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2014-09-15 15:21 DPW Central 14135871576 >> 14135871272 P 2/4
Permit No. DOS-14
CITY OF NORTHAMPTON, MA
DRIVEWAY PERMIT
Date: 8/12/14
Check#: 6995
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 curbeut
Permission to install a driveway at: 7 Adare Place
Fifteen(15)foot maximum width at the street line. Gutter drainage not to be disturbed. All
Drainage shall be directed off the driveway surface to adjacent land and not on the existing
Roadway. Driveway surface to be paved as soon as possible if the grade of the proposed
Driveway exceeds 3%or more. Homeowners will be held responsible for any cost to the City
of Northampton in the event of a washout of this driveway. Code of Ordinances $350-8 8
providing standards for private, individual driveways as amended by the_City_ Council
on October 15,2009,must be followed.
� By: Windsor Mallett
6<_ _
lam!lr AMOK R .,�, Telephone: f 1 978-440-7616
'�cA7ar. D�Rr'n
• �� ature:
rv� C.kns .�t
Proposed Location Inspection
Gravel Base Grade Inspected By,
Final Approval:
THE BOARD OF PUBLIC WORKS voted that petition be granted.
Edward S. Huntley,P.E.
Director of Public Works
Cc: Building Inspector
(SUBJECT TO ATTACHED CONDITIONS 1 &2)
2014-09-15 15:21 DPW Central 14135871576 >> 14135871272 P 3/4
MUNICIPAL WATER AVAILABILITY APPLICATION
Northampton Water Department
237 Prospect St.
Northampton,MA 01060
587-1097
A Department of Public Works Trench Permit shall be required prior to any construction or
connection activity associated with this application.
Location : 7 Adare Place, Northampton
Inquiry Made By: Windsor Mallett 978-440-7616
Date of Inquiry; 8/12/14
Number of Type of Single Family X Type of Private X
Units: 1 Units : Ownership:� � Apart. Comm p Condo
Multi-family Rental
(Alt)lnlirant to ii11 on+the ahnvel
Municipal Water Main in
Front of Location? Yes:X No: site?Existing service to
s Yes: No X
Site
Size of Water Main: 6" Material: Cast Iron Age: 1923 ,
Approximate Static Street Flow Test Conducted:Yes: No:X
Pressure: 90psi If done attach results
Size of Service Connection
Suggested Meter Size:
Comments: The Water Department cannot guarantee adequate water pressure during peak demand
times at elevations above 320 feet.
• A corresponding water entrance fee skull be paid prior to making any connection to the municipal water
system.
• Arrangements of such installation shall be made with the Northampton Water Department with a minimum
of 5 working days notification,
• work pnform to Northampton Water Department specifications.
9A5j1KItelman,Superintendent of Water Dept,
Water Entry$200 Meter$ 100 Radio$1.00
cc: Ned Huntley,Director
Note-,If this availability is for a new construction,it must bg hand delivered to tbt$uildinp O
Inspector. 1
2014-09-15 15:21 DPW Central 14135871576 >> 14135871272 P 4/4
MUNICIPAL SEWER/AVAILABILITY APF LK A I IUN
Northampton Streets Department
125 Locust Street
Northampton, MA 01060
587-1570
A Department of Public Works Trench Permit and Sewer Entry Permit shall be required
prior to any construction or connection activity associated with this application.
Location:
7 Adare Place, Northampton
Inquiry Made By; Windsor Mallett 978-440-7616
Date of Inquiry: 8112114
Reason for
Request; New Construction Hook into City Utilities
Municipal Sewer Main in Front of Location: Yes —.)L No
Municipal Storm Drain Available: 5'/z deep Yes X No
Size of Sewer Main: Material: C Ll4 y Age: i9 1-3
Depth of Sewer Main:
Length of Sewer Main; �{(9
Size of Service Connection: n► �Knrn Q 1
Type of Service Connection;
Tie-in to Sanitary Main Tie-in to Sanitary Stub .fir,
Comments:
Ci Re uires 6" cieanout installed at City Pr9jMrty Line
Note: If this availability Is for new constructlon this form must be hand delivered to
Buildings Inspector.
A corresponding"sewer entrance fee"shall be paid prior to making any connection to the municipal sewer
system.Arrangements of such installation shall be made with the Northampton Streets Department with a
minimum of 5 working days notification. All work shall conform to Northampton Streets Department
specifications.
JV I
John Hall
Sewer Department
cc: Ned Huntley, Director DPW
Louis Hasbrouck, Building Commissioner
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NANCY J. STOUT, TRUSTEE OF THE NANCY J. STOUT NOMINEE TRUST
BOOK 8178, PAGE 34
SEE: PLAN BOOK 152, PAGE 79 (LOT 1)
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NANCY J. STOUT, TRUSTEE OF THE NANCY J. STOUT NOMINEE TRUST
BOOK 8178, PAGE 34
SEE: PLAN BOOK 152, PAGE 79 (LOT 1)
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DF71 �13r111II Z
�^ DEPARTMENT OF BUILDIItG INSPECTIONS
INSPECTOR
212 M�dn Street 0 Municipal B uildino
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Northampton, MA 01060
LOCATION
V
SQUARE FOOTAGE AMOUNT
BASEMENT @ .20
1ST FLOOR @.50 �D
2ND FLR @.30x _ _rte
av
FLOORS, FINISH ATTIC,GARAGE @.20
DECKTORCHES @ .20
TOTAL. l
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation:;r their employem
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,.or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses.. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to-thank you in advance for your cooperation and should you.have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MA.SSAFE
Fax#617-727-7749
Revised 5-26-05
www.mass.govldia
The Commonwealth of Massachusetts
` Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
s� www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information 'Please Print Legibly
Name(Business/Organization/Individual): C
Address: v n
c� L
City/State/Zip: � • Phone#: 1 �' (�(o
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a em to with 4. I am a general contractor and I
P 6. New construction
I (full d/orpart-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. E] Demolition
working for me in any capacity. workers' comp.insurance. 9. M Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.El Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL ll.[]Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑_Roof repairs
insurance required.]t employees. [No workers'
comp.insurance required.] 13.[] Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: \ W-4
Policy#or Self-ins.Lic.#: - /57- Expiration Date:
Job Site Address: C,e City/State/Zip: d.
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 ce under thepains and penalties perj ry that the information provided a ove is true and correct
Si mature: s Date: (Z
Phone#: �g (��D 2 2
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 Constructiio�n)Supervisor: �n Not Applicable ❑
Name of License Holder: Vy V��S� ' ` "� t ot1 JT 1& — I V 2
License Numb r
Addre Expiration to
SiJKAfure Telephone
9.Reaistered Home Improvement Contractor: Not Applicable ❑
Company Name �A � 1 . �� � �� Regist=-9-6 r
I �1 Lave 1
Address 1 .{ q Expiration ate
01 O�D O
COV "C� Z Telephone L /j 7bl(o
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....... ❑ No...... ❑
1P)Ott� Gvz 07-x- 02 3 - e� �S
t � I/i f /mot �b✓l << ��.
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 Addition Replacement Windows Alteration(s) Roofing
Or Doors C]
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[O] Other
Brief Work:Description of Proposedsxcd� D / �t ! n ' G �j, '5;Av((e— �M�/N bow Z - j0ws,
Alteration of existing bedroom Yes No Adding new bedroom Yes 1 No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building :One Family_Zz� Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
Q ! //' , w3t � 4 '32'
d. Proposed Square footage of new construction. BSh�. 1�-pru�CE' Dimensions
e. Number of stories? Erb 17—
f. Method of heating? V_GL, i q,,,-k :G D(Zj(_ Fireplaces or Woodstoves_YQ5 VP( Number of each
g. Energy Conservation Compliance. e,5 Masscheck Energy Compliance form attached? No
h. Type of construction ( G 04 ,�1
i. Is construction within 100 ft.of wetlands? Yes nL No. Is construction within 100 yr. floodplain Yes f�/ Vo
j. Depth of basement or cellar floor below finished grade & /
k. Will building conform to the Building and Zoning regulations? // Yes No.
I. Septic Tank City Sewer Cll� Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS,AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
Pr
hereby authorize 1AA S
to act on my behalf,in all matters relative to wo authorized by this building permit application.
Signature7of Owner Date {(f 11 1
V�► `t 4�Cysp� l'�SJI 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
p aIties f perjury.
P' )ame
A AAAA
nature of Owner/Agent Date
004 -1 i 5 C St�I'� VAC,5 VZk t"-4— 0-A 1
a f Pavkl . Or Apv, ( t4, ZnIk , `pit=vm k -#-- MQ-Zo Iq-co
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
y Building Department
Lot Size �� J S, o0-7 S
Frontage
Setbacks Front
f y–/
Lance Side L: R: L: R: �7
r
Rear 10
7 r,
Building Height
Bldg.Square Footage l % 6 �1 i5T zN�`� affil c
Open Space Footage % ,c��-7
(Lot area minus bldg&paved C666 ( -9,1 qo Sq I ( !"
parking)
Shy
#of Parking Spaces � p
Fill: tj
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site? �7
NO DON'T KNOW ® YES 0 S9 d
IF YES, date issued: �.
I ;
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW Q YES o
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO G."')"-' DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES NO ®''
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 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
- City of Northampton Status of Permit:
_ Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability,
V "A J 3 2014 ty
u orthampton, MA 01060 Two Sets of Structural Plans
lectric, Piumbin e 4 3-587-1240 Fax 413-587-1272 Plot/Site Plans
Northampto&h q��06p ctions Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: y.T�his section to be completed by office
�6-� Al 0(-(1 _�{ Map t1 / � Lot 19 q Unit
pCR- 1V `rVlst Jy�
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: Y�Y l S ^.vwe—( VVX 0
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 ut rized Agent:
o t-a co U
Name(Print Current Mailing Address:
Signaturer 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 '
®0. 000,
2. Electrical (b)Estimated Total Cost of
006 Construction from 6
3. Plumbing 2 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
his Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
_a
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s.r
r
File#BP-2015-0181
APPLICANT/CONTACT PERSON MERIDIAN CONTRACTING LTD
ADDRESS/PHONE 9 OLD COUNTY RD#2 SUDBURY (978)440-7616
PROPERTY LOCATION 7 ADARE PL
MAP 24C PARCEL 197 001 ZONE URB(NULL) (1 / I
THIS SECTION FOR OFFICIAL USE ONLY: f kov,
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED WDATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT SFH W/DECK/PORCH ATT GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 102842
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I"MATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
olition elay
ure o uil mg Offs al 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.
7 ADARE PL BP-2015-0181
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24C- 197 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-2015-0181
Project# JS-2014-001835
Est. Cost: $490000.00
Fee: $1487.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MERIDIAN CONTRACTING LTD 102842
Lot Size(sq. ft.): 8015.04 Owner: GOLDEN CHRISTOPHER D
Zoning: URB(NULL) Applicant. MERIDIAN CONTRACTING LTD
AT. 7 ADARE PL
Applicant Address: Phone: Insurance:
9 OLD COUNTY RD #2 (978) 440-7616 WC
SUDBURYMA01776 ISSUED ON.9/16/2014 0:00:00
TO PERFORM THE FOLLOWING WORK.CONSTRUCT SFH W/DECK/PORCH ATT
GARAGE
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 Deaartment 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 9/16/2014 0:00:00 $1487.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner