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16A-034 (2) 33 CHESTERFIELD RD BP-2021-1240 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16A-034 CITY OF NORTHAMPTON Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit# BP-2021-1240 Project# JS-2021-002060 Est.Cost: $6400.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): Owner: ROGERS DONALD&DEBBRA Zoning: Applicant: ROGERS DONALD & DEBBRA AT: 33 CHESTERFIELD RD Applicant Address: Phone: Insurance: 450 SPRING ST O 584-7462 O LEEDSMA01053 ISSUED ON:4/29/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:DECK ATTACHED TO BACK OF 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: 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 Si „att 4. '1'• p y � ( FeeType: Date Paid: Amount: Building 4/29/20210:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2021-1240 APPLICANT/CONTACT PERSON ROGERS DONALD&DEBBRA ADDRESS/PHONE 450 SPRING ST LEEDS ()584-7462() PROPERTY LOCATION 33 CHESTERFIELD RD MAP 16A PARCEL 034 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLI ATIQN CHECKLIST fpNC SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid '! Building Permit Filled out Fee Paid Typeof Construction: DECK ATTACHED TO BA F HOUSE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Li/act/al Signat e of Building Official 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. ip U The Commonwealth of Massachu -,O I�`�,' Board of Building Regulations and Stan 'ds''%, �/ FO Massachusetts State BuildingCode, 780 C.M UNI PALITY �.ti 1s,, USE Building Permit Application To Construct, Repair, Renovate Or \4 zt R ised Mar 2011 One-or 7wvo I amity Dwelling , tis f ,t This Sc" ton For Official Use Only Building Permit Number: 19-pi -/ rIl.+a#e Applied: . 1, i • Pq...a1. Building Official(Print N.mie) SunrEure I D: SECTION It SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 3..a.---Gae,5 . ...Ccil PooLd K.ags . 2 ..I10A-o 1'-QO 1_ 1.1 a Is this an accepted street?yes r/ no Map Numbe Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: .. . 4, .,....3 155 Zoning District Proposed Use Lot Area(sq f1) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 7‘ tyli AP IA 074-I 90 1.6 Water Supply: (M.(G.L c.40,§54} 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone?Public Tf Private 0 —/ Cl:ee i yesl8" Municipal LN On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: �f�a2oQe� \ 2c cs & nn s a� o to 3 Name(Print) City, >r State,ZIP ..3.3 _hes ei(:.ci e Id ceid 413=3. -13 36 "b. k rar.i.e...0> a.Ji:cO'P No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction 0 Existing Building 0 Owner-Occupied C I Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other '6t1 Specify: _ _ {1;,,,, Brief Description of Proposed Work': I:,tec cl<Ghea. .j tqc_._ tvose la cam.+ LO Z.de a? pee4 !©i SECTION 4::IS 1:'IM.A'1-E:D cON;STRUCTiON COSTS Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee.: $ indicate how fee is determined: �o t 11�C1. Q.. 0 Standard City/Town Application Fee 2. Electrical $ 0 Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (IIVAC) $ Lis:: S. Mechanical (Fire $ Suppression) Total All 11�' /$� CheckA ClieclNomount: 4 6.Total Project Cost: $ Ix 1•400:3•0 cp 0 paid in Full ID Outslandi3 g:Balance Due: City of Northampton Massachusetts 'Or t DEPARTMENT OF BUILDING INSPECTIONS •!: \ 4;,; 212 an Street • Municipal Building Northampton, MA 01060 PROCEDURE FOR OBTAINING A RUH.:DING PERMIT FOR WINDOWS, DOORS, ROOFS,RENOVATIONS, ROOF 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. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new /replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements(if applicable). 9. Energy Code —all new construction(Gut/Rehab) requires a HERS Rater Affidavit 10. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street TYPe Description U Unrestricted(Buildings up to 35,000 Cu.ft.) Restricted I&2 Family Dwelling_ City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(111C) IBC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFF IDAVIT if.M.G.L.c. 152.§ 25((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 0 No SECTION 7ai OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPIAES 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. Print Owner's Name(Electronic Signature) Date SECTION 71):OWNER I 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 accurate to the best of my knowledge and understanding. TntitD -' c),asel.r-S 41 st a Print Owner's or Authorized Agent' ame(Electronic Signature) Date NOTES: I. A.n 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(111C)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the H1C Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gpv/do 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (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 heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • ✓aCfi 00,- j Ee • Q ,L� o �a o�O�r10• c.utR.7fl J �l�i 0 O n c� » IS The Commonwealth of Mossachosetts Department of industrial Accidents ' 0 g 1 CongreTs Street,Suite 109 .17 Beston,, MA 0114-2017 4irs,;::„7,,o''''' went moss„govitlia Workers'Cornipeusation huntrance Affidavit RtaildersiContractorsiEleetelela nsiPlo Wien. 'TO HE FILED WIT/1 IMF-1,110n1"/INC;.411"BOtill'I', A 1 Alicant Infort lion Please Pend Le thl Name 1l-iiisinewOrwinizaticriandividnakt7bDC142., .c3 Address: City/StateiZip:.,A,,..e.e.A,Sr ti) R o(05 3 Phone#: .• - -3, 0 1, -5(.,.. :aut 3.0a an naiiikokte.Chatt4 dui saptatirlate boat r:Type of project irequiimd): In I alt it 41,11Offiet veitt , regoilkleat adt.0e0;44.Patt-tir"22r 1 7,. 0 New conslourtien , lri I not a silk purism or reaussensktip ans'..1 have ass awsplaryters,matt ag ika-ow n 8. 0 Remodeling ergaavicy.. '?.hlat maker**ormorx.irraxontra vesorival4 l.. ,r, 9. 0 Dernofition it ii,t I ain a ktitSsti5fratia Job%all wort rsetotal.pilo worktar'tottvi.x. oss4;azuerta,2 eatainAl..)' !. 10 0 Building addition 4.0 i tini.a UrfalftrAVAWT Wild Will..tY4 kariaget tangestros.sev.au ravatiott a-tg4.,:e .i'M Offty pittiteny.. 1 WiR , trortoxr AtS.22E tal oniintennl ritiver time-;4:04tem"sararspeemotion imsaverve ox are:wire :1 mr3 Electri cal repain or additions ,1 „groroptiettaa with rso ele.olo!,,ers. 12.LI Pui lmbng tepairs ce‘addititats gatsseral sxsorratorr wad I ittawa kireti due rak.-ersarxrettora liskezi ors tire stkedrerd arteci. I 31:1 Rooftepairs nesse ao.bmarrasslors:leeeszt elm:lop:cis vrail Evsve workeza'zomp.ibtoranee.'; 1 4.1 3 NI ei:1 Wt$12.4.4 tt terporitni unit its,tiffikum hswearaprir.td&Insti 4. Oth l rigItr.of r.mtiriplipit.pet totGa..e.. Jç „ IZ§1t43,,orid we kcit.e mu aransltxyratets.No warn'evslay.imam:vex rsvagire.4. ) ny- opptitao tea eluceki;ivy%iscl arum asses fill eta£**tectivat,kelow glow:mg?;Mx mattrx*;•et'avezostairal raxli4I iota:as:04m. t koarrourvinera who admit drir affidavit itutieiang iltry UM<king v:it work.old els=Vasa warairk,whsirufigra,alma v)vforreit a rim afertkaviv iv/Jawing web_ tQuarattetvi not the&Ihn,box inina anailte4 2ri:alditionitl St2V.44 Amara*rire..mama ark atdv-ravvraz wets avd Aire ts(rtztrazz to nor drove anitio-loixe oriploye,e,y,., tr.dre...kt .rovaresderS keeik elopktytn*,dory vases(mtwitiz,dtrixworkerss'vamp.Issilky re:miser. i Offi alit tem/tipple that Is providing waders'costpettuition ins40.1itee fin.toty egsployevs. Below is the pitiky aoit f IA site itsfottnatiott. Inioirmate Company Name ..... — Policy#or Self-ins.L .#: Expiration Date: Job Site Address: CityiStateqip: Attach a copy of the workers'compensation polity Ala radon page(showing the policy number and expiration date). Failure 1.0 ik.101.1ft coverage as fccgoirod and MGT e. i 52, §.25A at a Crirtiillesi ctikliklitiltx latigthihalile by a fate up to$1,500330 armor one-year tittpriAmtrualt,att.well as civil penaltiost in the f(mtlft earn STOP WORK ORDER and a foie of up to$250.4/0 a day against the violator.A copy of ibis statement nary be tbmarded to the Office of inveittgations of the DM for insurance coverage verification. ....____......._ _ _ _ I do ttereby ccrify under the tains I peonities drperjory that the 1o/formation provided above is true and correct .ab.:Ipatin-e: Wk..: 411051sP i •e Phone 4: ... , . .... . . . . (.1.fficial ose en0.. Do mat write in ibis itero,nt fr completed by city or to WAt Ofilard. v i! City ar Tows: Permittlicense 4 1 laming Authority(circle nary 1,Stotrd al lleahla 2.Building Department 3.t:ityfrOwn Clerk 4,Electrical Inspector 5. Plo inking,Inverter .,, 4 6..Other l' (.niatitiet Person: Phone#:: ' , City of Northampton • /01 /. Ma s s achus e tts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MG.. c 40, 554, a condition of Budding 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: ela Location of Facility: (ke(Re cr(i 13oArn ek-ov) The debris will be transported by: Name of Hauler: Signature of Applicant: LibS1'@ City of Northampton a a Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Stx:z:<::. • Municipal Building Northampton, MA 01060 ���%db`" t�,,:•" HOMEOWNERS'E.XEMPI'IOW ELIGIBILITY AFFIDAVIT 1, —Dp cflcv d c f'St'a5r (insert full legal name), born insert month, day, year), hereby depose and state the/following: 1. 1 am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. 1 am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. 1 qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns 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 home owner. 4. 1 do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of : t , 20 a.( (Signature)