37-022-003 BP-2022-0237
600FLORENCE RD UNIT COMMONWEALTH OF MASSACHUSETTS
3
Map:Block:Lot:. CITY OF NORTHAMPTON
37-022-003
Permit: Ahs Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0237 PERMISSIONIS HEREBY GRANTED TO:
Project# 2021 RENOVATION Contractor: License:
Est. Cost: 9240
Const.Class: Exp.Date:
Use Group: Owner: L AMES, BETSY
Lot Size (sq.ft.)
Zoning: SR Applicant: L AMES, BETSY
Applicant Address Phone: Insurance:
25 MOUNTAIN LAUREL PATH UNIT
3
FLORENCE, MA 01062
ISSUED ON:03/10/2022
TO PERFORM THE FOLLOWING WORK:
CREATING NEW MUDROOM/LAUNDRY
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:
• V yg . (At,
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
.."
14: -...-----/-3:"------__
iL, The Commonwealth of Massachusetts 4/4R -Board of Building Regulations and Standards 9 --/VOR ..
Massachusetts State Building Code, 780 Clvij3:- (90(19 MUNICIP*LITY
-;;"-,-----.
USTI
Building Permit Application To Construct.Repair, Renovate Ort*tnOsk.a, Rel4set 1 Jyar 2011
One-or Two-Family Dwelling
-- L;
This Section For Official Use Only -......,....z...n.....,
---...
Building Permit Number: GP- )- ao— . "--1 Date Applied: ..__,.
1/ 3.-10-7-02-Z_
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address:3 ropw-vitAd LAwaiti,14111t 1.2 Assessors Map&Parcel Numbers
FL.4114.0,(-4, otth 0106'4. 7 02 z....
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use I 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,, site disposal stem 0
LJ On ssiom LJ
Check if yes0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Sit ri,i 4.* A-A446 fue,s4p#44, ,444 of totet.
Name(Print) City, State,ZIP
I Mwut*T4,,,..i L4v(1.1.t. /24/74 17***,,1 il-3 a 1.? yis•6-4 s.....(r411910„riomi.4440,1 .
No. and Street Telephone Email Ad ress
SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply)
!
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 I Alteration(s) (it Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 4,4)01,44, p.4714iiet. ,if*.0/loom .4,ini 1,40.511(4./0,4/44._
AA,tertirriftit- how 4.0-44.05 t,h hiftuAA-v ro frolic .4- Olvv.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
I.Building $ "--,-,P.IP, 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ I 2.90.OP
0 Total Project Costs (Item 6)x multiplier x
3.Plumbing $ 7,4"iv.," 2. Other Fees: $
4. Mechanical (HVAC) $ List:_
5.Mechanical (Fire $
Suppression) Total All F021 19(1
Check l'•Io. I Check Amount 6. Cash Amount:
6. Total Project Cost: $ 17.1o.00
0 Paid in Full CI Outstanding Balance Due:
City of Northampton
Massachusetts
/
.+ $ t 4DEPARTMENT OF BUILDING INSPECTIONS ;
212 Main strut • Municipal Building t
• _ ,, Northampton, MX 01060
W 3'=
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 &2 FAMILY DWELLING,ADDITIONS,POOLS, DECKS,ACCESSORY STRUCTURES,
FENCES,GROUND MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specification of proposed work(digital and hard copy).
3. Site Plan with location of proposed structure(s)and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC 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.
7.
/
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL T}pe(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35.000 cu.Il.)
R,a,,-,. Restricted I&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(IIIC)
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 . 0
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
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 i this application is true and accurate to the best of my knowledge and understanding.r
Print Owners or Au//thcrnzed 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 MG.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.ttov/dos
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"
4pit'oeisi-iovc
CITY OF NORTHAMPTON 1711$ 1.5
.13011-4.A4• Ater
SETBACK PLAN 4.40.5
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE'YARD
FRONT SETBACK
FRONTAGE
City of Northampton
Massachusetts
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' I DZPARTMENT OF BUILDING INSPECTIONS -;.• '
212 Main Street • Municipal Building
�y
��� Northampton, MA 01060 4.tp,�, jS1`
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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:
4)4 fJ4't. - '5TA-,�
Location of Facility: C
The debris will be transported by:
ivUtkeiName of Hauler: Como
Signature of Applicant: Date: 3Gl'- -
The Commonwealth of%fassachuserts
„_,,,, Department of Industrial.9ccidents
,----i„„.,e.
!t .:wwSb:.,.. A 1 Congress Street. Suite 100
` Boston, NIA 0.114-.01"
Vr ss•,s+s.utass.gos,No
AN„s her C oinpensation Insurance.fsdarit:Builder;(ontractors Electrician:Pitucbera.
TO BE FILED WITH THE PERs lIT EK,,AVTHORITY.
.4ppbcant Iuf•.•rsBitaou Plea:*hint Leetbh-
Naz:ze Sui,:reess OuamIsncr Z i:adisify 1341$I Apvirvi
Address: 3 M avps-AI N L 4 C. eitnJ
City State Zip: f? 44, 04. Mk Di otaa. Ph:,-e "7 if-'''472- 3043
Ali set as eaplectc'C keck tit appropraact!as
Type of project(required):
:01 a=r a s.np;a er sscF arcs fa!:=l st pa. cz»)• ' ❑-.tic eatrtnction
:Q:az a x:s prap:sstc:c:pzr.s:::tp aad hr's ao s:apaovss:ar:tis:g ::o asp g ❑ latnnerhn(
saw :apac:- :':c atessr'cc._p .:.:•:.'a:cs sic:.::sd:
9
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iC=Q Busking 3i4WOa
-Ni i a:a he ss=n it>ai sria is sr..g cc awa:ars to:ca&,:.a::acA on xb Fersrrp :rri•Z.
sates•:a•a:.cr:=actc:s..hu hay:s wx•isa: :aa.s::=c:ca—z.ucs u us:ass 11.0 Mammal:span o: 3,i,i11130.1.
prspascx:sits at s:;pit.ss: 12,0?.aza; sepau:oa aciWcots-.
•D:a_z aeaert" -t;.-z: :%a its!.is=ed riss ssst-cca7xron t:sto3 c:the a:•azasd�.ae: 13 CI.Rootrepair.
Tsa:a wabrcc .t. ^..ra,a s=F:aYss:aad hr.s tsxiszs'cow =su*acs:
f_El Ws rs a eel;:mac:acd It:o crs :'e w.-cusd tau:nti c f s:ascp cs .Y.,:.Y.,:::.per '. :
14.QOtbes
:.11`c}.sad we ar.s co s p:r•a: z:o arcessn'caz :am-sacs:+s.asti;
'As!,spy Scut tar ehs, s tc s._ .:a:::f.L sot ca►torsos ta'.nx ahva=4=sr wcri sn'ecr ras:uw26 pok. adsrseat..a:
• essaxas:1 aho%skate_..:a54::.t=.,a'caL:g a,-ass dtas t s«Qari sad axes:..n acts.!•:aara cer%mas:.,:':ac:-a:rz*Sass: a tacssc.f soh
c: :x:`:a::h►:i tla::bcs mL:t ara.ciwd as 14,3.s:3as::a sc a-a s:z sae as-aw,si aas :-:tatac:x•.tad swa s-as:sa r.c=teas satss:azt.•
s ptc,ss: :`ass::?+-:c_tactx:hers szcp:^-ss: ;is,is r.t pta:.'vs a sr at.isc cam pc.ic-rxt`:
I cm an tntplos tr that is providing not kcrs'compensation Insurance for my employees. Beloaa is the pohey end lob site
information
ircurz ce Company Name:
Poky t=o:Self-inn.Lac u: E,puacou Dare
Jot: Sate r;:1d:s=..: C:n•State Zap:
Attach a copy of the Worker;'cosapen:ation pobcy declaration page(.boring the pobry number and expiration date).
Fain:a to:es-u e;overate a,segtu:ed under NIGL c 152. 25A i,a cry:%-nalatec,punishable by a fine up to'S .`60.00
a d or one:•e.s :mp: o:use:t.as cell,as wal peraltre i form of a STOP WORK ORT?3t and a Ent of up,o S_5C 04 a
day aagasr~:t dte•.1.0:ate:.A copy of du: statement may be fc sr tided to the Ofrsce of Inve',tlptioa:of the DIA for ut ura i e
:ones-age ver.fi: r cn-
I do hereb+ crrup�ft mkt the pains and penalties o►f urr that the information provided cx+e i s cs:rc cud eorrecc
��a :ttue f .....ft-----/A
Date 3tj 112'
d one 17r- 413 -3at3
Of>tnai use onh. Do runt+ante ur this crew.to be cortr leted In cite or torn orficial
C in or Town: Permit License=
1::u:ng.kuthoritl (cucle ours:
1 Boar d cf Health :. Btuldiug Department ? C ir? Toiiu C let). 4.Electrical Iu:pector =.PIumbtug Ill-pecso:
6 Odic
Contact Per oon: Phone-:
T
City of Northampton
`p,*
?9 Massachusetts ��� "dr,
9
DEPARTMENT OF BUILDING INSPECTIONS ,
«+ - 222 Main Street • Municipal Building �►�
�,/Ai✓oro, hortha,.r.ton, XA 0i060 _
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
1, 5 ` t_ (insert furl legal name), horn Jzig 1 I7S-(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 11o.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.RS.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 1 qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work
on my parcel, 1 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 1 engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel,I acknowledge that 1 am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this 3t'day of 144 , 20 31Z.
Sig
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