35-142 (3) BP-2021-2069
35 WESTWOOD TERR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-142-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2069 PERMISSION'S HEREBY GRANTED TO:
Project# 2021 - RENOVATION Contractor: License:
Est. Cost: 0
Const.Class: Exp.Date:
Use Group: Owner: LORENCO, TERESA M. & PETER A.
Lot Size (sq.ft.)
Zoning: WSP Applicant: A. LORENCO, TERESA M.&PETER
Applicant Address Phone: Insurance:
35 WESTWOOD TERRACE
•
NORTHAMPTON, MA 01060
ISSUED ON:10/22/2021
TO PERFORM THE FOLLOWING WORK:
wall added by previous owner
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.
Signature: I Iel art I
Fees Paid: $65.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RE
The Commonwealth of Massachus•tts „DAL:
Q Board of Building Regulations and St.ndar'. FORA
l' IW.
OCT 2 1IC PALITY
Massachusetts State Building Code, 7:0 C R �021 i E
Building Permit Application To Construct,Repair, ' •noD =T nF• nun.DiNDemolish a R: ised ar 2011
GN I EaSPEC i�
One-or Two-Family Dwellin' NORT
This Section For Official Use Only •" ' ' "oso
Buildin Permit Number: �/!-,L j ZOC(y DateJ Applied:
I E u► &C;r5� 1L'�'C� IQ ZZ ZdZ 1
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
Li Property Address: 1.2 Assessors Map& Parcel Numbers
J
3e V s J--w O:) f I?M" L
1.1a Is this an accepted street?yes kr"*.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 Yard
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 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
2.1 Owner'of Record:
- -(6. reAzp ` 0)(e4i► a MA , O/04,2
Name(Print) City,State,ZIP
3 Sc vk/Gafi 6, d 7i✓''-A-‘4. iiiy7i -94u --11-) Iry vrilouse+e V (A)-
No.and Street Telephone Email Address I
New Construction ❑ Existing Building Owner-Occupied 0
Repairs(s) 0
Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Unit er 0 Specify:
Brief Description of Proposed Work': IL L( a .S
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ p 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 0 2. Other Fees: $
4. Mechanical (HVAC) $ 6 List:
5. Mechanical (Fire
Suppression) $ b Total All Fees $
Check No.lb I Check Amount: L
6.Total Project Cost: $ 0 0 Paid in Full 0 Outstanding Balance Due:
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.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC 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 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 0 No .❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
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 application.
Print Owner's Name(Electronic Signature) Date
ifiCTION 7b:4111.1.1iiiiMiMMEMEMENMEMENDN
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.
/0 • g-0 ' a-1
Owner's or Authorized Agent's N (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.gov/dps
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"
"` • The Commonwealth of Massachusetts
. Department of Industrial Accidents
• 1 Congress Street,Suite 100
-Alt- _' ', Boston. MA 02114-2017
www.mass.gov/dia
%linkers'('umpensatiun Insurance atfids%it:Builders/Contractors/Electricians,'Plumbers.
•11)BE I11-k.1)%%1111 riHE PEKN111-1 l (:AI"f11O1R1Tt'.
Applicant information Please Print Leeibls
Name tBusinesse(kpnia/m' ��/anndividual) ,'L- (j -p
Address: 3 S� (wediiittIT�ij 7 r X4
City/State/Zip:_ 1 rre/L'li,e__ AAA 00 G 11)hone#: z-ig-3 31 - 1 G3,'
Megan an crnplritr"_'(heck the appropriate Sot:
Type of project(required):
I.a tam a employ et w dh employees(full and or part-tinrel.' 7. 0 Ne►s construction
U l airs a sole proprietor or pustncnl p and have no employees working fur me m 8. CI Remodeling
u apucrtr.[No isorktn`camp.uewtaetz required" 9. 0 Demolition
.a honrn.ama doing all work myself.iNu workers;tune.Lowrance n.gwrot.)«
loci Building addition
a hunrarwma and w ill be hiring tvrrtr-.rton to conduct all work on my prupm.Th. I w dl
c-n ure that all tuntracturs tither hart wudcri`compensation insurance or arc sole 11.1J Eketrieal repairs or additions
pruptxtun w nth no employees.
12.0 Plumbing repairs or additions
t.c:3 I am a Ztcm.ral contractor and I have hired the sub-euntractan lrstrol un the attached shoat
These sub-contractors hate t-rttploiees and!woe swutkers'eurnp.insurance.:
130 Roof repairs
6.0 w c are a corporation and rAtfr officer,has a c lamed their nght of exion+true per vK _4:il
14.fOdtet
t
I'-'. I i 41_and or.:haw so tvrplwres.[No'workers'comp.insurance required.I
':ern applreatt that checks buy-i mint also till out the scYtwn helots show mg then wudcr+'compensating"policti information.
. Homeowners who submit dus attrdanrt mahtattnr:they arc doing all work and then hoc outside cantrwiwn mint sarbnut a nea Aida*it indicating aurh.
•('untractun that cheek this hol.roust attached an additional stair show rag the mine ut the sub-c intr:wtors and state whether or nut thus:nestles fume
employees. It the sub-trmtrs:turs hasc employees.they oust pros ute then workers"tynnp.pokes number.
I am an employer that is providing workers'compensation insurance for m►'employees. Below is the policy and job site
information.
lnsurrnce Contpanr Nance:
Polies =or Self-Ins.Lie. 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 hs a tine up to SI.500.00
andkor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the%iolator.A copy of this statement may be forwarded to the Office of Ins estigattems of the DIA for Insurance
coverage verification_
I do hereby ce fib.under the pains and penalties o/perjury that the information prtnided above is true and correct
OU -�!
Phone»:
Ir 11
(I Official use only. Do not write in this area.to be completed by city or town officiaL l
fCity or Town: Permit/License rb
1 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#:
City of Northampton
Massachusetts ��. ti
-i t DEPARTMENT OF BUILDING INSPECTIONS
- 212 Main Street • Municipal Building vti
\ ' Northampton, MA 01060 "11,
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 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:
(4v
Location of Facility: " 4C!11
k MirirkkixtetAA Aar.
The debris will be transported by:
Name of Hauler:
Signature of ApplicantjMiD v \ UtY/ Date: 16`)1) " �(
City of Northampton
YH AM
� rOti SAS SAC
Massachusetts mow`' e
� ( 1 • DEPARTMENT OF BUILDING INSPECTIONS
' i11.04*17!ce 212 Mnin Stret 40 Municipal Northampton MA 0 060 Building vb�s`� `^`D
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, I - ?-VLL (insert full legal name), bornI2-2x?iliisert
month, day, year), hereby depose and state the following:
1. I 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. I 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. I 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. I 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 dt 114-- , 2027.
(Signature)