8 Hinckley BP 2019-04-25File# BP-2019-1145 oK
APPLICANT/CONTACT PERSON ROBERT GOYETTE JR
ADDRESS/PHONE PO BOX 698 WESTFIELD (413) 568-8614
PROPERTY LOCATION 8 HINCKLEY ST
MAP 30B PARCEL 126 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin Pennit Filled out
Fee Paid
Typeof Construction: NEW SINGLE FAMILY HOUSE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 056035
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I~RMA TION PRESENTED:
__ Approved __ Additional pennits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§ _________ _
Intennediate Project: ___ Site Plan AND/OR ____ Special Pennit With Site Plan
Major Project: Site Plan AND/OR Special Pennit 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 ____ WeJI Water Potability Board of Health
___ Permit from Conservation Commission ___ Pennit from CB Architecture Committee
___ Permit from Elm Street Commission
___ · Demolition Delay
Signature of Building Official
____ Permit DPW Stonn Water Management
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 ofMGL 40A. Contact Office of
Planning & Development for more infonnation.
City of Northampto
Building Departme t
212 Main Street
Room 100
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOL1SH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
8 1-f, ,vr:.. LE'-< 5J-e.€L, Map
This section to be completed by office
3{_) '{; Lot / J-lt Unit'----
N dl.trflftllr77} Ill I IYJ It O IO b 2 Zone ______ Overlay District. ____ _
1-----------------------El~m St. District'-------CB District ____ _
SECTION 2 • PROPERTY OWNERSHIP/AUTHORIZED AGENT
Ji \ h1.
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item
1. Building
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5)
Telephone
E 0 . .,V)DX (!{8 .. lil&S t,:'I £C.,D . /JIJ/10/086
Current Mailing Address: ' '
C!i 1?:jSb 8 ··8(?/l/ c EiL &V!{(,3 -l,S"'OI
Telephone
Official Use Only
(a) Building Permit Fee
(b) Estimated Total Cost of
Construction from 6
Buiiding Permii Fee
Check Number
This Section For Official Use Onl
Building Permit Number: ___________ _ Date Issued: ________________ _
..L'c,~Nl)A'f(c1JJ
Signature: ~--=';;;;;;;;;;;;;;;;;;;;;;;;;;;;;;.;.;;;;;;.;;;;;;.;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;/ __ 'iiiiiiiiiiio---------------------+-
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER 0~
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Lot Size
Fronta e
Setbacks Front
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
arkin
# of Parkin S aces
Fill:
volume & Location
Existing
CJ
CJ %
Proposed Required by Zoning
This column to be filled in by
Building Department
CJ
CJ
A. Has a _;!l:cial Permit/Variance/Finding ever been issued for/on the site?
NO (0 DONT KNOW O YES 0
IF YES, date issued:! I
IF YES: Wa_!Jhe permit recorded at the Registry of Deeds?
NO (0 DONT KNOW O YES 0
IF YES: enter Book j ! Page ... j -------..... , and/or Document #._j __ _-=_]
0 8. Does the site contain a brook, body of water or wetlands? NO @ DONT KNOW O YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained
C. Do any signs exist on the property? YES
IF YES, describe size, type and location:
0
0 , Date Issued:! ... _____ __,
NO eS
D. Are there any proposed changes to or additions of signs intended for the property? YES Q
IF YES, describe size, type and location:
L-
E. Will the construction activity disturb (clearing, grading,~vation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO \.:!}
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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SECTION 5-DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition D
D
Replacement Windows Alteratlon(s) D
or Doors D Roofing D
Accessory Bldg. D Demolition New Signs [Cl] Decks [CJ Siding [Cl] Other [Cl]
Brief Description of Proposed
Work: ·72, ('t ,1JS1R,2c.TA: $,,Ilk? t £ €1H11ll .i( Ha ·« l}-S PGf: A-171l(_fff;/) Pl../lM;i {g,k,vlt)fiY :SJTP~~
Alteration of existing bedroom ___ Yes _L__ No Adding new bedroom ___ Yes J No lrSStJt!. At 11 0
Renovating unfinished basement ___ Yes ./ No 8 /6f t 8 Attached Narrativ
Plans Attached 011. -Sheet
6a. If New house and or addition to existin
a. Use of building : One Family~---Two Family ____ Other ___ _
b. Number of rooms in each family unit: __ 7.,__ ____ Number of Bathrooms_.._'3 ___ _
c. Is there a garage attached? Yfi;S
d. Proposed Square footage of new construction.
' t ,,
Dimensions __.._.).._q~~~(_':f:~fl~··J.f~------
e. Number of stories? 2 -~~----------
f. Method of heating? L£' C.,fK /1/{t(.M /ht?,. Fireplaces or Woodstoves _y:J _____ Number of each -===::
g Energy Conservation Compli~nce. 1€5-tz!Tl}Cllf)iJ Masscheck Energy Compliance form attached? _l/,_~~·-..s~· __ _
h. Type of construction R. ·.3 T'fr{!, ,5'
i. Is construction within 100 ft. of wetlands? ___ Yes L No. Is construction within 100 yr. floodplain Yes ...ll._No
I , / *'
j. Depth of basement or cellar floor below finished grade -'-..-·~·t;_....0~-....,k, ... ' _____ _
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
I, Kas«rC t2tJil1l! '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.
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable D
Name Qf ucense Holder : &, 8/U?v' {atJ !.f €17Z -:Ji. . cs -os, o3S::
License Number
Address ' ~ ;Z. 0,,3,)!{1.B -8tJ'I
9. Registered Home Improvement Contractor; Not Applicable D
lf;e,Tlt<izt: )/,;;n~ :Iic; ?..osllrTfbo'(I:,@; /J,Cl37
company Name Registration Number
'P, O,i)ov '9/PJ /4s ~ So.rc1-r~w ttL MB£> Etp?l.rofi1.t Address/
{J}£srftL UJ,, !f}/t () /0 $ G Telepho~t~.$'~8,Bt /.
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 ...... D
m ily nf N nrtlr ttmpLrn
Jhtss nr.trus.rlls
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
Fee Calculator for Residential Properties
Basement @ .20
1sr Floor@ .50
2nd Floor@ .50
~ Floors, Finish Attic, Garage @ .20
Deck / Porches @ .20
Square Footage
tl0b
490
2s2+42,
3"
Total:
Amount
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Wm·kers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Ila 17P(i:,[, tt:2M £5 'L.K.«
Address: 'e 0. J5 Qc' '2'18 / L/£0 Sa,;-cff1tt1JWAI f<aB12 I
City/State/Zip: Phone#: 41,3 -,S"G:,8 -B{p/4
Are you an employer? Check the appropriate box:
I.~ am a employer with J../ employees (full and/or part-time).* 2.o I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.] 3.o lam a homeowner doing all work myself. [No workers' comp. insurance required.] t
4. DI 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
proprietors with no employees.
5 -0 l am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers' comp. insurance.? 6.o We are a corporation and its officers have exercised their right of exemption per MGL c.
152, §1(4), and we have no employees. [No workers' comp. insurance required.]
Type of project (required):
7. ~ew construction
8. D Remodeling
9. D Demolition
10 D Building addition
11.0 Electrical repairs or additions
12. 0 Plumbing repairs or additions
13. 0Roof repairs
14. 00ther _______ _
*Any applicant that checks box #I 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 sub-contractors have employees, they must provide their workers' comp. policy number.
Below is the policy and job site I am an employer that is providing workers' compensation insurance for my employees.
information.
Insurance Company Name:-ltc,__,..t±:~D'4-1.L..I.B____..M:~~--~~""'--'-"u.. """""""--L1"'"0fd.........,_~..,_'//11)~i,__ _______ _
Policy# or Self-ins. Lie. #: U/GA 53 S 7 (;, '7 :? Expiration Date: 4" / I q ___. ___ ...._._---' _______ -+-____ ~f---------I I
Job Site Address: 8 il,NK..L-'f.'1 s-reu;:r City/State/Zip: !vtJe...Tt,fl(fllflaJ1} lfJ A ao,2..
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expirailimJate).
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 ofup 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.
Date:
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/fown 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 burn leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number:
Revised 02-23-15
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
www.mass.gov/dia
Properfy Home Energy Rating Certificate Jason&. Morissa Fregeau 8 Hinckley St. Florence , MA 01062 tiERS Rating Type: Rating Date: Registry ID: Projected Rating 10/14/18 Certified Energy Rater. Rating Number: Mark Bashi$ta -Projected Rating: Based on Plans -Field Confirmation Required. C,. Estimated Annual Energy Co~ --... --Use MMBtu Cost HERS Index: 53 I General ·Information He~tlng 65.6 $1459 Cooling 2.1 $107 Conditioned Are1 3645 sq. ft. House Type Single-family detached Hot Water 13.9 $303 Conditioned Voh.une 33763 cubic ft. Foundation Conditioned basemelit Lights/ Appliances 29.4 $1582 Bedrooms 3 Photovoltaic$ -0.0 s-o Service Charges $48 -..... I I Percent 42.% 3% 9% 45% ,()% 1% I Mt!chanic:al Systems Features _ I Total 111.0 $3499 100% l Heatlna: Fuel-fired air distribution, Propane, 96.0 AFUE. CooUng: Air conditioner, Electric, 16.0 SEER. Water Heating: Duct Leakage to Outsid Ventilation System Prograrnr'i"lable Thermostat Instant water heater, Propane, 0.81 EF, 0.0 Gal. 0.00 CFM25. Balanced: HRV, 67 cfm, 34.0 watts. Heat•Yes; Cool•Y&s 8Uild1ng Shell Fe,styres Ceiling f'lat Sealed A~~h: vaulted Celling Above Grade Walls Foundation Walls R-49.0 NA NA R-21.5 R-21.0 Slab Exposed Floor Window Type Infiltration Rate Method R·O.O Edge, R•O.O Under R-30.0 U-Value: 0.300, SHGC: 0.310 Htg: 3.00 Clg: 3.00 ACH50 Blower door Criteria This home meets or exceeds tfle minimum criteria for the following: 2009 International Energy Conservation Code 201 z International Energy Ccnservatfon Code 2015 International Energy COhservatlon Code l~-I Lights and Appliance F ~atyres New England Energy Raters 198 Sylvester Rd Percent Interior Ughttn1 100.00 Percent Garage Lighting 100.00 Refrigerator (kWh/yr) 691 Oishw~sner Energy Factor 0.46 Range/Ovei, Fuel Clothes Dryer Fuel Clothes Dryer CEF Celling Fan (cfm/Watt) Propane Electric 2.62 0.00 Aorence MA 01062 413,570-5750 Certified Energy Rater: REM/Rate -Residential EnerJY Analysis and Rat1n1 Software v15.6.1 ~ a~~ This information does not constitute any W4rranty of energy costs or savings. Q 1985-2018 HORESCO, Boulder, Colorado. The Home Energy Rating Standird Disclosure for this I\Ome is available from the ratint provider. 1
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street• Municipal Building
Northampton, MA 01060
Massachusetts Residential Building Code
Section 110.R5.1.2
Homeowner: Person (s) who own a parcel ofland 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 11 O.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
Massachusetts
DEPARTMli:NT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building
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:
8 Hl61t< LDi ~Tfll;T
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
US A l1ikLJaJ&+ (a cttc Ll dJG 7;,;c 'I S:5Ho 1-flrM R..olrO £;rs·rlJt,vD5dl.J CtOboBB
(Company Name and Address) ' -'
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 debris will be disposed.
,,·· r ' .I
Commonwealth of Massachusetts
Division of Professional licensure
Board of Building Regulations and Standards
Constru.ct-'k>n Supervisor
CS-056035 E-J.p ires : 05~01 /2020
ROBERT T GOYETTE, JR"
P.O. BOX 698~
WESTFIELD MA...,01086
r I :\' .\ "'~~
Commissioner
-0
):..L cc.Q.,__,;,.---0 I} • • •.
Undersecret1ry