37-022 (3) BP-2022-0074
600 FLORENCE RD UNIT COMMONWEALTH OF MASSACHUSETTS
5
Map:Block:Lot: CITY OF NORTHAMPTON
37-022-005
Permit: Agricultural All
Bldgs
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0074 PERMISSION IS HEREBY GRANTED TO:
Project# BASEMENT RENO Contractor: License:
Est. Cost: 33000 SPENCER SHUMWAY 109237
Const.Class: Exp.Date: 10/10/2023
Use Group: Owner: DAIGNAULT, ANNE TRUSTEE
Lot Size (sq.ft.)
Zoning: SR Applicant: SPENCER SHUM WAY
Applicant Address Phone: Insurance:
130 SHEFFIELD DR (413)221-4049
BELCHERTOWN, MA 01007
ISSUED ON:01/25/2022
TO PERFORM THE FOLLOWING WORK:
FINISH SECTION OF BASEMENT
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
1 y . T'.. .,
' f
Fees Paid: $214.50
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts
Board of Buildin R lations and Standards' ` ' FOR
4)' Massachusetts State Building Code, 780 CMit / \`-✓ ;'.'.."--4-ISCIPEALr11.7
q �
Building Permit Application To Construct,Repair,Renovate Oar/Demoh�h t4 ,Revised Mar 2911
One-or Two-Family Dwelling 7 22 1 /
This Section For Official Use Only " 7, ,(%;i�r,,;V,..,,_ /l f
°ns -; r!
Building Permit Number: 60- ,A.�)'3LI Date Applied: - 'art,7 rn1r.0 ,
14440/11/4- 4.' i I: l
Building Official(Print Name) Signature I
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1.1 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 Yard
Required Provided Required Provided Required Provided
MI- f - ,(/sit
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public M Private 0 Zone: _ Outside Flood Zone? Municipal ici On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
1 er'of Record:
A,ine I p' n,rUif rusee of Tlorene.et (!1A- 0 to(o2
Name int)g ne '9, ,}f Run;ly cru t City,State,ZIP
5 MOOotQin Le u cet -t'h tt 5 (o ll-tt44 -1 au'] Gtrine..ealdeGod O gmaul.c o om
No.and Street Telephone Email Addre
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 151, Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify.
Brief Description of Proposed Work2: 1744 servo., a/ gcrea.,,,,1, 5e e 4. cde./ p/ s y
' dr t,.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs. Official Use Only
(Labor and Materials)
1.Building $ .?4,Coo 1. Building Permit Fee:$ Indicate how fee is determined:
/ ❑Standard City/Town Application Fee
2.Electrical $ '7,cal) 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 0 2. Other Fees: $
4.Mechanical (HVAC) $ Cr — List:
5.Mechanical (Fire
Suppression) $ 0 — Total All Fees:
6.Total Project Cost: $ Check No..� 41 Check Amamt:„2 ,tt ash Amount:
❑Paid in Full 0 Outstanding Balance Due:
C>—"7sv.'r-
tree itµ�.yi License Number Expiration Date
Name of CSL Holder/30 .S4egka /�i1w List CSL Type(see below) (/
No.and Street Type Description
ite OIUU� Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
�d/ SF Solid Fuel Burning Appliances
g/3 0�/-74 Yq dodn.1-7 Cok r %i-&�� I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) // 3.2k +R / .23
5QCii(O' vonway HIC Registration Number Expiration"Date
HIC Cavany Namy or HIC Registrant Name //
NNo.3o ReV .d✓ �7"1-4t y 'i�71 .0�€4,,i 4i'-i,
/ rGe 1 Oially 0 /-at4 107 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 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*etar �11l tmW0.Y��humbiiaky 6n 61'actro 0 u.c.
to act on my behalf,in all matters relative to work authorized by this building permit application.
e r l 111112da2
Print Own (Electronic Si Date
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 accurate to the best of my knowledge and understanding.
major• <� 5,��,.�"'''� //7/h..701
Print Owner's or Authorized Agent's Naabe(Electronic Signat re) 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 arrecs 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.govioca Information on the Construction Supervisor License can be found at www.mass.govidps
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"
5 Mountain Laurel Path Northampton,MA 01062
Basement Renovation
7'10" 10'5"
* Electrical Panel
A 5-0 Double doors
Mechanical Room B 2-8 LH
D Existing 3-0 Door to bulkhead
Shelving 8'x 2'
B
Closet -B
5'5" s' Office I
Stairs
18' 20'
N.
5 A
0
0
Living Room
12'7"
0
a
ro
D 1
26'7"
The Commonwealth of Massachusetts
r Department of Industrial Accidents
"" �+Ito= 1 Congress Street,Suite 100
_ IN Boston, MA 02114-2017
* www.mass.govldia
11 urkers'Compensation Insurance Affidavit:Builders/Contractors/E lectriciansiPlumbers.
TO BE FILED%%Il tl '1HI.P}:RMI r1Irc:At l l�(rRlrti.
Applicant Information / Please Print Leeh ib
Name tHttsUICSS'O gantration:Individual1: �r �v�. �f2l/7 ev _.4•0 a/wa y/
Address: (3o die
CityfState1Zip: fa kw"JM49 01CD7 Phone; : Gfi3;.22l �oY9
Are gar an a'Check the a1 +��ebw
Type of project(required):
1.01 am a employer with employees(full shim r pan•timel." 7. 0 New construction
2 3a I am a suit proprietor or pantxrs.np and have i*i employees wuAmsr for me In 8. 'v
any capacity.[No workers'comp.miiurazwe tequixnid_j Remodeling
30 lion a homeowner doing all work myself.No workers'c insurance ❑Demolition
'�P- m4ametl.I
4.01 am a humeowmt and will be hams coneradursto conduct all work on my property_ I will I0 Building addition
ensure that all contraLturt either have workers'commensation insurance or are sok i i.o Electrical repairs or additions
promo:tors with no employees_
12.0 Plumbing repairs or additions
50 I am a general contractor and I hale hoed the sub-contractors Bated on the attached sheet
13.0 Roof repairs
Meese sub-conmactunx Ittbr inn bytes and have workers comp.tnstuunce.:
60 We ate a axporation and its officers have ex M etcianl their right of exemption per GL c. 1 d.D Othet
152.¢04).and we have no employees.[No workers'comp_insurance required]
"Any applicant that cheeks boa a I must also fill out the section below showing their workers'compensation pulley mlormatwn.
i Homeowners who submit this aftidaoit indicating they are doing all work and then hue outside ecmtraetors must.submit a new affeda.it mdknting such.
:Contractors that chit this box must attached an additional sheet showing the name of t e sub-ewuractors and state whether or nut those moths live
employees. lithe sub-contractors hose employees,they must provide their workers'comp.policy number.
!am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
hrfor mation.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: CitytStat&'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 NIGL c. 152,1125A is a criminal violation punishable by a tine up to S I,500.00
and/or 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 violator.A copy of this statement may be forwarded to the Office of Investigations ot'the DIA for insurance
overage verification.
!do hereby certify u r the pains d allies of perjwy that the information provided above is true and correct
Signature: - Date: /�/0,7.2
Phone#: O3 '.2.1/—efoVr
Official use only. Do not write in this area.to be completed by city or town officiaL
city or Town: PermitlLicense a
Issuing Authority(circle one):
1. Board of lieaith 2.Building Department 3.('ityrt'own Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
M
' Massachusetts `• x- '��•
+
r w y M
• z DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building vti O��,- "!4 Northampton, MA 01060 rsth 3 t�l
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: lAS 7` Hs% 410,- j//7 GY�YC
The debris will be transported by:
Name of Hauler: ,v w�,cww
Signature of Applicant: Date: //.00.72
5 Mountain Laurel Path Northampton,MA 01062
Basement Renovation • Electrical Panel
A 5-0 Double doors
7'10" 10'5" B 2-8 LH
D Existing 3-0 Door to bulkhead
Mechanical Room
existing floor joist
4 2x4 kd top plate
Shelving 8'x 2' "E
B Dropped Ceiling
Closet -B
5'5" 5' Office I
n
Stairs
i 2x4 roxul batt
I 1/2"MR gypsum board
18' _ 20' �2x4kdstuds
A
0
£ Living Room 1"polyiso board
12'7"
0
0
D I existing concrete floor I 2x4 PT bottom plate
26'7"