37-065 121 BLACK BIRCH TRAIL BP-2020-1222
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map_Block:37-065 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2020-1222
Project# JS-2020-002061
Est..Cost: $600.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): Owner: KATHERINE ALLEN
Zoning: Applicant. KATHERINE ALLEN
AT. 121 BLACK BIRCH TRAIL
Applicant Address: Phone: Insurance:
121 BLACK BIRCH TRAIL (413) 320-7944 O
FLORENCE ,MA01062 ISSUED ON:7/10/2020 0:00:00
TO PERFORM THE FOLLOWING WORK:FINISHING ATTIC SPACE
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 7/10/2020 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
i� ,V1A A rnoJF w►rt�e-ws Se 0"rati2
Department use only
City of Northampton "' Status of Permit:
,r Building Departmen \ Curb Cut/Driveway Permit
212 Main Street7� '� Sewer/Septic Availability
!I Room 100/ c% Water/Well Availability
a Northampton, 1060 J Two Sets of Structural Plans
T.
phone 413-587-1240 Fa -587-1�I� 1316t/Site Plans
9Ttiqf, JO ther Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, �^ E DEMOLISH A ONE OR TWO FAMILY DWELLING
50
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
12 1 B[Ac k WrG1ATroLi ( Map �� Lot 0 6/� Unit
F f7 re.tce., MA O Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
a`i�,i✓ri►��/��I + Mreix i2- cxck �i:�_1�T►�� F19►-P,4-rce A4
N —7 Current Mailing Address:
y r3 -- 32-0--794
Telephone
r(2-2AAqu1jtlhorized
Aaent:
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 c�-o / d o v-,S c L, (a)Building Permit Fee
pe-Ir✓vi-t -
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) 50
5. Fire Protection 16QO
6. Total=0 +2+ 3+4+5) 40o Check Number
This Section For Official Use Only
��ay j ,
Building Permit Number: 12-Zz DateIssued:
Signature: 7 /d o 20
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
ection 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
—� Existing Proposed Required by Zoning
_ D This column to be filled in by
Building Department
C Lot Size
J. Frontage
p Setbacks Front
�4- Side L: R: L: R:
JRear
Building Height
Bldg. Square Footage %
Open Space Footage _ %
' (Lot area minus bldg&paved
Uparking)
n
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW Q YES Q
IF YES, date issued:—
IF YES: Was the permit recorded at the Registry of Deeds?
ILI
NO O DON'T KNOW /-A YES O
+- IF YES: enter Book Page and/or Document#
J
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
4— IF YES, has a permit been or need to be obtained from the Conservation Commission?
A Needs to be obtained O Obtained Q , Date Issued:
.t-
C. Do any signs exist on the property? YES 0 NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YESO NO
S 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 O 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 1711
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[0]
Brief Descripption of Proposed
Work: Flv►isln;vu? ct.sed
is CLI rPcd,�,� ge"W'A-Pot- "16k% KLJS ;,%,5L, -�'Ievt�Se�a P2ryvr,
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No exrLa
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing, complete the followina: r✓G,
(�rte-�pCr r 't)
a. Use of building : One Family V Two Family Other I
b. Number of rooms in each family unit: , yUuy'V6 Number of Bathrooms I
c. Is there a garage attached? *=U 7 (r�0 i pe4'k H e,=j ht)
d. Proposed Square footage of new construction.—^,[ llT'4- Dimensions �.�J l X Z 5 +i v►iShirA Ce,c
e. Number of stories? ---� 3
f. Method of heating? 0►o-c.ee a,v- t�=447j�A Fireplaces or Woodstoves L Number of each
g. Energy Conservation Compliance. Fl ie!4 I St6w Masscheck Energy Compliance form attached?
h. Type of construction tire:
i. Is construction within 100 ft.of wetlands? Yes V/ No. Is construction within 100 yr. floodplain Yes 1-'� No
r
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
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.
i
nature of Owner Date
I, K.ttkei-i'vke . L A! 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 and penalties of perjury.
":��j,tev i n e. L, At k e4 ,
Print Na
Signature of Owner/Agent date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 03/
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
9. Reciistered Home Improvement Contractor: Not Applicable V.
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
• ". Massachusetts
�a .,A c
DEPARMW OF BUILDING INSPECTIONS �` M
212 Main Street • Municipal Building SJy 1D�
\ Northampton, NA 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units.—or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note.If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: rekioy aiiy\ Est. Cost: $ 1 uJ
Address of Work: 12.( aGk• F3 t rck Tra
Date of Permit Application: t�� 0 Z V
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
1/Job under$1,004.00
17, Owner obtaining own permit(explain): D W PI e r d o i n� 'vya r*-
Building not owner-occupied
_Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Date Contractor Name HIC Registration No.
OR:
Notwithstanding 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
DEPARTA�11P1' OF BUILDING INSPECTIONS x
ti �
212 Main Street • Municipal Building
Northampton, Mh 01060 sSb „y7���
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
' c:r�r.. �s •.. s�
Massachusetts
c
DEPARTMENT OF BUILDING INSPECTIONS x
212 Main Street •Municipal Building yeti Com'
---�' 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.
.- a1VVI V,t No c"rI'S
The debris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
[7o►mp5�e;- avr IDC F.�1ac \rCl�
( lease print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
nature of Perm i pplicant or Owner Date
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.
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