32A-202 (12) BP-2023-1286
59 PHILLIPS PL COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-202-001 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-2023-1286 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 INTERIOR RENO Contractor: License:
Est. Cost: 32500 KRIS THOMSON CS084152
Const.Class: Exp.Date: 04/09/2025
Use Group: Owner: T. BERCUVITZ, DEBRA
Lot Size (sq.ft.)
Zoning: URC Applicant: KRIS THOMSON CARPENTRY
Applicant Address Phone: Insurance:
362 KENNEDY RD (413)695-6487 SOLE PROPRIETOR
LEEDS, MA 01053
ISSUED ON: 09/18/2023
TO PERFORM THE FOLLOWING WORK: •
RELOCATE KITCHEN,ADD HALL, CLOSETS & l BEDROOM ON 1ST FLOOR
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:
•
0 • V • T1 1 I 0
Fees Paid: S211.00
• 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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o The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
-,1P, ,z Massachusetts State Building Code, 780 CMR MUNICIPALITY
i USE
„ Buildi g Permit Application To Construct,Repair,Renovate Or Demo]ish a Revised Mar 2011
't-tt a__ ill
One-or Two-Family Dwelling
This Section For Official Use Only
Building
);ermit Number: Date Applied:
'WO (a>, "7-2 q-l13Z023
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prope ,Address: 1.2 Assessors Map&Parcel Numbers
59 ( (11, P 1� 3� -20a-co l
l.la Is this an accepted street?yes Oc no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
. 354a -re_
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 01 Private 0 Zone: _ Outside Flood Zone? Municipal On site disposal system 0
Check if yew
SECTION 2: PROPERTY OWNERSHIP'
2.1 O ner'of R rd: /
J e j r _,er e- v) T--2. P) 41-,,,.,4 , , ,n A a I a 6 0
l Nw►e(Print) City,State,ZIP
,.� 51 e k'U PLt 413 6�f t= 4�'°► dLv tc ti..,`i- e Ga,�.�, .,.ed
INo.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building I$ Owner-Occupied f®, Repairs(s) 0 Alteration(s)VI Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units 2. Other ❑ Specify:
Brief Description of? opos d Work2: ++
V`0 V-L V-.t 1"Uke n -p In.e ) t A L ON i
r0 Os t� A
0,. c.c.,I r Vn 0. 1 j/ c 1 o s,e.-f sties v,. .4 b 6 e ao yr%
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ i2, 5J�0C3 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 CIStandard City/Town Application Fee > �-b
0 Total Project Cost3(Item 6)x multiplier x(O
3. Plumbing $ 2,5 0 0 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire Total All Fees: $
Suppression) $ b a
Check No.9bO$ Check Amount:2►1.— Cash Amount: _
6.Total Project Cost: $ 3 2., 5 0 0 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts
C ,4,,,, DEPARTMENT OF BUILDING INSPECTIONS .S
� .'��-� , 212 Main Street • Municipal Building
Northampton, MA 01060
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) O$ j 2 �( ,
Kr J S. '. t o' 5- License Nu ber "E1x'pirat' ion+Date
Name of CSL Holder i ,
C1 2 1Q+^ 1.(Le. 4 (7 j 4A List CSL Type(see below) �J
No.and Street V, J Type Description
„ 1 c ,l/(n T V r) . U Unrestricted(Buildings up to 35,000 cu.ft.)
C.�Q ,/� R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
�� RC Roofing Covering
r7 -19 WS _ Window and Siding
41 7' SF Solid Fuel Burning Appliances
j I Insulation
�1 Li
5'd►"��,�eh�r l�'
Telephone Email ddress �I,I,cy' D Demolition
5.2 Reg tered Home Improvement Contractor(HIC) 1 -7 1.5 13 $ r 5
Ir't c /3 o s C5- HIC Registration Number Exp ration Date
Company a or HIC
C Regist nt NarVp rb • `o.an Stree
O3 Email address
SA tiCG� �
-cr Asc 1 l
J
City/Town,State,ZIP Telephon
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 '14 No . 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT/ k
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.
9(
lef- 3
Print Owner'I e(Elect nic Signature) ate
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 tr e and acc e to the best of my knowledge and understanding.
KrlsF' r,rw eftr. V
ati ¢/ZD
Print Owner's or Authorized Agent's N e le • a is Ignature) e
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
SIDE YARD SIDE YARD
FRONT SETBACK_
FRONTAGE
City of Northampton
v'u riff?;
Massachusettsit
DEPARTMENT OF BUILDING INSPECTIONS }'
212 Main Street • Municipal Building
Northampton, MA 01060 $;-}��
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:
The debris will be transported by:
Name of Hauler: 4 3 �Q U tn,. StC
Signature of Applicant: Date: al_142----3
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.govidia
Workers'('ompensation Insurance Affidas it:Builders/Contractors/Electricians/Plumbers.
ro HE:FILED WITH'rlIE PERMITrING AUTH()tl 11.
Information Please Print l_teihls
Name taustries,s;Orgarnzation,lnOrviduah. ,
Addressr3L2____ ‘A,v1)2',
CityiState,Zip. , _
,zzA5.}Atnin5.2_ Phone#: (09._Ste+ 7
Ate pea it emplace?Check the appruprlatv lmet: Type or project(required):
aI am a ernplava ttb „iameloyees Ira wart or piat-tirret,' 7. 9 New construction
leftin a sole pevprietim or partnerskup and hucc ao employee*working tor MC in 8—rat Reinodeling
Cy capacity,[No vs what'comp.mut:ince nAturred,)
9. al Demolition
30 I ant a homeowner doing all work myself.[No workers"cony. rnstimetez.•remured.j
I 0 C1 Building addition
4E31 am a hunectrwrier and will ltee burns VOnitaatIr* all work un my property I will
emote that all contrai:tult either have workers'currepcmatunt insuranix or art auk 110 Electrical repairs or additions
prupnewet with no erriployccs.
12.0 Plumbing repairs or additions
ss0 1 aln yerrucral corm:mot And 1 leay.c hind the tub-euntractors listed on the auaeitod Atiget
131:Roof repairs
1-hcse suh-contrzietort have employee*and lease w takers'comp.insurance.:
1400thei
6.0 ss'c are a corporation arid its officers have excrciaed their right of exemplum'ter NCI
tL§1i•l,and we have no emplaces.[Nu workers'comp.Minn:ince re4eined.1
"Any applicant thaidureks hot F I mum alto fill out the below show ins then workers`eutimemation yolk",enformatum,
Ilinneow nest who solemn this affidavit utilscauntr they AIVilgYtnir all work and then hire outside eoittraewry name tubmit a new affidav it eradicating suct
untructors that check this hot must guilt:a an additional ehect show mg the name of the*.al--eontraetore.and 4.g,e.whether or not[how tiniIICYlta
employee, lithe suls-eureiractors have employ etY.they must rut ide their workt.T.4'voirip.relic).number.
I am an employer that is proriding workers'compensation insurance for my employees, Below is the polity and job site
information.
Insurance Company Name:
Policy 4 or Self-ins.Lie. Expiration Date:
Job Site Address: City`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 NIGL c. 152. §25A is a criminal violation punishable by a fine up to S1,500.00
orator one-year imprisonment.as well as civil penalties in the form off STOP WORK ORDER and a fine of up to 5250.00 a
day against the violator.A copy of this statement may be forwarded to the Mice of hivestil,!atioas of the DIA for insurance
coverage veritication.
I do her ; under e! with , it f perinty that Vise information provided a twe is truc WU!Ceirred
I_51 2_3
Snnature.
offichrl live only. Do not write in this area.to be completed by city or town official
it". or Town: Permit/License#
Issuing Authority (circle one):
I. Board of Health 2.Building Department 3.City?Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
�+ Q k rr
1 lip
Massachusetts
is $-
ft F gI. DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building ���� ,- .
a,- Northampton, MA 01060 ‘
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (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. 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 , 20_.
(Signature)
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Scale:1/4"=1'-0" O.nwi„y No.
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EX-1
SCHEMATIC-09/21/2022
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EX-1
SCHEMATIC-09/21/2022
___ •
File #BP-2023-1286
APPLICANT/CONTACT PERSON:KRIS THOMSON CARPENTRY
362 KENNEDY RD LEEDS, MA 01053 (413)695-6487
PROPERTY LOCATION 59 PHILLIPS PL
MAP:LOT 32A-202-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $211.00
Type of Construction: RELOCATE KITCHEN,ADD HALL, CLOSETS & 1 BEDROOM ON 1ST FLOOR
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:
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 Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: '§
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.