29-280 (6) BP-2023-0838
359 BROOKSIDE CIR COMMONWEALTH OF M• SSACHUSETTS
Map:Block:Lot:
29-280-001 CITY OF NORTHA PTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGI.TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A)
BUILDING P RMIT
Permit# BP-2023-0838 PERMISSIO IS HEREBY GRANTED TO:
Project# DECK Contractor: License:
Est. Cost: 3846
Const.Class: Exp.Date:
Use Group: Owner: DOMI CK DINITA A
Lot Size (sq.ft.)
Zoning: URA/WSP Applicant: DOMI I CK DINITA A
Applicant Address Phone: Insurance:
359 BROOKSIDE CIR
FLORENCE, MA 01062
ISSUED ON: 06/26/2023
TO PERFORM THE FOLLOWING WORK:
ADD SLIDING DOOR
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:
>2
I
•
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: 413)587-1272
Office of the Building Commissi er
The ommonwealth of Massachusetts
,: •imilliFis
nd f Building Regulations and StandardsFOR
!.#1 sa usetts State Building Code, 780 CMR MUNICIPALITY
' "IqT BUtCDIly USE
Hq �� i+t.App ication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
°1 060 One-or Two-Family Dwelling
This Section For Official Use Only
2 i
Building Permit Number: 3 0-,.1-3- g 3 V Date Applied:
‘um.3iZ's 177 6 Zt'2623
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION 1
1.1 Property Address. 1.2 Assessors Map&Marcel Numbers
1.1 a Is this an accepted street?yes >1 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'
2.1 Owner'of Record:
Name(Printj City,State,ZIP
35- I�( *-5 (co Cc • (1(3 33 1-/ e.0 ddom 1 -m i ccsw .
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building k Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Additionfr
Demolition 0 Accessory Bldg. 0 Number of UnitsOther C,7 Specify:
Brief Description of Proposed Work': $1,'ter?.9 (--t7C
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor 9.4 Maaterials
1.Building $ /)��-P• ) 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Costa (Item 6; x multiplier x
3.Plumbing $ l'/ 2. Other Fees: $
4.Mechanical (HVAC) $ 0 List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No.` IU+u Check Amount:"" Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 OLtstanding Balance Due:
City of Northampton
Massachusetts w" _ cf
,�, * c';
' DEPARTMENT OF BUILDING INSPECTIONS �-.
�,' �, 212 Main Street • Municipal Building 11. 47
Northampton, MA 01060 Pf'$S°` `+,.\
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)
License Numbe- 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 Sclid 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 B ILDING 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 pe it 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 curate to the b t of m I y knowledge and understanding.
( 023An
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 owne.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 informations on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can 3e 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 ha.flbaths
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
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
44N�4x> Massachusetts r
DEPARTMENT OF BUILDING INSPECTIONS S 3r ,r
212 Main Street • Municipal Building
Northampton, MA 01060 -I, x-1%��
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: 1/0/ ' Gtogeliati.
4.1
The debris will be transported by:
Name of Hauler: l)/ I
Signature of Applicant: i Date: /_d_,./ic2
,.
'.. .,m7---
m The Commonwealth of Massachusetts .
..... ,,....
Department of Inilustrial A eeidents
I Congress Street,Suite 100
Boston,MA 02114-2017
-;.,— www.tnass.gawdia
Vi orkers* Compensation Insurance Affidavit:BuilderContrattorsiEkctricianstPluitibers.
TO BE FILED WITH THE PERNII'11117NG AIIIIIORI Cli.
Applicant Itifirrination . Please Print Legibli
Name iiittSiteeSkOl'gaillintlintlildiVidniiir --"O(n -1— ---ayr\qc1Tic„....
Address: 5(:) .1(-1 1,.....R
Ci f
S' '
CityiStateiZip: C' Phone At:_____ _ ,
...„...._ __..
yea an,enapknice Cheek the appropriate iiiis: Type/if-project(required):
it3 lain a entpkwer with.„„ , erriploysies tied antler parbilinet.* 7. D New Conk-Wilt:lion
dfj I am n a sole propriettor ea ponnewhip and haw mart eitaphiyetiti working for ow in 8, 0 Remodeling
a my capacity_[No waiters`croup.insuranee &whited]'
9. ri Demolition
3 I AM 2 homeowner doing all bork myself.iNtet boaters"cult*, nuterattiese terpured 1'
1.0 0 Bit titling addition
4.EI I ant a kainotiwner and still be hiring eareirectore to essatinet all work ton try prdpirty. 1 si til
ensure that all collimators Unita haw%tan&eooveruanan nnannincr faT are nale 1 1 4:1 Electrical repairs or additions
runtariettla8 with ort tittployees.
i 2 ' i Plumbing repairs or additiom
,....-1
$0 I ant a general contractor tual I hese hired the oub-eunowituri hated on the anachod sheet
13.0 Roof repairs
these bah-TEM nue to m lane employees and have butlers'comp,insurance.:
I 4_ri Other
a corporation aid i6 officrss have beetriired their tight of exemption per isiCil c.
li-t t and we haw no wiployees.p4.0 wark...as'tamp..ataaaacv rumaaai
*Any afftlierrat drat checks bmi 'I maw stan fill out the eectitan below showing then boritors*compensatiomi policy inforintifitat.
4'iloanwobrient who salmi"alibi athelitsit indication they are all work and then hire onside conmeters limb;inborn a nest affidas it restiebting such
1,Colattractors that cheek thrts hoe must attached an additional sheet showing the name efthic rativeinteracters and mote whether et not thtse OttiriCi.1124,4
ottarlorlist. lf the subia;mat:tors hose emplo:p,nes,they rated retvide their workers'comp,pulley number
I Unt arc employer that is protiding irorAers*compensation insurance for my employees, Below is the pulley and job site
inforntarion.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Die:
kb Site Address: City`StateZip: _
Attach a copy of the workers compensation policy declaration page(showing the polies number and expiration date),
Failure to set:we coverage as requited under MCit e. 152,§25A is a criminal violation punishable by a fine up to SI,51)0.00
artitor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a line of up to 5250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Inymtigations of the DIA for insurance
coverage verification.
I do hereby certify der the; ills and pe es of perjury that the information provided abakw is true and correct
, -
Siunatur , i ,47/Z .)
___
07/4Cid1( Date: (7 d,3/(7)- --
Phone
Official use only. Du not write in this area,to be completed by city or lawn official.
City or Tomo: Permittieenie#
:,. Issuing Authority(circle isne):
I Board of Health 2.Building Department 3.CityiTossu Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:,,,
City of Northampton
Massachusetts
S t * 4
g .
DEPARTMENT OF BUILDING INSPE ONS �__
u * 4 -T', 212 Main Street • Municipal Building ply _ ��^`
-14
�' Northampton, MA 01060 5a`F - b<
HOMEOWNERS'EXEMPTION ELIGIBILI' AFFIDAVIT
I,(- D(n C -C �(Yrvr\ CI (ins: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. .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 constru,ted in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner" 's defined at 780 CMR 110.R5.1.2:
Person(s)who owns a parcel of land on which he/she resides sr intends to reside, on which there is,or
is intended to be, a one-or two-family dwelling, attached or • -tached structures accessory to such use
and/or farm structures. A person who constructs more than o e home in a two-year period shall not be
considered a home owner.
4. I do not hold a valid Massachusetts construction supervision licen • and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirem: is for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in co nection 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.
Signe nder the pains and pens ' s of perjury on this(9 3day of 2G1,2/1‘ ab()Lb0;2e-
(Signature)
�—� • r/ `/
,' =t City of Northampton -
A v Massachusetts .:.
'qr :-; " DEPARTMENT OF BUILDING INSPECTIONS
ak
�.. 212 Main Street,Room ioo Fss
Northampton MA oio6o
(413)587-1240
•
Plat Plan Drawing
To be submitted with permit applications for 1-or 2-family additions,deck, porches, pools,and
detached accessory structures. 0 tkinci �(Propertyaddress: 36CAOr00Ls ( Q .c- Ili O( c
Proposed work: —0PC L.
Information/detail requirements: •Septic system tank and drain field(if applicable).
• Street(s) by name •All existing structures including decks, pools,
• Front of house detached garages,carports,sheds,etc.
• Driveway •All proposed additions,decks,porches,pools,
• Easement(s) detached garages,carports,sheds,etc.
•All property line dimensions • Distances of existing and proposed structures to
lot lines and other structures.
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OMS Ver.0003.15.00(Current) RICH SAALFRANK
Product availability and pricing subject to change. PATIO DOOR
Quote Number:EEWLYUG
UNIT SUMMARY
The following is a schedule of the windows and doors for this project. For additional unit details, please see Line Item
Quotes.
Additional charges,tax or Terms and Conditions may apply. Detail pricing is per unit.
NUMBER OF LINES:3 TOTAL UNIT QTY: 3 EXT NET PRICE: USD 6,192.46
LINE MARK UNIT PRODUCT LINE ITEM NET PRICE QTY EXTENDED NET
PRICE
1 Essential Sliding Patio Door 1,831.74 1 1,831.74
RO72"X80"
Elevate Sliding Patio Door 2,015.30 1 2,015.3
RO72"X80"
3 Elevate Sliding French Door ( 2,345.42 i11
RO72"X80"
3g1,(0 . _
OMS Ver.0003.15.00(Current) Processed on:7/1/2022 1:44:40 PM Page 2 of 7