38B-305 (3) 50 FAIRVIEW AVE BP-2021-0111
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38B-305 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Deck BUILDING PERMIT
Permit# BP-2021-0111
Proiect# JS-2021-000178
Est.Cost: $2500.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES O'SULLIVAN 66335
Lot Size(sa. ft.): 11325.60 Owner. GILFORD PETER&ELI SSA A LFORD
Zoning: URB(100)// Applicant. JAMES O'SULLIVAN
AT. 50 FAIRVIEW AVE
Applicant Address: Phone: Insurance:
264 BUCK POND RD (413) 532-1312 SOLE PROPRIETOR
WESTFIELDMA01085 ISSUED ON.7/28/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-BUILD 7X7 DECK
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 7/28/2020 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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2_0,l„ l(,
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g The Commonwealth of Massachusetts
(� Board of Building Regulations and Standards MUNICIOPALITY
n ; f Massachusetts State Building Code,780 CMR USE
C� Building Permit Application To Construct,Repair,Renovate Or Demolish aRevised Mar 2011
L5 One-or Two Fantil),Dwelling
3 This Section For Official Use Only
t Number: - AD 2,1 11 l Date Applied:
Building Official(Print Name) Signature D
SECTION :SITE INFORMATION
1.1 Property Address: r 1.2 AsseoMap&Parcel IVumbgrs
� c �_ ,
I.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yazd
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private❑ . Zone: — Outside Flood Zone? Muoicipal*A On site disposal system ❑
Check if y
SECTION 2: PROPERTY OWNERSHIP'
2 Owners of Record:
� T�,'�: ►�} 1 �i tic +:` t ,ti l t7 to
Name(Print)( ) City,State.ZIP
- Q t"✓ callt V 4 'W3 695 S �a rv► „q
J ft- ;
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction Existing Building❑ Owner-Occupied ❑ 'Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Othcr ❑ Specify:
Brief Description of Proposed Work': % i K _
ZL_t-2 ci F
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1.Building $ ��6 j 1. Building Permit Fee:$ Indicate holy fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cosh(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees”S
Check No Check Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
V %J4. LY V Z L-L1CLLLLV L-V11
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Massachusetts
t � s DEPARTMENT OF BUILDING INSPECTIONS
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212 Main Street • Municipal Building JZ_, �9
Northampton, MA 01060co
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PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 &2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s)and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5.Worker's Compensation'lnsurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, H1C Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner(if applicable).
9. Note any Conservation and/or special permit requirements (if applicable).'
10. Driveway Permit(if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit-public land by DPW/private land by Building Dept.
13. Stretch Energy Code -all new construction will require a HERS Rater Affidavit to be submitted with
permit application before issuance of permit.
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CITY OF NORTHAMPTON
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SETBACK PLAN
MAP: O LOT
3oS .
LOT SIZE: ` Z- '2�S
REAR LOT DIMENSION
REAR YARD
Ids!'.4?�-
SIDE YARD SIDE YARD
FRONT SETBACK_ _ {
FRONTAGE__l G c) ___
` SECTION 5: CONSTRUCTION SERVICES
S. Construction Sttpenisor` 1License(CSL) 2� 2 J
`k V License Number Expiration ate
Name of CSL Holder
!'�l` �a�� '�� List CSL Type(see below)
No.and treet Type Description
g U Unrestricted(Buildings up to 35,000 cu.ft.)
Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
1 ^ , , ,p�— WS Window and Siding
c 4'71C ��i_ A) SF Solid Fuel fuming Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Rome Improvement`Contractor(AIC)
ae) I-X'T(6 f� HIC Registration Number Expiration Date
HI Company Name or HIC Re
' trant N
�t'O 4-. J5(-1L 7ime �,1 ��1 {�—L-6IV�I IZS.c 10fJ
No.and Street Lf�> �3 Z 13 t Z— �' mail address
IA�lEl 6D GYl DIto�5
City/Town,State,ZIP Telephone e-GON T t N LT—
SECTION
6: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..........K6— No...........0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED 147EN
OWNER'S 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 applicatio
Print Owner's Name(Electronic Sipature) Iyate
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and ace nate to the best of my knowledge and understanding. �^
1 ���
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.Pov!dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.fr.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
'Number of bathrooms Number of half/baths
Type of hearing system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage'maybe substituted for"Total Project Cost"
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Building Department
:r ux 212 Main Street
Northampton,Massachusetts 01060
Phone(413) 529-1402
Fax (413) 529-1433
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance with the provisions of MGL c40, s54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility_
The debris will be transported by:
Name of Hauler_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signature of Applicant:__ ____ _ ___ ___ ___ _Date:_ _ Z�
The Commonwealth of Massachusetts
Department oflndustrialAccidents
1 Congress Street,Suite 100
Boston,M4 02114-2017
www.mass gov/dia
Z1-orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(BusinesdOrgani2adon/Individual):
Address:
City/State/Zip: c "j \ � ►�A Phone#: ( Z
Are you an employer?Check the appropriate box: Type of project(required):
I.r-1 I am a employer with employees(full and/or part-time).* 7. fAii-ew construction
2.al am a sole proprietor or partnership and have no employees working forme in $, F Remodeling
aay capacity.[No workers'comp.insurance required.]
3.FJ I nm a homeowner doing all work myself.[No workers'comp.insurance required_]'
9. "D Demolition
4.F71 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 Q Building addition
ensure that all contractors either have workers'compensation insurance or are sole I LEJ Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet-
These
heetThese sub-contractors have employees and have workers'comp.insurance.t 13.0 Roof repairs
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 N 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 subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
lam an esrployer that is providing workers'compensation insurance for my employees. Below is the policy 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 pace(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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby ce underthe ains and penalties ofperjury that the information provided above is true
/and correct
Signature: Date:... — — 2-02-
Phone 4:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Ndt -Altm70/J A►A
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Descriptor
26 A:1.5Fr/B
S 6 E 1404 sgft
5 BAR
15 5 42 sgft
C:1 Fr
1.5FFIB 42 sc$t
1404 D:OFP
26 26 36 sgft
E:OFP
30 sgft
F:Conc Pati
286 sqft
46
'B 3 'D T
16
Conc Patio 18
268