31A-156 (7) BP-2023-1274
61 MAYNARD RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31 A-156-001 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-2023-1274 PERMISSION IS HEREBY GRANTED TO:
Project# SAUNA 2023 Contractor: License:
Est. Cost: 30000
Const.Class: Exp.Date:
Use Group: Owner: AMY SHATZ LAUREN J&
Lot Size (sq.ft.)
Zoning: URB Applicant: AMY SHATZ LAUREN J&
Applicant Address Phone: Insurance:
61 MAYNARD RD
NORTHAMPTON, MA 01060
ISSUED ON: 09/14/2023
TO PERFORM THE FOLLOWING WORK:
BUILD SAUNA IN GARAGE
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:
• ,r
Fees Paid: S195.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenterNiew/15553/Resideptia...
\ 14' -ntcr•/i/--)S P1.��</5
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' ,/VV ommonwealth of Massachusetts
,, *'. itFP B, of : 'lding Regulations and Standards FOR
i C,„ /, MUNICIPALITY
yl,
w v Mas•achus tts State Building Code, 780 CMR USE
o,°Tyo(��a�ti�lding Pt / pplic ion To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
Mnl� > One-or Two-Family Dwelling
N kspF
q o,cp-I This Section For Official Use Only
Building Permit Num�q ; 1 R / 9g Date Applied:
/E1)„•.)4Z55 ZdZ 9-0 zdZ.:3
Building Official(Print Name) Signature Date
SE TI 1:SITE INFORMATION
1.aletypitas fri ,,ei
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'
2 1 Owner'reh of Rec�r .r-4 AJO ,' N /� M A 0 /060
Name(Print) City,State,ZIP
6 I M 0.70•.c RL, 6/7-S I0--0353 Ls L4egh 71- (cam
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition rir-
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Bri f Description of Proposed Work': \./ w i 1 I k'v; 1 Ll i rl o h +��E+6 .L
50—kinar 7 h 'ft-4 QOf + 7tt:s is .,, ex„,:„.
Sfr tir ty °t- -f ,..,.c. LJ —:.kw- mod. 40 , A
./dam
0e` (
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(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $Suppression) Total All F s:$
,A 4
of „Check N fG6heck Amount: ic6
6.Total Project Cost: $ 31,'^CCO 0 Paid in Full 0 Outstanding Balance Due:
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City of Northampton
Massachusetts Af,v. C
DEPARTMENT OF BUILDING INSPECTIONS x>
212 Main Street • Municipal Building Ca,
\ o Northampton, MA 01060 ssyj\'�"
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).
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.
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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
5.2i Registered Home I�oveme tractor(HIC)
'NO }� (�—�►'� HIC Registration Number irat. n Date
HIg pag.1;1 or HIC Re istrant y� 9
No Street( �'et Ciej ram. ( �C
City wn, State, IP 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 J
I,as Owner of the subject property,hereby authorize OCI C re, ; '� R :S L;- . r'CV^Z. ✓tit > "`�'lt/
to act on my behalf,in all matt elative to work authorized by this building permit application.
Print Owner's Name( ectro Si ) D te
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby a t under the pains and penalties of perjury that all of the information
contained in this applicatio is true ccurate to the best of my knowledge and understanding.
Print Owner's or Authorize gent's Electronic Signature) D te
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"
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780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenterNiew/15553/Resideo•Lia...
_....._ The Commonwealth of Massachusetts
Department of Industrial Accidents
,,-Av-,:--"' - i I Congress Street,Suite 100
Boston,MA 02114-2017
wtogniass.govidea
SI-inters Compensation Insurance AlTida%it:Bultders/ContractorsiElectriciansirlo cabers.
It)RE FILED Willi THE rElevillTINC:AtIlli/DirlI
Applicant Information Please Print Lenihls
Name(13usiness'Organization1ndtmdual): ...0,...,..,ree1 ,
Address: 6 i
City/State/Zip: No (11,110-evip L Tvn,W0(04gone#: G I "?-SO -o3s-3
r
Are yen iiii mattok*te Chock the apprapriate tart: Type o roject(required):
LEI I am a employer wit , ermiloyees(hill muter part-timet* 7. New construction
.am a sole proprietor or partnership and base tio employe:es working for me in Fi. cj Remodding.
any cape:int[No workem'comp.insuran 'quiroll
0 ilt 30 I a honvenwam doing all work nnylclf.N i.O V.nkt.TN'cur .irtAILUILLV 11411111ireti. 9. Dernolitim
I'
a 0 0 Building addition
4. am a homeowner and will bc hiring caisractors to nduet all work on my property_ I will
ensure that all contramors either hales workers"cempensation insurance or alt sole i 1E3 Electrical repairs or additions
prupnitnem'with nu arplu2.cm,
12.1:1 Plumbing repairs or additions
.),13 I am a general commetot and I have hired the soh-contractors listed on the attached sheet
Ili:Roof repairs
These AM-connactem have employees and lune workers'comp.immolate.:
14.0 Other
itLi tke ore a evaporation and its officers hare exercised their ngla iit cxemmina,per PAGL c. -
and Av have no onalpleyem.No u mien'comp.immancc regain:31j
An applicant that checks hod ul nand also fill out the section below h'hi.,..1,ing their workers'compensation policy information_
4 lionicossoins who submit this affidivit indicating they arc doing iiit work and then him mashie contractors Maid submit a new affidavit indicating sick.
l't.oiatractors that check this Isits mast attacked an aishrional sheet shoo mg the name of the sids-contractors and itate V4 hettice re not.thoohc.,,,,lititic,fax,,,:
employivs„ lithe sub-cormactors Fuse employees,they most pros hie their workers comp_policy numb,cr
.... . . „ .. , .
I am an entphlyer that is providing os,orkers"compensation Insurance for my employees. Below is the policy attd Job site
inforatation.
Insurance Company Name: _
Policy#or Self-ins.Lk. .;:: Expiration Date:
Job Site Address: City/Statellip:
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 tine 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 he forwarded to the Office of Investigations of the DIA for insurance
cokerage verification.
i
I do hereby certify under the aill.%i d penaltie perjury that the iitfOrmation provided oh or is t ne and correct.
Sienature: Dale. S 0/5 ..?t,?
r . 1
(-Phone:--°: (r.) 1 -2 - 10 - 13 5 3
„3
Official use only. Do itat write in this areal,to be completed by city or town official
(its or Town: Permit/License A
„
Issuing Authority(circle one): r,
I.Board of Health 2.Building Department 3.Cityriown Clerk 4.Electrkal Inspector 5. Plumbing Inspector
6.Other
: Contact Person: Phone#:
— --- -
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780(..4R: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenter/View/15553/Residentia...
f
City of Northampton
yN5 sr;
Massachusetts .�� ...- ee
DEPARTMENT OF BUILDING INSPECTIONS
t "''
212 Main Street • Municipal Building ,t �i
.;w Northampton, MA 01060 ssPii, -)���
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: V a'-'` It •'1
The debris will be transported by:
'Er'
Name of Hauler: Pe r r.1 /,-tvi. -e H 00 c(9
Signature of Applicant: 7 Date: 6i&5 13
5 of 6 8/16/2023, 9:02 AM
780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenterNiew/15553/ResideI ia...
City of Northampton
n3 rr
MassachusettsAi
s DEPARTMENT OF BUILDING INSPECTIONS S\
yo. �l 212 Main Street • Municipal Building
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
L. L_ire.._Jl 4 �''— • (insert 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. 1 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 per'u a-this S day of 14Vt�U S4. ,2(?3
(Signature)
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