29-582 (3) BP-2022-051 7
131 WOODS RD COMMONWEALTH OF MASSACHUSETTS
Map:B lock:Lot:
29-582-001 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-2022-0517 PERMISSION IS HEREBY GRANTED TO:
Project# BASEMENT RENO Contractor: License:
Est. Cost: 35000
Const.Class: Exp. Date:
Use Group: Owner: ROMAIN WEBER, JACKSON K& SARAH B
Lot Size (sq.ft.)
Zoning: URA/WSP Applicant: ROMAIN WEBER, JACKSON K & SARAH B
Applicant Address Phone: Insurance:
131 WOODS RD
FLORENCE, MA 01062
ISSUED ON:05/13/2022
TO PERFORM THE FOLLOWING WORK:
BASEMENT RENO
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
• Ir 6 )2 (P1
Fees Paid: $227.50
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
1
if/Ay 12
,..1 , 2Q22 The Commonwealth of Massachusetts
4t__ . .............
Board FOR
Board of Btiily.1rb I:<..;.:�.......:.c— .3.::_:...:..-
If
MUNICIPALITY
•; �'1 1,i,r isP; Massachusetts Slate Building Code, 780 ChMUSE
lM � �fFC ` ..,
-13 ildi ihfhit Application To Construct,Repair,Renovate • Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildn� Permit Number: 410' }.)'' gJ 7 Date Applied:
euio
(Z),
li .
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.2 Assessors Map& 'arcel Numbers
r S Pla e4cc At 010 b 2 2 f S Z-
1.1a Is this an acrep'�:d street?yes no Map Nurrn ._�- Pared Numb r-
1.3 Zoning Information: 1.4 Property Diiuens ons:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Buila:::6 Setbacks(ft)
Front Yard --_ Side Yards -�__- Rear Yard
Required Provided Required Provided Required Provided
1.6 VI'ater•Supply:(M.G.L c.40,§54) 1.7 Floc11 Zone Information: 1 Sewage Disposal System;
Public❑ Prir�;'.e❑ Zone: _ Otrtsi l-l l&d 7c*f:? A uaici �.1 C! U. _-, L
Check if yesLi Ir' '��'' c`}
ssj 2 ...0
t° 'of£Web c 1 �i-<<,vrA to AAA- C 1 lAZ-
Name —
(Print) City,State,ZITS
131 l kill-0 -Z 1`4 LAicbt r^.Jatio w .K. !9 q.rw.1 •`•
W000�s -- -_ -- _
No.and Street Telephone Email AL—Micas
New Co:1st:act;o- f7 Exit ;nuildiw,-;V On;;t,-v,::.ci e Fr 1:c;::. . ; I hl: ;'.; Ae, _';_n
Demolition 0 Accessory Bldg.0 Number of Units Other ❑ Specify: — -_
Brie Description of Pro Work2: TV.;S\ V i r or se/A . 4 i-c K iit&.iL4a
U0. a►,. ;L.' tL -L i.A-�►(1 ' �,. Ce I, L11,
asVIAAS H;-Se1,4 ,: Cie C G4 A- t1 1c+c b0;1+ .14 .,..e (l.
Item Estimated Costs: 0
.•in!Th.,- 0•:'.
(Lab:r. and 1vLait.i r u.)
1.Building $ J31C 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical— — $- - �1� ` -�J ❑Sta.rcf;f d Ci!T!To�;ri Ap lication Pc
c
a ,_I Cr...,.' cy ,l x
3.Plumbing $ ( 2. Other Fees: $
4.Mechanical (IIVAC) $ _20List:_
5.Mechanical (Fire $ �j
Suppression) tr✓ Total All Fees: $ of D ).�0
no Check No. kl--0! Check Amount:
6.Tote Pro?,-,-r Ce= I $ ` ),,0 . Li Paid in I,. ((V�KLJ W jj
i:ii KL..Lib :aLC LiLi AL.
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.)
K 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 ❑ 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
By entering my name below,I hereby attest under the pains and penalties of perj ry that all of the information
contained in this application is true and accurate to the best of my knowledge an understanding.
•Jacksc 1 (A)-e r EV/IP2
Print Owner's or Authorized 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 M.G.L.c. 142A.Other important information on the IIIC Program can be found at
wNA v.mass.waa\ ,),,i Information on the Construction Supervisor License can be found at w 'a.may .<eu\ Jp'
2. When substantial work i 11j led,provide the information below:
Total floor area(sq.ft.) 4:4 r (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) 530 Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of laclf/bati,s
Type of heating system h:A:5 rtz k Number ofdreks./lxmrchcs
Type of cooling system ,; : -IS Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
HAM
City of Northampton
Massachusetts Q.�: •
j d �t
i d a DEPARTMENT OF BUILDING INSPECTIONS1,7
,7
�. 212 Main Street • Municipal Building v6 OD
k`d Northampton, MA 01060 ss fW 3i7���
IIMMINIMMINOMOMEMB
)6, �{1,,(J\C ',n C^AV (insert full legal name), born (insert 1 t,i
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 I I day of f , 200�.
(Si re)
__ The Commonwealth of Massachusetts
� '"t`M Department of Industrial Accidents
y = P; 1 Congress Street,Suite 100
•
-. ' Boston,MA 02114-2017
_:,• www.mass.gov/dia
11 orkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumhers.
'10 1W FiL.ED WITH THE PERMI.1'1'ING Al ITHORITY.
Annlicant Information _ _ Ple
ase Pr m int IA
Name (Nustnessorganizauon+Individual): vd._ ‘cSc\
Address:.— i 31 W S nor
ot �' A O O Phone#: �1 -(2i0 -a1 iLI
JLR j �,.
CitylStateJZip: :; ' / t�
Are you an employer (:heck the appropriate box: Type of project(required):
I.01 am a enipluyet with _ employees(full andwr part-timer).• 7. 0 New construction
Lint am a sole proprietor or partnership and have no arttployees working lot me in S. 0 Remodeling
any capacity.[itio workers'comp.insurance required.]
4. 0 Demolition
. a honnowner doing all work myself.[Nu workers'comp.insurance required.]'
10 O Building addition
OW a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'eornpensacwn insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
S I am a general contractor and I have hired the sub-contractors listed oar the attached sheet.
These sub-contractors have employees and have workers'con,.inrance. l 3 Q Roof R airi.
su
14.IOther h.❑we an a corporation and its officers have exivinved their right of exemption per Mtil_c.
C 'IAA jlrt k r ,14
152.*1(4).and we have no employees.(too workers'comp.insurance required.]
•Any applicant that checks box let must also fill out the section below showing their workers'compensation policy intur mat tun.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must sul+mit a new affidavit indicating such.
:Cotaraetors that check this box must attached an additional sheet showing the nitre of the sub-contractots and stag•whcthet or not those stones hate
enrpluyt:es. If the sub-contractors have employees.they must pro%ide then workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:_
Job Site Address: City Sttate/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 violatio punishable by a tine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WO ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of 1 estigations of the DIA for insurance
coverage verification_
I do hereby \erti under the al s and penalties of perjury thus the information prorided abut e i., true and correct.
7 1 II lo7:2
I'lntnc i i 6/0 0I44
Official use only. Do not write in this area, to be completed hr rift'or town official
City or Town: Permit/License#
issuing Authorith (circle one):
I. Board of IIcalth 2. Building Department 3.City/Town Clerk 4. Electrical inspector 5.Plumbing Inspector
b. Otht'r-
( ontact Person: ('hone#:
City of Northampto4
Massachusetts �4' - <
DEPARTMENT OF BUILDING INSPECTIONS 4". ,+ 1 212 Main Street • Municipal Building v,S
Northampton, MA 01060 s'bh
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a conditi n of Building Permit
Number is that all debris resulting fro this work shall be disposed of
in a properly licensed waste disposal facility, as defined by GL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: V PLL(3-
The debris will be transported by:
Name of Hauler: S F
X113aSignature of Applicant: Date: VI
Sectional Building Plan `
Shingles
Lto 'Assembly: -✓Folt
Pitch- Rafter �. iccBarrr�
Covering —�� _ _ or Roof Sheathing
Truss
linderlayme
fee Barrier Coiling hist _ ' ' 1,,,
Sheathing-
Trun-Cut Sheet Re iced Clew the to 'gt .-« E •ffi —.,-
t)r o support �� {,{ li
Rafter Size- 1
tafter Spacing- 12" 16" 19.2" 24" _ . ._.... A
ita r Clear Span
Itafter. ecies-
Ridge- Siding ,, .
. Ceiling Joist St . - • Sheathing -------- t •
Ceiling Joist Spncit - 12"16"19.2"24" s
Ceiling Joist Species- • rnsalaGott --" _..._ r
i
Insulation-R
interior Finish• ' Wall Framing _--
Attic.Ventilation- interiort inisti -------
Walls:
Siding-
1 ,
'
Sheathing-insulation- 1.1 fog
� i
Wall Framing- 7_t< g L.-
!leaders- j
Interior Finish-
nl Y tl
Floor:
fC Finished Floor-V i Ai _ 1s pJoor
Sub-Floor- - _ -',
Floor Joist Size- FloorJoiat Y T `
Floor Joist Spacing-12"16"19.2"24" Otszaztea
Floor Joist Clear Span- Clear te- ,, i owe
Floor Joist Species- v Span,to Clio opposite r'";- .,y;.
'Beam Type&Size- -. • ".
Distance From Grade- i '; '
—_ Sill Plate : t1,•� '''.
•
Foundation `4 ` °�%IA , `.- ,Foundation: _ _. __. . r rAnc °rage-
Sill 1' tc- Foundation Wall --- „,r w ; :'�t, a;.Q
Wall. pc&Size- q:e..
iteiufor•entent- —
zteinfoteement -.1....t ,•;
Concrete Floor Thickness- " .f;� ,'. ..
i v�ZF.�i:•,^G v
Vapor Bat ier- Concrete Floor '7 :
Column Pa Size- X Xlinlimmili
Column Spec g- . , s„i,, ;;r
Footing Width w Vapor Barrier .1 •
Footitig Height- Footing
Fooling Depth Belor4 rade- • ��
___.�.- - - r ..-_ti_____ _. .
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