18C-057 (6) BP-2023-0657
142 PROSPECT AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-057-001 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-2023-0657 PERMISSION IS HEREBY GRANTED TO:
Project# DECKS 2023 Contractor: License:
Est. Cost: 17500 THEODORE TOWNE JR 722
Const.Class: Exp.Date:08/20/2023
Use Group: Owner: CZELUSNIAK JAY R
Lot Size (sq.ft.)
Zoning: URB Applicant: THEODORE TOWNE JR
Applicant Address Phone: Insurance:
P O BOX 153 (413)297-29 1 6 0 MP151046
SOUTHAMPTON, MA 01073
ISSUED ON: 05/22/2023
TO PERFORM THE FOLLOWING WORK:
REPLACE DECKS
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:
�) 1 I'I�1
Fees Paid: $114.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
f ,
AN
The Commonwealth of Massachusetts : v '
VBoard of Building Regulations and Standards $FOR
Massachusetts State Building Code, 780 CMR' I�AYM `vU OPALITY
Building Permit Application To Construct,Repair,Renovate br Demolith a Revised Mar 2611
One-or Two-Family Dwelling ---
This Section For Official Use Only i
Building Permit Number: 6P -C/S...-.7 Date Applied:
Building Official(Print Name) I Signature. ✓ D
SECTION 1:SITE INFORMATION
1.1 Property Address: . 1.2 Assessors Map&Parcel Numbers
1Mz, Nr2C5 PC.ci . T j 8 G • 051 - U C) 1
l.la Is this an accepted street?yes )L 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
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 0 On site disposal system
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
3A`l cZ GL U j NJ AY._ 1 42. PiGsct>- rIVL 'Pie 9 c>ic)Ey>
Name(Print) /� City,State,ZIP
/HL yO 2e Pt<-1 rk tl - —
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(44ieck all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s)eik Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
gz P _ jevc .t 4C1.t.S — SA- ,; "5,12,15.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ i..7,S6 6 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees: $ j/14. "
Check No. 4) Check Amount: Cash Amount:
6.Total Project Cost: $ )7, 5 C Paid in Full ❑Outstanding Balance Due:
,
City of Northampton
at/" HAMT,., SS SC
.',6 �; Massachusetts �� , (�
tt
•
(�� DEPARTMENT OF BUILDING INSPECTIONS s
!re. 0 4 212 Main Street • Municipal Building vk OD
� Northampton, MA 01060 JSMW 3,30
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
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.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS e,aa72z ,Zo -23
i&i L. n.-, License Number Expiration Date
Name of CSL Holder
PA. k (5 3 List CSL Type(see below)
No.and Street Type Description
�. to l3ld�? Unrestricted(Buildings up to 35,000 cu.ft.)R Restricted 18(2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
'1t 3 z97-Z9/ T,wn'�•�J try / t`� i Solid Fuel Burning Appliances
I Insulation
Telephone Email address I' D Demolition
5.2 Registered Home Improvement Contractor(HIC)
� 13 Z is t 6.2e) -03
4$'J Ada, cJn • • HIC Registration Number Expiration bate
HIC C mpan Name or HIC Registrant Name
� ���. 453 a OC..JILif? AOL,.�Gl
No.and Street Email address
IAA., al 6-)3
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 '1./ie DC/LC -/ to.A 6 c
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 perjurythat all of the information
contained in this application is true
and accurate to the best of my knowledge anunderstanding.
!7'2,'3
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 n of 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 rodm 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"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT: 1Te a S'1-GG I
LOT SIZE: , 1 L
REAR LOT DIMENSION:
REAR YARD
10
SIDE YARD SIDE YARD
V
FRONT SETBACK
FRONTAGE
City of Northampton
as AMP ti 4\s S1c
f�•''� Massachusetts �4.� '<<
i
,- ( ram ' DEPARTMENT OF BUILDING INSPECTIONS 6 je
AI'l. r ` 212 Main Street • Municipal Building Jd Os
K�_ Northampton, MA 01060 fsh, 3\\J
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: Kid "t-t' ' 12 c-ZY r Ltk- 41
The debris will be transported by:
Name of Hauler: I N e,e,-ri-� yw A,6 5,L
Signature of Applicant: Date: S/Y'2 3
The Commonwealth of Massachusetts
e , l Department of Industrial Accidents
_; ta w 1 Congress Street,Suite 100
Boston,MA 02114-2017
www:mass.goildta
11uwkrr.'( umprnsation Insurance.t fnlasit:Builders'(`untradon/Ehretlitiaes/Mumbers.
10 BF:h as H SS I I II 11111 PEIeM$TTl G AUTHORITY.
Applicant Information Please Print t eribh
Name 4 Business(1rganvationinch%[Joel 6 c 46J/1...
Address: 4 133
City State!Zip: .5t 4.Th.p s fT'r. 1.4A Wei 3 Ione : -1 3 2i )-24/ Co
.err sun ear emplun (hitk Sr appropriate Trot:
Type of project(required):
10 1 art a employer atth err�doyees[full and part-tiro.1. 7_ N ConstrUCtlem
„ ant am •
a sole pn.prrctu ur purtns rp and hate rat.employs t Noel _ for me ur R. O Remodeling
ant aapa it',.(su northers'comp muranea required.)
30 I a h [c m a onrconnet doing in_Nor► ,self l` Notdats'a:t,n rn urance reunited_)"
9. p Detnolitxm
10 Q Building addition
4.0 I am a honk:.»:um and Nall ttl'huurse st•• actors to conduct II%oil on ms property. I aril
MOW that all cogttraturs enlace Iota N en`cuergensat insurance or are sole i i L Electrical repairs or additions
proprietor.Nith no nnploycos
12.0 Plumbing repairs or additions
5(3 I am a aana:ial contractor and I hart hued the • -Lorin' tt.rs lasted on the attached sheet_ 130 RWfrepatrs
These sub cLi tractors lase employees and last ter►t comp.uuura sx.
14.0 Other 1irf.—
b.Q N e are a corporation and its officers hat a cxacrsed • -u right of on:mi es per Wit.c.
1y2.1,14-11.and Ma:hate no emrrploaces.[No*mile . rip rnsra:ince requuavl.l
•Any applacaet that checks Io.t="I must also fill out the non tie .N slx,N ane their*int n'euttrpotaatton polies information.
Il..mtsiva rs Nho submit this:[hulas it uklecalrnw•ties re dome a Mork and then hue outside contractors must submit a nen affidavit Wiwi.
(ontractors that cheek this l'ot must attached an ahhtr cal sheet slat, mat:the name of time vast*etxittaetors and,talc,she her at nut theft m keahive
emplsnecs It the sun-contractors base emplosces.the nova prosufe th\rat [,.tiers'..[wesp polls:),merino
I am an employer that is providing wort. . 'compensation ranee for my employees. Below is the policy and job site
information.
Insurantce Company Name. LI (. y14 S]16
Policy#or Self-ms_Llc.#: Pr•--e r ITT /1 Expiation Date: b -2 `f. 23
Job Site Address: City''Stale'Zip:
Attach a copy of the workers' mpensation policy declaration page(sh ing the policy number and expiration date).
Failure to secure coverage as n utred under M(;L e. 152.§25A is a criminal violation punishable by a tine up to 51,500.00
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.(I0 a
day against the violator.A copy of this statement may be fora anted to the O(3ice of Investigations of the DIA for insurance
coverage verdieation.
I do hereby certtjj under the pains and penalties of perjury that the information provided above is true and correct
Signature: late.
Phone
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permittl_icense k
Issuing:authority (circle one):
I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Ocher
( ontact Person: Phone a:
_ The Commonwealth of Massachusetts
► __*,_` _ !1, Department of Industrial Accidents
=e►= 1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
'3;frnkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business✓Organization/Individual): Theodore Towne Jr
Address: PO Box 153
City/State/Zip: Southampton MA 01073 Phone#: 413 297-2916
Are you an employer?Check the appropriate box: Type of project(required):
1.01 am a employer with employees(full and/or part-time).* 7. New construction
2.0I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling
any capacity.[No workers'comp.insurance required.]
9. 0 Demolition
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will
10 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12. Plumbing repairs or additions
5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c.
14.0 Other —DE.C 1-
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
entployeac. If the cub contractors hay entpinyeec they mutt provide t •• • ••-••••_•• . -.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name_Male Street America (MSA)
Policy#or Self-ins.Lic.#:_MP151046 Expiration Date:_6/29/23
Job Site Address: /1'{Z inke5 F1SZ1 4v4 City/State/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 violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
cnverapp vPri fie atinn
I do hereby certify under the pains and penalties of per' ry that the information provided above is true and correct
Si nature: Date:3- '7-3
Phone#: 413 297-2916
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Percnn•, Phone#•
, "71 0
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Shingles
Roof Assembly:
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Pitch- Rafter '�, toeflatriat'
RDcd S1 eagihyg
Covering- 'Russ
Underlayment.- ,
Ice Barrier- Ceiling joist `\\
Sheathing-
Truo-Cut Sheet Required - ClearSpaa,to iho opposite support•
Or
!tarter Stzc- _ .
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![after Sparing- 12" 16" 19.2" 24" •- - t t .
[tarter Clear Span. '
Rafter Species- Sidiag ,
Itidge- ! C
Ceiling Joist Size- 5!►ttatlt$
Ceiling Joist Spacing-12"16"19.2"24"
Ceiling Joist Species- • i'nsulatloa t
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insulation-R
Interior Finish.- WaltFratning
Attic Ventilation- • Interior Finish
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Siding- 1 ,
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Sheathing-
I nsulation-
Wall Framing- ti
Readers- 3,
Interior Finish- • tI
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Floor:
Finished.Floor- Sub-Floor
Sub-Fluor- \.
Floor Joist Size- Floorjola
Floor Joist Sparing-12"16"19.2"24"
Four Joist Clear Span- 41 b m o ye
Floor Joist Species- ChtrSp 31,W tleaopin so PP ' - `
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Beam Type&Size- t,:r ,•
Ste'
Distance From Grade-
Sill Plate s�"
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Foundation: Foundation An ``If`��t•Anchor eizIte,h `;A".?..,
Anchorage- _ _ __ _. _.._ .._. r ,
Sill Plate- raundationWai1 „rfi,.•; '• 9"''
1Val1 Typo&Size- Y-- `t"`:', `�
Reinforcement- " ; •'-•+'"'4:
Concrete Fivor'[ItiCltttes- » retrlcut h }.#`.
Vapor Barrier Concrete Floor ,'r,"YA .,
Column Pad Size- X X • % `� , ..;tvc
Column.Spacing- -- - __ . ':r r• _ __..-._...... _..-.
Footing Width- r St •d ~`
Vapor Harrier r
Footing b'Height- i e y
•
Footing Depth Below Grade- Posting • . . '
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