23A-111 (5) BP-2021-2084
2 MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-111-001 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-2021-2084 PERMISSIONISHEREBYGRANTED TO:
Project# PORCH/STAIRS Contractor: License:
Est.Cost: 40000 DONALD DESCHENE 020676
Const.Class: Exp.Date:09/13/2023
Use Group: Owner: DESCHENE, NANCY TRUSTEE
Lot Size (sq.ft.)
Zoning: GB Applicant: DONALD DESCHENE
Applicant Address Phone: Insurance:
143 FAIRWAY DR (201)668-1222
NORTH DARTMOUTH, MA 02747
ISSUED ON:11/01/2021
TO PERFORM THE FOLLOWING WORK:
RECONFIGURE AND REBUILD REAR STAIR/PORCH. NEW RAMP
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: p
ii
Fees Paid: $280.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
File #BP-2021-2084
APPLICANT/CONTACT PERSON:DONALD DESCHENE
143 FAIRWAY DR NORTH DARTMOUNTH, MA 02747(201)668-1222
PROPERTY LOCATION 2 MAIN ST
MAP:LOT 23A-111-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $280.00
Type of Construction: RECONFIGURE AND REBUILD REAR STAIR/PORCH. NEW RAMP
New Construction
Non Structural 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 SpecialPermit 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
_ I I
Si ature 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.
Imo- DNS
0
The Commonwealth of Massachusetts
Office of Public Safety and Inspections
Macsai-husetts State Building Code(780 CMR)
N." - Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Ruldin� �j Numbe► 'ad-1 gl Date Applied: Building Official:
{ t - , SECTION 1:LOCATION
• _ 5-L t-C -►-` C L 01062
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION?:PROPOSED WORK
Edition of MA State Code used titi If New Construction check here 0 or check all that apply in the two rows below
Existing Building Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes Id No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No4
Brief Description of Proposed Work 1~coter1ert1Re. A4t,reqz
_c_AA _*w tatLir P) ST1"'iT-- 9.l1} roc rotr 14-
1 I t--u.se- o'r.- ,N 1 t-t.[ U tAD P&r t 1"
Apt c-p41-t ols‘
SECTION&COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): > Proposed Use Group(s): 1;
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 3 055 .S.4 StrcI—iis
Total Area(sq.ft)and Total Height(ft) '›CCO ' 3.,r16 _ ,
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 1 B: Business ik E Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional 1-1❑ I-2❑ I-3❑ 1-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1❑ S-2 0 U: Utility 0 1 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 lB 0 IIA O IIB ❑ IRA 0 IIIB 0 IV 0 VA 0 VB
SECTION 7:SITE INFORMATION(refer to 780 CMR 1053 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public Check if outside Flood Zone❑ Indicate municipal A trench will not be Licensed Disposal Site❑
Private 0 or indentify Zone: or on site system 0 rrquuedor trench or specify
permit is enclosed❑
Railroad right-of-wa . Hazards to Air Navigation: MA Historic Commission Review PAIL e<<::
Not Applicable Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No Yes 0 No tiK
SECTION&CONTENT OF CERtICATE OF OCCUPANCY
Edition of Code l Use Group(s): ¶ Type of Construction "
Does the building contain an Sprinkler System?: PO Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION _
Name and Address of Property Owner
'a 214 Lek I1-y Tf t 143 _F-0,ifvsra t'ic:ut No ftl&PADA 3)7 7
Name(Print) No.and Street City/Town Zip
i
Property Owner Contact Information
Tee' On/i 0 0 ill&7t - - ao_..L. - Iaa7- 3i,Ac tire?f,i'l.coo,
Title Telephone No.(business) Telephone No. (cell) e-mail add
If applicable,the property owner hereby authorizes
Name Street Address City 'own State Zip
to apply for and act on the property owner`s behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft of enclosed space and/or not under Construction Control then check here 0.
Otherwise provide construction control formic(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
it i -
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Company Name
Nt-L D c-, t* SCt.-tA . G S- O2-O67-1(Ca - f hJL3
Name of Person Responsible for Construction License No. and Type if Applicable
t 4 5 ',.-11-w/..-C \4OVT\ 17 mouTt'k t1P. 02-141
i Street Address City/Town State Zip
( 1 -6 saga c ,esci^etle_ ►'i .crazy)
i Telephone No.(business) Telephone No.(cell) e-nta' address ,
SECTION 11:WORKERS'COMPENSATION INSURANC(:Al FHDAVIT(M.G.L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit hum the MA Department of Industrial Acrid must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the' uance of the building permit
Is a signed Affidavit submitted with this application? Yes No 0
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
ItemEstimated Costs:(Libor 40,000A0
and Materials). Total Construction Cost(from Item 6)=$
1.Building '%wr.��, $ "'T"'%tX . Building Permit Fee=Total Construction Cost x 7.00(Insert here
2.Electrical �""'$ 40,000.00 appropriate municipal factor)=$f1).-
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to CITY OF NORTHAMPTON
6.Total Cost $ 40,000.00 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby a undo pains and penalties of perjury that all of the information contained in this
application is true and accurate to the t wledge and understanding.
-6Gsg- iaaa.
Please print and sign name I Title c Telephone No. Date
Street Address City/Town State Zip Email Address
,
Municipal Inspector to fill out this section upon application approval: a % f� 1 x 4 ,' ( ce ]
Name I Dw
City of Northampton
/.ZYMAMf +M
ren o�j` S,4 ,. ,Clf
,� _. Massachusetts 4Y./
c
4,, 4 R1. '3 DEPARTMENT OF BUILDING INSPECTIONS igt
1x
� _.1 212 Main street • Municipal Building vim• 4a
\ W "% Northampton, MA 01060 rsbjy ,"`
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:
Location of Facility: j 0I1te Pet I �1
The debris will be transported by:
, I I
Name of Hauler: l'e1� +Gher✓Vl.u.K1
Signature of Applicant: Date: l° \ / )
The Conlmonweadth of Massachusents
Department of Industrial Accidents
1 Congress Street,Suite 100
Boson.MA 02114-2017
www.wtttlss.govldia
Workers'Campanulas tunraace Affidavit:Brllderi C mben.
TO DE FILED WITH THE PERMITTING AUTHORITY.
Annlicant Information j�,, Please lariat trebly
{ i%adi>at): .2�tal4 41°
Address: 3 Fait 1wo?/ 11 of
t r
City/StatelZip: lWM (11rt111,74,th/11/VO 7Phone#: 1"
Art yea soes*,er Cleett►eappropriateM,: Type taf project(required):
a c� Oa as
al t.u1 employer,Ol'ur partdirerl• 7.Rs/constconconstructiona sole rri i.'.r us.partnership as l has.au caplo)ce,is urlme, fur tam ro Lmodelirag
I say capacity [4u r ukcn'acme+ mnMaanor mowed J
3I am a huenns*,ser slums all%ua mywl([No a urlss".carp vasurarre rryria mill•
9. ❑Demolition
aI m a huasicar.m mat i*all b.[raring coatracvxs to canJuet all u tak w ..p my, mry.I aril PO❑Building addition
nacre char all casitzazion calms Irate samisen'cumpoo min uraarwer or art oak II Electrical repairs or additions
prupracwars*ids at employees.
ILO Plumbing n(riits or additions
Ian a vassal cswc aa aiur i 1 hate hard the auban crrac1aw, the
-d as s adadiedtieel
vassal
TLar subl w e ca totracs haltapkvyec+awlbne workers'comp.arotaraace.r 130RooCrrpaus
we n a its once=Iotacaw iced dtci rash'of ei ta, ua per XIGL c 14.Q Othei
Va a
1S2.ft(4mattrsinsweamplaysaa.Pie werkaaa'comp masa awe ragweed.j
!Alf!aogwini tea clacks later•t aria mho till nadir swim bcdora amens their*rite'crm ssiumiee Fahey larsis ima.
•Iiu.rarrec»*imp Wait dia atraiaaia joshes/mg they ate iraa ail week and dam kit wtatitlt taamraeaata talrr se tesii a mew affair.r■al..aing cue h.
:aaOacaan dui cie+d dial boa out Malta ere a.i.fitilmal,i.e+sbwis dat emit off aabeaaar-ai.ra and wee*Werth era arms[[hiss.iu.Lc.his c
eapluyars. If the wb-cootraws has a eapkahon,din ears[pros ak tSc.r a.uaiei wnia ,t number.
I CAN an employer that is providing workers'compensation insure for oty employees. Below is the policy and job site
information.
Insurance Company Name:
Policy X or Self-ins.Lit.#: Expiration Date:
lob Site Address: City/State/Zip:
Auacb a cop) of the markers'compenratfasa peaky dedarstiM Pee(showing the policy number and expiration date).
Failure to rxi u:r nos eriwc:s requited undo MGL e. 152.1125A is a etiminal violation punishable by a fox up to S I.500.00
and/or one-year imprisonment,as well as civil penalties in the fannofa STOP WORK ORDER and a tine of up to S250.00 4
day against tie a°iolator_A copy of this statement may he forwarded to the 011ice of Investigations of the DIA for insuran:i.
coverage verification.
!do hereby J' nderlkffwins and penalties of perinly that the information provided above Ls true and correct
sue: Mar 10I2\1
Phone r/'a31. G74) —
Official nee only. Do not write In this area.to be completed by thy or town official
City or"(woo: Perish/License
kissing Authority(drdt one):
I.!ward of Pled 2 iitdLdiog Department J.City/Town Clerk 4.Electrical luspe'for 5.PIuatblaj;Inspector
IL Other
t'on tact Person: Phone'ti:
( Initial Construction Control Document
f�l 07 To be submitted with the building permit application by a
E. v Registered Design Professional
for work per the 9`h edition of the
• !.,�.a� Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Dr.Deschene—Dental Office. Date:September 13,2021
Property Address: 2 Main Street—Florence, MA
Project: Check(x)one or both as applicable: ( )New construction (X)Existing Construction
Project description:Renovations to business office building to establish dental office,including replacement of exterior
stairs and HCP ramp,expansion of parking and reconfiguration of some interior rooms.
I Brian De Vriese MA Registration Number. 7348AR Expiration date: 08-31-22 ,am a registered design professional,
and I have prepared or directly supervised the preparation of all design plans,computations and specifications
concerning':
(X)Architectural (X) Structural Mechanical
Fire Protection Electrical Other.
for the above named project and that to the best of my knowledge,information,and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted
engineering practices for the proposed project. 1 understand and agree that I(or my designee)shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
I. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a' vet"or
electronic signature and seal:
(EREp ARexi,
\g
i
m l 1
c> No.7348 co
HEATH
MASS.
41711 OF µt'SgP
Phone number:(413)747-5285 Email: brian@jdarchitects.com
Version 06 11 2013
Appendix 1
Construction Documents are required for structures that must comply with 780 CMR 107. The
checklist below is a compilation of the documents that may be required.The applicant shall fill out
the checklist and provide the contact information of the registered professionals responsible for the
documents. This appendix is to be submitted with the building permit application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
I Architectural
2 Foundation
3 Structural
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing(include local connections)
9 Gas(Natural,Propane,Medical or other)
10 Surveyed Site Plan(Utilities,Wetland,etc.)
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Au.ess Review(521 CMR)
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
'Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein Work so identified
must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the
authority having jurisdiction.
Registered Professional Contact Information
4t3-145- 5255
"��1t-1`t �>�. �144$ 13-337-%Z-9
• brt�e�dAY�4tt'��,ce�l 13
Name(Registrant) Telephone No. e-mail address Registration Number
k -k . a13i
Street Address Gty/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Please follow this link for construction control forms to be used by Registered Design Professionals.