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42-179 115 GLENDALE RD BP-2020-0040 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42- 179 CITY OF NORTHAMPTON Lot: -1 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-2020-0040 Project# JS-2020-000062 Est.Cost:$119250.00 Fee: $487.20 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MICHAEL BROAD 046013 Lot Size(sq. ft.): Owner. MINERAL HILLS REALTY LLC zoninp,: Applicant: MICHAEL BROAD AT. 115 GLENDALE RD Applicant Address: Phone: Insurance: PO BOX 94 SHUTESBURYMA01072 ISSUED ON.7/29/2019 0:00.00 TO PERFORM THE FOLLOWING WORK.-NEW SINGLE FAMILY HOUSE 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# 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 Occupancy Signature: FeeType: Date Paid: Amount: Building 7/29/2019 0:00:00 $487.20 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0040 APPLICANT/CONTACT PERSON MICHAEL BROAD ADDRESS/.PHONE P O BOX 94 SHUTESBURY PROPERTY LOCATION 115 GLENDALE RD MAP 42 PARCEL 179 1 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICAPONTHEMLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T eof Construction: NEW SINGLE FAMI 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 INFORMATION PRESENTED: Je!!!�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 Demolition Delay 7111 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. Department use only City o ort ampton Status of Permit: Buildin De artment Curb Cut/DrivewayPermit tl L 2011 1 � 12 aln Street Sewer/Septic Availability om 00 Water/Well Availability A ton, MA 01060 Two Sets of Structural Plans °t F GUILDING 11, r RT 3e587-1 40 Fax 413-587-1272 Plot/Site 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 Map Lot 12q Unit 115 Glendale Rd (lot#1) 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 N ri t) Current Mailing Address: 413-586-5430 A�� — Telephone Signature 2.2 Authorized Aq 413-586-5430 413-586-5430 N (Pr Current Mailing Address: 413-586-5430 Sign re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $98,250 (a) Building Permit Fee 2. Electrical 9,000 (b) Estimated Total Cost of Construction from 6 3. Plumbing 5,000 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 7,000 6. Total=0 +2+3+4+5) $1 19,250 Check Number o� This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date megan @ pvhabitat.org EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 .46 acres 1 F-46 Frontage [-- Setbacks Front NT] U Side [.:L---� R:� L:43' R: 15' 0 Rear U 20 Building Height Bldg. Square Footage - ] % X36 ) Coo 0 Open Space Footage % --- (Lot area minus bldg&paved Ll 886 95 parking) #of Parking Spaces L �7 Fill: --- --, -- (volume&Location) ___._ tbd based.on_p-radlnM L-_ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW O YES O IF YES, date issued: 9/12/16 IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW O YES e IF YES: enter Book 12486 Page! 226 and/or Document #, � B. Does the site contain a brook, body of water or wetlands? NO e DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtainedO Obtained O Date Issued: 1 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 Q NO O IF YES, describe size, type and location: temporary construction sign for Habitat for Humanity 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 e IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑✓ Addition Replacement Windows Alteration(s) Roofing Or Doors E3 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding[O] Other[O] Brief Description of Proposed build new single family home Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing,complete the following: a. Use of building : One Family x Two Family Other b. Number of rooms in each family unit: 4 Number of Bathrooms I c. Is there a garage attached? no t i d. Proposed Square footage of new construction. 936 Dimensions X e. Number of stories? 1 f. Method of heating? mini-split heat pump Fireplaces or Woodstoves none Number of each g. Energy Conservation Compliance. Yes Masscheck Energy Compliance form attached? Preliminary HERS h. Type of construction stick framed i. Is construction within 100 ft. of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade d CA k. Will building conform to the Building and Zoning regulations? `� Yes No. I. Septic Tank ­'� City Sewer Private well City water Supply V:� SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, bmam 91�! "4' n e t-�t/'e �I� as Owner/Authorized Age`ntTierebeeclare that thd-statementE(f9b information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signei urider the pains and penalties of perjury G PrinVlSlania ignature o ne g t Dat SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Michael Broad License Number PO Box 94, 36 Briggs Rd, Shutesbury, MA 01072 046013 Address Expiration Date 4114/21 Signatur e A { TelephonL,�+Yj,�u 413-636-6747 9. Registered Home Improvement Contractor: Not Applicable 0` Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton I Massachusetts 1• DEPARTMENT OF BUILDING INSPECTIONS S` \ 212 Main Street • Municipal Building Jas Sca Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the re stration of contractors and subcontractors performing improvements or renovations on detached one to four f ily homes. Prior to performing work on such homes,a contractor must be registered as a Home Imp vement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, pair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-ex ng owner-occupied building containing at least one but not more than four dwelling units....or to structures which are djacent to such residence or building"be done by registered contractors. Note:I f the homeowner has contracted with a corporation or L ,that entity must be registered Type of Work: Est. Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the fol wing reason(s): _Work excluded by law(explain . _Job under$1,000.00 _Owner obtaining own perm' (explain): Building not owner-occu ed Other(specify): OWNERS OBTAINING THEIR N PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCO RACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NO HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142 .SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER T BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penal es of perjury: I hereby apply for a uilding permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwit/nding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts Ws. i' DEPARTMENT OF BUILDING INSPECTIONS y x 212 Main Street • Municipal Building \\` Northampton, MA 01060 ssYiyr `1 Massachusetts Residential Building Code Section 110.R5.1.2 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. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. 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. City of Northampton r• Massachusetts r y DEPARTL-XNT OF BUILDING INSPECTIONS x 212 Main Street •Municipal Building yet- b Northampton, MA 01060 Debris 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. The debris from construction work being performed at: 115 ee',',Sa Qt P-j (Please print house number and street name) Is to be disposed of at: 1 (Pleas print namejand loca on f facility) Or will be disposed of in a dumpster onsite rented or leased from: ySea u I wG Ao �ml (Company Name and Address) RA -7 IZ-111 Sig aturof er it licant or Owner Date /l ei� � , Exe r�v�� �e 5 If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debriswill be disposed. ' The Commonwealth of Massachusetts ....._.... . W Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 N www mass.gov/dia 1Vurkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumber-s. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Pioneer Valley Habitat for Humanity, Inc. Address:PO Box 60642 City/State/Zip:Florence, MA 01062 Phone#:413-586-5430 Are you an employer?Check the appropriate box: Type Of project(required): 1.Q✓ 1 am a employer with 8 employees(full and/or part-time).* 7. ❑✓ New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 1[]1 am a homeowner doing all work myself.[No workers'comp.insurance required.] 10E] Building addition 4.[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs (hese sub-contractors have employees and have workers'comp.insurance.t 6❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check 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 must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Lockton Affinity, LLC Policy#or Self-ins.Lic.#:C48747401 Expiration Date:4/1/20 Job Site Address:115 Glendale Rd City/State/Zip: Northampton,MAO 1062 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer if under the p 'ns an enalties of perjury that the information provided above is true and correct. Si nature: Date: -7 Z 1 Phone# 3- 6 43 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. 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 a joint 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." 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 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 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia ��-ti T � DATE(MM/DDIYYYY) A C CERTIFICATE OF LIABILITY INSURANCE 07/02/2019 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(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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER TACT NAME Lockton Affinity, LLC FAXNE 888-553 Lockton Affinity, LLC LAIC�No.Ext): AIC No:913-652-3967 PHO =9002 E-MAIL P. O. Box 873401 ADDRESS: _ _____ Kansas City, MO 64187-3401 INSURERS AFFORDING COVERAGE NAIC# INSURER A: INSURED INSURER B:Bankers Standard Insurance Comany 19279 Pioneer Valley Habitat for Humanity, Inc INSURERC: PO BOX 60642 INSURER D: Florence, MA 01062-0642 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 WITH RESPECT TO WHICH 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. INSRJ TYPE OF INSURANCE ADDL'ISUBR -- - POLICY EFF 1 POLICY EXP POLICY NUMBER MM/DDIYYYY MWDDIYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ JCLAIMS-MADE 0OCCUR PREMISES Ea occurrence $ _ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PO- JET 17 LOC PRODUCTS-COMP/IOP AGG S OTHER: $ AUTOMOBILE LIABILITY (Ea accident)I $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTNON OWNED P RTVDA AGE S HIRED AUTOS 9 AUTOS Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE S DED I I RETENTIONS $ B WORKERS COMPENSATION 064960994 04/01/2019 04/01/2020 g PER ETR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 1064964 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St ]�.$J� AUTHORI/ EPRES -r Northampton, MA 01060 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 31307187 1064964 Permit No. D 11-19 CITY OF NORTHAMPTON, MA DRIVEWAY PERMIT Date: 06/05/19 Check#: 9221 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 without the express written permission of the Tree Warden. The undersigned respectfully petitions The Department of Public Works for: A new Curb Cut Permission to install a driveway at: 115 GLENDALE RD, LOT 1 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 permit in addition to this permit. By: Pioneer Valley Habitat for Humanity, Inc. Telephone: 413-586-5430 megan@pvhabitat.org Signature: Superintendent—Tree Warden Highway SWgrtptendent Date Forestry,Parks&Cemetery Date Proposed Location& Tree Protection Inspections Tree Protection& Gravel Base Grade Inspected Final Approval le /- 1-1(� f Director of Public Works g1!�-etU%c PEr--> P&F°sfz� co' i azFcR- -- uu '8 <w PWI M Cc: Building Inspector (SUBJECT TO ATTACHED CONDITIONS 1 & 2) Home Energy Rating Certificate Rating Date: 2019-07-10 Registry ID: Unregistered Projected Report Ekotrope ID: gdEzyjDv HERS' Index _ Score: Annual Saving • • • . • • • score / performance - .- $2,208 r i i• jefficient learn more,visit www.hersindex.com • an Your Home's Estimated Energy Use: This home meets or exceeds the Use IMBtul Annual Cost criteria of the following: Heating -.0 $433 2015 international Energy Conservation Code Cooling 0.4 $25 Hot Water .0 $433 Lights/Appliances 1 1.9 $733 Service Charges $84 Generation (e.g.Solar) 0.0 so Total: 26.4 $1,707 HERSAndex Home Feature Summary: Rating Completed by: M—E—Ey Hcme Type: S;nglefamily detached Energy RaterJamie Callan so Model: N/A RESNET ID:3463906 faisof EtD Community: NIA Home! =30 Rating Company:Riverbend Design,LLC M Conditioned Floor Area: 936 fY -„ Number of Bedrooms: 2 151 Riverside Drive,Florence,MA 01062 Reference 413-923-1553 dome wo Primary Heating System: Air Source Heat Pump•Electric•12 HSPF TQ Primary up Cooling System: Air Source Heat Pum .Electric•21 SEER Rating Provider.Energy Raters of Massachusetts s:s ; s s Primary Water Heating: Water Heater•Electric•0.91 Energy Factor 2 Woodiawn Street Amesbury,MA 01913 House Tightness: 3 ACH50 978-270-3911 's "''°"• '•� Ventilation: 50.0 CFM•24.0 Viatts W Tho Duct Leakage to Outside: Untested m Above Grade Walls: R-29 Zero E„er6Y i0 Ceiling: Vaulted Roof,R-b7 tTr l/11 t F' Ci t{�ft/2 H0M11e C Window Type: U-Value:0.28,SHGC:0.2$ Jamie Callan,Certified Energy Rater w•u•rvn Foundation Walls: N/A Digitally signed:7/10/19 at 11:53 AM ♦ • • "' r : • rn-w Energy Rating Standard1 • •r this house is available from the ratingprovider. This rep • •- •t constitute arrywarranty or