16A-012 (3) 33 CHESTERFIELD RD BP-2020-0979
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16A-012 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: MODULAR SFH BUILDING PERMIT
Permit# BP-2020-0979
Project# JS-2020-001657
Est.Cost: $194500.00
Fee: $927.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DENNIS C PITTSINGER 007513
Lot Size(sg.ft.): 36154.80 Owner: ROGERS DONALD& DEBBRA
Zoning: URA(100)/ Applicant. DENNIS C PITTSINGER
AT. 33 CHESTERFIELD RD
Applicant Address: Phone: Insurance:
49 BOFAT HILL RD (413) 296-4320
WILLIAMSBURGMA01096 ISSUED ON:3/2/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-NEW MODULAR 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:
i
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 3/2/2020 0:00:00 $927.50
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2020-0979 ' rV1G00 w,TA T41 S
APPLICANT/CONTACT PERSON DENNIS C PITTSINGER Qr WE 90 40
ADDRESS/PHONE 49 BOFAT HILL RD WILLIAMSBURG (413)296-4320 1 ` F�
PROPERTY LOCATION 33 CHESTERFIELD RD 'PS 40 LA
MAP 16A PARCEL 012 001 ZONE URA(100)/ ,��� FONN Wo
c
THIS SECTION FOR OFFICIAL USE ONLY: 'D�SL
PERMIT APPLICATION CHECKLISTIf��
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid
Typeof Construction: NEW MODULAR HOUSE
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 007513
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Sign ure of Building Official VU 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.
/Z310ef 19�
Versionl.7el-Buildin Permit May 15, 2000
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property AddressThis
_ This section to be completed by office
3 3 ��� r�'LL -� \�'� t 1 �l Map Lot Unit
�CeC1 mpg Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
D MOLD i�1112I)E A TI,--_ cr s Q C)
Name(Print) Current Mailing Address:
I-ee s. MCL-
S i g n a t u re
rte-Signature 1Bt/' � Telephone D-
133(0
2.2 Authorized Agent:
Name(Print) Current Mailing Address
Signature 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 (b) Estimated Total Cost of
Construction from(6)
3. Plumbing I O1 Gcz) 00 Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection I �, 0cc-0�-')
6. Total = 0 +2+3 +4 + 5) Qy SC,0.p�) Check Number
This Section For Official Use Only
Building Permit Number Date
Z —f 7f Issued
Sig ature: � � 9 �O
r /
BOOIng Commissioner/Inspector of Buil0iogs Date 1Y
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other Lj
Brief Description Enter a brief description here.
Of Proposed Work: Q- et" , (mt—;cLb u-) a- e, —t-
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential f4 R-1 R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1 Sc ........ -___.._._. . . _..... _.............. 1 St
2 .1 IQ
2 3
m 3rd (�DO
3 _ _ _ _... _ ._ ..___ U�UI
4th 4 t
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L. c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ® Private ❑ Zone Outside Flood Zone,$] Municipal ® On site disposal system❑
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
ConstrvctibA,upervisor
CS-007513 Expires: 11/30/2021
DENNIS C PITTSINGER
49 BOFAT HILL ROAD
WILLIAMSBURG MA 01096
kO
Commissioner
rJ.rrM�rr.rr/.J
Office of Consumer A fairs&Busjness I egulatlon
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Individual before the expiration date. if found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
102496 07/01/2020 One Ashburton Place-Suite 1301
DENNISoston,MA 02108
ENNIS PITTSINGER
i
. i
DENNIS C.PITTSINGER
49 BOFAT HILL ROAD C} Not valid without Wignature
WILLIAMSBURG,MA 01096 Undersecretary i
i -
Versionl.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size 34�
Frontage
Setbacks Front /w
Side L: R: _ L: Ilo R �w
Rear i
Building Height
1�• 0 ltde
Bldg. Square Footage % I lg3 39 a.
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: NpN�-
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DON'T KNOW 0 YES 0
IF YES, date issued:
. .................................... ... .......
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained l Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location:
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 ® NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
cyan �� �;�ei nq
Name(Registrant):
Registration Number
Address H q sa.0
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
I I
Address Registration Number
E
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
�CLr Not Applicable ❑
Company Name:
Responsible In Charge of Constructionj� Q�
Addres
2-6t zc>
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, c ►d;gbh, < (�L`�c: `� as Owner of the subject property
hereby authorize -3)eu►>k 0, - ,A J 1n��� to
act on my behalf, in II matters relative to work authorized by this buil ing permit application.
a I ar?
Signature of Owner Date
I, -�Qyyk VVI, 1S' 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 an�enalties of perjury.
01Z
Print Name
nature of Owner/Age-nt7 Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
U
en V`\ ifs I "lie,-- C S t') b-S 13
Address Expiration Date
'4ci e)C �� � -7/ !
2
Signatur q1 Telephone
- 2
(,-113 z o
SECTION 13-WORKERS'CO iPENSATION 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 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: 3 3 per (
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant
?Z27 22 -z,
Date Signature of Perm Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
> 1 Congress Street,Suite 100
Boston,MA 02114-2017
www massgov/dia
R'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le(ibly
Name (Business/Organization/Individual): �, / r
Address: 'q C1Oc•�' �1 (�
City/State/Zip: lvc Oto(16 Phone#: L413 320
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with employees(full and/or part-time).* 7. ®New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3. I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 Building addition
4.0 I 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 1.❑Electrical repairs or additions
proprietors with no employees.
12.F-1 Plumbing repairs or additions
5.M I am a general contractor and I have hired the subcontractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
6.M We are a corporation and its officers have exercised their right of exemption per MGL c. 14.QOther
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.
tContractors 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 subcontractors have employees,they must provide their workers'comp.policy number.
I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
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 certify under theins and penalties of perjury that the information provided above is true and correct
� Z :Z
Sienature: _J^^✓fit• ttr Date: 27 2-o
Phone#: act t, J 'A 3 rJ
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
It
Permit No. D13-20
CITY OF NORTHAMPTON, MA
DRIVEWAY PERMIT
Date: 2/10/2020
Check 1238 J
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
expressed 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: 33 CHESTERFIELD ROAD, LEEDS, MA 01053
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: Debbra Rogers
Telephone: 413-687-3222
Signature: 6L
Superin ndent—Tree Warden
Hi h a tendent Date Forestry, Parks&Cemetery Date
Proposed Location&
Tree Protection
-aw
Inspections
Gravel Base Grade
Inspected `
Final Approval
Director of Public WL"kZX7
Cc: Building Inspector
Z�Att l 1-.kcxs Y - p
(SUBJECT TO ATTACHED CONDITIONS I &2)
Permit No. D-20
Conditions: Driveway Permit
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: Debbra Rogers
Address: 450 Spring Street, Leeds, MA 01053
413-687-3222
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.
Gtlkc C)AJ J 6 OS+rJ✓v
� � ��cC,�4U�4'►''t 02 ��.�wt,L,�'n
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MUNICIPAL WATER AVAILABILITY APPLICATION
Northampton Water Department Director
237 Prospect St.
Northampton, MA 01060
413-587-1097
A Department of Public Works Trench Permit shall be required prior to any construction or
connection activity associated with this application.
Location: 33 CHESTERFIELD ROAD, LEEDS,MA
Inquiry Made By: DEBBRA ROGERS 413-687-3222
(Name) (Telephone Number)
Date of Inquiry: 2/10/2020 Fire Line Irrigation Domestic X
Number of Units: 1 Type of Units: Type of Ownership:
Single Family X Private X
Apartments Condo
Multi-Family Rental
Commercial
(Applicant to fill out the above)
Municipal Water Main in Front of Location: Yes x No
Existing service to site? Yes x No
Size of Water Main: 8" Material: Ductile Iron Age: 2015
Approximate Static Street Pressure: psi 70 Flow Test Conducted: Yes No x
(If flow test conducted attach results)
Size of Service Connection: i" Suggested Meter Size: 5/8"
Comments: The Water Department cannot guarantee adequate water pressure during _
peak demand times at elevations above 320'
THIS ADDRESS HOOKED INTO WATER IN STREET 2018 WHILE ST.PAVED
- A corresponding water enterance fee shall be paid prior to making any connection to the municipal
water system.
Arran o ch installatio 1!be made with the Northampton Water Department within a
mi um of 5 wo in da tilic tion.
I work sha confo m o ZWter Department specifications.
(Water Superintendent) (Date)
*Water Entry x ($1,250) Domestic *Meter $ 450 *Radio Read $150
($2,500) Subdivision (fee to be determined)
(Includes fire line if required)
cc: City of Northampton Building Dept./Commissioner
NOTE: If this availablitiy is for a new construction,it must be hand delivered to the Building
Inspector D
*Fees will be charged based on current fee structure at the time of entry application ��
MUNICIPAL SEWER AVAILABILITY APPLICATION
Northampton Streets Department Director
125 Locust Street
Northampton, MA 01060
413-587-1570
A Department of Public Works Trench Permit and Sewer Entry Permit shall be required prior to any
construction or connection activity associated with this application.
Location: 33 CHESTERFIELD RD, LEEDS
Date of Inquiry: 02/10/20
Inquirer with contact info: DEBBRA ROGERS 413-687-3222
Reason for Request: NEW CONSTRUCTION SPRING OF 2020
Municipal Sewer Main in Front of Location: Yes v No
Size of Sewer Main: Material: ey G Age: _
Depth of Sewer Main: 61 S}v b
Length of Sewer Main:
Size of Service Connection:
Type of Service Connection:
Domestic Tie In: ✓($1,250) Subdivision Tie In : ($2,500)
Tie-in to Existing Sanitary Service: ($1,250)
Comments:
City Requires 6" cleanout installed at City Property Line
Note:If this availability is for new construction,this form must be hand delivered to Building Inspector.
A corresponding"sewer entrance fee" shall be paid prior to making any connection to the
municipal sewer system. Arrangements of such installation shall be made with the
Northampton Streelts Department with a minimum of 5 working days notificaiton. All work
shatl conform to Northampton Streets Department specifications.
Date:
Sewer Dept. Foreman
*Sewer Entry$ /
*Fees will be charged based on current fee structure at the time of entry application
ENFORM 02
SHEET 52_OF
/ CONSTRUCTION CONTRACT NORTHAMPTON D.P.W.
L
WORK SHEET ENGINEERING DIVISION
,A ,3
PROJECT NAME: Spring Street CONTRACT # 307-97
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REVIEWED BY DATE
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City of Northampton
Massachusetts
- DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
y Northampton, MA 01060 rr't ,,r""�
Fee Calculator for Residential Properties
Location
Square Footage Amount
Basement @ .20 � 3 '231 . ( o
111 Floor @ .50 y 3 5q 1 , 51)
2"d Floor @ .50
'/2 Floors, Finish Attic, Garage @ .20
Deck / Porches @ .20 �0
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This card Signifies
JONATHAN
rRUNELLE is iuly
. .
Championcertified by
+. certified
installer and is responsible for the proper placement
and connection of units
manufactured
by
Champion/Excel in accoMance with • ,
J
This
t
certification01/02/21
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constr., cd ri 1Sdpe,rvisor
CS-087471 -- E,7xpires: 06/18/2021
JAMES M KITCHEN
P.O.BOX 300' 1
CHESTERFIELD MA 01012
Commissioner n /
Home Energy Bating Certificate Rating Date: 2019-11-05 HIS &
Projected Report Registry:D: Unregistered HERS
p Ekotrope ID: M28AIZXL
HERSO IndexAnnual Savings
1 Spring St
Your home's HERS score is a Telative
/ •• 5, MA 0 1053
• • • - s• $ 21280
'•
the 5learn more,visit www.hersindex.com *Relative to an average U.S.home The Home Store
• - • • e • •
Your Home's Estimated Energy Use: This home meets or exceeds the
Use[MBtu] Annual Cwk criteria of the following:
Heating 38.0 $1,003 2015 International Energy Conservation Code
Cooling 0.0 $0
Hot Water 1.9 $101
Lights/Appliances 12.7 $672
Service Charges $60
Generation(e.g.Solar) 0.0 $0
Total: 52.7 $1,83c
HERSInclex Home Feature Summary: Elating Completed by:
M-e Energy Home Type: Single family detached Energy Rater•Adin Maynard
,Sp Model: N/A RESNET ID:9463452
Existing
110 Community: N/A
awRating Company:HIS&HERS Energy Efficiency
Conditioned Floor Area: 1,152 ftp Mailing:12 Perkins Ave.Northampton MA 01060
m Number of Bedrooms: 2 4136588784
ReMenne orne loo Primary Heating System: Furnace•Propane•96 AFUE
90 Primary Cooling System: N_A Rating Provider:Energy Raters of Massachusetts
80 Primary Water Heating: Water Heater•Electric•3.24 Energy Factor 2 Woodlawn Street Amesbury,MA 01913 '
60 House Tightness: 2.3 A07H50 978-270-3911 ^}"�
S0—ift Ventilation: 45.0 CSM•11.0 Watts
i •o This Home
wDuct Leakage to Outside: Untested
io Above Grade Walls: Attic,
Zero Enerto10 Ceiling: Attic,R-59
Home WindowT e: U-Value:YP Adin Maynard,Certified Energy Rater
r,•: .rs..,
`"'`�` Foundation Walls: R-15 Digitally signed:11/5/19 at 3:47 PM
Ekotrope
reportelwtrope- The Energy Rating Disclosure for this home is available from the Approved Rating Provider.
This does not constitute any warranty or guarantee.
2015 IECC R-406 Projected
RESNET : Energy Rating Index Report
RESIDENTIAL ENERGY SERVICES NETWORK
Property Organization Energy Rating Index Information
Builder-The Home Store Company:HIS& HERS Energy Efficiency Projected Rating
Address:450 Spring St, Leeds, MA 01053 Phone:4136588784 Rating No:
Rater:Adin Maynard Rater ID (RTIN):9463452
Date Rated:2019-11-05
HERS Index Estimated Annual Energy Consumption*
More Energy Rated Home Calculated Rated Home Cost($/yr)
Energy Use(MBtu)
150
Existing
140 Heating 38.0 $1,003
Homes 130 Cooling 0.0 $0
120 Water Heating 1.9 $101
110 Lights&Appliances 12.7 $672
Reference 100 g pp
Nome 90 Photovoltaics 0 0 $0
ao Total 52.7 $1,836
70 � Based on standard operating conditions
bo ERI with PV:54
50
40 This Home ERI without PV:54
30
20 Annual Estimates
Zero Ener 10 Electric(kWh):4,397.8 CO2 Emissions(Tons):5.4
Home +� Ener Savings **:N/A
Natural Gas lTherms):0.0 9Y 9 ($)
_=w Less Energy
"Based on the 2015 IECC R-006 Reference deslpn home
010+1 Ritsr+cr �%
•
• •' • • .- PASS
7ThishomeEETS theEnergy Rating Index Score requirement of 2015 IECC R-406 for Climate Zone 5. It
f the requirements verified by Ekotrope. Mandatory requirements are summarized on the 2nd page
of this report, some of which are not verified by Ekotrope.
Name: Adin Maynard Signature: e%�A �
Organization: HIS&HERS Energy Efficiency Digitally signed: 11/5/19 at 3:47 PM
• • • - 1F.1 •
,,.y�oryp�a�Q��•.
�°..
Company:Energy Raters of Massachusetts
Address:2 Woodlawn Street Amesbury, MA 01913 —
= iNallr O••13t � .
Phone#:978-270-3911
Fax#:
To determine if a provider is properly accredited go to:www.resnet.us/professional/programs/search_directory
(Projected. Confirmation required.)
RequirementsClimate Zone 5 Mandatory
Provision Number Topic Compliance Decision
2009 IECC Table Building thermal envelope minimum insulation levels and PASS
402.1.1 or 402.1.3 maximum fenestration U-factor and SHGC
R401.3 Post a permanent certificate listing the level of efficiencies Certificate required for CO
installed in the house
R402.4.1.2 Envelope air leakage maximum leakage rate FAIL
R402.4.1 /Table Comply with air sealing and insulation requirements in Table Checklist required for CO
R402.4.1.1 R402.4.1.1
R402.4.4 Rooms containing fuel-burning appliances PASS*
R402.5 Maximum fenestration U-factor and SHGC (U-Factor)PASS
(SHGC)PASS
R403.1.2 Heat pump controls PASS*
R406.2 Ducts outside of conditioned space to be insulated to a PASS*
minimum of R-6.
R403.3.2 Duct sealing on all ducts PASS*
R403.3.3 Duct testing for ducts in unconditioned space PASS*
R403.3.5 Building cavities not used as ducts. PASS*
R403.5.1 Heated water circulation and temperature maintenance PASS*
systems comply
R403.5.3 Hot water pipe insulated to R-3 PASS
R403.6 Mechanical ventilation meeting the requirements of the IRC PASS*
or IMC. Outdoor air and exhaust dampers installed
R403.7 ACCA Manual J and S conducted for all heating and cooling ACCA forms required for
systems. permit
R403.8 Systems serving multiple dwelling units to meet the PASS*
mechanical requirements of IECC commercial code
R403.9 Snow melt and ice system controls installed where applicable PASS*
R403.10 Pools and permanent spa energy consumption meet PASS*
requirements for heaters,time clocks and covers
R403.11 Portable spas meet the requirements of APSP-14. PASS*
R404.1 High efficacy lights installed in 75%of permanently installed PASS
fixtures.
This is a projected rating.These items must eventually be field-verified by the Rater,Field Inspector,Code Inspector,or Builder.
Building Specification Summary
HIS
"roperty Organization Inspection Status HERS
+50 Spring St HIS& HERS Energy Effici4 Results are projected
Leeds, MA 01053 4136588784
Adin Maynard
Rogers Residence—prelim
Rogers Residence_HomeStore Builder
The Home Store
Building Information Rating
Conditioned Area[ftZJ 1,152.00 HERS Index 54
Conditioned Volume[ft'] 20,102.00 HERS Index w/o PV 54
Thermal BoundaryArea[ftp] 4,761.30
Number Of Bedrooms 2
Housing Type Single family detached
Building Shell
Ceiling w/Attic I R55_mmni,CE16",10-16 U-0.02 Windows(largest)I U-Value:0.3, SHGC:0.29
Vaulted Ceiling I None Window/Wall Ratio 10.15
Above Grade Walls 12x6 , 16oc R21, FG, G3 U-0.05 Infiltration 12.3 ACH50
Found.Walls 14"ThermalStar intergrade R-15 Duct Lkg to Outside I Untested
Framed Floors I None Total Duct Leakage I Untested
Slabs I R1 OP under all R-10
Mechanical Systems
Heatina Furnace• Propane•96 AFUE
Cooling N_A
Water Heating Water Heater•Electric•3.24 Energy Factor
Programmable Thermostat Yes
Ventilation System 45.0 CFM • 11.0 Watts
Lights and Appliances
Percent Interior LED 100% Clothes Dryer Fuel Electric
Percent Exterior LED 100% Clothes Dryer CEF 2.6
Refrigerator(kWhlyr) 650.0 Clothes Washer LER(kWh/yr) 152.0
Dishwasher Efficiency 260 kWh Clothes Washer Capacity 4.2
Ceiling Fan None Range/Oven Fuel Electric
Ekotrope RATER-Version 3.2.2.2292
All results are based on data entered by Ekobope users.Ekotrove disclaims all liabillty for the information shown on this report.
Component Loads
HIS
Oroperty Organization Inspection Status HERS
450 Spring St HIS& HERS Energy Effici, Results are projected
Leeds, MA 01053 4136588784
Adin Maynard
Rogers Residence—prelim
Rogers Residence_HomeStore Builder
The Home Store
Heating & Cooling Loads
10
8 t
6
4
M
(D
T
m 2
-2
-4
-6
Above-Grade Infiltration & Slabs & Roofs Ducts Windows & Foundation Internal
Walls Ventilation Floors Doors Walls Gains
Heating ■
Cooling 0 Ekotrope RATER-Version 3.2.2.2292
All results are based on data entered by Ekotrope users.Ekotrope disclaims all liability for the information shown on this report.
Pa ays Pa. UL
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CHESTERFIELD ROAD
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DONALD ROGERS
DEB131tA ROGERS
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Commonwealth of Massachusetts
Manufactured Buildings Program
Transmittal Form for all correspondences relating to
Manufactured Buildings and Building Components
To: Linda Shea, Manufactured Buildings Program Phone Number: Date Transmitted
linda.shea@mass.gov 617-826-5225
Commonwealth of Massachusetts Office of Public Safety and Inspections Attn: Manu. Bldgs.
Board of Building Regulations and Standards 1000 Washington Street, Suite 710
Boston Massachusetts 02118
The person forwarding this material shall complete the following portion of this transmittal
Name of Person MC Number TPIA Number
Transmitting Material Aaron Trometter 509 02
The following information is being transmitted to the Board of Building Regulations Please indicate the Distinct
and Standards and/or the Department of Public Safety for reasons detailed below Model and/or Serial Use
(Please check the appropriate box or give a further description of the transmitted Number pertaining to Group
items under the section labeled other. Be sure to identify the appropriate Use Group.) transmitted items
Building Plans for Review and Approval ❑
Building Plans forwarded as a record copy for your files
(Review not required) 42185 single family
Revised building plans for review. ❑
(Please clearly identify revisions on the plans.)
Revised Building Plans forwarded as a record copy for your files ❑
(Review not required-Please clearly identify revisions on the plans.)
Compliance Assurance Programs Original Submission ❑ Modification to: ❑
Calculations Manual Original Submission ❑ Modification to: ❑
Installation Manual Original Submission ❑ Modification to: ❑
Systems Drawings Original Submission ❑ Modification to: ❑
Other-Provide a detailed description
of any other materials which are being
transmitted. Identify any revisions clearly
along with BBRS number.
Also, identify the requested action.
Site Location: 33 Chesterfield Road, Leeds, MA 01053
The office transmitting this information has reviewed the above mentioned and attached materials and has found them,to the best
of our knowledge and abilities,to be in compliance with the codes and\or rules and regulations for the Commonwealth of
Massachusetts'Manufactured Building Program,as applicable
Digitally signed by
D. D.Renee Moist
DN:cn=D.Renee
Signed By Renee Moist,o,ou=PFS, Signed By
for TPIA: email=renee.moist BBRS No: assigned by Mass. for MASS:
pfsteco.com,c=US
Moist Date:2020.02.13
10:20:59-05'00'
Print Form
TY li
THE HOMES ORE
PO BOX 300
WHATELY,MA
01093
COPYRIGHT 01007
THIS DOCUMENT AND THE
SUBJECT MATTER
CONTAINED HEREIN IS
PROPRIETORY AND
MAY NOT BE REPRODUCED
'OUT THE WRITTEN
PERMISSION OF
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CHAMPION FACTORY 041 --
CHAMPION MODULAR,INC.
10642 S.SUSQUEHANNA TRAIL
LIVERPOOL,PA 17045
MODULARD U L A R
BRAND: CK
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PLACEMENT OF 28 GAUGE MATE WALL PLATES H O MES
BUILDER:
CUSTOMER/PROJECT:
BUILDER'S SIGNATURE/SIGN-OFF:
ENGINEER'S/ARCHITECPS SEAL
I I ' INSTALL ALONG THE TOP I
NO MORE THAN 36" APART
APPROVERS SEAL
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TYPICAL LOCATIONS TYPICAL LOCATIONS
OF THE 4x6 MATE OF THE 4x6 MATE
WALL PLATES WALL PLATES
I I I MODIFICATIONS
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FASTEN EACH PLATE (TO EACH WALL)
Lfl WITH (2) 0.113"x 1.5" NAILS
PROJECT:
TYPICAL DOOR OPENING TYPICAL LARGER OPENINGS 000-0000
IN THE MARRIAGE WALL IN THE MARRIAGE WALL
TITLE; MISC
tDRAWN BY:
O � VID E,
HI LUPIGSLEY DATE:
SCALE: 1/8"=V-0"
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1+19,47769 FILENAME:MATE WALL PLATES 2
SOIST ��' SHEET:
- s FAST E N I N G
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10108/18 PROPRIETARY AND CONFIDENTIAL
THESE DRAWINGS AND SPECIFICATIONS ARE ORIGINAL,
PROPRIETARY AND CONFIDENTIAL MATERIALS OF CHAMPION.
COPYRIGHT o 1976-2014 BY CHAMPION