02-027 (8) e
Massachusetts Department of Environmental Management 1 4 3 5 8
Office of Water Resources
TYPE OR PRINT ONLY Well Completion Report
1. WELL LOCATION GPS (OPTIONAL) LATITUDE "'y r ' LONGITUDE
Address at Well Location: '_1-LE S R"7' Property Owner: 'Ir i_qtr_ Yi1 i l-le r s Inc
Subdivision Name: Mailing Address:4 3 Batas St--s at
1--,e!ca
City/Town: City/Town: LLD-tha:noton '�1A 01 -05:)
Assessors Map Assessors Lot #: NOTE: Assessors Map and Lot # mandatory if no street address available
Board of Health permit obtained: Yes ❑ Not Required, Permit Number Date Issued
2. WORK PERFORMED 3. PROPOSED USE 4.'DRILLING METHOD
CQ New Well ❑ Abandon Ll Domestic ❑ Irrigation ❑ Cable ❑ Auger
❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal Q Air Hammer ❑ Direct Push
❑
Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud Rotary ❑ Other
S. WELL LOG a: Unconsolidated Consolidated 6.SITE SKETCH (Uss Pan wmd WK ma M with dktanaw)
W Permeability
Q m
From (ft) To (ft) High Low Other Rock Type
fall
7. WELL CONSTRUCTION ;' 8. CASING
Total Depth Drilled 2 211 From (ft) To (ft) Casing Type and Material Size O.D. (in) Well Seal Type
Date Drilling Complete 0 1 135 117 nrivas_nOe
1 -10-32)
9. SCREEN
From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter
10. FILTER PACK/GROUT I ABANDONMENT MATERIAL .11_ADDITIONAL WELL INFORMATION
From (ft) To (ft) Material Description Purpose Developed? ❑ Yes ❑ No
Fracture
Enhancement? ❑ Yes ® No
Method
Disinfected? ® Yes ❑ No
12.WELL TEST DATA(PRODUCTION WELLS) 43.STATIC WATER LEVEL(ALL WELLS)
Yield Time Pumped Drawdown to Time Recovery to Depth Below
Date Method (GPM) (hrs & min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT)
14. PERMANENT-PUMP:(IF-AVAILABLE) �;$&NAMEIADDIUW OF PW INSTALLATION MPANY -
Pump Description Horsepower icc ,V?(Z-
Pump Intake Depth (ft) Nominal Pump Capacity (gpm)
16.`COMM
17:WELL E1 tt:LE$'$ f¢TEMENT,,,:jWN This well was drilled and/or abandoned under my supervision, according to applicable rules
and regulations, and this report is cgcnplete and corre t the best of my knowledge.
Driller: Michael LaRoche Supervising Driller Signature: Registration #A
Firm: Kirke R Kensha;e I:is Date: �����'r Ri Permit#:
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
t �
Sample # 9122C
HOWARD LABORATORIES OF NEW ENGLAND, INC.
750 North Pleasant Street
Amherst, MA 01002
- Phone: (413) 549-8260 Fax: (413) 549-1850
MA Lab License: M-00851
WATER ANALYSIS REPORT
Analyzed For:, Wright Builders,;" Sample Location: Lot 3, Off North Farms Rd
Address: 48 Bates St. Northampton, MA
Northampton, MA 01060 Sampled By: HWD
Date Sampled: 1/18/02
Telephone: Date Received: 1/18/02
PARAMETER RESULTS LIMITS COMMENTS
Total Coliform OK
Bacteria 0 Colonies/100ml 0 Colonies/100ml
H 7.44 pH Units 6.5-8.5 pH Units OK
Manganese 0.014 mg/I 0.05 mg/l OK
Hardness 30 mg/1 No Standard <50 SOFT, >100 HARD
Conductivity 0.08 ms/cm No Standard No Standard
Chloride 11.6 mg/I 250 mg/l OK
Iron 0.04 mg/1 0.3 mg/l OK
Sodium 1 mg/l 28 mg/l OK
Nitrate 0.0 mg/1 10 mg/l OK
Nitrite 0.003 mg/I I mg/l OK
*
*
Color 17 Ptco Color Units 15 PtCo Color Units
Turbidity 2.39 NTU 5 NTU OK
Recommendations: See enclosed MA DEP Interpretations sheet for parameters marked with an asterisk.
This sample meets acceptable standards of potability for the parameters tested, except for those parameters
marked with an asterisk (*).
Analyst: BA Date: 1/22/02
Checked By: Jonathan S. Begg
Laboratory Supervisor
a " (r IfU of IIZ� 3II1 T fIITi ;��
n�E?A.RTMENT OF BL;ILDIIG INSPECTIONS `� E
212 Main Street ' Municipal Building
IN„r_CTOR � �.,,,
Northampton, lfass. 01060
Square Footace F�rcunt
Basement @ .10 J ITS(o ` (00
1st __cor @ .40 \$33 "133,y)
2nd F1ccr @ .20
1/2 Floors, Attic, Garage .10 6-4D
Deck, Porches -10 �` �p
Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes.
Insulation Thickness in Inches by Pipe Sizes
Heated Water Non-Circulating Runouts Circulating Mains and Runouts
Temperature(F) Up to 1„ Up to 1.25" 1.5"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
Table 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
Piping System Types 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 1.5 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)
i
Heating and Cooling Piping Insulation:
[ ] HVAC piping conveying fluids above 120 T or chilled fluids below 55 T must be insulated to the
levels in Table 2.
i
Floors:
[ ] 1. Floor 1: Slab-On-Grade:Unheated, 6.0'insulation depth,R-10.8 continuous insulation
Comments:
Slab insulation to extend down from the top of the slab to at least 6.0 ft. OR down to at
least the bottom of the slab then horizontally for a total distance of 6.0 ft.
Heating and Cooling Equipment:
[ ] I. Air Conditioner 1: Electric Central Air, 14.1 SEER or higher
Make and Model Number
[ ] 2. Air Conditioner 2: Electric Central Air, 14.1 SEER or higher
Make and Model Number
[ ] 3. Boiler 1:Gas-Fired Steam,90 AFUE or higher
Make and Model Number
Air Leakage:
[ ] Joints,penetrations,and all other such openings in the building envelope that are sources of air
leakage must be sealed.
[ ] When installed in the building envelope,recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture
and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944
Us)air movement from the the conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled.
Vapor Retarder:
[ ] Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors.
Materials Identification:
[ ] 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
equipment must be provided.
[ ] Insulation R-values,glazing U-factors,and heating and cooling equipment efficiency must be clearly
marked on the building plans or specifications.
Duct Insulation:
[ ] Ducts shall be insulated per Table J4.4.7.1.
Duct Construction:
[ ] All accessible joints,seams,and connections of supply and return ductwork located outside
conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed
using mastic and fibrous backing tape installed according to the manufacturer's installation
instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted.
[ ] The HVAC system must provide a means for balancing air and water systems.
Temperature Controls:
[ ] Thermostats are required for each separate HVAC system. A manual or automatic means to
partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided.
Heating and Cooling Equipment Sizing:
[ ] Rated output capacity of the heating/cooling system is not greater than 125%of the design load as
specified in Sections 780CMR 1310 and J4.4.
Circulating Hot Water Systems:
[ ] Insulate circulating hot water pipes to the levels in Table 1.
Swimming Pools:
[ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20%
of the heating energy is from non-depletable sources. Pool pumps require a time clock.
[ ] 23. Window:Frank Type J: Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 24. Window:Frank Type K:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 25. Window:Frank Type K:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ] Yes [ ]No
Comments:
[ ] 26. Window:Frank Type L: Wood Frame,Double Pane with Low-E,U-factor: 0.370
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 27. Window:Frank Type L:Wood Frame,Double Pane with Low-E,U-factor: 0.370
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break?[ ]Yes [ ]No
Comments:
[ ] 28. Window:Frank Type NL:Wood Frame,Double Pane with Low-E,U-factor: 0.290
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 29. Window:Frank Type NL:Wood Frame,Double Pane with Low-E,U-factor: 0.290
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 30. Window:Frank Type NR:Wood Frame,Double Pane with Low-E,U-factor: 0.290
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break?[ ]Yes [ ]No
Comments:
[ ] 31. Window:Frank Type NR: Wood Frame,Double Pane with Low-E,U-factor: 0.290
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 32. Window:Frank Type P: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:
Doors:
[ ] 1. Door: Frank#1 Custom Wood: Solid,U-factor: 0.540
Comments:
[ ] 2. Door:Frank#2 French 3682: Glass,U-factor:0.330
Comments:
[ ] 3. Door:Frank#3 Thermatru: Solid,U-factor:0.150
Comments:
[ ] 4. Door: Frank#5 7282: Glass,U-factor: 0.330
Comments:
[ ] 5. Door:Frank#6 7282: Glass,U-factor: 0.330
Comments:
[ ] 6. Door:Frank#6 Sidelight: Glass,U-factor: 0.330
Comments:
[ ] 7. Door:Frank#8: Glass,U-factor:0.330
Comments:
[ ] 8. Door: Frank#9: Glass,U-factor:0.330
Comments:
[ ] 9. Door:Frank#10: Glass,U-factor: 0.330
Comments:
[ ] 8. Window:Frank Type D:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 9. Window:Frank Type E: Wood Frame,Double Pane with Low-E,U-factor: 0.370
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break?[ ]Yes [ ]No
Comments:
[ ] 10. Window:Frank Type E:Wood Frame,Double Pane with Low-E,U-factor: 0.370
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ] Yes [ ]No
Comments:
[ ] 11. Window:Frank Type E: Wood Frame,Double Pane with Low-E,U-factor: 0.370
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ] Yes [ ]No
Comments:
[ ] 12. Window:Frank Type F: Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break?[ ]Yes [ ]No
Comments:
[ ] 13. Window:Frank Type F:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 14. Window:Frank Type F copy 1: Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ] Yes [ ]No
Comments:
[ ] 15. Window:Frank Type F copy 1:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break?[ ]Yes [ ]No
Comments:
[ ] ( 16. Window:Frank Type F copy 1:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ] Yes [ ]No
Comments:
[ ] 17. Window:Frank Type G:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 18. Window:Frank Type G:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ] Yes [ ]No
Comments:
[ ] 19. Window:Frank Type H:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 20. Window:Frank Type H:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ] Yes [ ]No
Comments:
[ ] 21. Window:Frank Type I:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 22. Window:Frank Type I: Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ] Yes [ ]No
Comments:
REScheck Inspection Checklist
Massachusetts Energy Code
REScheckSoftware Version 3.5 Release lb
DATE: 03/31/03
TITLE: Frank
Bldg.
Dept.
Use
Ceilings:
[ ] 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation
Comments:
[ ] 2. Ceiling 2: Cathedral Ceiling(no attic),R-38.4 continuous insulation
Comments:
Above-Grade Walls:
[ ] 1. Wall 1:Wood Frame, 16" o.c.,R-20.0 cavity insulation
Comments:
[ ] 2. Wall 2:Wood Frame, 16" o.c.,R-20.0 cavity insulation
Comments:
Basement Walls:
[ ] 1. Basement Wall 1: Solid Concrete or Masonry, 8.5'ht/6.0'bg/8.5'insul,
R-13.0 cavity insulation
Comments:
Windows:
[ ] 1. Window:Frank Type A: Wood Frame,Double Pane with Low-E,U-factor: 0.370
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 2. Window:Frank Type B:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 3. Window:Frank Type B:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes[ ]No
Comments:
[ ] ( 4. Window:Frank Type C:Wood Frame:Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 5. Window:Frank Type DT:Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 6. Window:Frank Type DT copy 1: Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
[ ] 7. Window:Frank Type D: Wood Frame,Double Pane with Low-E,U-factor: 0.340
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ]Yes [ ]No
Comments:
Window:Frank Type F copy 1:
Wood Frame,Double Pane with Low-E 27 0.340 9
Window: Frank Type G:Wood Frame,Double Pane with Low-E 12 0.340 4
Window:Frank Type G:Wood Frame,Double Pane with Low-E 12 0.340 4
Window:Frank Type H:Wood Frame,Double Pane with Low-E 10 0.340 4
Window: Frank Type H:Wood Frame,Double Pane with Low-E 10 0.340 4
Window:Frank Type I:Wood Frame,Double Pane with Low-E 13 0.340 5
Window:Frank Type 1: Wood Frame,Double Pane with Low-E 13 0.340 5
Window: Frank Type J: Wood Frame,Double Pane with Low-E 36 0.340 12
Window: Frank Type K:Wood Frame,Double Pane with Low-E 21 0.340 7
Window:Frank Type K:Wood Frame,Double Pane with Low-E 21 0.340 7
Window: Frank Type L:Wood Frame,Double Pane with Low-E 4 0.370 1
Window:Frank Type L: Wood Frame,Double Pane with Low-E 4 0.370 1
Window:Frank Type NL: Wood Frame,Double Pane with Low-E 16 0.290 5
Window:Frank Type NL: Wood Frame,Double Pane with Low-E 16 0.290 5
Window:Frank Type NR:Wood Frame,Double Pane with Low-E 16 0.290 5
Window:Frank Type NR:Wood Frame,Double Pane with Low-E 16 0.290 5
Window:Frank Type P:Wood Frame,Double Pane with Low-E 52 0.330 17
Door:Frank#1 Custom Wood: Solid 22 0.540 12
Door: Frank#2 French 3682: Glass 20 0.330 7
Door:Frank#3 Thermatru: Solid 20 0.150 3
Door: Frank#5 7282: Glass 51 0.330 17
Door: Frank#6 7282: Glass 42 0.330 14
Door:Frank#6 Sidelight: Glass 11 0.330 4
Door:Frank#8: Glass 42 0.330 14
Door:Frank#9: Glass 42 0.330 14
Door:Frank#10: Glass 42 0.330 14
Wall 2:Wood Frame, 16" o.c. 2145 20.0 0.0 127
Basement Wall 1: Solid Concrete or Masonry 1028 13:0 0.0 68
Wall height: 8.5'
Depth below grade: 6.0'
Insulation depth: 8.5'
Floor 1: Slab-On-Grade:Unheated 228 10.8 155
Insulation depth: 6.0'
Air Conditioner l: Electric Central Air, 14.1 SEER
Air Conditioner 2: Electric Central Air, 14.1 SEER
Boiler 1: Gas-Fired Steam,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 Massachusetts
Energy Code requirements in RES checkVersion 3.5 Release lb (formerly MECchec/ and to comply with the mandatory
requirements listed in the RES checkInspection Checklist.
The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design
Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the
design load as specified i)1 Sections 780CMR 1310 and J4.4.
Builder/Designer - Date 2,
Permit Number
REScheck Compliance Certificate Checked By/Date
Massachusetts Energy Code
RES check Software Version 3.5 Release lb
Data filename: C:\Program Files\Check\REScheck\Frank.rck
TITLE:Frank
CITY:Northampton
STATE: Massachusetts
HDD: 6404
CONSTRUCTION TYPE: 1 or 2 Family,Detached
HEATING SYSTEM TYPE: Other(Non-Electric Resistance)
DATE: 03/31/03
PROJECT INFORMATION:
Frank
COMPANY INFORMATION:
Wright Builders Inc.
COMPLIANCE: Passes
Maximum UA=985
Your Home UA=800
18.8%Better Than Code(UA)
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R-Value R-Value U-Factor UA
Ceiling 1:Flat Ceiling or Scissor Truss 962 38.0 O.Q_ --- 29
Ceiling 2: Cathedral Ceiling(no attic) 1638 0.0"- 38.4 41
Wall 1:Wood Frame, 16" o.c. 1937 20.0 0.6 59
Window: Frank Type A:Wood Frame,Double Pane with Low-E 44 0.370 16
Window: Frank Type B:Wood Frame,Double Pane with Low-E 24 0.340 8
Window:Frank Type B:Wood Frame,Double Pane with Low-E 24 0.340 8
Window:Frank Type C:Wood Frame:Double Pane with Low-E 40 0.340 14
Window: Frank Type DT: Wood Frame,Double Pane with Low-E 20 0.340 7
Window: Frank Type DT copy 1:
Wood Frame,Double Pane with Low-E 20 0.340 7
Window:Frank Type D:Wood Frame,Double Pane with Low-E 20 0.340 7
Window: Frank Type D:Wood Frame,Double Pane with Low-E 20 0.340 7
Window: Frank Type E:Wood Frame,Double Pane with Low-E 10 0.370 4
Window: Frank Type E:Wood Frame,Double Pane with Low-E 10 0.370 4
Window: Frank Type E:Wood Frame,Double Pane with Low-E 10 0.370 4
Window: Frank Type F:Wood Frame,Double Pane with Low-E 27 0.340 9
Window: Frank Type F:Wood Frame,Double Pane with Low-E 27 0.340 9
Window: Frank Type F copy 1:
Wood Frame,Double Pane with Low-E 27 0.340 9
Window:Frank Type F copy 1:
Wood Frame,Double Pane with Low-E 27 0.340 9
SECTIONS-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: tt�� Not Appplliicablle]]��❑
Name of License Holder:_ 1 L=a�t�!�!�!--______—_--____-__ — 1114 Y!___----__
License Number
1-A - - I)-
nn M�
Address fjf Expiration ate
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
--Y1Q - ►� � ------------------------------------- --- t� b
e --
Company ame Registration Number
deS S — b J M -----------
Address Expiration D to
- ------------------------ -----TelephonAV�
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...... ❑
I L - Home Ow er 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 Alterations) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other[ ]
Brief D t'on of roposedf
j
Work � -
7� S��(14i'YI� . k'�Ci '1�(tf'YI� Z IuT 1 S �%IGL �•
Alteration of existing bedroom-----Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement ----Yes Yes __—_—No
Plans Attached Roll -Sheet
6a.1f New house andor add it on to existing housina. complete the follow np:
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.__YN2- _= Dimensions--------------
---------------
e. Number of stories? 1 t Z
f. Method of heating? � Fireplaces or Woodstoves Number of each l [t°Qif
g. Energy Conservation Compliance._ L.kt Mascheck Energy Compliance form attached? �„S
h. Type of construction
i. Is construction within 100 ft.of wetlands? ----Yes Yes _X— No. Is construction within 100 yr. floodplain--___Yes L`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 AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,—5�i1e— � _ —_ _ as Owner of the subject
property
hereby aWhorizei to ac n y b alT, in 1, to r tive V work authorized by this building permit application.
-- -- ----- — - ----------- -----------------------------------------------------
Si at ner Date
1. �N`!� 4�� — �1� ]L�! � as Owner/ utho�rized
hereby declare that the stat4ments a information on the foregoing application are true and accurate, to the best of mry Knowledge
and belief.
Signed u der the pairs and penalties of perjury.
-�!ir�l -- 1 -----------------------------------------------------------------
Print Name
--------------------------------------------
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
✓� + Building Department
Lot Size J�� �i • �j^�1, 7 o,4
Frontage I--7(o'
Setbacks Front 27�j
Side L: R: L 22 R:Jb
Rear
Building Height it
Bldg.Square Footage % T 1c�1 I I i C111-
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces 4
Fill: _
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page_ and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW
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 _ NO JS
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: __
• a
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Drlveuuay Permit -
�^ 112 Main S#eet Sewer/Sep, c°Availability
Room 10b Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plana—' _
phone 413-587-1240 Fax 413-587-1272 Plot/Site,Plans'__— �-
Other p
F_ APPLICATION TO CONSTRUCT,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
�}
Map--S1_ ---- Lot__1,,�y 6-2_----Unio j
Zone T --Overlay District--�
Elm St.District___ CB District��__'_
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address: j
0
---- '--- --------------- ---------- Telephone /{ CZC _i cj Z
Signature —1 J
2.2 Authorized Age t:
Name(Prim# Current Mailing Address:
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTIONI COSTS'
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building Building Permit Fee
2. Electrical (b)Estimated Total Cost of
e3b 000 Construction from 6
3. Plumbing c)0 Q Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection}I U�
6. Total=(1 +2+3+4+5) Check Number d
This Section For Official Use Only
Building Permit Number: ----- Date
- -- — Issued;
Signature: _�_--_-- �___ _ T ---------_--_ __ ---------------°------
Building;Commissioner/Inspector of Buildings Date
y
File#BP-2003-0808
APPLICANT/CONTACT PERSON Wright Builders
ADDRESS/PHONE 48 Bates St (413)586-8287
PROPERTY LOCATION 680 NORTH FARMS RD
MAP 02 PARCEL 027 001 ZONE RR 0"*3
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T_ypeof Construction: CONSTRUCT 2 STORY SFH ATT/GARAGE/DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 047146
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 V
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 Commission
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.
O O
Glitz of Nazt4aillptan - r
� 9 �assachusrtte
DEPARTMENT OF BUILDU\TG INSPECTIONS
INSPECTOR 212 Main Street • Muuicipal.Building
Northampton,MA 01060
CERTIFICATE of OCCUPANCY and USE
This is to certify that permission is hereby granted under 780 CMR, sixth edition of the
Massachusetts State Building Code, allowing the occupancy or use of the premises or
structure or part thereof located at
680 North Farms Road — Lot #3
as shown on the Assessors Page# 02 , Lot# 27 Zone RR
in the City of Northampton, as herein specified:
CONSTRUCTION TYPE(780CMR 6) 5B
USE GROUP CLASSIFICATION (780 CMR 3
OCCUPANT LOAD PER FLOOR (780 CMR Table 1008.1.2 4U PSF
30 PSF
LIVE LOAD PER FLOOR(780 CMR Table 1606.1) P F
Under the following limitations, special stipulations, and/or conditions of the
permits:
Issued this 27th day of April , 20 04
Certificate of Occupancy and Use# BP-2003-0808
Authorized Department Personnel
Electrical Elevator
Fire Plumbing
Building �d ,r����/� Gas
Building Commissioner
This certificate shall be posted by the owner, in a permanent manner and in a visible
location, on all floors designated as use group H, S, M, F, or B, and in every room where
practicable of use group A, I, R-1, or R-2 per requirement of 780 CMR section 120.5
Posting Structures.
I�ki�/��CC� ��io-�Gll�
LOT#3 -680 NORTH FARMS RD BP-2003-0808
GIS#: COIF■MGNWhALTH OF MASSACHUSETTS
Map:Block:02-027 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category_ '113h3 U LDI NG PER—MIT
T
Permit# BP-2003-0808
Project# J5-2003-1325
Est.Cost: $6500!00.00
Fee: $1548.00 PERMIS 5i ON IS HERE13 Y GRANTED TO:
Const.Class: 5B Contractor: License:
Use croup: R4 Wright Builders_ 047146
Lot Size(sq.ft.): Owner: FRANK STEVE
Zoning: RR Applicant. Wright Builders
AT: LOT #3 - 680 NORTH FARMS RD
Applicant Address:_ Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON:4110103 0:00:00
TO PERFORAI THE FOLLOWING WORK.-CONSTRUCT 2 STORY SFH ATT/GARAGE/DECK
POST 'THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: 71/,5-/03 �f Meter:
�/ Footings:
Rough: Rough: '��3 )louse# Foundation:
J ('0va-n) VV Driveway Final: NO L� 4)to- 5.:7 f- G 3
-� U�y rrrz�v�O-- F���L 0
Final. Final: � y
G_v 6� /l ,7 ,, d�✓ Rough Frame:Q Vim. `��i-0.3
,2 V
Gas: �/ ire De artme Fireplace/Chimney:
ti
Rough: Oil: Insulation: Q ry
Final: 3 moke• Final: tf I<, 7.0 Y
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON"VIOL N OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy si ng aturee._
FeeType• Receipt No: Date Paid: _ Check No: Amount:
Building 4/10/03 0:00:00 15253 $1548.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
ro 'iy'