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11A-023 (3)
BP 2022-1079 32 UPLAND RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: I IA-023-001 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-2022-1079 PERMISSION IS HEREBY GRANT I TO: Project# 2022 PORCH Contractor: License: Est. Cost: 5000 Const.Class: Exp.Date: Use Group: Owner: F RONDINA DAVID C&TRINE Lot Size (sq.ft.) Zoning: URA Applicant: F RONDINA DAVID C&TRINE Applicant Address Phone: Insurance: 32 UPLAND RD LEEDS, MA 01053 ISSUED ON:09/01/2022 TO PERFORM THE FOLLOWING WORK: BUILD OUT PORCH 8 FT&SCREEN IN 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 VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner i The Commonwealth of Massachusetts ,. * -, Board of Building Regulations and Standards FOR wy Massachusetts State Building Code,780 CMR MUNICIPALITY / USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:(3p 202,2-1 O`] Date Applied: Si T613 t � Building Official(Print Name) Signature SECTION 1:SITE INFORMATION 1.1 Property Address: Leeds Assessors Map&Parcel Numbers J 3a vplit, •d. ice s t 0 - 023 - nn Li l a Is this an accepted street?yes no Map Number Parcel Number 1.3 o Information: 1.4 Property Dimensions: . 31Cc�rc 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❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system D Check if yes❑ SECTION 2: PROPERTY OWNERSHIPS 2.DaV Owner*a /� ds M fRecKDnd'4 4 D/ps,�LL� Name(Print) City,State,ZIP 3 Up( 4% o/ Ad so,/pit l-"Qio,7 823or 9' ;1.0O3 No.and Street Telephone mail Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction`s. Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s), Addition - Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: B C_/t c 9✓f C v e r e.,it fl o r c i, an add; >1 i.z g f f't.1TSCP eAec4 ^ 1n SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ S,©O 0 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ © ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 0 2. Other Fees: $ 4.Mechanical (HVAC) $ 0 List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No.1-1-1-7 Check Amount: ,Cj D-°Cash Amount: S'6.Total Project Cost: $ 000 +0� 0 Paid in Full 0 Outstanding Balance Due: J r, ,, 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 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 in this application is true and accurate to the best of my knowledge and understanding. C RDn c1i4f. PI/01 /Aa Pnnt 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 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" • n1,,.,RIn )NIR0 RH w .•III i p, NCH A�oR TO eeuvu ran. il II 1 !%10nx0lMRY _ ,_lilL �_ ;• n�+ I_ I ) REMOVE ROOF.EXISTING d a iff y J EXISTING PHOTO FORaI SLAB TTREMAIN. z 0 liaue.w. 11 d F (A II =CI W J MVO 1 YR.VER,AD.OIMEA01OR0 FIRST FLOOR PLAN-NEW SCALE-I/4'-1'-0" dz PERSPECTIVE-NEW /:VRIllttttt a A WS RIX)F RAFTERS i 16.0C W/I/t ZIP SH AT H:CNI1AND )XISIrNC STANDING SEAM METAL ROOF. WINDOW I VENTING AS RICK DIED.BATE von.BASEMENT I NxITATION TOR-I9 VALVE I+. ALL EXTERIOR TRIM TI)MATCH EXISTING. J ✓ 1 1` sND FLOOR -S_� „1�„\1�`�1„11,1�1,111111,111`111111,,,,,�„�\1,\11 i ��— -1 MT.GORGRLTE XA0 LV91TA'1Il)I911lS HE1UMR,'11'P. 11,,,1,��„1•�1, — oeR,oawAiR Mn I I �IQ_ rm. 0L[0RIl�TO L[VhlWO00 kI'-Y L_ _I L— ______1 L J SNi EOT WAIL CONSIRLCITON•Ili O.C. L — — I W/DY N.V WOOD%XNII BATHING I AND HARM 0 .e ^^.� ---1 LAP It!I(:.ERIO DING R31 xATT H. Ml'R)x :± AND VT 1NTTRIOR ORVWAIJ.FINISH. EXTERIOR TRIMS'OM. [. Y.E GOMGR[n MORT rwll ruin MAT ALAS MO � efNENlQ)O SILO,reGO•w+e OL ''� WO FLOOR CIINSIX1L COON W/.TAT �> I roc - ROOROnrznneo.2 •? Asa ADVANPECTI SIT4LIw&Y RIGID FOAM - M --I W OP EXIS 7N S EACH11\SLAa AND BAIT INSTTATION Y. 1ST FLOOR u=n=n=• * n=n- PRIOO vSAIn ALL GinlRL EXISTING PORCH Ii ' C b R TO GOROnWGTOR SLAB R FIIOSI' Fr WIDE UGI)AT)NCRRIV. O FOUNDATION 3 WALL TO REMAIN D o WALL W/SNP?FOOTING. V ■ BASEMENT FLOOR PLAN-NEW MIN.sa BELOW GRADE O O ga 6 1 SCALE.-I/4'-1'-0' 1 t i I SECTION THRU PORCH SCALE-3/8'-I'-0' A V i City of Northampton • Massachusetts �?' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 •yj�� 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: va`4 cy c The debris will be transported by: Name of Hauler: °' di» ., Signature of Applicant: '—'� e r .�Ot-� Date: g'/a R' .1 . __ The Commonwealths ofMassachusetts a' Department of Industrial_Accidents k _~•r= 1 Congress Street,Suite 100 a=d ' , Boston,114 02114-201 -- WWW tass.gotldia �me Workers'Cotopen:alion Insurance Affidavit:Builders'Contractors}Electricians'Plumbers. TO BE FILED\\TTH THE PER\fIPIZNG AUTHORITY. ?applicant Information p P1ea-e Print Lesibty Lame(Business Orpnizationlnda: Ht): 0 4 .r tJ C r1 0,s J i,q T�. 3 a Lip, Q, d if rlddre». City/State Zip: 1-,e e el S, Mg ©(taS 1.7 Pll•_Ire = Y i 3 • a s 0 ,/ d'.16 Aroys.as employer!C heck tie appropriate bar: Type of project(required): 1.0 I a=a amp:oyes with emFlosros:kfnl:and Cr part-era).' 7. D New contluMlon :.❑I a.a rocs proprietor c:pa_rtner:M add have m employees working fame S. 0 R'emodelinpv `ate.:^r plc r cla. coop.insurance rsrt:izzd] 9. El Demolition 3. nc aa homisou-ner ao att aL• rn wad myself-[No workers'com ms p. wsanca regrind.)' 10[Building addition 4 0I a:a he •_�w-ner and will be luring contra:on to conduct aJ work on my Frey I wiJ .a 4S:1119 that aJ CantactC:i a:Mar have workers comFe ssancn iasCrancs cc are sale 11.0 Electrical repairs or ittion.s proprietxs with no employees 1_? .0..vnubuig repairs or 'non: `- I a=a genera.contractor and I bays lured for sub-ccaascten l_•seed ea the attached sb,. 13.17 Roof repairs These sub-ccmracton hr...mp:ayee;and ha-..a armors'co =sv.-anc.t 60 It's are a ee canon and ir.°Tins tars exercised:hair rig cf exemption per MGL c 14'ID Other :52. 11(4).and we luny no aear:ores.(No wcrleers'comp.masaanc,reg=rad.? 'Any aFclua.nt that checks t•n tt mast also MI out the sect.=below showing:heir workers•ccepsasato Fs.L•.-.m_ :mi oa .Homeowners who submit this af5drat:adicatna thsi•are doing aJ work and ben hue outside contactors must s.brim a new affeio r:indicating such :.acsttac:ors Eta:rheas:Ls bcz mast srachad as additional sheet showing:he name of:he sub•ccntactari and s r.whether cc not those entries have employee. If:he sub-centractars hr:.employee:.they malt prcv a!boa atlas:"coc.. pclic n.mber I am an employer that is providing workers'compensation rtrsurance for in; employees_ Be1on rs the polres andj site information. Insurance Conipary-Name:.._ Policy=or Self-in:.Lie. _: E.vnatron Date: Job Site Address:____. CityiState'Zip: Attach a copy of the workers'compen:anion policy declaration page(shoeing the policy number and eipirati. ' date). Failure to secure coverage a- required under MGL c. 152,,§'SA is a Criminal violation punishable by a fine up to SI ,t a 00 and'or one-year imps tsorm.rt.as well as cavil penaltie in the form of a STOP WORK ORDER and a fine of up to S 0.00 a day again+-t the violator.A copy of this statement may be forwarded to the Office of In Ligation:of the DIA for insurance coverage verni.:3nCIL I do hereby cern s under tithe pains and penalties� of petjun•that the information provided ab/m•e is true and correct Sisnature '{� C /'"�� Date g/ a qt' a a Phone z Y13, a so . / ea 6 Official use only. Do not"vise in this area, to be completed by city or town official C it-or Town: Permit Licence= Issuing Authority(circle one): 1.Board of Health :. Building Department 3.City Town Clerk 4.Electrical Inspector Plumbing Inspector 6.Other Contact Per:on: Phone,=: 1 City of Northampton Massachusetts \s I' , t- . yo4 DEPARTMENT OF BUILDING INSPECTIONS y 212 Main Street • Municipal Building Jos Northampton, MA 01060 sf W a,0‘ HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT / I, v a` I lI C 1�Q D- d. 4 4. (insert full legal name), born Y/ 27(insert 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 dq day of 4 cv , 20aa. (Signature)