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Untitled 250 GLENDALE RD-LOT BP-2017-0671 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:49-052 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:New Single Family House BUILDING PERMIT Permit# BP-2017-0671 Project# JS-2017-001097 Es(.Cost:$400000.00... Eee:$1848.00 PERMISSION IS HEREBY GRANTED TO: Const.C7nss: Contractor: License: Use Groan: RAYMOND A GOULET 054782 Lot Size(so. ft.): 81500.76 Owner: CI L REALITY OF MA INC Zoning: Applicant: RAYMOND A GOULET AT: 250 GLENDALE RD - LOT 1 Applicant Address: Phone: Insurance: 69 METACOMET ST (413) 537-1825 WC B E LC H E RTO W N MA01007 ISSUED ON:I1118l20I6 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 4 BEDROOM R-3 GROUP HOME POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Numbing tnspeetorof Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House St Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: il: Insulation: Final: Smoke' Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building II?18/20160:00:00 $1848.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner -0011 O K, � gOttC tt File H BP-2017-0671 ^s n 1 / lli^l 6) APPLICANT/CONTACT PERSON ND A GOULET ADDRESS/PHONE 69 METACOMET STO BELCHERTOWN (413)537-1825 }j01_ U ,V` QM'' Il0 ��,,`.'�`�1' PROPERTY LOCATION 250 GLENDALE RD-LOT I a " MAP 49 PARCEL 052 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid (105 BuildingPermilFilled out Fee Paid --- --" TypedConstruction: CONSTRUCT 4 BEDROOM R-3 GROUP HOME New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 05478 3 sets of Plans/Plot Plan THE F'�}LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON j ç11 Ac 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 Nan 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 I ion Delay / / Air S!Rice cr Balding 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 MGI.,40A.Contact Office of Planning& Development for more information. hza&f.1SCLGmt �' 0 r,`1.� G��l c Department use only City of Northampton Srsof Pe:Pudding Department - Curb Cut/Driveway Permit j" 212 Main Street Sewer/Septc Availability Room 100 - Water/WellAvailability Northampton, MA 01080 Two Seteof Structural Plans phone 413-587-1240 Fax 413-587-127Z PotSke Mans Other Specify APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE MIF STATION 1.1 : �.,5"-Q This section to be completed by office LOT I GL& YDeLL ROG1? Map Lot unit IdQRtHMTillron, MA. zone_ Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2,1 Owner of Racpr4: / O td t oL„ C L REL) GR ITIIA. PIC . IS`I ekRikR DOC hug. HfRTFo.t CT. Nann Current McAlltgAddeas: DavidMcKin!®y $iota-s(03- tOoit vrosionivenvinienilse 2.2 Authorized Anent: 0 1 0 01 C LLC R&vmmtaap A. G6q}t.T Vt %Ile'AzoPcT SI. {J NG}GiiCfte.i&,, Nnq - Name(Print) Current Mang Amoss: zyze-de- 9 /3-s3-) -12s Signature telepMre SECTION 3-ESTIMATED CONSTRUCTION COSTS item Estimated Cost(Dogars)to be Official Use Only -... completed by permit applicant 1. Building ._, uilding _ (a)Building Permit Fee Qu d .— 2. Electrical 2 b r 00 b {b)Estimated Total Cost of 6 Construction from/8) 3. Plumbing 3.1 000 Building Permit Fee 4, Mechanical(HVAC) :S, 0 0 " 5.Fire Protection 31-, peer -- ye�yr ft. Total=(1+2+3+4+5) )Od,000 . oef CheckNumber .2 70 41 47 g(I<12 This Section For Official Usa Only Date Building Permit Number. Issued Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING AU Information Must Be Compteted. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning � �} This column to be titled fn by i W 06�3 kincd robe, r -3 Building Department Lot Size £i,01 S.F. $1,481 5F. . Frontage 3:3°.7+b 230, to Setbacks Front iDl, Side L: R: L: SS R: y9t Rear 301 Building Height ;i' Bldg.Square Footage Open Space Footage % (Lot area minus bldg&paved I b,l bs parking) N of Parking Spaces 7 Fill: (volume&location) ,Sbp 4. .. A. Has a Special Permit/Variance/Finding ever been issued for/on the site? ''M2 -3NO 0 DONT KNOW v YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW Q YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O 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 O NO 0 W YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House CO Addition ❑ Replacement Windows Alteratlon(s) I l Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [CO Decks Ill Siding IC] Other lc] work:firDescription of Proposed Li he4rootn R-3 Gtoh4 [4op1E Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached NarrativeRenovating unfinished basement Yes No Plans Attached Roll I-Sheet ea.If New house and or addition to existing housing.complete then following:R a. Use of building:One Family Two Family Other V —3 b. Number of rooms in each family unit: 1-2- Number of Bathrooms P2 c. Is there a garage attached? o Co9RB6E 3136Xao' d. Proposed Square footage of new conswction. Dimensions 5 6 a Number of stories? If n I f. Method of heating? 1- N A 1 (o pA l't E" Fireplaces or Woodatoves N 6 Number of eacha Yesg. Energy Conservation Compliance. Masscheck Energy Compliance form attached? /G S' h. Type of construction 1-71'C 6- i. i. Is construction within 100 R of wetlands? Yes V No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade '1r 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 1'K-e�,Nyy� up, •'p.ta tl�� ,4,)c as Owner of the subject property hereby a .. ze Rea/ GojL I to act• y behalf,in all makers rel-1ve to wecedcaatboiaeL btlYakyyding permit appll non. Scree VViiceVVP�IrePsiddent/Development (ell( (6 o • - 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. Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 81 Licensed Construction Supnisori AA Not Applicable 0 Name otuee Hewn*Sitar RH7mon+' . sociL t cs - cc'i732 License Number (,9 TerthcomcC STft l 13Jc,b tgrow4, mB.01007 of/0612oiA Address Expiration Date (<f 41t3- STI ) - / 2S Signature Telephone 9.Realstemd Home Imnrovement Contractor: Not Appiicabie Company Name Registration Number Address Expiration Date Telephone_,i, SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I.c,152,§25C53)) 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 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. pefinition or 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 horn in a two-Pear 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 bpikline 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 Slate Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: L°T I Gt.bveLE Rd . idoRtbgnp7b‘,, MA . The debris will be transported by: (.uAStc n1 G • The debris will be received by: W 9StL ro An G Building permit number: f� n Name of PermitApplicantRGC LU- Re)/n9 19 A 9 Got4(cT y/./-/ Date /046 of 6 Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents It err t Office of Investigations is ; _; 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/ContractorstEleelricianstPtumbers Applicant Information {J I Please Print Legibly Name (Business/Organization/Individual): (' LLC- R `u G Address: b4 MET econm Steed' City/State/Zi.: 3e-1Cc,ftbWh, OR. 011567 Phone#: 1113- ✓ 3�" �8'2S Are you an employer?Check the appropriate box: Type of project(required): 1.E I am a employer with 3 3 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 4 9 Building addition [No workers' comp. insurance comp. insurance.= required.) 5, ❑ We are a corporation and its I0.❑ Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their I I. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 1/0 repairs insurance required.] ' c. 152,$1(4)_and we have no 13.❑Other employees. [No workers' comp.insurance required.] "Any applicant hat checks box el must also fill out the section below showing their workers'compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractont roust submit a new affidavit indicating such. lCmtlractors that check this box must attached an additional sheet showing she name of he suhwnaastow and state whether or not those entities have employees. tithe sub-contractors haveemployees,they must provide their workers comp.policy number. I am art employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: L 141 Ins LoRt Policy#or Self-ins. Tic. #: W L J 31 i a't��n a-se D I (O Expiration Date: 01I / 03'' O CI Job Site Address: Lot ( Lc - a4lc..(x c�- City/StatelZip: atC-}ytGYztjo, 016 0 Obb 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 theee DIA for insurance coverage verification. I do hereby certify ode the at and penalties of perjury that the information provided above is true and correct Signe re: Date: /11 Phew.#: 913- 531 - /flC Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License it Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other 4 Contact Person: Phone#: ACORD CERTIFICATE OF LIABILITY INSURANCE DATE A OSA"°0 ORO THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the pogcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not corder rights to the certificate holder in lieu of such endorsement(s). PRoaUOtR PO BA :CONTACT M)Chelle Telmuf BELL&HUDSON INSURANCE AGENCY, INC. ,"a,XO��,,jµ13)323-9611 Lao,' NEE EBTAIL SS: mfehaull(RDeIIandhudsoncom _. P.O.BOX 669 _ INSURERS)AFFORDING COVERAGE_ _NAIL. BELCHERTOWN MA 01007 RISUMERA: TM INS CORP _._ 33600 _ INSURER INSURER .. _ . _. _.. RGCLLC MURESC INSURER D -.. .—. 69 METACOMET ST INSURER E: BELCHERTOWN MA 01007 mwaERF: COVERAGES CERTIFICATE NUMBER: 90828 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLJCIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, Rica Adh.B BAR PoU�4 Edi TTt11LYCCP _.. URI TYPE OF INSURANCE INSD END ROUGE NUMBER IMMNWYYYYI IMIaIDWYYYY) OMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S (YAIMSWADE IOCCUR 'MAEB PA-PPorW) I5. MED BAP one GENLAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE ADE WAHEckert) '5 - - NfA PERSONAL ADV 2Y $ _ l AGGREGATE I POLICY I I JECT _ I LOC PRODUCTS'COMPOOP AUG 5 5 I OTHERCOMBINED SMILE OMIT AU'IOM0BIL1LE W&Iffl I .LB(EEtd ) s . ANY AUTO SODEN INJURE(Po pommy 5 ALL OWNED SCHEDULED N/A BODILY INJURY(Pmar'GMMn E AUTOS ._ AUTOS HIREDAVT05 — `MGNOWNCD PROPERTY DAMAGE AUTOS (PuLmade Its ' UMBRELLA OAS OCCUR 1 EACH OCCURRENCE 5 EXCESS UAS CLAIMS-MADE N/A ,AGGREGATE A OFFICER/MEMBER EXCLUDED, NA NA NA WC_31$383858016 '01/0312016 5 WOANR EGLDCYOMPENSABON XI INRTVIE I 0NH -• ANYPROPRIYTORSARTNER,EXECUTIVE �� A EL EACH ACCIDENT 5 100.000 I Otf03f201T MomPlitory : EL DISEASE.EA EMPLOYEE S 100,000 II Resunder DESCRIPTION arpnnN OE OPERATIONS baN. EL DISEASE POLICY LIMIT I 5 500000 I N/A DESCMPIION OF OFERABONS f LOCATIONS/VESICLES TAMED im.ANaloAM RmYM.Sd!AWe,may be embed if nota WXe M nq*NIYY Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay alarms for benefits to employees in states other than Massachusetts ifthe insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certficate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at VOW.mass.govfkNMvikers-compensatiKNwesligationst. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Northampton ACCORDANCE WITH THE POLICY PROVISIONS, 212 Main Street AUTNOMtEOREFAESENTATNE Northampton MA 01060 "i , k Denies M.Cro` M,CPCU,Vise President–Residual Market WCRISMA 0)19852014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACCIREP CERTIFICATE OF LIABILITY INSURANCE to a/2"°0 6' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(tes)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement($. PRODUCER COT PL Lisa M. Desroches, CD, ARM Bell S Hudson Insurance Agency PHONE Fm (413)323-9611 LFAX ex.No0413)323-SS32 19 N. Main Street Ate.ldearocbesebeliandhudson.com INSUREP4SI AFFORDING COVERAGE NAIL Belchertown MA 01007 INSURER Main St. America Assurance Co. INSURED INSURER B: RGC LLC INSURER C: .i.... .. 69 Metacomet Street INSURER o: INSURER E: Belchertown MA 01007 INSURERF: —..... ...._ COVERAGES CERTIFICATE NUMBERMaster Cert 14/15 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W]H RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR R TYPE OF INSURANCE NSI WVD POUC1 NUMBER 04:1 ER (M*D IVYYYI UNITS GENERAL LIABILITY EACH OCCURRENCE Is 1,000,000 DAMAGE TO RENTED s 500,0Do X COMMERCIAL GENERAL LIABILITY JMISFSIEp tv A CLAIMS-WOE XJ OCCUR NPT3717Q 111/1/2014 11/1/2015 MED EXP(Any Ars pesonl a 50,000 PERSONAL&ADV INJURY s 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PERT PRODUCTS-COMPIOP ACC E 2,000,000 X-1 POLICY jFT 1 l LOC �'-... �.... E _.. AUTOMO LE LIABILITY COMINNED SINGLE LIMIT JELMIEdenll BODILY WORM IPd AALL OWNED SCHEDULED BODILY INJURY(Per at, n) $ AUTOS AUTOS NI ED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS IPTFLTsS s UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LAB — CLAIMSMAOE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION rWCSSTatU- ICTx. AND EMPLOYERS'LIABILITY I WITS FR ANY PROPRIETORMARTNERIEXECUTwE YIN EL EACH ACCIDENT E OFFlIMWAIRMeYBER EXCLUDED, C� NI MA E L DISEASE.FA EMPLOYEE i ttyos LRbIPTION OPERATIONS Mow EL DISEASE POLICY LIMIT E DESCRIPTION Of OPERATIONS:LOCAUONSt VEHICLES AW,ACORD 101.At:AMAMI Rini*[Sdwda Emit space N RQWtett Rome Builder CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPMATION DATE THEREOF. NOTICE WILL BE DEITVEREO IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: Building Department 212 Main Street AUTHORIZED REPRESENTATIVE Northampton, MA 01060 Tetrault CPC], CLC/ /i�y ( ilt.yE ACORD 25(2010105) 6J 1933.201O ACORD CORPORATION. All rights reserved. INSII2R,tn,rcmn, 'Ma arncn name.Ana/non are.enlata.ed m..Le of tenon Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as an individual,partnership,association,corporation or other legal entity.or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MOL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally, MOL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,i necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance, If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information Of necessary) and under"Job Site Address"the applicant should write"all locations in _(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. #617-727-4900 ext 7406 or 1-877-MASSAFE Revised 7-2013 Fax#617-727-7749 www.mass.gov/dia City of Northampton Massachusetts ti � x ri ‘4. DEPARTl4:ar OF aaILDINO INsEECTIONS 212 Main Street • Mmicipal Building JS \\ _ Northampton, MA 01060 ry X113 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner . •u O . t.E` ^X PTIQN ACKNOWLF.J)G£MEN_T The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines"Homeowner'as, `Person(s) who owns a parcel on which he/she resides or intends 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 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 own 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 fbefnre backfill) sonortubeiloles_( efore our), a rough building nsoectior (befgrg work is concealed). insulation inspection(if required)aid a final building inspectIolh 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 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 City of Northampton Massachusetts 'y , y( DEPARTMENT OF BUILDING INSPECTIONS iCy$iiiF�fl} `tK i T 212 Main Street e Municipal Building J Northampton, MA 01260 yA, v>‘ Fee Calculator for Residential Properties Location : 6 Ardai f Square Footage Amount Basement @ .20 _ 1ST Floor @ .50 ;ix SF 3/3 (v / g G I 2nd Floor @ .50 _ T 112 Floors, Finish Attic, Garage @ .20 89'o jlJ� Deck / Porches @ .20 50) //-• Total : /J 1e.7cV ENERGY STAR v3.0 Home Verification Summary Propertyqs Organization HERS ROta_ N/A J ✓ Infrared New England Projected Rating Lot 1 Glendale Road 508-728-1099 10/13/2016 Northhampton,MA 01062 Norbert Reichhold Rating No:690 Rater ID:5209289 Weather:Northampton,M4 Builder Lot 1 Glendale Road Chris Gonzalez Lot 1 Glendale Road.blg Projected Rating: Based on Plans - Field Confirmation Required. Building Information Rating Conditioned Area(sq ft) 3594 HERS Index 52 Conditioned Volume(cubic ft) 26706 HERS Index w/o PV 52 Insulated Shell Area (sq ft) 8369 HERS Index Target(SAF Adjusted) 64 Number of Bedrooms 4 HERS Index of Reference Design Home 68 Housing Type Single-family detached Size Adjustment Factor 0.94 Foundation Type Unconditioned basement This home DOES NOT MEET the EPA's requirements for an ENERGY STAR Home. HERS Index w/o PV<=HERS Index of Reference Design Home AND HERS Index<=HERS Index Target to comply. RY$WR Building Shell Ceiling : CE,6-24,F • • Wim- • - Seal- • _ Vaulted ing4 R38,s 24,C J.025 Window/ Ratio 0.15 Above Grad ills R21,F. -16 058 Infiltra -- ' 'wer door t- - Found. Wall- d) None I . • - g: 4.00 Clg: ACH50 Found. Walls( d)I R0,11 0" • 6 ge t tside 0.04 CFM25 / • • •rs R3: ,12-24 0.034 Duc :kage 0.04 CFM25 / I Mechanical Systems Heating Fuel-fired air distribution, 100.0 kBtuh, 95.0 AFUE. Cooling Air conditioner, 60.0 kBtuh, 13.0 SEER. Water Heating Instant water heater, Prop, 0.97 EF. Programmable Thermostat Heat=Yes; Cool=Yes Ventilation System Exhaust Only: 73 cfm, 15.0 watts. Lights and Appliances Percent Interior Lighting 100.00 Clothes Dryer Fuel Electric Percent Exterior Lighting 100.00 Clothes Dryer EF 3.01 Refrigerator (kWh/yr) 643.00 Clothes Washer LER 704.00 Dishwasher kWh/yr 260 Clothes Washer Capacity 2.87 Ceiling Fan (cfm/Watt): 0.00 Range/Oven Fuel Electric Note: Where feature level varies in home, the dominant value is shown. REM/Rate-Residential Energy Analysis and Rating Software v14.6.4 This information does not constitute any warranty of energy cost or savings. ®1985-2016 Noresco, Boulder, Colorado. Air Leakage Property Organization HERS N/A Infrared New England Projected Rating Lot 1 Glendale Road 508-728-1099 10/13/2016 rrawrs eeNGLAN°a Northhampton, MA 01062 Norbert Reichhold Rating No:690 Rater 10:5209289 Weather:Northampton,MA Builder Lot 1 Glendale Road Chris Gonzalez Lot 1 Glendale Road.blg Whole House Infiltration Blower Door Test Heating Cooling Natural ACH 0.24; 0.18 At @ 50 Pascals 4.00 4.00 CFM @ 25 Pascals 1135 1135 CFM @ 50 Pascals 1780 1780 Eff. Leakage Area (sq.in) 97.797.7. Specific Leakage Area 0.00019' 0.00019 ELA/100 sf shell(sq.in) 1.17 1.17 Duct Leakage Leakage to Outside Units j 1st ft 2nd Floor( CFM Cv 25 Pascals 144 CFM25 /CFMfan 0.0664 CFM25 /CFA p ' ', • 152 CFM per 152 CFM @ 5 FT Eff. Leak. : • ea Thermal ' ienc Total r . .. nits -'ctLeaka• I 0.0400 Ventilation Mechanical Exhaust Only ASHRAE' Sensible Recovery Eff. (%) 0.0 62.22010 Total Recovery Eff. (%) 0.0 Rate(cfm) 731 73 Hours/Day 24.0 24.0 Fan Watts 15.0 Cooling Ventilation Natural Ventilation' ASHRAE 62.2 -Ventilation Requirements The ASHRAE 6/2 flow rates shown above are the CONTINUOUS mechanical fresh air ventilation which will meet the Whote-building requirement under that version of the standard. Both values incorporate any appropriate'infiltration credit'. Intermittent mechanical ventilation may be used if the flow rate is adjusted accordingly. For example, the runtime can be reduced to 12 hours per day using a doubled flow rate, as long as the system provides ventilation at least once every 3 hours. For more detail, refer to the appropriate standard. REM/Rate-Residential Energy Analysis and Rating Software v14.6.4 This information does not constitute any warranty of energy cost or savings. CO 1985-2016 Noresco,Boulder,Colorado. 0 REScheck Software Version 4.6.2 Compliance Certificate Project Four Bedroom Residence Energy Code: 2012 IECC Location: Northampton, Massachusetts Construction Type: Single-family Project Type: New Construction Conditioned Floor Area: Z570 ft2 Glazing Area 20% Climate Zone: 5 (6404 HDD) Permit Date: Permit Number: Construction Site: Owner/Agent: Designer/Contractor: Lot A,Henry Street CIL Realty Maier Design Group,LLC Amherst,MA 157 Charter Oak Avenue 100 Wells Street Hartford,CT 06106 Hartford,CT 06103 (860)293-0093 ompliance: Passes using UA trade-off Compliance: 2.1%Better Than Code Maximum U4 3]3 Your 0A: 363 TOe%Better o,Wo:se Than Code Index reflects how close to compliance the house is based on[ode traie-off MM. It DOES NOT provide an estimate of energy use of cost relative to a minimum-code home. Envelope Assemblies IIIIIIIIIIIEIIIIIIMMMIIEIETEIIIII Ceiling 1: Raised or Energy Truss 2570 41.0 0.0 0.024 62 Floor 1:All-Wood joist(Truss:Over Unconditioned Space 2,570 30.0 0.0 0.033 85 Wall 1:Wood Frame, 16"o.c, 144 21.0 0.0 0.057 6 N104:Glass 40 0.300 12 Wall 2:Wood Frame,16"o.c. 59 21.0 0.0 0.057 3 Wall 3:Wood Frame, 16"o.c. 290 21.0 0.0 0.057 11 Door A/101:Glass 40 0.300 12 Window W-1:Vinyl Frame:Double Pane with Low-E 14 0.320 4 Window W-1:Vinyl Frame:Double Pane with Low-E 14 0.320 4 Window W-1:Vinyl Frame:Double Pane with Low-E 14 0.320 4 Window W-1:Vinyl Frame:Doubie Pane with Low-E 14 0.320 4 Wall 4:Wood Frame, 16"o.c. 144 21.0 0.0 0.057 6 C/112:Glass 40 0.300 12 Wall 5:Wood Frame.16"o.c. 400 21,0 0.0 0.057 19 Window W-1:Vinyl Frame:Double Pane with Low-E 14 0,320 4 Window W-2:Vinyl/Fiberglass Frame:Double Pane with Low-E 7 0.320 2 Project Title: Four Bedroom Residence Report date: 09/30/16 Data filename: M:\2016\2016-037 CIL Glendale Rd NorthHampton MA CG\DOCS\16037 compliance Page 1 of 2 report.rck C1114:Glass 40 0.300 12 W-1:Vinyl/Fiberglass Frame:Double Pane with Low-E 14 0320 4 Wall 6:Wood Frame,16"c c, 144 21.0 0.0 0.057 6 C/115:Glass 40 0.300 12 Wall 7:Wood Frame, 16"cc. 124 21.0 0.0 0.057 7 Wall 8: Wood Frame. 16" ac 224 21.0 0.0 0.057 12 Window W-4:Vinyl/Fiberglass Frame:Double Pane with Low-E 4 0.320 1 Window W-4:Vinyl/Fiberglass Frame:Double Pane with Low-E 4 0.320 1 Wall 9:Wood frame, 16"ob. 92 21.0 0.0 0.057 4 A108: Glass 20 6.300 6 Wall 10:Wood Frame,16"c c. 104 21.0 0.0 0.057 3 Window W-1:Vinyl/Fiberglass Frame:Double Pane with Low-E 14 0.320 4 Window W-1:Vinyl/Fiberglass Frame:Double Pane with Low-E 14 0.320 4 Window W-1:Vinyl/Fiberglass Frame:Double Pane with Low-E 14 0.320 4 Window WA: Vinyl/Fiberglass Frame:Double Pane with Low-E 14 0.320 4 Wall 11:Wood Frame. i6"o.r. 368 21.0 0.0 0.057 19 Window WA:Vinyl Frame:Double Pane with Low-E 14 0.320 4 Window W-2:Vinyl Frame:Double Pane with Low-E 7 0.320 2 Window W-1:Vinyl Frame:Double Pane with Low-E 14 0.320 4 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 ,esitned to meet the 20121ECC requirements in RE�ck Version 4.6.2 and to comply with the mandatory requirements i/. e r Scheck Inspection Checklist. j �/ yrn La&Itr4'H tiacc, .4 14 lrea `1 7//3Vt Name-Title Signet r- / Date Project Title: Four Bedroom Residence Report date: 09/30/16 Data filename: M:\201612016-037 ❑l Glendale Rd NorthHampton MA CG1,DDCS116037 compliance Page 2 of 2 report.rck Permit No. W25-17 CITY OF NORTHAMPTON, MA RESIDENTIAL OR COMMERCIAL BUILDING WATER ENTRY APPLICATION A Department of Public Works Trench Permit shall be required prior to any construction or connection activity associated with this application. To the City of NORTHAMPTON, MASSACHUSE]TS: The undersigned, being the OWNER'S AGENT of the property (Owner,Owner's Agent) located at 250 GLENDALE ROAD , does hereby request a permit to install and (Number) (Street) connect a 2" Water Service to the RESIDENCE at said location, (Size) (Residence,Commercial Bldg..etc.) I. "Owner" shall mean the person holding title to the property served or to be served by the water service. 2. The person or firm who will perform the proposed work is RAY GOULET/RGC, LLC of BELCIIERTOWN,MA 01007 (Name) (Address) 3. Plans/sketch and specifications for the proposed water service shall be attached to permit. In Consideration of the granting of this permit, the undersigned agrees: I. The Water Department shall make all taps to the water main. 2. WATER ENTRY PERMIT FEE is$200.00. 3. Additional work performed by City forces from the water main to street line shall be paid at the prevailing labor rates and cost of material. Water Meters 5/8" $130,00 Water Meters 3/a" $140.00 Radio Read $135.00 Water Meters 1" $180.00 ***** Water Meters 1.5"and above shall be purchased by the owners using city specs. 4. A fee of$135 for the Radio Read Fee with the purchase of a new meter. 5. The Water Superintendent shall be notified for water line inspection prior to backfill of trench. D &017 -2.Y3 Permit No. W2517 CITY OF NORTHAMPTON, MA. RESIDENTIAL OR COMMERCIAL BUILDING WATER ENTRY APPLICATION DATE: 10/24/16 (Applicant) Name of Applicant: Ray Goulet, RGC. LLC Address of Applicant: 69 Metacomet Street, Belchertown,MA Telephone #: 413-537-1825 $ 200.00 Entry fee paid Check No. 2751 $ N/A Meter fee paid Check No. N/A $ 135.00 Radio Read Fee paid Check No. 2751 Application a.prov . and permit issued: 7,7: � � r DATE: ff C f , SIGN i: (Director of Public Works) Fee Schedule: Water Entry Permit Fee: $200.00 5/8"Meter Fee $130.00 %" Meter Fee $140.00 1" Meter Fee $180.00 Radio Read Fee: $135.00 VAwin2\adminAPermits\Water Application\Water Permit 2017AW25-17 250 GLENDALE ROAD.doc Permit No. W25-17 WATER CONNECTION INSPECTION REPORT Northampton Water Department 237 Prospect Street Northatn:rion, MA O1060 (41") 587-1570 �, ' Date: 10/24/16 Domestic: . X Fire Line: �r Irrigation: Type of Service: New X Renewal Repair I 1 Pipe: Size 8" Material DI Age 2006 Water Entry Fee: Paid Yes 775C,, No L_ I N/A L Meter Size N/A Fee Paid Yes LIM' No L N/A ( X=1 Radio Read Fee: Paid Yes X j Check# L 275.1-] Cash [:::- Location of Installation: 250 GLENDALE ROAD,FLORENCE 49-052-001 ( treat an. um. r) -(arn) Permit Issued To: Ray Goulet/RGC, LLC Contractor/Developer Installing Service Connection: Same Telephone No.: 413-537-1825 The service connection at this location was inspected by the undersigned on (Date) at and approved by --(Time) —Water Superintendent I have instructed of that the installation can be backfilled. Measurements for all installation shall be documented by the Water Department. The information shall be on file at the Public Works Department office. Copy to Supervisor: Date: Copy to Utility Billing: Date: ,' 1 ,7.1-1 C Copy to Office Manager: Date: tJ d 1 l Permit No. D11-17 CITY OF NORTHAMPTON, MA DRIVEWAY PERMIT Date: 10/6/16 Check#: 2707 FEE: $250.00 Proposed driveway must be staked and address and/or lot number posted. Public Shade Trees are protected by MGL Chapter 87. Do not cut, trim or remove any trees on City property. The undersigned respectfully petitions your honorable body for: A NEW CURB CUT Permission to install a driveway at: 250 GLENDALE ROAD, FLORENCE Fifteen (15) foot maximum width from street line to property line. Gutter drainage not to be disturbed. All drainage shall be directed off the driveway surface to adjacent land and not on the existing roadway. The first one hundred (100)feet of the driveway surface shall be paved as soon as possible if the grade of the proposed driveway exceeds 3% at any point in the first one hundred (100) feet. Homeowners will be held responsible for any costs to the City of Northampton in the event of a washout of this driveway. City is not responsible for culverts installed under driveways in City layout. Code of Ordinances §350-8.8 providing standards for private, individual driveways as most recently amended,must be followed. By: Ray Goulet, RGC, LLC Telephone: 413-537-1825 ignature: /1.1 Proposed Location Inspection By!IF' ( - � // "/76E6___ Gravel Base Grade Inspected By: Final Approval: - *R �/ 7T5r GEC 4AU� - f,0/t1+C r cicn'cn (l w.v) ''ak Director of Public Works Cc: Building Inspector ,�‘A/N/ft• Z-CSC AOCASIA (SUBJECT TO ATTACHED CONDITIONS t & 2) Permit No. 011-17 Conditions: Driveway Pemrit In lieu of plan approved by the City Engineer I agree to the following added conditions: 1. I will contact the Department of Public Works and have an inspector check and approve the graded gravel base prior to paving to insure compliance with slope and location; 2. I further agree that if in the inspections, any of the permit conditions are not met that I will at no expense to the City remove and replace the driveway as directed by the City Engineer. By: Name: Ray C;ioulet/RGC, LLC Address: 69 Metacomet Street, Belohertown, Ma 413-537-1825 Note: The Public Works Department recommends that you provide a plan showing the proposed driveway with grades and location in the future to avoid possible expense which you will incur by not getting approval of actual plans in advance. For Commercial and Industrial applicants, a plan showing the proposed driveway with grades,location and Planning Board permits are required. Cc: Building Inspector • Re: 250 Glendale road driveway tnta ima / > R�l/� pgtxrailcom:993 fetch>U7D> 1NS0X>30133'.header=_, Subject:Re:250 Glendale road driveway From:Raycarge<raycargc@yahoo.com> Date:10/26/2016 10:03 AM To:Richard Parasiiid crparasiliti@nonhamptonma.gov> C.L. Frank has started @ 250 Glendale road this morning 10-26-2016. Thanks Ray Sent from my iPhone On Oct 18,2016,at 3:46 PM, Richard Parasiliti<rparasiliti@northamptonma.gov>wrote: Hi Ray, Nice to meet you today, please see the following below. 1.Tree Protection. The three oak trees that are flagged with orange paint near the proposed driveway will be protected with trunk protection and tree protection zone fencing.This fencing is to protect the tree and root zone from compaction and mechanical damage. The fencing shall be some type of portable chain link that should be at a minimum height of 5 feet. These locations are to have the correct root pruning methods prior to mechanical excavation as recommended in the ANSI 300 Part 5. Please see the attached documents that follow the ANSI 300 Part 5:Tree,Shrub,and Other Woody Plant Maintenance-Management of Trees and Shrubs During Site Planning,Site Development,and Construction. 2. Prior to the driveway permit being issued the tree protection shall be in place for the oak trees.. Once installed I will return to inspect the work and if found correct I will sign the permit. 3.We will also have to meet to discuss any future trimming of any of the other trees in the public right of way during the construction process in particular prior to the water service being installed. Please let me know if I have forgotten any. Best, Rich On 10/17/2016 3:43 PM, Raymond Goulet wrote: yes 10:00 works On Monday, October 17,2016 3:24 PM,Richard Parasiliti <rparasiliti(Wnorthamptonma gov>wrote: Ray does 10am work for you tomorrow? On 10117/2016 11:59 AM, Raycargc wrote: Thank you I am on site now. I can meet any time tomorrow, Ray .,P� '11 /2/7016 9'09 AM Re:250 Glendale road driveway imap://imap gmaii.com:993/fetch>UID>/INSOX>30133Teader ISent from my Phone I I 1 On Oct 17, 2016, at 10:56 AM, Richard Parasiliti crparasiliti@northamptonmaqoy>wrote: Hi Ray, I would be happy to meet with you on site. I would Tike to wad untiI engineering stakes out the ROW in the front of this property They should get to it today or tomorrow,then we can set a time for us to meet. Thanks, Rich On 10/14/2016 3:55 PM, Raymond Goulet wrote. Ft Rich, I would like to move the drive towards the left property line. This move will not impact any trees on the towns property. I could narrow the driveway to 12 if necessary. I spray painted the area with white paint at the street. I can meet you on site to work out any details. Thanks Ray Goulet 413-537-1825 -- I Richard C. Parasiliti Jr. Highway Superintendent/Tree Warden ISA Certified ArboristMunicipal Specialist 125 Locust St. Northampton, Ma. 01060 413-587-1570 Ext. 4317 r_dar asilitipnorthamptonma.goy Richard C. Parasiliti Jr. Highway Superintendent/Tree Warden ISA Certified Arborist Municipal Specialist 125 Locust St. Northampton, Ma. 01060 413-587-1570 Ext. 4317 rparasiliti(anorthamptonma.gov Richard C, Parasiliti Jr. Highway Superintendent/Tree Warden ISA Certified Arborist Municipal Specialist 125 Locust St. Northampton; Ma. 01060 413-587-1570 Ext. 4317 rparasilitienarthamptonmo,opv I <6MP Mang.TreesDuringConst.pdf> 2 of 2 1)12/20,16 9:09.AM . '.50 Glendale Rd. imap://imap.gmailcom:993/fetch>UI04/INBOX>30339?header=... Subject:250 Glendale Rd. From:Raycargc craycargc@yahoo.com> Date:10/31/2016 12:25 PM To:"rparasiliti@northamptonma.gov"crparasiliti@northamptonma.gov> Fencing installed —IMG 1606.JPG -- -- - -._. } sf r • k ,i —IMG 1607JPG - -- — -- - - - - —_. _ -- of 4 11/2/2016 8:56 AM 250 Glendale Rd. imap://imag.gmail.com:993/fet'ch>USD>JSNBOX>30339'Z}leader-.,. , - .. .. k 4D r r. .. I .1 4 fit - I t i ' :: , tr .IMG1005.JPG_ ?<A 4. 11/2/20168:56AM , 150 Glendale Rd. imap://imap.gmail.corn:993/fetch>IIID>/INBOX>30339?header=... L ; 6; 4 ' 'Ard -'" ; —IMG 1596.JPG__ ___ of4 12/2/20165:56 AM 250 Glendale Rdmap://imap.gmail.corn:993/fetch>UID>/INBOX>30339'theader=.._ . 1 . , '. • V4 R 2113 • . Zy�. tar 1 . 111.11111.11.1111111111111.1.1.1111111111111.1 Sent tram my iphane IMG_1606.1PG 202 KB IMG 1607.JPG 202 KB IMG 1605.JPG 186 KB IMG 1596.1PG 171 KB 1 of 4 11/2/20168:56AM k PENDING APPROVALL ros="atrte,,w CITY OF NORTHAMPTON,MASSACHUSETTS 250 GLENDALE ROAD DEPARTMENT OF PUBLIC WORKS h ..4 125 Locust Street 'french Permit Number: 2017-243 Northampton,MA 01060 413-587-1570 Date Approved: re ) / Fax 413-587-1576 Expiration Date: a Z/a5 (for City Use Only) — EXCAVATION/TRENCH PERMIT Pursuant to G.L. c.82A and 520 CMR 14.00 et seq. (as amended) This permit must be fully completed prior to consideration. Submit completed form with permit fee to Northampton Department of Public Works, 125 Locust Street,Northampton, MA 01060. This permit is issued under the provisions of M.G.L.c. 82A, 520 CMR 14.00 and applicable sections of the Revised Ordinances of the City of Northampton, including,but not limited to, Section 285-21. Fee: $250 Check#: 2707 Date Issued: 10/31/16 Name of Applicant Primary Phone# RGL, LLC RAY GOULET 413-537-1825 CELL/RAY Street Address Emergency Phone# 69 METACOMET STREET City/Town State Zip Email BELCHERTOWN MA 01007 Name of Excavator Primary Phone# SAME Street Address Emergency Phone# City/Town State Zip Email Name of Property Owner(s) Primary Phone# CIL REALTY OF MA,INC.. Street Address Emergency Phone# 157 CHARTER OAK AVE City/Town State Zip Email HARTFORD CT 06106 Insurance Certificate# Policy Expiration Date ON FILE Name&Contact Information of Insurer ON FILE Dig Safe# 2016-411-2398 999 Pg 1/4,Excavation/Trench Permit �\� r, rw,/�JN sAF\ t 10 250 GLENDALE ROAD Project Description/Location of Work.Provide the following: L1 Description of purpose and exact location of proposed work including description of what is to be laid or repaired in the proposed trench (e.g.water pipe, sewer pipe, drain pipe,gas line, power line,Communication lines, etc ii Sketch or drawing showing all proposed work. V Anticipated Start of Work Date. NEW DRIVEWAY NEW LOCATION SEE NEW PLANS En NO % Check here if Emergency. Describe. Work in Public Right-of-Way Work on Private Property al Work within State La out(If yes,attach State Permit) Work within 100 ft.of a wetland or 200 ft.of a stream or river.(If yes,attach Permit) all Work within Floodplain.(If yes,attach Permit) Public Water/Sewer/Drain Entry Permit(Attach Permit, if available) Driveway Permit(Attach Permit,if available) P ,2/4 •By signing this form,the applicant,owner and excavator all acknowledge and certify that they are familiar with,or,before commencement of the work, will became familiar with,all lawsandregulations applicable to work proposed,including OSTIA regulations,M.G.L.c. 82a,520 CMR 14.00 et seq.,and any applicable municipal ordinances,by-laws and regulations,and they covenant and agree that all work done under the permit issued for such work will comply therewith in all respects and with the conditions set forth below. The undersigned owner authorizes the applicant to apply for the permit and authorizes persons duly appointed by the municipality to enter upon the property to monitor and inspect the work for confoe suity with the conditions attached hereto and the laws and regulations governing such work for the du ration of the construction. The undersigned applicant,owner and excavator agree jointly and severally to reimburse the municipality for any costs and expenses incurred by the municipality in connection with this permit and the work conducted thereunder, including but not limited to enforcing the. requirements of state Jaw and conditions of this permit,inspections made to assure compliance therewith,and measures taken by the municipality to protect the public where the applicant,owner or excavator has failed to comply therewith,including police details and other remedial measures deemed necessary by the municipality. The undersigned applicant,owner and excavator agree jointly and severally to defend, indemnify,and hold harmless the municipality and all of its agents and employees from any and all liability, causes or action,costs and expenses resulting from or arising out of any injury,death,loss or damage to any person or property during the work conducted under this permit By signing this form,the applicant, owner and excavator acknowledge that they have read and understand all the information set forth in and referenced within this application package and that they agree to comply in all respects with the requirements therein_ /0/4/7-olb Applicant ...,....Date Excavator Signature(if different) Date Owner Signature Of different) Date Pp&ta t j To be completed when approved permit is picked up. fty signing below,the applicant acknowledges and agrees to all the conditions of approval stated below and validates/lithis permit. Applicant Date For City Use--Do not write in this section Department Approvals/Comment Other Referenced Permits Water \ )K tljzrn, Sewer 1ems\\ffat/a, r -...... Streets{ ^KJ"' [ r- 6 —/.b _.... Condition of road: / [. nip, - // Road last paved: ! i p, C,o , Conditions of Approval II Control Density Fill Required Refer to Engineering for plans EMust install clean-out(See Attached) Subject to 5-yr.pavement moratorium I Other requirements(See Attached) Water/Sewer/Drain Entry Permit Fee $250 Permit Application Fee received(Check payable to the City of Northampton) Fee Waived. Reason: Permit A! fir rector ot'FuhL rorks Dare P 4,4 a''� S� Commonwealth of Massachusetts o/D/lo ', 9 City/Town of Northampton Number Application for Disposal System $ /f9 Construction Permit Fee Form to B. Agreement The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not tolace/he system in operation until a Certificate of Compliance has been issued by this Board of �n. i David McKinley � 6/2-11 Date B Application Approved B /s i6 Name � JJ Dale �µG/414.5.✓K p r�Application Disapproved for the following reasons: , uJ1 dmdhirms: 1).Svalem Dealgaet^"tM;1 s° ata metalled That the send with the e aPPm"vd Pimw and Tfdlf• Inaeeotd em with the S.AS.conntucted in tl_IfOis iaasya t moat conduct a hoama Title 5 fi111he Systeuvvtad etre prIaf to the plaWnteM nspacdon of fhe w o r the fie. mode dlmine conntuction by tho :1 Nn change mobil approval by both the Sytea� n.lnlcner elet wind d.thout Baud of BealthAscal �Idmr cmidiliaoC t5form1a.doc•06103 Application for Disposal System Construction Penne•Page 3 of 3 A, Commonvietath Of Malleeetealowevw f „t,;M" 'y l{!l w City/Town of Northampton - L Application for Disposal System $ LCD. tiro o Construction Permit F°' ear Form to DEP has provided this form for use by local Boards of Health if they choose to do so. Before using the form,check with your local Board of Health to make sure that they will accept ft. A. Facility Information Important: when suing out Application Is hereby made for a permit to:1p Construct a new on-site sewage disposal system forms an die ❑Repair or replace an existing on-site sewage disposal system computer.use ❑Repair or replace an existing system component only the tab key to move your cursor-do not 1. Location of Facility: dee return 131e 8 m teeLal 1 Glendale Road(Map 49 Parcel 052) /.threte ...,..._ .- Address or Lot# Northampton MA 01060 City/Town State Zip Code 2. Owner Information CIL Realty of MA,Inc. Name 157 Charter Oak Ave, Address(if different from above) Hertford C7 06106 Cityttown State Zip Code (660)490-0934 Telephone Number 3. Installer Information Name Name of Company .'--- Address Oltylrown .... State -... 2p Code Telephone Number 4, Designer Information Donald Frydryk,P.E..P.L.S. Sherman 8 Frydryk,LLC Name Name of Company 3 Converse Street,Suite 203 Address Palmer MA 01069 City/Town State Zip Code (413)293-6210 Telephone Number t5formla,dor 136103 FILE COPY Application for Disposal System Construction Permit•Page t of Commonwealth of Massachusetts Tit City/Town of Northampton Number Application for Disposal System Construction Permit Fee Form IA A. Facility Information (continued) 5. Type of Building: 2 Dwelling 0 Garbage Grinder(check if present) Other: Type of Building Number of Persons Served ❑ Showers Number of showers ❑ Cafeteria ❑ Other fixtures Specify other fixtures: 600 6. Design Flow: _. Gallons per Day Calculated Daily Flow: 621 Gallons 7. Plan: 2016 2 Date of Original Number of Sheets Revision Date Plan of Proposed Sewage Disposal System Prepared for CIL Realty of MA, Inc. Tide of Plan 8. Description of Soil: See attached plans and soil evaluation sheets for complete information. 9. Nature of Repairs or Alterations(if applicable): 10. Date last inspected: Date t5forml a doc•06/03 Application for Disposal System Construction Permit•Page 2 of 3 Commonwealth of Massachusetts *st kCity/Town of Northampton Number i,— Application for Disposal System - Construction Permit $ Fee Form 1A B. Agreement The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place.the system,in operation until a Certificate of Compliance has been issued by this Board of =nn. David McKinley 6/4 716 it- ...• Date .. Application Approved By: Name Date ... Application Disapproved for the lot/owing reasons: Vous 1a,doct 06/03 Apploation for Disposal System Construction Penne-Page 3 of 3 Commonwealth of Massachusetts 44j, _ 'r City/Town of Northampton ._ : . , .�. - Number Z: f _e Disposal System Construction Permit Form 2A DEP has provided this form for use by local Boards of Health. Otherforrns may be used,but the information must be substantially the same as that provided here.Before using this form,check with the local Board of Health to determine the form they use. Permission is hereby granted to: Important fomes on g out Name Name 0f Company computer,use only the tab key Addressto move your cursor.do not .... use the reiwn CityytTown State Zm Code key to perform the following work on an on-site sewage disposal y.---r, g system: J+� 0 Construction ❑ Repair or replacement ❑ Repair or replacement of system components Lot 1,Glendale Road(Map 49,Lot 052) Facility Address .` Northampton MA 01002 City/Town State Zip Code CIL Realty of MA.Inc. (860)490-0934 Omer Telephone Number The work to be performed is further described in the Application for Disposal System Construction Permit.The applicant recognizes hislher duty to comply with Title 5 and the following local provisions or special conditions: All construction must be completed within three years of the date balmy. Approved by Date —" Tine t5form2adon 06E03 Disposal System Construction Permit Page 1 of t Hllltown Environmental FORM II - SOIL EVALUATOR FORM PM. Box 314 Page I of 3 Chesterfield, MA 01012 (413) 496 - 449 No. Date: Commonwealth of Massachusetts No f ti4 L,�a , , Massachusetts .... til Sui 1 /i i .A.A./ ess e t or I -_ ite 'wa?e list() #. Alia k_ J /�avn cn Date: 6/1;/G3 Performed By: / ..-_. Witnessed By: . Pact- /1`�c r .lnln _._ _.. ._ ._. .. _. La' o-.,:e...I(cn +I, 4 Lis.dy Bt.�t Gazed, Rrd r. lurk l-l1/I Rd. .µ.. Po ,�,� "' / Nq+(,e..Id +-/A c1° 5 New Construction Ll' Repair ❑ 047 - 3007 Office Review Published Soil Survey Available: No ❑ Yes Q� // Year Published IT I Publication Scale 11/.5640 Soil Map Unit /49A 6/1"`k�`1) Drainage Class (ve Soil Limitations PR.q' R. 14,r_.. _. .. Surficial Geologic Report Available: No E Ycs ❑ Year Published Publication Scale Geologic Material (Map Unit) _ __ _...__. ........ Landform _._... _._ ....... ..... _._ .. . _ .. Flood Insurance Rate Map: / - Above 500 year flood boundary No [aces [ 1-, Within 500 year flood boundary No [Yes ❑ Within 100 year flood boundary No Yes 0 Wetland Area: National Wetland Inventory Map (map unit) - -- -- -- -- --- - Wetlands Conservancy Program Map (map unit) �1 - ..__... . -. Current Water Resource Conditions(USGS): Month /tiny 7t03_. Range ;Above Normal ❑Normal Below Normal 0 Other References Reviewed: _ Del ArPEOVED FokV.12/O1/f5 HILL cI+IJLN4tRcrjME:srfAl-c,C,MR IL,CcM I . 1 ch L,..�IaL RC;..;l 84,0m, �I- < Ft-_ On-Site Review A On-Site Review Deep Hole Number I Date: 6/2/ '03 Time Moen Deep Hole Number I Date: 6 /2?/03 Time IZ.:30 Weather C,v-r.,. ei OWeather S_.._y fi0. Location (identify on site plan) C 95 42` IT ;SI N 7 Z'4Z•9?I vI Location (identify on site plan) 42' 17,37714 72-4-2.917 W Land Use W 0nds Slope (%) I Land Use W pori Slope(%) Surface Slone None Surface Stone N0,.o_ Vegetation: , oak �, Pink e. o. . r, Rnn_ Landform: Landform: -Del+o, Position on Landscape(sketch on back) Position on Landscape(sketch on back) Distances from: Distances from: • Open Water Body Zoo 4. feet Drainageway )00 Jr feet Open Water Body 2>+^ feet Dralnageway I oh* feet Possible Wet Ares 100+ feet Property Line So)4' feet Possible Wet Ares ,os,- feet Property Line 75't feet Drinking Water Well 150+ feet Other Drinking Water Well I Se+ feet Other DEEP OBSERVATION HOLE LOG DEEP OBS RVATION HOLE LOG depth from soil baton mil iniadsoil cola soil g other depth Soot mM il ¢on soil leture soil color soil moryOthoNp p mil: (USDA) I mo anm..n 1 eumore.atones.boulders) euroee (USDA) lwr.e9 (mma+re,stones,boulders) (inches) (Conuslenc %carnet pnclhes) _ Consistency%mewl i.0 -7'' A .c5L 25'3/3 f`'. IpeYs^- „h p -Hi, A +SL 2.(7 !/3 None, L(«= p.,,v,'b 7-17" 13 I Lr) IDVR4/o r H , ,- ( . iv., ,,i',;, 0.. 5 u-LI' $„) LS lc/k4/b ()Mt Mt ti -L.hle molt 775., m5 2cy4)4 r , ZI ?4" G ., 5 2.5y6/4 N3c,n1,se,g;-Digs ._ 75-124 (.- — � C Zsy�4a 1c0cc �L e• 7+-Ito CZ- ; zsv6/� ;�� ,..,,,, , ,-;-,,‘..)--4,... Is f'.< ,,, . , , Parent Material(geologic) C'a,gash Parent Material (geologic) 0 u�wa:'>. Depth to Bedrock fJo,.h Depth to Bedrock None. Depth to Groundwater: Depth to Groundwater: Standing Wale,in the Hole N-AAStanding Water in the Hole p)or,e Weeping from Pit Face IJoceWeeping from Pit Face P-z,,,e. Estimated Seasonal High Water I Let -- Estimated Seasonal High Water I20'' FORM 11 - SOIL EVALUATOR FORM 1� ('� Page 3 of 3 /-roper-4y Location Address or Lot No. Cjar`.}^k RDt 4 forI jf Rd. ,Determination for Seasonal High Water Table Method Used: 0 Depth observed standing in observation hole .. ... inches a Depth weeping from side of observation hole /20* inches Depth to soil mottles /Zbt inches ({:o,_ L4-4> i- 4-) 0 Ground water adjustment . feet Index Well Number _.. Reading Date . Index well level .. Adjustment factor __..._. Adjusted ground water level _ _...._ _.. .. . _. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in aI areas observed throughout the area proposed for the soil absorption system? Yes If not, what is the depth of naturally occurring pervious materia!? Certification I certify that on 4-29-47 (date} t have passed the soil evaluator 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-717—t- — Date 6/23103 DEPAMKOVED FORM 11/07t91. FORM 12 - PERCOLATION TEST Location Address or Lot No. C, Lr,.!c•le COMMONWEALTH OF MASSACHUSETTS rJor irk Massachusetts Percolation Test' Date: 4/13 /D3 Time:. Observation Hole # P- ! (A Depth of Perc 45 " 5 4-7 Start Pre-soak I '.33 1 : ¢O End Pre-soak 24 c4{kR„s :,h 4 M ff I' i� . �4 Gall o.,s 1.A6 Nin. Time at 12” t/INaLtr- 6S,k (A.6_ SM,k Time at 9" Time at 6" Time 19"-6") ‘, Rate Min./Inch < Z mi., L, C 2 Al, Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed fly Site Failed ❑ Performed By: 1 /\av k 1 h0”nr =n Witnessed By: Pe4c. M- (-HeIat Comments: _.. _.. . 0' o I P DEI.APPROVED FORM•WOW lILLTOWN ENVIRONMENTAL COASULTING • i-I ILLrc' NENdiRmJM 141-A L. @?CMAI L. Cot✓,