42-180 125 GLENDALE RD BP-2019-0208
GIS#: COMMONWEALTH OF MASSACHUSETTS
MwBlock:42- 180 CITY OF NORTHAMPTON
Lot: - 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-2019-0208
Project JS-2019-000340
Est.Cost:$236372.00
Fee $613.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PIONEER VALLEY HABITAT FOR HUMANITY 046013
Lot Siadsg ft.): Owner: MINERAL HILLS REALTY LLC
zoning: Applicant. PIONEER VALLEY HABITAT FOR HUMANITY
AT: 125 GLENDALE RD
Applicant Address: Phone: Insurance:
P 0 BOX 60642 (413) 586-5430 0 WC
FLORENCEMA01062 ISSUED ON:8/17/2018 0.00:00
TO PERFORM THE FOLLOWING WORK 2 STORY SINGLE FAMILY MODULAR HOME
FOUNDATION AND FINISH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House N Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: 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 Occuoancv signature:
FeeType: Date Paid: Amount:
Building 8/17/20180:00:00 $613.50
212 Main Street,Phone(413)597-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0208
APPLICANT/CONTACT PERSON PIOb :ER VALLEY HABITAT FOR HUMANITY
ADDRESS/PHONE P O BOX 60642 1 ORENCE (413)536-5430 Q
PROPERTY LOCATION 125 GLENDALE RD
MAP 42 PARCEL 180 ZONE
THIS SFJTIO F'ORIFk'ICIAL_USE ONLY:
PERMIT APPL'CANF CHF(KU—ST
ENC ILOZ 'D REQUIRED DATE
ZONING FORM FILLED OUT _
Fee Paid
Building Permit Filled out
Fee Paid
Tyacof Construction: 2 STORY SINGLE FAM[ LAR HOME 0(AN D F(N O
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included'
Owner/Statement or License 046013
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN179tMATION 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:.§
r ,
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 BoardofHealth
Permit from Conservation Commission Permit from CB Architecture Committee
_Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
c�ic it
Signature of Budding ONic� I� Dat
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.
r Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
Department use only
City of Northampton Status of Permit:
Building Department Curb CuttDriveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Pians
phone 413-587-1240 Fax 413-587-1272 PIOVSite Plans
Other Spedfy
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Prooertv Address: This section to be Completed by office125 Glendale Rd Map Lot /90
0 Unit
Northampton, MA 01062
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Mineral Hills Realty, LLC PO Box 60642 Florence, MA 01062
Na a Print) Current Mailing Address'.
413-556-5440
Telephone
Signal r
2.2 Authorized Apart:
Pioneer Valley Habitat for Humanity, Inc. PO Box 60642 Florence, MA 01062
Na (Print) Current Mailing Address_
413-586-5430
Signage Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical not available (b)Estimated Total Cost of
Construction from 6
3. Plumbing modular construction Building Permit Fee ��� CO
includes most of these C/
4. Mechanical(HVAC) trade costs
5. Fire Protection
6. Total—2.3,,4+5) $236,372 Check Number
This Section For Official Use Only
Building PerDatemit Number: Issued:
Signature'
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column lobe filled in by
Building Dd anment
Lot Size .96 acres .96 acres
Frontage lila back lot on common drive lila back lot on common drive
Setbacks Front 20'
Side L: R: L: 15' R: 15'
Rear 20
Building Height D 21'
Bldg.Square Footage D 0 °" 1 210 3
Open Space Footage
(Lot need minus bids&paved 1011 41,]86 97
parking)
4 o Parking Spaces D 2
Fill: tbd based on grading
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW O YES
IF YES, date issued: 9/12/16
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book 12486 Page 226 and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO O
IF YES, describe size, type and location: temporary construction sign for Habitat for Humanity 4'x 3'on wood frame
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 acre9 YES O NO O
IF VES,then a Northampton Stem Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition ❑ TRepiadomorlwindowsltera[ion(s) Roofing Accessory Bldg. ❑ Demolition ❑ nsMI Decks [q Siding[p] Other[ED]
Brief Description of Proposed
Work: foundation,interior fnish work and siding for 2 story single family modular home
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing complete the following.
a. Use of building . One Family x Two Family Other
to. Number of rooms in each family unit: 7 Number of Bathrooms 2
c. Is there a garage attached9 no
J. Proposed Square footage of new construction. 1.210 Dimensions 13.75'x 44'
e. Number of stories? 2
f. Method of heatingg ductless mini split Fireplaces or Woodstoves none Number of each
g. Energy Conservation Compliance. yes Masscheck Energy Compliance form attached? preliminary HERS
In Type of construction modular construction-wood framed
i. Is construction within 100 ft.of wetlands?_Yes V No. Is construction within 100 yr floodplain_Yes ✓ No
j. Depth of basement or cellar Floor below finished grade rm-crawlspace
k. Will building conform to the Building and Zoning regulations? V Yes_No.
Septic Tank V_ City Sewer Private well City water Supply V
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject
properly
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date 1• as Ow er/Authorized
Agent herb declare that the statem t and information on the foregoing appli tion are true and accurate,to the b of my knowledge
and belief.
Sig ad under the pains and penalties of peg
G/ dXe r-
C/
Signature er/Age Da e
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable ❑
Name of Lieetue Nease.: Michael Broad 046013
License Number
PO Box 94,36 Briggs Rd,Shutesbury,MA 01072 4114119
Sig 0 Expiration Date
,LA(/l/M/ 413A39-6747
ignature I Telephone
S.Realstared He,Imomvemsnt Contractor, Not Applicable,2K
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.162,§261
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....... 10 No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was Waded to include Owaer-occupied Dwetiines 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 710, Sixth Edition Section 1083.5.1.
DeenNion 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 fame
structures.A person who capstimcls more th p ham ip r o w r.
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 building permit,
As acting Construction Supervisor your presence on thejob site will be required from time to time,during and upon
completion ofthe 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 injuria not resulting in Death)ofthe Maseachuscas General Laws Annotated,You may 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
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: 125GIendaie Rd Northampton, MA01062
The debris will be transported by: Habitat volunteers or Duseau Trucking
The debris will be received by: valley Recycling or Duseau Trucking
Building permit number:
Name of Perm it Applicant Pioneer valley Habitat for Humanity, Inc.
8113118 1 � Executive Dlredor
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
d Boston, MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Pioneer Valley Habitat for Humanity, Inc.
Address: PO Box 6D642
City/State/Zip: Florence, MA 01062 Phone#: 413-586-5430
Are you an employer?Check the appropriate box: Type of project(required):
1.9 I am a employer with 6 4. EJI am a general contractor and I
employees(Poll 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 g. ❑ Demolition
workingfor me in an capacity. employees and have workers'
y P h' 9. E] Building addition
[No workers' comp, insurance comp.insurance.=
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I l.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t a 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
'Any applicant that checks box 61 must also till out the section below showing their workerscompensation policy information_
t Homeowners who submit this affidavit indicating they arc doing all work and then him outside contractors must submit a new affidavit indicating such.
:Contractors floc d cck this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they most provide their workers'camp.policy number.
I am an employer that is providing workers'compensation insurance fur my employees. Below is the policy and job site
information.
Insurance Company Name: Lockton Affinity, LLC
Policy K or Self-ins. Lic. #: C48747401 Expiration Date: 4/1/2010
Job Site Address 925 Glendale Rd City/8tatazip: Northampton, MA 01_062
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 e. 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 eertnder a pans and penalties ofperlwy that the information provided above is true and correct.
Signature' i(.r Date: 8/13/18
Phone#: 413-59-5430
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License H
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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 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."
MGL 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, MGL 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, if
necessary, supply sub-contractor(s) name(s), address(es)and phone numbers) along with their certificates)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 if you 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 (if 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 bum 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
I 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
( DEPARTMENT OF BUILDING INSPECTIONS
Ma
212 in Street & Muninicipal HullGing SJS C
'\. NonNampton, !W 01060
INSPECTOR
LouisHasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOMEOWNER EXEMPTION ACKNOWLEDGEMENT
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 (before backfill).sonotube holes (before pours a rough building inspection
(before work is concealed) insulation inspection (if required)and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing &gas)the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
Home Energy Rating Certificate Rating Date: 2018-07-12
Registry ID: Unregistered
Projected Report
Ekotrope ID; 7d 1 QX W 1 d
Index • Savings
Your home's HERS score el atve125 Glendale R•
•performance score. To low the number, 01062
, Northampton, MA
42 the more energy efficient the home.To $ 2,42
learn more,visit www.hersindex.com 'Relative to an average U.S.home PV Habitat for Humanity
Your Home's Estimated Energy Use: This home meets or exceeds the
Use [MBtu] Annual Cost criteria of the following:
Heating 5.4 $276 Energy Star v3
Cooling 0.4 $21 Energy Star v3.1
Hot Water 10.2 $518 2015 International Energy Conservation Code
Lights/Appliances 13.5 $689
Service Charges $0
Generation (e.g.Solar) 0.0 -$0
Total: 29.5 $1,503
Home Feature Summary: Rating Completed by:
w•....n. Home Type Single u pony detached Energy Raterlanne Cal lan
Conditioned Floor Asea. 1.222 sq.it RESNETID:3463900
r"a'"r Numm
berof 8edrooc 3
HOt"" Rating Company:Povol House Energy Consulting
Pi l maty Heat ng System: Ab S ow0
ee Hear Punt p•El ecbtc-3. 00P 429 West S[S ulon 105,Am heist,MA
g System: ow
ne ercnane Pinto,y Co.11 us, Ai,S ee Heat Pum p•El I bic-25.35EER
.am: 100 Primaryehtei Heating: iVeter Heater-Heroic.09 Energy Factor
House Tiohmazs ]nCHSp Rating Provider.Energy Raters of Massa dt users t- .is µse
Ventilation: 50u CFM•24-0Watts
Duct Lea kage to Outside: Untested .e• s
b Above Grade Walls R-34
s" mbeonrt Ceiling: Attic.R-43
s" WfHom Type: U-Values 0270 SHCC 0.300
1-1, try o Foundation Wdll, I1 A Y
Jamie Callan,Certified Energy Rater
Dlgltally elgned. 7 12,18 at 850 AM
doeftrope- The Home Energy Raring Standard
Disclosure
Permit No. W02-19
Date Approvedr.�—] 5"1 zi2E,
Exp. Date: 412I//!B
CITY OF NORTHAMPTON,MA
RESIDENTIAL OR COMMERCIAL BUILDING WATER ENTRY PERMIT
A Department of Public Works Trench Permit Shall be required
prior to arty construction or connection activity associated with this application.
To the City ofNORTHAMPT'ON, MASSACHUSETTS:
The undersigned,being the OWNER of the property
(Owner,Owner's Agent)
located at 125 GLENDALE RD ,does hereby request a permit to install and
(Number and Street)
connect a 2" Water Service to the RESIDENCE at said location.
(Sim) (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:
BRADWAY CONSTRUCTION ,of 396 WEST ST,LUDLOW,MA
(Name) (Address)
3. Plan/sketch and specifications for the proposed water service shall be attached to permit.
In Consideration of the graming of this permit,the undersigned agrees:
1. The Water Department shall make all tsps to the water main.
2. WATER ENTRY PERMTT FEE IS 51250.00 SUBDIVISION ENTRY FEE 52,500.00
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 5/9" S450.00
Water Meters 3/4" 5450.00
Water Meters I" $550.00
Radio Read N/A $150.00
Water Meters>1"wW dm purchased by the City and churned to the customer.
4. A Radio Read Fee is charged with the purchase of a pew meter.
5. The Water Superintendent shall be notified for water line inspection prior to backfill of
trench.
bla- I$
W03-1q
Wo c!-1 H
za14 SEE ATTACHED UTILITY CONNECTION REQUIREMENTS
Permit No. W02-19
CITY OF NORTHAMPTON,MA
RESIDENTIAL OR COMMERCIAL B ING WATER ENTRY APPLICATION
DATE: 7/25/2018 SIGNED
PIONEER HAB I FOR HUMANITY
(Name of Applicant)
PO BOX 60642,NORTHAMPTON,MA 01060
(Address of Applicant)
413-586-5430(MEGAN MCDONOUGH)
(Telephone No.of Applicant)
$ 200 Entry fee paid Check No. 8675 — i u6),c f(c ohs [F` zoi S
9xolydC rfi avatlah�(�F..�
$ 130 Meter fee paid Check No. 8875 U
$ 135 Radio Read fee paid Check No. 8875
Application approved and it issued:
DATSIGNED: i
(Director of the Department of Public Works)
Fee Schedule: Fire Line Fee included in Water Entry Fee
Water Entry Permit Fee $1,250.00 Subdivision Entry fee $2,500.00
5/6"Meter Fee: $450.00
3/4"Meter Fee: $450.00
1" Meter Fee: $550.00
Radio Read Fee:,, - $150.00
SEE ATTACHED UTRITY CONNECTION REQUIREMENTS
Permit No. D14-18
CITY OF NORTHAMPTON,MA
DRIVEWAY PERMIT
Date: 05/31/18
Check#: 8808
FEE: $250.00
Proposed drivewaymust be staked and address and/or lot number acted Public Shade Trees
are protected by MCL Chapter 8Z Do not cut,trim or remove any trees on City property.
The undersigned respectfully petitions The Department of Public Works for: A new Curb Cut
Permission to install a driveway at:
Common Drivee-ay to service#125, 129, & 133 Glendale Rd., Florence, DTA
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.
No excavation is authorized without a valid trench pernalt in addition to this yerinit.
By: Pioneer Habitat for Humanity
PO Box 60642, Florence, MA 01062-0642
Telephone: 413-586-5430
mature: ExeArrC1W
Proposed Location Inspection By: of ox 119
Gravel Base Grade Inspected By:
Final Approval:
Director of Public Works
Cc: Building inspector
(5"E< —�
usa aiy/rJ aa»csry v^ $uSJJ d n W�'iwosFc v?t,1
ab'a,Ml�'1d��? .�.�- •v���oarcG cvwo rr�-&>>vc.1�,`L
nares "�L/ 'i aF`'f s
0-4
u/•£Y vcvt4 av,✓� h 2cf/ �tl r
BI�oP-LCJ
�•�1 �- c.�..-tL�,+>oz+c1 ,orv1sd �-7 {c'
�u}pels �n�1�� otv�
�J - cn, ' �
a2 B" "3 1d�'v?w�Q c1L s3+�,Nw y Jwry5
cow),) (°1
2 " �,s JJ�aloaCA /vrv3&2el— aoaw�fS � rrGO '1bo y
%AOID/ �Vuog!pL4 s ai9 it JZIQ ON (,,
(SUBJECT TO ATTACHED CONDITIONS 1 &2)
Permit No. D14-18
Conditions: Driveway Permit
In lieu of plan approved by the City Engineer I agree to the following added conditions:
1. 1 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. 1 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: Pioneer Habitat for Humanity
Name: Pioneer Habitat for Humanity
Address: PO Box 60642
Florence, MA 01062-0642
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.
Ce: Building Inspector