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37-022 (38) 23 MOUNTAIN LAUREL PATH-600 FLORENCE RD BP-2020-0755 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37-022 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit# BP-2020-0755 Project# JS-2020-001298 Est.Cost: $1000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use croup: Homeowner as Contractor Lot Size(sc. ft.): Owner. TURNER KARLEN GAIL Zoning. Applicant: TURNER KARLEN GAIL AT. 23 MOUNTAIN LAUREL PATH - 600 FLORENCE RD Applicant Address: Phone: Insurance: 600 FLORENCE RD #23 (413) 582-0608 O FLORENCEMA01062 ISSUED ON.12/23/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-EXPANDING SIDE PORCH 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: FeeTvpe: Date Paid: Amount: Building 12/23/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner NO- Departmefi se'on y City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability } -4 Room 100 WaterNVell 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,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 PropertyMAddress: n A� //��1��1� L�tf/1i�. I �/ Map_ Lot 1 Unit CSC c' 6 ?, Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT X 2.1 Owner of Record: c2, .,2 ItloaaiLpoln 1Z/1 Name(Print) Cvrrent Ma ing Address: Z� phone Signature 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 �U UQ (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee p 4. Mechanical (HVAC) 5. Fire Protection X 6. Total=(1 +2+3+.4+ 5) �� Check Number 7-5 This Section For Official Use Only Date Building Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 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 Frontage Setbacks Front Side L= R: ...' L:= R:= � Rear i Building Height Bldg. Square Footage % _._._.._ I Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: _. (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW O YES 0 IF YES, daPeissued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DON'T KNOW Q YES 0 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 1P 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 0 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 0 NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,a cavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 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 E] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Ali Siding [O] Other[a Brief X Descri do of Proposed � h+ � � vp '^cWork: L�XAfArftl41" � F2aryy Alteration of existing bedroom Yes4—No Adding new bedroom Yes _No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 7 //b 6a. If New house and or addition to existinq housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade 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 � w I, f/� L LGU as Owner of the subject property hereby authorize to act on my behal in all ma rs relati. a to work authorized by this building permit application. T19, a2z � Signature of Owner Date I, 6RI L as Owner/Authorized Agent fiereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name ZI �7 Z Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 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 x S/ Massachusetts DEPARTMENT OF BUILDING INSPECTIONS D 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: -; � Ad'-J 7-fi A 44 a 4 F-L az'-�-/ (Please print house number and street name) Is to be disposed of at: x VA Lt €Y �6ZVe L, G .z3�fn T/Y�M��z�J (Please punt name and location of facility) 07/9ej Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 12- pP 9 x Signature of Permit Applicant or Owner Date / 9 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. The Commonwealth of Massachusetts Department of Industrial Accidents V_ 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly X Name(Business/Organization/Individual):T� Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. ❑New construction .1 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any clapacity.[No workers'comp,insurance required.] 9. ❑Demolition [4.'E] 11 am a homeowner doing all work myself.[No workers'comp.insurance required.]t I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.[]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs 14. Other These sub-contractors have employees and have workers'comp.insurance) .0/r K- 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. C►[� 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job 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 certtJy under t e pains and penalties of perjury that the information provided above is true and correct �( Si nature: Date: Z / Phone#: Of ficial 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#: 12 �pac s S 8'231 E S 83.38'23" E S 83'38'23" E ` 4.0 5 .401 i 59.40' S .a i m SPdces f , � (oz , 7-D i 28e • - �. �X�STin1G �iO�Pd�f# f 24 FF 90.0 FF 94.0 23* _30 FF 2 988 - FF 94.0 - - 41, -------- -------- -- ------ '---- = - "�� FF 90.0 flT)l °fl1 1 17. - - - Tea FF •94. FF/94 - . 1 FO FF 98.0 \ \ / � N�lO1d62 14 \� — ----- ' - ----- — FF 98.0 -�-- -�- 9s:o i f rT ST p / �� V cd i�B/ 77 jOAIIII- 11910 rf166 JW 7- 12-110 AO66ie A,4 O ✓r8 7- /.? 771 Ass-iSrflnlr RN;cQ»G t^oM�li`ssi`onJt2 r�LFCr/��C�lL �it�SPFcro2 St'ctionaI Building Plan ` ' Sliu>gles hoof\- Shcathing : 1Znf ter ice Ilazriar Pitch - / or Roof Sheathing Cover-int, f Truss Ice Ba - Tnrss-Cut Sheet Reel ''ed 'Clear Span,to thcopposite mapport ter �C 11 ft Siu- �CI{after acing- 12" I „ 19.2" 24" - - Rafter �(R�ti'fer Spe ics- - Ridge- 5idiag X oiling J t S .c- Siicatfting X Ceilin Dist Sp jug- l2"16"19.2112411 x Chi ' g,foist Speci rnsulaGon solation-R j Z X fat or Finish- \'1aIlI'ratnlag Attic.I tilatian- Interior Finish --- 11'al(s: S ing- Sh thin"- i ltlsu tion- I �K1Va1t Fra ng-_ Ilead T'loot-: Finished Floor- S�,1r-P1oor Sub-Floor•- Floor•,foist Size- k /( X Floor Joist Spacing-12"Ib"19.2"24" Floarloist Dfstenoe ?(Floor Joist Clear Span- /l 1 Clear Span,lW tf►e o � rCOm oraJo )< loor Joist Species- !1lLUC�/`�Sl?''` PlDsitc sjpport llenin Type&Size- .SIIA/ L�tGG�C�aX/Q/�7.t7dd��/Z Distance From Grade- =a•:�c Sill Plate sy -7f_i;`` `-• ,y? foundation: FoundationAnclior �r ' ��Z`''�Z✓`� Anchorage- Sill Plate- foundation Wall "► 'C' '��y�' �( all Type& Size- ti Y'Yh: �• , \N Reinforcement- — ^yam=: Concrete Floor Thickness- .r,(ti', Vapor Barrier- t ,{ 1� Concrete Floor Column Pad Size- x1c. Column Spacing- - Footing Width / Vapor Itarr itr Footing Height- J Footing •',��..,�k� )( Fooling Depth Below Grade- — r J N . loin 44 low r V040 • �,,� SAG Aft FS � I jw -of C i Al owl 5 O/x E 1 0/ — C99'�/.� 1 p.L j! bei7 'la'oN I v 9 10 rl r3 i Y 5 At l f ��rsrl�� 4 4a•F G%ctA/�4�1/�F 3� t� Wru STRY RN--"Nk PITY - - - l�� sT p. too*1 W AVIO-e- of ,o-' D,ec KIiAI �o�M s TYp Y'uioE f2uy��.0 w/ATH S �Q'posr � y 71 �D � l