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02-028 (7) Z � r / dd i LW W a V. :J p p Z � , m t�/r u rn 1�Yiy N �J f z L N '" 0 Ec. / m I I c I o5cvr� PR-0 po517 ► It2 , \ Owner: { . 114 t I1c, 61&;z `-� �' /, f t=�5 f�E t,,,T• �-�-Y. �l rj,co \ �`j----� .ice I a a / 4 ! I I fl— -- - - Project Name: No sip-4-, wo o n S em V4't4 Location: � \\� I!�' ' 1 t I o, -- _ i Lam•�� � — — — t �-�o2-r'r}- fir._-r�_�y �, Date: 2 �'"j /L)-Z7 Revisions: cc c{ v 00 TiQ-eec T 5�✓t� Scale: I To cAVo i `~ or as noted. Approvals: � 11rZ �t Sheet No. l of Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Appeals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, 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 Department of Environmental Protection Regional Office (see Attachment) to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Request for Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wpaform2.doc•rev.3/1/05 Page 5 of 5 c Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 5. The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: Exempt Activity(site applicable statuatory/regulatory provisions) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Av m-l� O'ET1.M95 op-old"wce, tt dq Name I Ordinal ce or Bylaw Citation C. Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on M by certified mail, return receipt requested on e(0 L-Aa/ Date Dat This Determination is valid for three years from the date of issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office(see Attachment) and the property owner(if different from the applicant). ig natu 0. Dates wpaform2.doc•rev.3/1/05 Page 4 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post-marked for certified mail or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone. ® 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). No work is allowed outside of the non-encroachment line as shown on the plan. ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpaform2.doc•rev.311/05 Page 3 of 5 Massachusetts Department of Environmental Protection ' Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) or Order of Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received from the issuing authority(i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act. Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent. ❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent or ANRAD Simplified Review(if work is limited to the Buffer Zone). ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Citation wpaform2.doc•rev.3/1/05 Page 2 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information -� - I i'�� _ Important: [ When filling out From: s forms on the Northam ton `�U�� 2G05 ' computer, use only the tab Conservation Commission k aSr'_CJ lull$ key to move To: Applicant Pro�erty Oww�if differ%xiW en applic nt): your cursor- -__. __.. . __� do not use the Elizabeth Denny/Julie Pokela return key. Name Name 642 North Farms Road tab Mailing Address Mailing Address Florence MA 01062 City/Town State Zip Code City/Town State Zip Code 1. Title and Date (or Revised Date if applicable)of Final Plans and Other Documents: Northern Woods Plan of prosed sewage disposal system with proposed 03/20/03 revised deck shown 05/09/05 Title Date Title Date 2. Date Request Filed: 05/09/2005 B. Determination Pursuant to the authority of M.G.L. c. 131, § 40, the Conservation Commission considered your Request for Determination of Applicability, with its supporting documentation, and made the following Determination. Project Description (if applicable): Construction of a 10'x 12' deck onto the rear section of the house. Project Location: 642 North Farms Road Florence Street Address City/Town 02 028 Assessors Map/Plat Number Parcel/Lot Number wpaforrnldoc•rev.3/1/05 Page 1 of 5 ���y — Pokelq Qec Ic F�o� T✓b I 6.5300 3.3300 — 2xia tt cL i ( J h flCN(x ' Rn41 deck 642- IJ0rA\ FIF � cc�� (�fl'x ILI 1 i I 6,45010 �z.s5ao I 1ZKIfl , 9� k .y w.0000— k ash kA&,r J,)Q A dot gHAMPT of Xart4ainptun z r $ 1�Rassac}�usetts r DEPARTMENT OF BUILDING INSPECTIONS f INSPECTOR '212 Main Street • Municipal Building Northampton,MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/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 fame 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 oven 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 I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location r I 0 �— F E o rfI 13111 foil A f Jq,s3 arch n"fle' - — Q DEPARTMENT OP BUILD0\10 INSPECTi01.'S 212 Main Strcct ' Municipal Building NorLhampton, Mass. 01060 «'OR14:R'S CONEPENSATION LNSURANCE Al,=, i Tj7 i (li ccasx/permj ttcc) - - —- i \I,rlth a ptZncipal place of businessfresidence at: - (Phone`!) ty/natc1:6 p) do hereby certify, under che.panns and penalties of perjury, That ( ) I am an employer providing the folio.vine worker's comoc isadon coverage For Inv etlJp!Ovccs xvor�Dng on diis job: (Insul-�c Comoaz-) (Policy Nt mb-c_r) -- (r:pirtior, Dzt^) i O I am a sole proprictor, general contractor or homeoi�,ner (c tie one) and hwe hired the cono-actors listed below c-,bo have the iollovjoQ worker's coEioerLtaaon pc!icies: i (i+qm-, Of Contmci0") (In2r311cc Comoam./Pouc; ��tilIIli'{r) (Y?:a3i��Qn ��.liC ) (Name of Coo crac or) (lnsaranc;. Comoaa}yPo!ic_; NUM-C-r) (-B-D ir lion Date) (Name of Connano.-) ClmsuFancc Company[PoU NumbJ) (EzpiYz600 Date) (Name of Contraaar) (Losuran Comcauy/Poticy Numh r) ( xpi-,ioo DatL). (&0'14,ad'—�ocj 6--irocc x_-V to axtucE iarocmition pctaiy,os to.0 cc=-_cto:-I) . (✓) I am a sole proprietor and have no one working for me. I� ( ) I am..a home owner perfonu'mc all the work myself. INOTE:ptesc be sorzrt tfi*•utJe bcmco vocr�..-bo CMEP1aY PcrLOO:co �• - crL,oa c repair..uric 02.d.c!!_�of cot mo t qL o Lb-o'-=rj is tcsieb the bomoownc raids or oa the Vame�p �tbeao�r we -�:.lty oLr--.6 i to Lc eizployc-� �e the..�5 e c=pc=:.lica Aa(G L!!52_e 1(5)},:Pplintioo by.bamcoa-oa fcr:Grp.a permit ray c idm the Ic-p.l cL_lt"of a ¢ployx uoder di Workoe,CooVom.s,ioQ Act_ [uada 2.ad tba copy cr th:u m.y b. to t>.t,,,or>a J ,tee y owe or[:>_.�ra U- Cva sp waif euioo"ad the L-il-c 14'= a tovcTSbo tinder soevoa 23A of MGL 152 na led to the i p-silica of-i-i"pcczwl= 000sisiug of a fiat oCup to S 1,500.00.ndlor ia> yo oCup to one yc3r sod a%i1 pas-tua is rbc forest of a Stop Work Ordcr cod fl=0(S 100.00 r d_y sptiust me For dc�.rta�=�u,c call �/ Pcrmit Numb= — Lot Signaciur of LicvuaJPcrmiucc e l : SECTION 8-`CONSTRUCTION SERVICES f 8.1 Licensed Construction/Supervisor: ''II-- Not Applicable ❑ Name of License Holder: C�Q C Ie„s. U"• ,:/f�/'MC�S G S OL o U y License Number Addresg Expiration Date 4/1?—.3& ' Signature Telephone 9 tegis�ed orate#mara mei> Co a`t L 01 Not Applicable ❑ 116 3 yo Company Name Registration um er — --"— C�a.r1s.% 40 I/N+G1 6WO6 Address Expiration Date Z� �a�e� ,fir �� ��• Le„cref Telephone 6 SECTION 10-WORKERS'COMPENSATION INSURANCE"AFFIDAUIT(M.G I- ;.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...... ❑ X11 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. Defnition 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 r Y.~�t C4 714 d C Q•"'I P (<c\C.L C '�' ��r ., l SECTION 5-DESCRIPTION'-OF PROPOSED WORK(check all applicable) New House ❑ Addition F-1 ; Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [96 Siding[E:3] Other[0] Brief Description of Proposed Work: Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa {ilew`�hotase�a�t r�di�`ial�to.�extst«tu:�aa slnct-�cornplete�the �Iol�trta: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction L Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a'-OWNER AUTHORIZATION-,TO"BE COMPLETED WHEN OWNERS AGEN/T.QRCONTRACTORAPPLIES'FOR BUIGDtNG:PERMIT I, Devi n as Owner of the subject property hereby authorize a r lo Ho to act on be If,in all tters relative to work authorized by this bwlding permit application. Z'S' ' vo s Sign t f Owner Date 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. ' C Print Na/m///e///� ////. 1 Signature of Owner/Agent Date Section 4. ZONING All Informatioh 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 x S r — Setbacks Front L/I I q'! Side L:- � R:' ' Rear Building Height Bldg.Square Footage % —I Open Space Footage �__ % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: r J� (volume2Fc Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: { IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page; i and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES 0 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 r NO i IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r }m 'City of Nor0ampton = 0 .-,Building Department 212 Main Street r�. Room 100 APR 2 9 20 Jorthampton; -MA 01060 „ phone 413-587-1240 Fax 413-587-1272 4 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION.1 -'SITE"INFORMATION 1.1 Property Address: Tlars sectron to be completed by affice a t 7F. 4, r a -A r.AAS He'fe'ltC MA 6(v VL � Uveriay D�stnct r Zone � J Efm St Drstnct }".. C&bisfnct SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT, 2.1 Owner of Record: Name(Print) Current Mailing Address: ` -a /p L e / t� G.,vj Telephone S i t r 2.2 Authorized Agent: C k a (-l e s G. H,9 1.%e s CP,rej-CW'. 4'14 el"_l Name(Print) Current Mailing Address: t° _1 _ y/& 3 e, )-l YzG 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 (b}Estimated Total Cost of Construction from 6. 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official'Use Only Building Permit Number te. r. Issued: Signature: , i Building£ommissioner/Inspectorof Buildings Date � �aA �or Zr dec for 0A P6 a )OD s/ykL fT L X/o 1 Z oe deg(<:�� aa000 c� c-, SIC be Y deep File#BP-2005-1062 APPLICANT/CONTACT PERSON CHARLES G HOLMES ADDRESS/PHONE 27 LAUREL HILL DR LEVERETT (413)367-2826 PR©PERTYLOCATION"G42-NORTH FARMS RD CMAP 02 PARCEL 028 001 Z NE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out r Fee Paid Typeof Construction: CONSTRUCT 9 X 12 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 060364 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION P SENTED: 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 f� Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Stree ommission Z. 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. BP-2005-1062 642 NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS GIS#: CITY OF NORTHAMPTON Map:Block:02-028 Lot: -001 Permit. Building BUILDING PERMIT Category'Deck Addition Permit# BP-2005-1062 Project# ]S-2005-1449 Est Cost $2500.00 PERMISSION IS HEREBY GRANTED T Fee: 50.00 License: Const. Contractor: 060364 UseUse Group CHARLES G HOLMES t or size(sa. ft.): Owner: DENNY ELIZABETH A licant: CHARLES G HOLMES zoni— ng� AT: 642 NORTH FARMS RD Phone: Insurance: Applicant Address_ (413) 367-2826 27 LAUREL HILL DR LEVERETTMA01054 ISSUED ON.-6121105 0.00.00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 9 X 12 DECK POST THIS CARD SO IT IS VISIBLE FROM D.P.W.T E STREET Building Inspector Inspector of Plumbing Inspector of Wiring Service: Meter: Underground: Footings:Huse# �0 4 Z_—S dk—�2 J House Foundation: Rough: & Rough: Driveway Final: Final: Final: Rough Frame: Fireplace/Chimney: Gas: Fire Department Insulation: Rough: Oil: Final: Smoke: THIS PERMIT MAY BE REVOKED BY THE CIT OF NORTHAMPTON UPON VIOLAT ON OF ANY OF ITS RULES AND REGULATIONS. , Si nature: Certificate of Occu anc Date Paid: Amount: Feel e: Building 6!21/05 0:00:00 $50.00 212 Main Street,Phone(413) 587-1240,Fax.: (413)587-1272 Building CornnussiO",.' -Antliony Patill)