35-153 (4) BP-2023-0757
788 RYAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-153-001 CITY OF NORTHAMPTON
Permit: Addition
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0757 PERMISSION IS HEREBY GRANTED TO:
Project# DECK 2023 Contractor: License:
Est. Cost: 1500
Const.Class: Exp.Date:
Use Group: Owner: M MONSKA JOHN M&JEAN
Lot Size (sq.ft.)
Zoning: WSP Applicant: M MONSKA JOHN M&JEAN
Applicant Address Phone: Insurance:
788 RYAN RD
FLORENCE, MA 01062
ISSUED ON: 06/15/2023
TO PERFORM THE FOLLOWING WORK:
8X14 DECK ADDITION OFF OF THE POOL
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: II_
3117/
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
File #BP-2023-0757
APPLICANT/CONTACT PERSON:MONSKA JOHN M&JEAN M
788 RYAN RD FLORENCE, MA 01062
PROPERTY LOCATION 788 RYAN RD
MAP:LOT 35-153-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $65.00
Type of Construction: 8X14 DECK ADDITION OFF OF THE POOL
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
1( Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Spec'.1Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Va nce*
Received&Recorded at Registry of Deeds Proof Enclose4
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water P Otability Board of Health
Permit from Conservation Commission Permit fro CB Architecture Committee
Permit from Elm Street Commission Permit DP Storm Water Management
Demolition Delay
�. _ � � i; via/9.3
Si. ature of Building Official ate
Note: Issuance of a Zoning permit does not relieve a applicant's burden t comply with all zoning
requirements and obtain all required permits from Board of Health,Co servation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standar s of MGL 40A.Contact Office of
Planning&Development for more information.
JUG -�
The Commonwealth of ass chusetts
Board of Building Regula ons�afitf FOR
MUNICIPALITY
Massachusetts State Building Code,, ` MgpEonoNs USE
Building Permit Application To Construct,Repair,Renovate ' lish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: /V.. 3 '7' Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
111 ��� TI 0 r{n�. 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
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 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
v� n Mof15 � OC-e-( Coe- Mf 01 CCR a.
Name(Print) City,State,ZIP
?e 12 n Z.cc 4,3-543-5`- J 3o fvn ��{{0nn` -Lt 6 Mai . .cow
No.and Street Telephone Trr►hil Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition D
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
-elginrDescri s 1- 1 l-1) O-- 't X I y
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Iiem 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ C),
Suppression) Total All Fees:,$ ti
Check No.r� Check Amount: V
0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
x Massachusetts 4
5 A.
DEPARTMENT OF BUILDING INSPECTIONS �_ 'may
212 Main Street • Municipal Building '-', ,,
" Northampton, MA 01060 4 3"W.
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF 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 specifications of proposed work(Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements(if applicable). or
9. Energy Code—all new construction(Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
I
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. It.)
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 . ❑
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.
--37,M n 01 tY1DnSIC4L- _,..c i'�--G— w 7 ao.Z3
Print Owner' heri} i tr
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 infor nation 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"
!.,.Z.„ The Commonwealth of Massachusetts
Department of Industrial Accidents'
I Congress Street,Suite 100
Boston, MA 02114-2017
bs..
www.mass.govidia
-t.750
Ilorters Compensation Insurance Affida%it:Builder
l't)Ht.FILED WITH"I IIL PERMIIITSC;AUTHOR111.
Annlicant Information Please Print Legibls
Name itiusiness;Organizatiortilnitivatual):
Address:
City/State/Zip: Phone g:
,trie you an cavils"er?Check the appropriate bat: Type of project(required):
1 0 I 31'11 a employer voth enegaisyssrs(fall and-or part-Ureter.' 7. 0 New construction
I am a sok;mg:rector or jrannershrp and hase no cnsployck v.orkuut Cur rue III K. 0 Remodeling
: y c-arpacini No workers'comp,insurance required I
9. El DernOittiOrt
‘.......-,3 in a homeowner doing all 4P.ork myself.INo workers'comp_mouratice requared1°
10 0 Building addition
" 4.0 1 arn II horneowncr and*di be haute contradors to conduct aft tkurk eft ray property, I will
mane that all coritracturs either hare workers'euerspenation insurance or are sole I i.0 Electrical repairs or additions
pnrprsetors with no employees,
110 Plumbing repairs or additions
:SO/am a rater-al contra:out and I hare hired the sub-contractors Listed on the attached sheet,
I ID Root repairs
These sub-euntrarctors llore employee?,and bast workers'comp,untorance
I-inOther
,.....E3 We are;1 Llnpucabon and liA officers have CACnnsed their right of excersgstion rsr 11/4161-C
1 2,,4,..I 1 It.and v4 c'Wit mu CZTVIVYCK1.[NU workers'comp.insurance required]
4-
4 ‘1,. 4rpti,.011 nix,.h.,x.i...,m box a 1 nun;also till out the wettest brio*%hulk inn then nt.rrkers'compensation policy utionnatton
titneus*nerk who sistmut this Aid:tilt miscalling they are doing all work and then lure outside cinites,ctors most sabrint a new affklac it Jradicaiing such
.:Ctintractors.that cheek rhit box must attached un additional `sheet show Mg the name of the sulneoniractors and state v.hether or nut thust entstret.h.sw
ernploveo.. If the sub-tuairacitns base clunks ces,die)must pro.ide their workers'cot-op.policy number
/um an employer that is providing'workers'compensation insurance for my employees. Below is the policy rind job site
information.
Insurance Company Name:
Policy#or Self-iris. Lie. #: Expiration Date:
Job Site Address: Ciry,StateiZip:
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 crirniruil violation punishable by a tine up to$1,500.00
andlor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against die violator_A copy of this statement may be forwarded to the OtTwe of Investigations of the DIA for insurance
coverage verification
I do hereby certify under the P4thiN and penaMeN of perjury that the inlaTtnation provided above Is true and correct.
Willa 7d1— ‘---
//r all 617/010 a.2
Official use only. Do not write in this area,to he completed kr city or town official
City or Town: PermitiLicense#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
,, . ,
City of Northampton
(7--
:, Massachusetts ,�. 4 e
a: Aif
it: DEPARTMENT OF BUILDING INSPECTIONS Z
212 Main Street • Municipal Building '*+�;� -,�'
Northampton, MA 01060 'j`/,y i.-'''%
valliPPRUCTION DEBRIS APFIDAT
(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: vC& I I e•, ( yc.j 1 no,
Location of Facility: ? ( e,-,5`r(.k.,, i( O(\ 12-1) , I,),-Tv 4 tA r-r01' rtc,„_.
The debris will be transported by:
Name of Hauler:
Signature of Applicant: "G' �l/ Date: 6//a° .3
City of Northampton
t Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building1,410
Northampton, MA 01060
16111b WA(.
I, 0 h (, Pions key._ 3 I y I/ �n'rt full legal name),born_ (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 ? day of J J Na- ,20..3
7
(Signature)
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
tilcrC
BE
P0-0 \ C. I
1.
i 0 ji
O W
•
SIDE YARD SIDE YARD
HoJcL
FP-oNt
FRONT SETBACK
FRONTAGE
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.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
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: OWNER1 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.
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 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"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
� 2 )
7I )( 0 , >)
On 400
ax4
&N vl
4 0 uob1e
SIDE YARD 17e) ~' IMO,' • SIDE YARD Ft. 7
trma
?OST
ax,0
L4xt
"Dovbl�
wi C Jd can Geoitt
FRONT SETBACK
FRONTAGE