Package(A through KK from Table J5.2.1b): Heating Degree Days(HDD,S)from Table J5.2.1a:
(For items d.through i.,fill in all values that apply from Table J5.2.1b:)
a. Gross Wall Area sq.ft f Wall R-value R-
b. Glazing Area' sq.ft. g. Floor R-value R-
c. Glazing%(100 x b_a) % h. Basement wall R-
d. Glazing U-value U- i. Slab Perimeter R-
e. Ceiling R-value R- j. Heating AFUE
❑ Component Performance: "Manual Trade-Off'(Limited to wood or metal framed buildings only)
Climate Zone(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14
Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet,if applicable]
❑ MAScheck Software
Attach Compliance Report and Inspection Checklist printouts
❑ Home Energy Rating System Evaluation
Attach Home Energy Raring Certificate(HERS rating score must be 83 or higher)
❑ Systems Analysis OR ❑ Renewable Energy Sources
Attach Mass Registered Architect or Engineer Analysis
ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wall+Ceiling Area 735 sq.ft. b. Glazing Area' S`// sq.ft. c. Glazing%(100 x b=a) T3%
❑ ADDITION with Glazing%(c.)up to 40%may use 780 CMR Table J1.1.2.3.1 below:
MAXIMUM U-value MINIMUM R-Values
Fenestration' Ceiling' Wall Floor Basement Wall slab Perimeter Depth
0.39' 1 R-37 R-13 R-19 I R-10 R-10 4 ft
1 Glazing Area may be either Rough Opening or Unit dimensions.
2 Based on NFRC listing. Applies either to every unit,or to area-weighted average of all units.
3 R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area
(i.e.-not compressed over exterior walls,and including any access openings.)
❑ "SUNROOM"addition(greater than 40%glazing-to-wall and ceiling gross area)
Attach"Consumer Information Form"from 780 CMR Appendix B.
Official's Name: Official's Signature:
Application Approved ❑ Denied ❑ Date of Approval/Denial:
Reason(s)for Denial: (provide additional details as needed on back side)
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DEPARTMENT OF BUILDI]\TG INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
North,unpton,MA 01060 1
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CNlR 108.3.4 to
act as has/her construction sup, "sor. 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 inspections are
made
understand the above.
00me owner-/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date 7 0 b
Address of work
location a S AaQ a d�
Oy _
� .F .�E U.Z�� LJrf ��Ql"flji:illl�lfDll
DEPARTMEIJT OP BUILDF)\C INSPECriot,,s
212 Main Strcct ' Municipal Building
Northampton, Mass. 01060 '
, J
i
Zvoi cons COIKPENSATTON MSURA..NCE Al,I'l7)AVI-j'
(li MaS--Jpermi tfcc)
a principal place of business/residencc at:
i
Not"llrlawP-w (phone')VV 3- 3;1-'D
(sortJcity/ izj p) (`�166d
do hereby certify, under the paans and penalties of pc 'ury.; :hat
( ) I
an an employer providing the followine worker's comocnsabon cover-age for ln)
elnployces woriong on this job:
Qnstzn� Conr�r) (Polio: N+i r) -- ( :pirdor, D21^)
O I am a sole proprietor, general contractor or homeowner (code one) and have hired
the conua(ngrs listed below wbo have the `oUo ing Worker's ca Mipensa 'on policies:
(i+fill]: Of CO r Ci0') (IIIR I�I7(^ Comp m)Y-PGUc-i Nurt-c ) (Expira"20 D-Itc)
(Name of Conlraaor) (UIs,.uancc COmDan)'/POIiCi Nuzacc'r) (Ea-Dif iron Date)
(Name of Conaacto,) (Insura-ncc Compaoy/PoUq- Numbu) (Expirdon Daic)
(Name of Contractor) (In_suranc-- Comcany/Poticy Numb-:r) (Expiration Daft).
i (nIIzc�_dutocaJ rSoa,if ncce>_1 -tO atcludc inforrla.'ioo pertniai.as to.L co=,,- a)
{ ) I am a sole proprietor and have no one working for me.
I am.a home owner performing all the work myself:
NOTE:plea be ew zre Lz kfJe 6cmeo.vacrs..too em�loY➢� w c• - • =,'a M r rcTau..-Or"k vU L d..<11_Z of
not taoce the t�rw t=t*J is the bomcc--c rcidn or ca the p-oun6 z7purteal7 the rn c c we C-k By arsd�c+i Lobe
eixployc1 unCc the-ui:ch O—P .c-Act(GL152-s1(5)),r-pgG=6w by a hamcoavc for:bc=_cr pamh=y ctiide tLc
j Ic-PJ cu-'uc of as cr ployx aadrr d-WorS -,Cooapooaa O Act_
I--dcr-aad tba a oopy a thic mt.co,=may bo fo--,ded to tho Dop_tmmd or j a-cricl Accd=L,'OJL_of 4u+c'<000 for the
eova�c ve'irextioa and Uu Lal=c to sc„urc toverI9r=d--u=uoa 25A of MGL 151 c=lad to the iap-Z ion of cimiatl pca+.Wt
coosiriztg orz rmc ortp to s 1}oo.00 arwor tmpriyo®,=o(up to occ yvr tnd civil pc=ij=io tSc form o(a Stop Work Ord--and a
riff+o(S I00.00 1 d--y Lpjct a M,_
For dcp+rtm-r,t u.c orily
Si Zion of Lic=nSc�lperrnittcc —?�2 0�j Ivt3Q°-- Lot ^ J .
R
SECTION 8-CONSTRUCTION SERVICES 14
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
.. ..R MW, Not Applicable .❑
J Heatsferec lommproenent :oitracfo �
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10 WORKERS'COMPENSATION INSURANCEAFFIDAVIT(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...... ❑
�`-.� 111,1 111 , Il _
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 1083.5.1.
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 buildine 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.
7rtiomeowner Signaturet �
SECTION 5-DESCRIPTION OF PROPOSED!'WORK(check all applicable)
New House ❑ Addition ;:Z Replacement Windows Alteration(s) Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[C]]
Brief Description of Proposed f
Work: Vl L V)1011 a I-d0K
Alteration of existing bedroom Yes DC No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _ No
Plans Attached Roll -Sheet
��
865-lf' ewm ouse�an�or C di lO Ito exls(n 1Oi]sirlQ �GOmt�@ e 1e O�owinQ:
a.L 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? Al 0
d. Proposed Square footage of new construction. 23'K Dimensions �� x f
e. Number of stories?
f. Method of heating? 6/ 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? A Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade Y�¢
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION7a- OWNER AUTHORIZATION=-TO BE COMPLETED..WHEN
OWNERS:AGENT OR CON CRAGTOR APP.LIES.FOR=BUILDING PERMIT
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
z^,e S 7 M O ' 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 the pains and penalties of perjury.
—l
ce(,rNe-s— (�f M►s
Print Name
Sign re of Owner/Agent Date
°
^ . .
`
Section 4. ZONING Al I 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
Frontage
Setbacks Front
Rear
Building Height
Bldg. Square Footage
Open Space Footage %
(Lot area minus bIdg&paved 1
#of Parking Spaces
(volume&Location)
-
A. Has a Special Perm it/Varia nce/Fi ndi ever been issued for/on the site?
NO 0 DON7KNOVV 0 YES
IF YES, dote issued:"
IF YES: Was the permit recorded ut the Registry ufDeeds? '
NO �� DO
NT m / mxuvv 0 ,cu
IF YES: enter Bonk PuUa and/or Document#|
/
��
B. Does the site contain a brook, body of water orwetlands? NO v���� DON7KNDVV �_� YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobmobtained �~\ Obtained Date �u 'sumd�
�~� 8�� ' . �
��
C. Do any signs exist un the prope�y? YES �_� NO
IF YES, describe size, typo 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 nrinit part ofo common plan
that will disturb over 1 acre? YES 0 NO ��
��
IF YES,then u Northampton 3tnnn Water Management Permit from the DPW io required.
i� .
-i ty of Northampton t _-
1 13�
uilding Department
?12 Main Street
Room 100
Not f"ampton, MA 01060 u•
phone 413587-1240 Fax 413-587-1272 x
APPLICATION.TO 0O TRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
vs cve. G, .J�t
O/ O b Z. done �" Qvea�rTlct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner Record: •.----��---
r1(a wl 1-;s' 7-21-4 0 ��/0 -a/r a� /�o t'/h a►-✓I ti
Name(Print) Current Mailing Address:
s�Y 33ao
Telephone
Signat
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-'ESTIMATED CONSTRUCTION COSTS:
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building / (a)Building Permit Fee
D O prt�
2. Electrical ,(b)-Estimated Total Cost of
-Soo, Construction from 6
3. Plumbing Building'Permit Feer
4. Mechanical(HVAC)
5. Fire Protection j O O,
6. Total=(1 +2+3+4+5) /0 If"• Check Number Q
' This Section For Official Use Only
Building Permit.Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2007-0129
APPLICANT/CONTACT PERSON DIMOS JAMES K
ADDRESS/PHONE 140 FAIR ST EXT NORTHAMPTON (413)584-3320 Q
PROPERTY LOCATION 305 WESTHAMPTON RD
MAP 36 PARCEL 155 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
f' PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT 14 X 17 ADDITION TO EXTEND LIVING ROOM
New Construction
Non Structural interior renovations
Addition to Existing -
Acc_essory Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
it�ATI ON PRESENTED:
oved 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 Commis
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.
3,( W,£t,STRAMPTON RD BP-2007-0129
GIS#: COMMONWEALTH OF MASSACHUSETTS
a ':Block: 36- 155 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2007-0129
Project# JS-2007-000192
Est. Cost: $10800.00
Fee: $119.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sa. ft.): 54885.60 Owner: DIMOS JAMES K
Zoning: SR Applicant: DIMOS JAMES K
AT: 305 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
140 FAIR ST EXT (413) 584-3320 ()
NORTHAMPTONMA01060 ISSUED ON:812512006 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 14 X 17 ADDITION TO EXTEND
LIVING ROOM
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 8/25/2006 0:00:00 $119.00MO
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo
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305 WESTHAMPTON RD BP-2007-0129
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36- 155 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildina
Category BUILDING PERMIT
Permit# BP-2007-0129
Project# JS-2007-000192
Est.Cost:$10800.00
Fee: $119.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor License:
Use Groun: Homeowner as Contractor
Lot Size(sg.ft.): 54885.60 Owner: DIMOS JAMES K
Zoning: SR ADnlicant: DIMOS JAMES K
An 8051MESTHAMPTQN RD
Appheani Address: Phone Insurance:
140 FAIR ST EXT (413) 584-3320��
N0RTHAMPT0NMA01060 ISSUED 0N812512006 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 14 X 17 ADDITION TO EXTEND
LIVING ROOM
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: C
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final: I "
-&7 6'1 Rough Frame: o I 1) D o L U (S
OZ -
Gas: Fire Department Fireplace/Chimney:
K f tbto 6 pt< c6 ow 14 10"9#1-k3
Rough: Oil: Insulation: L.W&k 1
Final: Smoke: Final: d 1< 1 cj .d'7 .-1
THIS PERMIT MAY BE REVOKED BY THE TY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGUL ON
Certificate of Occupancy si nature:
FeeType: Date Paid: Amount:
Building 8/25/2006 0:00:00 $119.00M0
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
0