41-005 (6) 11/2/2015 City of Northampton Mail-1472 Westhampton Road solar
CRY Of
Narftunpton Louis Hasbrouck <Iasbrouck @northamptonma.gov>
1472 Westhampton Road solar
1 message
Louis Hasbrouck < has brouck @northamptonma.gov> Mon, Nov 2, 2015 at 10:49 AM
To: ann @northeast-solar.com
Cc: Linda Lapointe <Iapointe @northamptonma.gov>, Kim Carson <kcarson @northamptonma.gov>
Ann,
You'd not get much back based on our refund policy. I'd suggest you leave the permit open and submit an
amendment when the project goes forward. The fee to amend a permit is $25.00 and it the refund would only be
$23.00 out of $138.00.
Let us know what you want to do.
Louis Hasbrouck
Building Commissioner
City of Northampton
Town of Williamsburg
(413) 587-1240 office
(413) 587-1272 fax
https://mail.google.com/mai I/ca/u/0/?ui=2&ik=ec5fl9a57e&view=pt&search=sent&th=l5Oc8e3858aOf829&siml=l5Oc8e3858aOf829 1/1
.' L
NorthEast Solar OCT 3 '( 1
136 Elm St.
r,
Hatfield, ma 01038
7
REJ472 Westhampton Rd. building and electric permit applications withdrawal
October 26, 2015
To the Building Inspector:
The roof at this address did not pass the structural review by our engineer so we
are going to install a ground mounted system instead. I would like to withdraw
our building and electrical permit applications for this project at this time and will
resubmit for the ground mount system when the design is complete. I understand
that there is a charge incurred from the work you have done and request that you
reimburse us the permit fees less your charge. I do apologize for the extra work.
---�Best -
Operations
ann @northeast-solar.com
413-247-6045
it
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a�-- Main electric
panel in
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City of Northampton
Eve L Andrade Building Department
Plan Review
1472 Westhampton Rd 212 Main street
Northampton, MA 01060
Northampton, Ma 01060
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® Mechanical Properties 10 Electrical Properties(STC')
Cells 6 x 10 300 W 295 W 290W 285W 280 W
Cell vendor LG Maximum power Pmax(W) 300 295 290 285 280
Cell type Monocrystalhne
MPP voltage Vmpp(V) 3 2.0 31.9 31.8 31.6 315
Cell dimensions 156 x 156 mm
Cell busbar 3 MPP current Impp(A) 942 930 919 909 8.97
Front cover Glass Open circuit voltage Voc(V) 39.5 39,3 39.2 390 38.9
Dimensions(L x W x H) 1640 x 1000 x 35(cnrTI) Short circuit current Isc(A) 10,0 9.91 9.80 9.68 9.56
Static load 5400 Pa(snow) Module efficiency(%) 18.3 180 177 174 171
2400 Pa(wind) Operating temperature(°C) -40-+90
Weight 16.8±0,5 kq Maximum system voltage(V) 1000
Connector type MC4 connector In 67
Maximum series fuse rating(A) 15
Junction box IF 67 with 3 bypass diodes
Length of cables 2 x 1000 mm Power tolerance(/) 0-3-
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(A 1703 Maximum power(Pmpp) 220 216 213 210 206
Product warranty 10 years MPP voltage(Vmpp) 293 292 291 28.9 28.8
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REC is a leading vet t ically Integrated player In tile solar energy industry.Ranked among the world's largest producers ofpolysiliconand ^
wafers For solar applications and rapidly growing manufacturer'of solar cells and modules,REC also engages in project development �{
activities in selected PV segments.Founded in Norway in 1996,REC Is an International solar company employing about 3.200 people
worldwide with revenues close to U5D 2.4 billion.
www.recgroup.com
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EVALUATION REPORT '°
wow a9
Report Number: 0248
Originally Issued: 09/2012
Valid Through: 09/2013
TABLE 1: ALLOWABLE LOADS FOR EZ ROOF MOUNT L-FOOT KIT(lbs.)1,2'3,4,5
Load Direction Ultimate Load Test Load at Test Load at Calculated Allowable
(see figure below Test Value 0.250 inch 0.1.25 inch Fastener/Metal
g ) F.S.=3.0 deflection deflection Strength
Design Load
Uplift(Withdrawal) 715 1,800 695 340 340
Lateral 260 240 130 153 130
Notes
1. Allowable load values are based on the least value from the ultimate lead of three tests(strength limit),tested
load at 0.125 inch deflection(deflection litnit),calculated fastener capacity(withdrawal or lateral)for wood
with a specific gravity of 0.55(Southern Pine)or allowable stress of the aluminum L-foot connector.
2. Allowable load values are based on lumber with all of the following characteristics:
a. Located in dry service conditions where the moisture content does not exceed 19%for an extended period
of time such as in covered structures.
b. Located where it does not experience sustained exposure to elevated temperatures that exceed 100°F.
For any other conditions,allowable table values shall be multiplied by the related adjustment factor(s)(C,,,
and/or C,)in accordance with the Natiohal Design Speeificatiod for Wood Construction(NDS-05).
3. Allowable load values are based on lumber with a specific gravity of 0.55(Southern Pine or equal).
4. Allowable load values for withdrawal are based on a minimum penetration of 2'/2 inches into the roof rafter
by one 5116 inch x 4 inch long stainless steel lag screw.
5. Allowable values may not be increased for load duration in accordance with Section 10.3.2 of the NDS-05.
EVALUATION REPORT
Report Number: 0248
Originally Issued: 09/2012
Valid Through: 0912013
TABLE 2:MATERIAL PROPERTIES
Component Material
Shoe Aluminum alloy ANSI/AA A380.0
Waterproof Washer EPDM with durometer rating of 60
Lag Bolt 304 stainless steel ASTM A 240
L-foot Aluminum alloy 6063-T6 ASTM B221
Hex Cap Aluminum alloy ANSI/AA A380.0
Flashing. Aluminum alloy 1060 ASTM 13209
EZ ROOF MOUNT COMPONENTS
l
Figures: Shoe Assembly Figure 4:Hex Cap
- i
Figure 2:Lag Bolt Figure 5:Flashing
6--,,
Figure 3:L-foot
Page 4 of 4
EVALUATION REPORT
Report Number: 0246
Originally issued: 09/2092
Valid Through: 0912013
TABLE 1: ALLOWABLE LOADS FOR EZ ROOF MOUNT L-FOOT KIT(ibs.)'2'3'4,$
Load Direction Ultimate Load Test Load at Test Load at Calculated
rest Value 0.250 inch 0.125 inch Fastener/Metal Allowable
(see figure below) F.S.=3.0 deflection deflection Strength
Design Load
Uplift(Withdrawal) 715 1,800 695 340 340
Lateral 260 240 130 153 130
Notes
1. Allowable load values are based on the least value from the ultimate load of three tests(strength limit),tested
load at 0.125 inch deflection(deflection limit),calculated fastener capacity(withdrawal or lateral)for wood
with a specific gravity of 0.55(Southern Pine)or allowable stress of the aluminum L-foot connector.
2. Allowable load values are based on lumber with all of the following characteristics:
a. Located in dry service conditions where the moisture content does not exceed 19%for an extended period
of time such as in most covered structures.
b. Located where it does not experience sustained exposure to elevated temperatures that exceed 100'F.
For any other conditions,allowable table values shall be multiplied by the related adjustment factor(s)(C,,
and/or C,)in accordance with the National Design Specification for Wood Construction(NDS-05).
3. Allowable load values are based on lumber with a specific gravity of 0.55(Southern Pine or equal).
4. Allowable load values for withdrawal are based on a minimuln penetration of 2'I] inches into the roof rafter
by one 5/16 inch x 4 inch long stainless steel lag screw.
5. Allowable values may not be increased for load duration in accordance with Section 10.3.2 of the NDS-05.
Uplift
Lateral
a
Page 3 of 4
EVALUATION REPORT
Report Number: 0248
Originally Issued: 0912012
Valid Through: 09/2013
4.21nstallation Rain test data and thickness of aluminum flashing
EZ Roof Mount must be installed using the 5/16 inch forbRoofdFlashing for P pe Penetrations Acceptance
([CC-ESt AC
diameter stainless steel lag screw at each bracket 286-2008). Rain test conformed to Underwriters
location as described in the manufacturer's installation Laboratory Standard for Gas Vents, UL 441-96 Section
instructions. Lag screw must penetrate into the roof 25.
rafter a minimum of 2 % inches. Prior to installation, the
roof rafter shall be bored with the required lead and Test results are from laboratories in compliance with
clearance hole for the unthreaded and shank portions ISO/IEC 17025.
of the lag screw as required in Section 11.1.3 of the
NDS -05. Threaded portion of the lag screw shall be 7.0 IDENTIFICATION
inserted into its lead hole by turning with a wrench and
not driving by a hammer. A die-stamp label in the flashing bearing the name and
address of the , the mode numer,
Use of auxiliary holes in the Shoe other than the use of IAPMO Uniform ES manufacturer
ks rof C nfo m ty' and this
an extra fastener to stop the shoe from rotating during Evaluation Report Number(ER-0248).
installation is outside the scope of this report,
Flashing should be installed full under the shingle up to
the raised portion of the flashing to prevent water A P M� U 5
ingress'under the shingle. No portion of the flashing
should be bent upward; the flashing must rest fully ES
against the roof shingles. Otherwise the water and wind
performance may be impaired. TM
5.0 CONDITIONS OF USE IAPMO#0248
EZ Roof Mount L-Foot Kit for Shingle Roofs described
in this report complies with the codes listed in Section
1.0 of this report subject to the following conditions:
5.1 EZ Roof Mount shall be installed in accordance with
this report, manufacturer's installation instructions and
the codes listed in Section 1.1.
5.2 Calculations to verify the imposed loads on the EZ
Roof Mount assembly do not exceed the allowable
loads contained in Table 1 of this report shall be
submitted to the code official when requested.
Calculations shall be prepared by a registered design
professional when required by the statues of the
jurisdiction where the work is constructed.
6.0 EVIDENCE SUBMITTED
Testing and analysis data submitted is in conformance
with Evaluation Criteria for Joist Hangers and
Miscellaneous Connectors(IAPMO ES EC 002-2011).
Page 2 of 4
EVALUATION REPORT
<;r
Report Number; 0248 w
Originally Issued: 09/2012
Valid Through: 09/2013
Division: 06—WOOD AND PLASTICS 3.0 DESCRIPTION
Section: 06060—Connections and Fasteners
REPORT MOLDER: 3.1 General Description
EZ Roof Mount L-Foot Kit consists of 5 basic
SunModo Corporation components: (1)shoe assembly with captive waterproof
1905 SE 51h St,Suite A washer, (2)lag bolt to fasten through the shingles to the
Vancouver, WA 98661 roof rafter, (3) flashing that is placed under the row of
shingles above the shoe and then over the shoe, (4) L-
EVALUATION SUBJECT Foot that is placed over the protruding shoe threads
and (5) hex cap that is secured on to the shoe. See
SunModo EZ Roof Mount L-Foot Kit for Shingle Figures 1 to 5 in Table 2.
Roofs
1.0 EVALUATION SCOPE: 3.2 Materials
EZ Roof Mount is fabricated from aluminum. Shoe
1.1 Compliance with the following codes: assembly is fabricated using casting aluminum alloy
with dimensions of 2.80 inches in diameter and 1.00
• 2009 International Building Code® inches in height. It is held in place using one 5/16 inch
• 2009 International Residential Code® diameter lag bolt that is 4 inch in length and made of
• 2006 International Building Code® stainless steel. Flashing is fabricated from sheet
• 2006 international Residential Code® aluminum with dimensions of 10.0 inches in width, 12.5
inches in length and 0.04 inches in thickness.
1.2 Evaluated In accordance with:
L foot is a 2.00 inch long unequal leg angle made from
• Evaluation Criteria for Joist Hangers and 6063-T6 aluminum with dimensions of 3.00 inches in
Miscellaneous Connectors (IAPMO ES EC002- depth, 2.00 inches in width and 0.24 inches in
2011),Approved March 2011 thickness. It contains a 0.375 inch diameter round hole
• Acceptance Criteria for Roof Flashing for Pipe with a 0.83 inch diameter chamfer (in base) that is
Penetrations(]CC-ES AC286),Approved April 2010 located in the center of the base leg. One slot
measuring 1.64 inch long by 0.40 inch wide occurs in
1.3 Properties Evaluated: the center and is located 0.30 inches from the top edge
of the vertical leg, which has a scallop front and rear
• Structural face. See Table 2 for component material properties
• Weather Protection and figures.
2.0 USES 4.0 DESIGN AND INSTALLATION
EZ Roof Mount L-Foot Kit for Shingle Roofs is used to 4.1 Design
mount solar systems and other rooftop devices such as
satellite dishes on asphalt shingle roofs with wood Tabulated allowable loads shown in Table 1 of this
rafters underneath report are based on allowable stress design (ASD).
Adjustments to these values are required for wet
EZ Roof Mount is specifically designed to be used for service conditions, sustained exposure to elevated
installation of solar panels for electric or hot water temperatures, use with fire retardant lumber or with
production on roofs with slopes from 3 to 12 units lumber whose specific gravity is less than 0.55
vertical in 12 units horizontal. (Southern Pine). Allowable values based on fastener
strength may be adjusted for duration of loading. See
footnotes of Table 1 for more detailed explanation.
Page 1 of 4
Copyright®2012 by Inlemalional Association of Plumbing and Mechanical Ornelafs.All rights reserved.Printed in the United States.No part of this publication may be reproduced,stared in
an elect,onic retrieval system,or transmitted,In any farm or by any means.elecironlc,mechanical,photocopying,recording,or otherwise,wiihout the prior written Permisslon of the
pvbilsher.Ph.1-877.41ESRPT•Fax:909,472.4171•Web:svxxlapmoes ara•soot East Philadelphia Street•Ontario,Califomia 91761-2618—USA +o•d,.a„Kr
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City of Northampton
Eve L Andrade Building Department
Plan Review
1472 Westhampton Rd 212 Main Street
4 Northampton, MA 01060
Northampton Ma 01060 ,3
s - a '
The Commonwealth of Massachusetts tlhf Form
Department of Industrial Accidents
Office oflnvestigations
L; 1 Congress Street, Suite 100
Boston, MA 02114-2017
www,mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
Business/Organization Name:Northeast Solar
Address:136 Elm St.
City/State/Zip:Hatfield, Ma 01038 Phone #:413-247-6045
Are you an employer? Check the appropriate box: Business Type(required):
1.❑✓ 1 am a employer with 10 employees (full and/ 5. ❑ Retail
or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7. ❑ Office and/or Sales (incl. real estate, auto, etc.)
employees working for me in any capacity.
[No workers' comp. insurance required] g• Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment
their right of exemption per c. 152, §](4), and we have 10.❑ Manufacturing
no employees. [No workers' comp. insurance required]*
4.❑ We are a non-profit organization, staffed by volunteers, 11.❑ Health Care
with no employees. [No workers' comp. insurance req.] 12.0 Other
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
I am an employer that isproviding workers'compensation insurance for nzy emplwees. Below is the policy informatioru.
Insurance Company Name:Hanover
Insurer's Address:1472 Westhampton Rd
City/State/Zip: Northampton, Ma 01060
Policy #or Self-ins. Lic. #WHN 5715134-02 Expiration Date:4/8/16
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 certify, under d s and per of peijury that the information provided above is true and correct.
Signature: _ °17�G. ----Date:8/18/15
Phone#:413-247-6045
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. Licensing Board 5. Selectmen's Office
6. Other
Contact Person: Phone#:
www.mass.gov/dia
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Phillip Baunsgard CS 10 6113
License Number
41 Heath Rd Colrain, Ma 01340 6/7/17
Address Expiration Date
413-247-6045
Signature Telephone
9.Rectistered Harhe Impirdmeffidilit Cbhtrectar: Not Applicable ❑
Northeast Solar 169641
Company Name Registration Number
136 Elm St . Hatfield, Ma 01038 7/14/17
Address Expiration Date
Telephone 413-247-6045
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(8))
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.......X7 No...... ❑
IL , 110me-OWIft0thleftio"flou
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 EJ
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [Q Siding[O] Other[M]
Brief Description of Proposed Install 18 Solar panels on residence
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _No
Plans Attached Roll -Sheet
da. It NOW hOU§e and.br addition to,existintt hausina...eompleW th6.t'oilow nq:
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
i. Is construction within 100 ft. of wetlands?_ Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and 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
Eve Andrade
I, , as Owner of the subject
property
hereby authorize Northeast Solar
to act on my behalf, in matters relative to work authorized by this building permit application.
Signature of Owner Date J
I, Northeast Solar 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.
Ann Bronner
Print Name
8/18/2015
Signature of weer/Agent Date
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
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: _ L:_. R:
Rear
Building Height
Bldg. Square Footage —i
i
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&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 Q YES Q
IF YES: enter Book Page= and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q Date Issued: F
C. Do any signs exist on the property? YES l NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
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 0 NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
i� � �
i
��� . . .
d Ceirtmant ttse art y.
City of Northampton Status of Feet rti
1 Building Department A Ou bovew y�or
2��s mit
..
212 Main Street e t eptla AVWIAb(iit :.. ...
Room 100 Weteri�ef�A�ailablllty.`
o>= Northampton, MA 01060 Iwo Sets of trubtUral Plans
phone 413-587-1240 Fax 413-587-1272 oIottstto Plans.':
Other Specify
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
147 2 Westhampton Rd, Northampton Ma 01060 Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Eve Andrade 1472 Westhampton Rd, Northampton Ma 01060
Name(Print) Current Mailing Address:
413-443-0053
Telephone
Signature "
2.2 Authorized Agent:
Northeast Solar. 136 Elm St, Hatfield Ma 01038
Name(Print) Current Mailing Address:
413-247-6045
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leted by ermit applicant
t. 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= 0 +2+3+4+5) 2 3, 959 Check Number d
This Section For Official Use Only
Building Permit Number: Date
- --- Issued:
Signature: _
Building CommissioneOnspector of Buildings Date
File#BP-2016-0509
APPLICANT/CONTACT PERSON NORTHEAST SOLAR DESIGN ASSOCIATES LLC
ADDRESS/PHONE 136 ELM ST HATFIELD01038(413)247-6045 Q
PROPERTY LOCATION 1472 WESTHAMPTON RD
MAP 41 PARCEL 005 001 ZONE
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: INSTALL ROOF MOUNTED 5AKW SOLAR ARRAY
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 106113
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO�IVIATION 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
o a
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.