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~ DEPARTMENT OF BUILDING INSPc
+ 3�
1 2]2 ltfain 5trcct R'Funicipnl Buiidinr
j I.:SP[�Tp2
Nor tfinmpLori, 1�5tt_c. OIOGO
Square Footage
P.moun t
1st Floor @
2nd Floor $--;0
1/2 Floors, Attic. Garage __15
Deck Porches $_1�
TOT U( I /
Massachusetts Department of Environmental Protection
i
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 5 — Order of Conditions 26-548
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
And the Northampton Wetlands Protection Ordinance— Chapter 24
D. Findings Under Municipal Wetlands Bylaw or Ordinance
1. Furthermore,the Northampton hereby finds (check one that applies):
Conservation Commission
2. ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
a. Municipal Ordinance or Bylaw b. 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.
3. ® that the following additional conditions are necessary to comply with a municipal ordinance or
bylaw: Code of Ordinances
Northampton Wetlands Protection Ordinance Chapter 24
a.Municipal Ordinance or Bylaw b. Citation
The Commission orders that all work shall be performed in accordance with the following 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.
If you need more c. The special conditions relating to municipal ordinance or bylaw are as follows:
space for
additional See"Attachment A"
conditions, ----- -- -- -- --- —
select box to
attach a text
document ---� --------- ___— _
E. Issuance
This Order is valid for three years, unless otherwise specified as a special condition pursuant to General
Conditions#4, from the date of issuance.
November 23, 2004
1. Date of issuance
Please indicate the number of members who will sign this form:
This Order must be signed by a majority of the Conservation Commission. z.Number of signers
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, if not filing elec cally (see Appendix A), and t e property
owner, if different from applicant.
Signature
r� ,
v
wpaform-ioc• rev.11/18/04 Psce^of 8
L11 8Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 246-548
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
And the Northampton Wetlands Protection Ordinance — Chapter 24
C. General Conditions Under Massachusetts Wetlands Protection Act
(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.
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" for, "MA DEP"J
"File Number 246-548 "
wpaform5.doc• rev.11122104 0
CITY OF NORTHAMPTON, MASSACHUSETTS
DEPARTMENT OF PUBLIC WORKS
125 Locust Street
Northampton, MA 01060
413-587-1570
Fax 413-587-1576
George Andrikidis, P.E.
Director
ASSIGNMENT OF HOUSE NUMBER(S)
Street: Northern Avenue
Assessors Map: Sheet 25C Lot 17
House Number: #56 Northern Avenue
Date: February 11, 2005
Remarks: The assignment of a house number for this lot was requested by the applicant for
permitting purposes.
Ned Huntley
City Engineer
cc:
Water Division Tax Collector
Sewer Division Massachusetts Electric
Streets Division Verizon Telephone
Inspectors Comcast
Assessors Bay State Gas
Police Department Post Office (Northampton)
James Thompson (GIS Coordinator) Post Office (Easthampton)
Applicant: Dave McCutcheon
263 Sylvester Road
Florence, MA 01062
K:'House Numbers\
.NUMBER I 51KLLI °L°••�� �^
Northern Avenue Mar. 19, 1954
NAME SERVICE RENEWED
Jacob Matusek
DO&Q-1d-
ENTERED ON
Northern Avenue
SIZE OF PIPE LENGTH OF PIPE TAP STOP
3i4" cop er 46' 6" 3/4" 3/4"
MEMORANDA
Box to main is 51' 611. 4 ft. of copper beyond box by NWD, then
owner ran galvanized pipe. Meter pit set 47' from box.
5-7-62: Connected to new 8" main by Was Bros.
i
> - NORTHAMPTON WATER WORKS �.}�`.n'.�,a. F11 K- SERVICE BOX LOCATION
i
I
1 ,
4
D
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P
Basement Wall 1: Solid Concrete or Masonnr 872 13.0 0.0 46
Wall height: 8-o'
Depth below grade: 8.0'
Insulation depth: 8.0'
Floor 1: All-Wood Joist/Tnzss:Over Outside Air 32 30.0 0.0 1
Furnace 1: Forced Hot Air. 90 AFUE
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,
specifications. and other calculations submitted with the permit application. The proposed building has been designed to
meet the 2000 IECC requirements in REScheekVersion 3.6 Release 1 (formerly MECchecl;) and to comply with the
mandatoti, requirements listed in the RESchec%Inspection Checklist.
Builder/Designer ,��_� �/j� �P,B� Date .y-17.17
Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes.
Insulatio Thickne s in Inches by 'iW Sizes
Heated Water Non-Circulating Runouts Circulating Mains and Runouts
Temperature( F U12 to 1" Up to 1.25" -15"to 2.0" Over 2"
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
fable 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp. Insulation Thickness in Inches by Pie Sizes
Piping System.T,ypfs Range(F) 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 1.5 LS 2.0
Low Temperature 120-200 0.5 1.0 1.0 1.5
Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0
Cooling Systems
Chilled Water. Refrigerant. 40-55 0.5 0.5 0.75 1.0
and Brine Below 40 1.0 1.0 1.5 1.5
NOTES TO FIELD (Building Department Use Only)
Heating and Cooling Equipment:
] 1. Furnace 1: Forced Hot Air, 90 AFUE or higher
Make and Model Number
i
j Air Leakage:
[ ] j Joints, penetrations, and all other such openings in the building envelope that are sources of air
j leakage must be sealed.
[ ] ( Recessed lights must be 1)Type IC rated,or 2)installed inside an appropriate air-tight assembly
! with a 0.5"clearance from combustible materials. If non-IC rated_the fixture must be installed with a
( 3"clearance from insulation.
I
j Vapor Retarder:
[ ] ( Required on the warm-in-winter side of all non-vented framed ceilings, walls. and floors.
(
j Materials Identification:
] J Materials and equipment must be installed in accordance with the manufacturer's installation instructions.
[ ] ( Materials and equipment must be identified so that compliance can be determined.
[ ] { Manufacturer manuals for all installed heating and cooling equipment and service water heating
j equipment must be provided.
[ ] j Insulation R-values, glazing U-factors,and heating equipment efficiency must be clearly marked on
the building plans or specifications.
1
( Duct Insulation:
[ ] ( Ducts in unconditioned spaces must be insulated to R-5.
( Ducts outside the building must be insulated to R-6.5.
j Duct Construction:
[ ] ( All joints,seams, and connections must be securely fastened with welds, gaskets, mastics(adhesives),
j mastic-plus-embedded-fabric,or tapes. Tapes and mastics must be rated UL 181A or UL 181B.
j Exception:Continuously welded and locking-type longitudinal joints and seams on ducts
( operating at less than 2 in.w.g. (500 Pa).
] j The HVAC system must provide a means for balancing air and water systems.
i
Temperature Controls:
[ ( ( Thermostats are required for each separate HVAC system. A manual or automatic means to
partially restrict or shirt off the heating and/or cooling input to each zone or floor shall be provided.
I
Service Water Heating:
[ ] ( Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the
water heater has an integral heat trap or is part of a circulating system_
( ] j Insulate circulating hot water pipes to the levels in Table 1.
I
Circulating Hot Water Systems:
[ ( j Insulate circulating hot water pipes to the levels in Table 1.
I
Swimming Pools:
[ ] j All heated swimming pools must have an on/off heater switch and require a cover unless over 201/0
j of the heating energy is from non-depletable sources. Pool pumps require a time clock.
j Heating and Cooling Piping Insulation:
[ ] j HVAC piping conveying fluids above 105 T or chilled fluids below 55 T must be insulated to the
I levels in Table 1
REScheck Inspection Checklist
2000 IECC
REScheckSoftware Version 3.6 Release 1
DATE:02/22/05
Bldg.
Dept.
Use
I
Ceilings:
[ ] I 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation
Comments:
[ ] I 2. Ceiling 2: Cathedral Ceiling(no attic),R-21.0 cavity insulation
Comments:
I
Above-Grade Walls:
[ ] ( 1. Wall 1: Wood Frame, 16"o.c.,R-13.0 cavity insulation
Comments:
[ ] I 2. Wall 2: Wood Frame, 16"o.c.,R-19.0 cavity insulation
Comments:
I
Basement Walls:
[ ] I 1. Basement Wall 1: Solid Concrete or Masonry,8.0'ht/8.0'bg/8.0'insul,
R-13.0 cavity insulation
Comments:
I
Windows:
[ ] I 1. Window 1: Wood Frame:Double Pane with Low-E,U-factor: 0.310
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break?[ ]Yes[ ]No
Comments:
[ ] I 2. Window 2: Wood Frame:Double Pane with Low-E,U-factor: 0.320
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break?[ J Yes [ ]No
Comments:
[ ] I 3. Window 3: Wood Frame:Double Pane with Low-E,U-factor: 0.330
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes[ ]No
Comments:
I
Doors:
[ ] I 1. Door 1: Solid,U-factor:0.140
Comments:
[ ] I 2. Door 2: Glass,U-factor:0.450
Comments:
I
Floors:
[ ] I 1. Floor 1: All-Wood Joist/Truss:Over Outside Air,R-30.0 cavity insulation
Comments:
I
Permit Number
REScheck Compliance Certificate Checked By/Date
2000 IECC
RESche ck Softwarc Version 3.6 Release I 'r
Data ('filename: C:AProgram Files\Cltcck\REScheck\McCutcheon Northern Avenue.rck
U
CITY: Northampton '
STATE: Massachusetts
HDD: 6404 r �'
CONSTRUCTION TYPE: Single Family 5 �
WINDOW/WALL RATIO: 0.22
rT..
DATE: 02/22/0
DATE OF PLANS: Februam 2005
PROJECT DESCRIPTION:
McCutcheon Development Corp
Northern Avenue
Northampton
DESIGN ER/CONTRACTOR:
Lvnn F. DeChesser.CPBD
74 Congamond Road
Southwick, Ma. 01077
413-569-0612
PROJECT NOTES:
1520 s/f. two stonr residence: Andersen double pane insulating high
performance«indows: Stanley steel insulated doors
COMP(AA>C-EPT117�-,Ma�imA=291 ,�Your H UA= 277
4.84'0 BTh,
Gross Glazing
Area or Cavite Cont. or Door
Perimeter R-Value R-Value U Factor UA
Ceiling 1: Flat Ceiling or Scissor Truss 608 38.0 0.0 18
Ceiling 2: Cathedral Ceiling(no attic) 168 21.0 0.0 8
Wall 4: Wood Frame. 16" o.c. 1458 13.0 0.0 90
Window l: Wood Frame:Double Pane with Low-E 10 0.310 3
Window 2: Wood Framc:Double Pane with Low-E 117 0.320 37
Windo« 3: Wood Frame:Double Pane with Loxv-E 175 0.330 58
Door 1: Solid 42 0.140 6
Door 2: Glass 21 0.450
'Nall 2: Wood Frame. 16" o.c. 24 19.0 0.0 1
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DEPARTMENT OF BUILDDIG INSPECTIONS
INSPECTOR '212 Main Street • Municipal Building
North,unpton,MA 01060
,r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as �,is/her construction supe: .':sor. Tlie state defines"Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be,a Sne or two farmer
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 n
understand the above.
(Home owner/resid is signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date L'
Address of work
locations
r
a
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ti� (rii� Pf �t�rfl�aiit}ifo�i
Q � flilart C{�RLItla
o DEPARTMENU OP i3UILDI)\,C INSPECT101.'S
212 Train Strcet INfunicipal Building
Northampton, Mass. 01000
w&RICE R'S COI\TPENSATTON G`ISURANCF' AI FU)/ivi
«,Ith, a principal place of businessfresidence at: ------
(phone-'=
(scr�t/ci tr/statcl�p)
do hereby cerrif);, under thc.pains and penalties of penury:, hat
( ) I am an employer providing die followinL!tvonc�rs cotnDcns_non cove age Cori Iny
etuplovecs Nvor>ong on this job:
(Lastir-_n=Conrz}') (PoLic:NtL r) :pirtior, t7 }
O I am a sole proprietor, general contractor or homeowner(c cie one) aBd have hired
the conn-actors listeJ below who have the `ollo%viog worker's Caooens2aon policies:
\`+fl n-, O'. Co„^ci0r) (Instirancc CoIr1D1n Yf GUc ?��U.tI1i'<: Y\�1F�:?Qi?
} } � D1lC}
- (Name of CouGac-iar) (insw-ancc ComDanyiPoUc Nujmucr) (-ExD cilon Date)
(Name 01Connacto.) Gnswaac Compan}-/PoUq- NusLu) (Expirdoo Date)
(Frame of Contractor) (Losurmcc Comcauy/Policy Numlr:r) (Eapifatioa Date).
(a[I3ul adu�ocal rb,-irncca.a--to -iarolmaaoa -_�to aU orb-tors)
O I am 'a sole proprietor and have no one workiDg for me.
( ) I am.a home owner perforTuma all the work myself.
NOTE:pica be aria=it• wjjc bcc)c,, m +.bo aaplay perom w do ,;•-•,-,,= c.IZC oo c rgair wOr-k oa.d%,cl--Z of
ooc mocc tb.n[l ru ^*%v is inch Ibc bomcowv rrmdc oc oc tSc a-ounc!,zppvttca_r1 jb.-_o c-c ooc C-_-r ty occrd--o]to be
eirployc unc a the..ui rf�cp=.xiea Act(GUI 523n 1(5)�:pptiabon by a bomcoaae far e bey=oc permit rz_r evid=cc tEe
lc-P1 ctaare or as cr.,rloyx under dra W.+-el coatyomitioa Act-
- [uadcztwd tb.d a e
°prr��+•�33ay bo foero.ord.d to the pcpnrtmmr of 1ad+.zrie!.,ceeco�Offoe of trs:ul+ooa roc th.
covcntsc r<rirolioo,ud Ihs Csltac w Loyrc tovcrase twdcr socCion 25A of htoL 152 as led tO the tzrposilioa orQlIISiaat pcazltic
eonxa:mg Ora rive orup to 5I}00.00 andfoe 6=pr6oam-.c=orup ta one ycjr sad a»1 peaa!'ja in e5c roan or Stop Wort;Order and a
rind 0(:S 100.00 a day.Ming ay- '
Fa dcp-t m-1`1 u,c only
Pcrmit Number i./'a p." Lot
si�naturr of Li�sct/Pccmiucc �T7ate -- J
SECTION 8-CONSTRUCTION SERVICES 71
8,1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Re Kterea'•.k`dViW ffi Fa�rer°rien GontFac r " "" Not Applicable ❑
Company Name Registration Rum e�--
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE'A-FIDAVLT`(M.G:L.c:1'52,.§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...... ❑
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 fot you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,Stat an Local onin Laws an�of huset ts General Laws Annotated.
_
Homeowner Si nature
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9
J„
SECTION 5 DESCRIPTION OP-PROPOSED WORK(check,a[Vapplicable)
New House Addition ❑:. Replacement Windows Alteration(s) ❑ Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[DJ Other[[:i]
Brief Description of Proposed
Work: �l �1��
/"� 1.-c, l
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
2°-' ,. .^-.:e=F�R**�' „ �
sa_C NeW Rio' se an l o de#ii tc> extstl c �o csl.Icr comp ete Ele fottouri#
a. Use of building:One Family Two Family Other /
b. Number of rooms in each family unit: e- Number of Bathrooms J
c. Is there a garage attached? I S Cf�l'<--�U/t-7f' ''�� --{
d. Proposed Square footage of new construction. �� Dimensions A x 3 CAP=r°G+e 1
�f
e. Number of stories? L�
f. Method of heating? �� T �l�l/� Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. T Masscheck Energy Compliance form attached? I
h. Type of construction W
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 oning regulations? Yes No.
I. Septic Tank City Sewer, Private well City water Supply
SECTION Ta-OWNERAUTHORIZATt6N-TO BE COMPLETED WHEN
OWNERS AGENT'ORCONTRACTOR APPLIES"`FOR BUIL6kd..PERMIT-
Sti.- C (� as Owner of the subject
property
hereby authorize
to act on my beh f, in all matters ilative to ork u horized by this building permit appf a'on.
Signature of Owner Date
as Owner/Authorized
Agent hereby declare that tfV 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 per'ury. '
Print Name AAAJ
Signature of Owner/Agent Date
Section 4. ZONING All Informatibti 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
I
Lot Size
Frontage
Sctbacks Front
Fzo
Side L:� R:1— R:'
i OC-0 a�
Rear
Building Height
Bldg. Square Footage %
Open Space Footage % n
(Lot area minus bldg&paved
parking)/
#of Parking Spaces
Fill:
(volume,&Location)
A. Has a Spe I Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW Q YES 0
i_
IF YES, date issued:i
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T 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 0 DON'T KNOW Q YES
IF YES, has a permit been or need to be obtained from a Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES Or" NO Q
IF YES, describe size, type and location: /t)u" --e-'
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO
IF YES, describe size, type and location: s
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 O r NO
i
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
e �
City of Nortf ampton a
Building Department
212 Main Street
Room 100 r et Y
w
Northampton; MA 01060
phone 413-587-1240 Fax 41,3,-587-1277
I � c �y � "
1P 5
�.
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMqhX A QNEy OR TWO FAMILY DWELLING
i
SECTION 1 -SITE INFORMATION
1.1 Proaerty Address: 5 (9 - t .Y ' ' Ieo a comptefed byaffrce
Vol 0C
w
A ]k r fit Apy(y, Zone verfay Drstrrcf
r Elm S�Distrrct :CB Distract
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED'AGENT;
2.1 Owner of Record:
Al At U 13) Iec,;-sc-I f At A
Name(Print) Current Mailing Add TN
ti. C Telephone
Signature /1
2.2 Authorized Agent:
t T ('C`
Name(Print) �j Current Mailing A dr ss:
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
2. Electrical `j;C 6 (b)Estimated Total Cost of r ay
Construction from 6 `( I
3. Plumbing r/ !� 0 Building,Permit Fee
4. Mechanical(HVAC) `�U 6!�
5. Fire Protection h
6. Total=(1 +2+3+4+5A,,7 I A coo Check Number p2 i
This Section-For Official'Use.Onl
I :Date .
Building PermitNumber. Issued:
Signature:
i
Building Commissioner/Inspector of Buildings Date
y a
File#BP-2005-0839
APPLICANT/CONTACT PERSON MCCUTCHEON DAVID J
ADDRESS/PHONE 263 SYLVESTER RD FLORENCE (413)587-4570 Q
PROPERTY LOCATION 56 NORTHERN AVE
MAP 25C PARCEL 017 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid '
T_ypeof Construction: CONSTRUCT 1 1/2 STORY SFH W/CARPORT
New Construction
Non Structural interior renovations
Addition to Existing Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan Fl dy1 ' -Ct
THE FOOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ION PRESENTED:
pproved 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 Stree ommission
�°aS
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.
56 NORTHERN AVE BP-2005-0839
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-017 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2005-0839
Project# JS-2005-1164
Est. Cost: $149000.00
Fee: $721.90 PERMISSION IS HEREBY GRANTED TO:
Const. Class: 5B Contractor: License:
Use Group: R4 Homeowner as Contractor
Lot Size(ssq.ft.): 123710.40 Owner: MATUSEK JACOB G &EDITH M
Zoning:URB Applicant: MCCUTCHEON DAVID J
AT. 56 NORTHERN AVE
Applicant Address: Phone: Insurance:
263 SYLVESTER RD (413) 587-4570 O
FLORENCEMA01062 ISSUED ON.812105 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 1 1/2 STORY SFH W/CARPORT
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 8/2/05 0:00:00 $721.90
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo