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29-103 (20) Z-4 K File#BP-2021-1431 APPLICANT/CONTACT PERSON CUMMINGS CLAY ADDRESS/PHONE 454 RYAN RD FLORENCE (413)230-8465() PROPERTY LOCATION 454 RYAN RD MAP 29 PARCEL 103 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENC REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 4 Op Typeof Construction: NEW DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON T‘P IC• TION BASED ON IN7ORMATION PRESENTED: Approved Additional permits required(see Iqy/) PLANNING BOARD PERMIT RE DER:§ Intermediate Project: Site AND/0 Special Permit With S• Ian ,`�o Pi r g C) Major Project: Si Plan D R Special Permit Wi ite lan �)AI TTIRd ZONING B0ARD PERMIT REQUI D UNDER. • Finding Spec •I Permit Varianc.i) _4,4) Receiv d&Recor.-• •t Registry of I-eds Proof Enclo d` ether Permits Re' ired: Cur, .. from P PW ater Availability/Well Sewer Availability Septic Approval Board of Health atyr Potability Board of Health Permit from Conservation Commission Perm from CB Architecture Committee Permit from Elm Street Commission - Permit DPW Storm Water Management Demolition Delay ficrArAtAL , Ilb . , toNai Sigpature of Building Official a 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. t RAJA to I I The Commonwealth of Massachus tts SUN 1 Board of Building Regulations and St nda FOR Massachusetts State Building Code, 7 4 o�c � CIPALITY , ��gTHA�1�orn�r,!NSp USE Building Permit Application To Construct,Repair,Renovate Or De 7 o rsed Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: O of'/7 3J Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 454 Ryan Rd, Florence Ma �9 /O3 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 ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Clay and Laura Cummings Florence, Ma 0102 Name(Print) City, State,ZIP 454 Ryan Rd 413-768-8683 deborahlnn@aim.com No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ra Specify: _Deck Brief Description of Proposed Work': 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: ❑ Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees: _ 576ft Check No.✓ •i t heck Amount: D Cash Amount: 6.Total Project Cost: $ q 0 Paid in Full ❑Outstanding Balance Due: City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 1 ` 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. 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specification of proposed work(digital and hard copy). 3. Site Plan with location of proposed structure(s)and setbacks. 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. 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.) 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 ❑ 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: 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. Clay and Laura Cummings 5/27/2021 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 ww .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" 576 Sq ft CITY OF NORTHAMPTON SETBACK PLAN MAP: 100 LOT: 66 LOT SIZE: 72,397 Sq Ft REAR LOT DIMENSION: REAR YARD 18 SIDE YARD 35 SIDE YARD 10 FRONT SETBACK 26 FRONTAGE City of Northampton g Massachusetts DEPARTMENT OF BUILDING INSPECTIONS P 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: Dumpster The debris will be transported by: cr711-4101404/6 Name of Hauler: U54 Dumpster company Signature of Applicant: UK27 £2411 L ZL(1t.LZ Date: 5/27/2021 The C nnt ortwedth oplassachusetts Departpiteirt ofiriflustrialActadrrrrs 1 Congress_rwt,Suite 100 BBm:tmmr,ALA 12114-201 • tricw. ass.gOaV to Wur 'Compen:ati*u Insurance Affidavit".Builders'Contractor:Electric1iarns Plumber:, TO RE FILED 1 1TH THE FER'.11.1.11 G T. HO a i Y.Applicant Information � Plea see Print Leah, NaNt re"ss Cci'Ta '�;.Ft y 1nd t " icon.'), Address: City. tate Phone Art Foal sa r Ciorcro,•-a• g.:-riar1 : T,-p pr Diest(required): ❑:s_m zz^ra�r es i_ as a(full=tor pire-cooms).* 7 ❑ =fit'i otistr'u[hati ❑'_=2 soa propxiat op-sad ina now 222p1.271424=ilia~ for ma do ❑ .e.M03 'htl a opo ^;•: do:•tea_ .crop :oa:-sar = nd.] 9 ❑D.smolition 3.XX I s`a hc.cccmmsx dss al:wool mtnga ENc• :a a =mop.=a:ssara escg irad: _ uilding -.❑I;_ 2.hocoaowszo azof gi:I}a baize>usLortor.to coadozo1.2:rook,nrxpcpa*c:: Ixci:I y 42411M oaat all ocaoradon Galhar lssa-a worisro.ocauFadoodoa aa: ran;.a or ors.nis _,.❑Lectr7ca13 r.r:or additions propels=will ab`araplcTaas. ❑_,. __. a repairs cam-a i 1teon . ❑I s=a canaaa_ .:o i:kayo a kind tl rab-coadozwrs kwood dta atta,i ad:last Thaw "-.o _raa.lace a oploy pima dlosn'cam. adanca: I' riof 'mrs . ❑:a a axs a cczp rarscsa ats:ir.a .ca >ssaa aaarodad d hair of aarrac c_•par ❑�:t1aE+1' g1(r),mod woo -a oysas.[No wriaars coda. Z221222Cii `Any apcliras that disal Ioduso oho Eli nsi da:ar s ^.h- -i=s 2181.1.7 a c 3 =s'cum,om sstrasap l R=n^•n�cism Y� liomapernariadoo Wm=i s affidavit i-a fos7.7 o a inn an cook and=on hors orataids:,am#ssrooaa=ost.-.117=-a nca a odor,=z:inolirsoods cs =rzity,c ": .c hca ana t 2...: 'atn 213i2222i 32221.sls.asrisr a asps of=a soars-costars sad rats•acbaths:or aoa:thoss a* Sias h21,2 anapio7mas s t -9_raatxactar:lzmaa rr ,ticasr oar t pro::i:h.s ;•c±s , ca.:.•+.polio =22k . oast en employer that s prmitling workers eoarapt canon itrsurance for my employees_ Beloit-is the pollethe police 47ndjob sire if!flrta traarc In e Name: Policy=or Self-in.Eic._: E im non Date. Job Site Address:_ City`State.rip: Attach a copy of theworkers'compensation police declaration page tshoning the policy number and expiration date}. Failure to secure ve a as requite ruder MGL o.15Z§25A is a Tiolation`hie by a fine tip to SI,500,00 and r ore-year imprisonment. 11 as ci it 1ti in the fonn oh STOP WORKORDER_and a fine of up to S2 0 a -v a 1iv-t the 7 ioL-tor. cam,of this-statt •gn-may be to the Office of In.re_liptienn of the ILA fur insurance d�+�`S'era. erifi-.ancr.. I do hereby cerrf under the pains Gird penalties of ?rtr •that the ratio provided is trite and correct ;mn turnZy ,ur Date:: 5/27/21 = 413-768-8683 Official rise only°. Do not+waite in this area,to be completed by car or town ofcio/ City or Town: Permmit`Licen e Issuing Authority(circle one): I,Board of Health ,Building Department 3 Cit+,-'Town Clerk 4.Electrical Inspector =.Plumbing Inspector 6.Clr C'onract Pea-sour Phone City of Northampton r Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ;), 212 Main Street • Municipal Building e, Northampton, MA 01060 fxNyY ‘ HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, Clay Cummings & Laura Cummings (insert full legal name), born 1/6/86 (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 27th day of May ,2021 . C� a ids Siature) Q t �? T 4 I 3 4 c -; II iII. 6/1/2021 City of Northampton Mail-PERMIT APPLICATION 1/....44 4E1 h a °f Kim Carson <kcarson@northamptonma.gov> Nortmpton PERMIT APPLICATION 7 messages Kim Carson Thu, May 27, 2021 at 12:01 <kcarson©northamptonma.gov> PM To: DEBORAHLNN@aim.com Please fill out and send back to me. Thanks, Kim Carson Northampton Building Department 413-587-1240 HIGHLIGHTED FORM - 1 & 2 Family building Permit 2020.pdf 980K Deborah <deborahlnn@aim.com> Tue, Jun 1 , 2021 at 10:21 AM Reply-To: Deborah <deborahlnn@aim.com> To: "kcarson@northamptonma.gov" <kcarson©northamptonma.gov> Hi, Please find the updated permit. I found the original document I sent via a link. I went to permits, fee's, and then it linked me to the form to fill out. It might be more helpful to link to the actual permit. I mailed because the website had said office's were closed, but a box was out front. It may not be an issue now, but had thought if no one was in the office, would the box be checked and therefore felt mailing would be quicket. Only sharing because it might make it easier for townspeople. & of course for you too if things were a bit more user friendly. https://mai I.google.com/mail/u/0?ik=28605c8627&view=pt&search=all&permthid=thread-a%3Ar46996321235554465&simpl=msg-a%3Ar81852162702... 1/4 6/1'2021 City of Northampton Mail-PERMIT APPLICATION Thank you for your help, Laura [Quoted text hidden] updated permit & 2 Family building Permit 2020.pdf 1007K Kim Carson Tue, Jun 1 , 2021 at 10:32 <kcarson©northamptonma.gov> AM To: Deborah <deborahlnn@aim.com> Thanks.. .I will need the name of the dumpster company. Kim Carson Northampton Building Department 413-587-1240 [Quoted text hidden] Kim Carson Tue, Jun 1 , 2021 at 10:32 <kcarson@northamptonma.gov> AM To: Deborah <deborahlnn@aim.com> Also will need structural and sectional drawings Kim Carson Northampton Building Department 413-587-1240 [Quoted text hidden] Kim Carson Tue, Jun 1 , 2021 at 10:54 <kcarson@northamptonma.gov> AM To: Deborah <deborahlnn@aim.com> Sorry, just noticed that you put the square footage in the spot that asks for the total project cost. Please let me know the total https://mai I.gong I e.co m/ma i I/u/0?i k=28605c8627&view=pt&search=a I I&permth id=th read-a%3Ar46996321235554465&s i m pl=msg-a%3Ar81852162702... 2/4 6/1/2021 City of Northampton Mail-PERMIT APPLICATION cost. Thanks, Kim Carson Northampton Building Department 413-587-1240 [Quoted text hidden] Deborah <deborahlnn@aim.com> Tue, Jun 1 , 2021 at 11 :24 AM Reply-To: Deborah <deborahlnn@aim.com> To: kcarson©northamptonma.gov Hi, I sent the drawing with the orginal paperwork. Should it be different? And it started in the application, sq ft could d as "total cost". I'll have to revisit and adjust. We haven't hired a dumpster company as of yet, but let's just use USA to be easy. Sent from the all new AOL app for Android [Quoted text hidden] Kim Carson Tue, Jun 1 , 2021 at 11 :32 <kcarson@northamptonma.gov> AM To: Deborah <deborahlnn@aim.com> Telling us the total estimated cost of the project will not change the amount of your permit fee. Please let me know what the cost of the project will be. I will revise the Debris Affidavit for you. https://mai I.google.com/mail/u/0?i k=28605c8627&view=pt&search=al I&permthid=th read-a%3Ar46996321235554465&simpl=msg-a%3Ar81852162702... 3/4 6/1/2021 City of Northampton Mail-PERMIT APPLICATION Maybe the person who is building the deck can help you with the structural drawings. Or they could call the office and speak with Kevin Ross. His number is 587-1239. Kim Carson Northampton Building Department 413-587-1240 [Quoted text hidden] https://mail.google.com/mai I/u/0?ik=28605c8627&view=pt&search=all&permthid=thread-a%3Ar46996321235554465&simpl=msg-a%3Ar81852162702... 4/4