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17A-080 F.i A"A1 LIlti b LIJA404 M-4, 1 aye t�kisr�� CgX_OL yti, Sri FORA 11 - SOIL EVALUATOR FORM Page 3 Determination for Seasonal High Water Table Method Used: ® Depth observed standing in observation hole aJ :!' = inches Depth weeping from side of observation hole ./7 6?.` inches Depth to soil mottles ............... inches 1,1, 6P c� Ground water adjustment _2, feet Index Well Number . ___ Reading Date _ _...... ..... Index well level ... ....... Adjustment factor ___.._ Adjusted ground water level _. . ..._...............__ .... ......... Depth of Naturally Occurring Pervious Material Does at Fast four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �' If not, what is the depth of naturally occurring pervious material? Certification I certify that on ` - (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature- ' ,� /� —. _Date r Pp.0/24/1999 10 D.L.P. TITLE 5 SOIL EVALUATORS LIST r t NAME ASSOCIATION STREET ADDRESS TOWN C. STATE PHONE NUMBER Barnard H. Hamill 8-Star Engineering, Inc. 9 Acton Rd., Suits 15 Chelmsford, MA 01824- 978-256-9216 Keith Murray Maisner 2rsm Corp. 360 Littleton Rd. Chelmsford, MA 01824- 978-692-2505 Jeffrey Rider How Surveying Assoc., Inc. 73 Princeton St. Chelmsford, MA 01863- 978-251-3132 Joseph D. Simon Land2ech Consultants, Inc. 7 Doris Dr. Chelmsford, MA 01863- 978-251-9638 Kevin M. Walker LandTach Consultants, Inc. 7 Doris Dr. Chelmsford, MA 01863- 978-251-9835 Earl J. Bernier, Jr. Leicester 206 251 Auburn St. Cherry Valley, MA 01611- 508-892-9165 Peter B. Frans 16 Depot Bt. Cheshire, MA 01225- 413-743-1356 Frank DsMarinis Baystate Environmental Consultants 68 Middlefield Road Cheater, MA 01011- 413-525-3822 George S. Van Orman Town of Beckst RD Box 72A Chester, MA 01011- 413-623-5735 Barbara A. Curran Town of Chesterfield P.O. Box 89 Chesterfield, MA 01021- 413-296-4243 Emily B. Holmberg Town of Chesterfield P.O. Box 89 Chesterfield, MA 01012- 413-296-4247 Richard L. Nawrocki 170 Slate Rd Chicopee, MA 01020- 413-592-4986 Michael Pietras Wilbraham BON 88 Paderewski St Chicopee, MA 01013- 413-596-2807 Sylvia Brown 15 Ben's Way Chilmark, MA 02535- 508-645-2105 Bill Elbow Board of Health P.O. Box 119 Chilmark, MA 02535- 508-645-2105 Li: Guda P.O. Box 417 Chilmark, MA 02535- 508-645-9758 Matthew E. Poole Chilmark BOH P.O. Box 119 Chilmark, MA 02535- 508-645-2667 Michael Reoaham Chilaark BOH P.O. Box 119 Chilmark, MA 02535- 508-645-2667 Charles A. Budnick Cabco Consult P.O. Box 14 Clinton, MA 01510- 978-368-1591 John McNally Newton Health Dept. • 140 Cedar St. Clinton, MA 01510- 976-552-7058 Ella S. Walsh P.O. Box 145 Clinton, MA 01510-0145 978-365-7087 Daniel J. Murphy 471 Beachwood St. Cohasset, MA 02025- 413-546-3966 Raymond R. Tehranian 288 Fair Oaks Lane Cohasset, MA 02025- 781-383-9268 Michael Friedlander Colrain B04h 262 East Colrain Rd Colrain, MA 01340- 413-624-3643 Shawn Kimberley Macleay Assoc 221 Ed Clark Rd Colrain, MA 01340- 413-625-9774 Donald Moore 148 Sumner/Stetson Rd Colrain, MA 01340- 413-337-4206 David Baker, Jr 34 Bruce St Concord, MA 01742- 508-695-5100 Robert G. Guernsey Septic Design i Services, Inc. 19 Border Rd. Concord, MA 01742- 978-369-7122 Dale Mackinnon Whitman i Howard, Inc. 196 Baker Ave. Concord, MA 01742- 976-237-5000 Stephen J. Masse Septic Design Services 19 Border St. Concord, MA 01742- 978-369-7122 Sharon Walker Mast- rook Acton BON 99 Tarbell Spring Rd Concord, MA 01742- 978-264-9634 David W. 'Perley David W. Parley, Civil Engineers 140 Comerford Rd. Concord, MA 01742- 978-369-2669 Stanley J. Sosnicki Town of Concord 141 Keyes Rd. Concord, MA 01742- 978-371-6275 Jordan Valdina 396 Cambridge Turnpike Concord, NA 01742- 978-369-7825 Diane P. York Concord BON 141 Keyes Rd Concord, MA 01742- 978-318-3275 Robert Delabarre PO Box 83 Conway, MA 01341- 413-369-4360 Peter Freisem PO Box 12 Conway, MA 01341- 413-369-4651 \ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 s ARGEO PAUL CELLUCCI BOB DURAND Governor Secretary JANE SWIFT LAUREN A-LISS Lieutenant Governor Commissioner THE LIST OF D.E.P. APPROVED TITLE 5 SOIL EVALUATORS August 30, 1999 This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World Wide Web: http:/twww.magnet.state.ma.us/dep Printed on Recycled Paper [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure—sensitive tape may be used for fibrous ducts . 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. HVAC 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 . MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F and circulating hot water systems . ---NOTES TO FIELD (Building Department Use Only)------- ------------ MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 John & Patricia Crescitelli DATE: 4-2-2002 Bldg. Dept. Use CEILINGS: [ ] 1 . R-38 Comments/Location WALLS: [ ] 1 . Wood Frame, 16" O.C. , R-19 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1 . U—value: 0 . 31 For windows without labeled U—values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS : [ ] 1 . Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1 . Furnace', 87 .0 AFUE or higher Make and Model Number THERMOSTATS: [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE': [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air—tight assembly with a 0 . 5" clearance from combustible materials and 3" clearance from insulation. 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—values, and heating equipment efficiency must be clearly marked on the building plans or specifications . DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 . 0 . ]PUCT CONSTRUCTION: MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 .0 Checked by/Date CITY: Amherst - STATE : Massachusetts j HDD: 6614 -- CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 4-2-2002 DATE OF PLANS: 04/02/02 TITLE : John & Patricia Crescitelli PROJECT INFORMATION: 38 Carolyn Street Florence, MA Addition; kitchen, bedroom and bathroom COMPANY INFORMATION: David Fortier Builders/Ron Altimari Woodworking Associates, Inc . 32 Laurel Street Northampton, MA 01060 COMPLIANCE : PASSES Required UA = 156 Your Home = 108 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA CEILINGS 748 38 . 0 0.0 22 WALLS : Wood Frame, 16" O.C. 707 19 . 0 0 . 0 43 GLAZING: Windows or Doors 41 0 . 310 13 FLOORS: Over Unconditioned Space 628 19 . 0 30 HVAC EFFICIENCY: Furnace, 87 . 0 AFUE -------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. 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 in sections 780CMR 13. 0 and J4 ., Builder/Designer_-`'" Date q o z v' a I APR Ax I 300 S4fT DoI jIa t ji So fr. SL I , U i � 1 I `Vf i 4.�ttA1dPJ. 0 e 01 $ �x of �DZ���11Y�I�IIlt a e �7(SE RfhttEf llE e DEPARTMENT OF BUILDITNG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WOR-KER'S COMPENSATION INSURANCE A t AVTT 7A�'') t ie.;Z /CC,,1)j_T1hA.1�j 4 5SG<<1F,2s (licensee/petmittee) with a principal place of busmess/residence at: ST /L�,'117 N lq,,q. 01 L,�,,C, (phone (stzret/cz'ty statrl/ rip) do hereby certify, under the pains and penalties of perjury, that. (�C) I am an employer providing the following worker's compensation coverage for Iny employees working on this job: '1SScG�Tr �v�U;T I S Cii� (/fit; U1�3 iSc�r G2 12C,163 (Insurance Company) (Policy Number) (Expi'mdo Date) �S34CH(,yerTI I'IvTvAL -TV-S, C" ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of(:ontacnor) (Insuran(-- Comparly/Poticy Number) (Expiration Date) (Name of( outrc or) (Insurance Company/Policy Number) (Expiration Date) (Name of Contactor) - (Insuran(-- Company/Poky Number) (Fxpirabon Date) (Name of Contactor) (Imutance Coinpany/Policy Number) (Expiration Date) (attach additioail shin tf ncc�suy to include mfo mit,oo pertaining to rill oo�tra rs) i O I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:pleaaa be aware that while homeowvm who employ percom to do m•Eat ccastr=on or repair work on a dwelling of not moee than Lb oo units in wirich the homoowmcr r mdcs or oa the pounds apptuteaaat thaRo arc not grocrady oomid rtd to be employers under tlk warkct's ccaipc�oa Act(GL152,n 1(5)),application by a homoow=for a licm=cc permd maY evidence the legal rtat as of an amployor under thn Workcet Compooaation Act. I understand ttut a copy of this rtatcmcat may bo forwarded to tba I?cpartnxo2 of Indauf j Acod=&OfEoa of LavA ca for tho covange vaificati',on and that failure to azure ooverngo trader socUoa 25A of MOL 152 can lead to the imposition of criminal perishes oomistiag of a&a$of up to S 1,500.00 and/or imptisofm cni of up to one year and civil penalties in the form of a Stop W ode Order and a fmo of s 100.00 a day tgninst mc. 1r 1 For depsrt n-t-J tun only Permit Number I_ G L Mag%t Lot# Sigilalture of I.tccasee/Permitlee e SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction fSupervisor: � r Not Applicable ❑ Name of License Holder: JF1 V i�JV Fd J�'J License Number Address l Expiratkiri Signaturev Telephone p lnn eC nQomn« Not Applicable ❑ � � eMO ffi—N-VT A�Tr�tA2t ��t�rt,lt�d�rcr�vllssaevair¢� 3 `i`1`( Company Name Registration Number -3I LAU4U `%i " 7L4i ,1yo 'c,-✓ 0 U Expirat/ -1 Address n to Telephone ��" �t�� 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'........ C91*1 No...... ❑ a r n r Vmp 3'ome JWne on. 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 buildinil 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 SECTION5 DESCRIPTION Ol PROPOSED WORK check all a licable ,. , nw? , i-= li New House ❑ Add'ition C� Replacement windows Alteration(s) ❑ Roofing ❑ Or Doors 9?" Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [v]' Other [ ] ,I Brief Description of Proposed Work:A&D laoi xag' AO000w KI r4 low v 6Mruc )hoo 30V, t uujt fiRloa l^ai li" nV''Skzz / EAiSpAi c Alteration of existing bedroom Yes V"" No Adding new bedroom ✓ Yes No �, i/V00L�v Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll ❑- Sheet 11 6a:Ifi Nefiou�earitiortlditiori to ezistinghousin complete"the=fi61 lawlni7: a. Use of building : One Family LZ Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? ¢ 1 d. Proposed Square footage of new construction. J �� Dimensions O X e. Number of stories? f. Method of heating?( ii- F ),tLd0 H-IT 4)AT44 Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? ye- 5 I In. Type of construction _51(�L—Re4nA 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 f, r GC.Ac.f S,04C(� k. Will building conform to the Building and Zoning regulations? ✓f 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, J°�,n ce e5ctell _ as Owner of the subject property hereby authorize -----D_V For i er' u.. i Alool ork $S •c i ,� 5 o acct on my behalf, in all matters relative to work authorized by this bLfilding permit application. .l _ 4..0 ;/. 3, a2©G�2 Signatu of Owner Date 1, �'J�L0 d�. t"y2i'lC2�L (t 2�s, 0a.v�- a +er/Authorized Agent hereby declare that the statements an 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. JAcJ 1� is' I �t2 i <k n Print Name C Pilo, 2 U Signature of Owner/Agent Dafte , J 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 Sr3-Ft- Frontage Setbacks Front I i a i ^31 Side L: 30 i R: ? L: R: 1(a Rear /v 1 �1 i d v Building Height 8 t r I Bldg. Square Footage u 1Z I 3 % 1 4 1 L �� a 1 Open Space Footage % (Lot area minus bldg&paved t j 1 4 T 91 q j � parking) ' #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES _ IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlar�:js? NO ✓� DON'T 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 ✓ 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: I Cit f Northampton fi F s: ,, �, B i g Department ~u � - �� `� Main Street -� oom 100 Fill APR — cQ02fNo, ` pton, MA 01060 a7 e s r t? phone 41387. 240 Fax 413-587-1272 Plote ns S Qtler� eo fy �� � , ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING r SECTION 1 - SITE INFORMATION r This section to be completed by;offtce 1.1 Property Address: S l.H L A/ C— Lot' Unit ��.L_^..L Zone" Overlay:District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: -�- 3�Ccro� S�• ,dale /�'J�I 0/06,2 i06z Name(Print) Current MaiVhg Address: Telephone Sig --- j 2.2 Authorized krent: '3Z LA(-2eeL ---c I -,�-' ------ I Name( n t Current Mailing Address: Signature — Telephone _ SEC1ION-'3ESTIMATED 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 G 0 Construction from 6_ 3. Flumbing I p U Building Permit Fee 4. Mechanical (HVAC) C 5. Fire Protection 3.T©. 00 6. Total = 0 + 2 + 3 + 4 + t5) _ `1'3 q oeL 0 0 Check Number_ This Section For Official Use Only Building Permit Number:_ `'I Date Issued: Signature: — Building Commissioner/Inspector of Buildings Date File#BP-2002-0846 APPLICANT/CONTACT PERSON David Fortier ADDRESS/PHONE 32 Laurel St (413)586-8965 PROPERTY LOCATION 38 CAROLYN ST MAP 17A PARCEL 080 001 ZONE URA/10 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 28 X 20 KITCHENBEDROOM ADDITION 2ND FLR EXISTING INSTALL SIDING&WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Staterner At or License 008026 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ U 4-o Intermediate Project: Site Plan AND/OR Special Permit With Site Plan recharv- P clo Major Project: Site Plan AND/OR Special Permit With Site Plan Imo/1©f f>. ZONING BOARD PERMIT REQUIRED UNDER: § 5h 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 -14 OW P-r4jd Signature of Buildi fficial 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. /767 6.4�1t �FGI �t ��rGPn� �/ t� U� /'toU2 ;i r 38 CAROLYN ST GIs#: COMMONWEALTH BP"2002-0846 Man Block: 17A-080 OF MASSACHUSETTS Lot:-ool CITY OF NORTHAMPTON Permit: Building Cate or :alteration-addition BUILDING Permit# BP-2002-0846 PETIT Protect# JS-2002-1407 Est. Cost: $93400.00 Fee:$224.00 PERMISSION IS HEREBY(, Cons— st=Class GRANTED TO Contractor: TO: David Fortier License: Lot SiZe(s2 ft.): 11630-52 008026 Zom U SP Owner: CRESCITELLI JOHN T&PATRICIA A —� AUpticant: David Fortier 1 olicantAddress AL 38 CAROLYN ST 32 Laurel St Phone; NORTHAMPTONMA01060 413 586-8965 Insu--rance: TO PERFORM THE FOLLOWING W 16io2 0:00:00 ADDITION, 2ND FLR EXISTING BATH, IN� -SIDING & WINDOWS,MUST BUILD TO RUCT 28 X 20 KITCHEN/BEDROOM RECHARGE ROOF RUNOFF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Underground: Building Inspector Service: Rough: Meter: Footings: �e-7 '? Rough: /�� House# / /� /�� ? Driveway Final: Foundation: © � Final:114111,411,01Z `.�( ��' �r l O� _` .�� a �� Final: Rough Frame; Fire De artment / ��/ Rough-l' ,�/� Fireplace/Chimney: g��/� � Insulation: Final:OR V/100A Smoke: 'j Final: THIS PERMIT MAY BE REVOKED BY THE CITE'OF NORTHAMPTON ANY OF ITS RULES AND REGULATIONS. UPON VIOLATION OF Certificate of Occu anc - � Fee T e: Recei t N Si nature: o� Date Paid: Check No: Building Amount: 4/16/02 0:00:00 4044 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 $224.00 Building Commissioner-Anthony Patillo