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29-394 (2) BP-2024-0443 99 BROOKWOOD DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-394-001 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-2024-0443 PERMISSION IS HEREBY GRANTED TO: Project# DECK 2024 Contractor: License: Est. Cost: 8000 Const.Class: Eap. Date: Use Group: Owner: SCHUBACH CYNTHIA M Lot Size (sq.ft.) Zoning: WSP Applicant: SCHUBACH CYNTHIA M Applicant Address Phone: Insurance: 99 BROOKWOOD DR FLORENCE, MA 01062 ISSUED ON: 04/18/2024 TO PERFORM THE FOLLOWING WORK: 12X15 DECK 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: :7 2. Fees Paid: S65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 2 File #BP-2024-0443 APPLICANT/CONTACT PERSON:SCHUBACH CYNTHIA Mt_fit 12Ev�a,, 99 BROOKWOOD DR FLORENCE, MA 01062 PROPERTY LOCATION 99 BROOKWOOD DR MAP:LOT 29-394-001 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: 12X15 DECK 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) For all projects that need additional reviews 0 ;-} �❑` as checked below,please see the Office of Planning& Sustainability Permit page or scan here PLANNING BOARD PERMIT REQUIRED UNDER:§ El�:a 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 l6-z2 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. APR 1 6 2024 The Commo wealth of Massachusetts J pReg�ulations and Standards FOR °LPN RF ssacht tt .tate Bulilding Code, 780 CMR SU MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling '[ Section For Official Use Only Buildin Permit Number: 619 �'f Date Applied: rJ &055 `i-)6•202 L/ Building Official(Print Name) ignature Date SECTION 1:SITE INFORMATION 401111111 ©166� 1.2 Assessors Map&Parcel Numbers b r Rerenc e.. M 1; 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 '" 11 ` eynI la 'EZJIIA e4o)*i " d i Name(Print) City,State,ZIP S 84,--4'g45-'CSaltAb01/44.1 249 i CIcuo.c°m No.and Street Telephone Email 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 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: IIIIIIMIMIIIIIIIIIIM/fit X /S f wok e-y1 U 14-P_ of r,n iovSQ 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: 0 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 Check No. Check Amount: Cash Amount: 6.Total Project ❑Paid in Full ❑Outs diAL96 Balance Due: \Q 2(7 �/ çko 'WV I City of Northampton - - ,‘ Massachusetts r �', , �� ' f t DEPARTMENT OF BUILDING INSPECTIONS ''.4! �„ 212 Main Street • Municipal Building 'sc. Cb .. 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. A 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 I&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 ❑ 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. gaga 1l1.LS- ner's or AuthotiLe ectronic 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" 5T R. G CT i&rv-z x 1601 CITY OF NORTHAMPTON w SETBACK• � PLAN Z1 gyp' MAP: LOT:3'f LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton Massachusetts JL DEPARTMENT OF BUILDING INSPECTIONS 1 ti' 212 Main Street • Municipal Building p... Northampton, MA 01060 '!'4 AFCA'''` =11,TatigruaiiiikenliibliSikiliimlarmiiiiiiiaT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the pr isions 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 Ii ensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: • l�'a,G "?,C ul" Location of Facility: ?\/ The debris will be transported by: Name of Hauler: .. ''. mow..,E . Signature of Applicant: Date: gp‘, • The Commonoveahh of Massachusetts Department of Industrial Accidents I Congress Street.Suite 100 ts. Boston. M102114-2017 www.ntass.goildia Winters Compensation Insurance Affidavit:Buiklers/ContractorsfElectricians/Plumbers. TO BE FILED W rill"I HE PERNIIITING AUTHOR'IV. Applicant Information Meuse Print 41011111.1gines.s,Organization Individual):___GfribiaLAStimAlack Address: 6rk Cilb C. 91 6c5ALJDO CityeStatelZip:Ployxit&API 10 (aa,_ Phone g DJ-4 S".. Ate you sus employer?Cheek the appraise-tiny looks irc of project(required): I am a t employ./ employees that and part-tinick• 0 New construction 20 lam a tole ptuprietut at purnerakup and has czuemployees winkinsa fur me in 8. ID Remodeling any cameo..[Nu w miters'emir.mummy r..-train.. 9. Demolition 30 I am a liornoawner doing all woei myself.[Nu 4.0.riers"comp insurance required I 10 Building addition 4.(WWII 1101110141143 and ssifl bc h.nn oratitactors in Lsirairet ail wink un tny preiscrty. I will CT'S un:that all contractors either have workers'conspensistron insurance or art sole II.0 Electrical repairs or additions prupntKt with nu employees.. 2.0 Plumbing repairs or addition; 1 am a sacral contractile and taxi:hired the sub-contracturs,lasted on the attached sheet, These sub-contractors ruse employees and rinse workers'eump.insurance; 130 Roof repairs 14.El Other 6.0 W.an:a...Input-Awn and itb officers base exacised their nElit exvinpt2un pct NCI c. 152_ I4I.and we hasc nu employ...vs.[Nu workers'comp.insurance required]. An applicant that chuls Kix.1 must also fill out the section below showing then workers'comperisation POI'K.,Inklenlithan- f lionstown4m.who surntuf tins affidasit netheaune tfte!,an%hung all wink and then hire outside euntracturs mint submit a new affidavit indicuranv sus.sh, 1Contrueton that check this box must andich..x.1 an addatiunal shsvt show ins the name of the surseontractors and state 4%,Itether us nut those employs:ex Ii sb i.11,--o)ntractor,, ccs.thcy must pru.idc their workers'est.inp.rvlie:. nix!), l ant an employer that is prodding Ortrrierk compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.L lc. : Expiration Date: 4.1.."1"1"114 9 13raol(aitod Dr, City'State'ZiP:F1111.1c.A...311.111A.LO Attach a copy of the workers'compensation policy declaration past(show in the policy number and expiration date). Failure to secure coverage as required under M.GL e. 152,§25A is a criminal violation punishable by a fine 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 be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I du hereb3 certilY under the pains and/wordily%of perjury that the information provided above IS true and correct.. Sit?nologrOTP -7S-\,k)1.14-TICO..ki 411PietaLt,r Il / Pb)ne. Official use only. Do not write in this area.to be completed by city or town official City or Town: PermitiLicense Issuing Authority (circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector o.Other ('ontact Person: Phone 4: A City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building � ;`, Northampton, MA 010601.f-)11�` WNERS'EXEMPTION ELIGIBILITY AVIT Ap r.1 a0 4 yn ft (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 I (o ,20, i(S re) i ''L C 1 3 .'') 7,..,1 .. - .1_ CA v *----NN 4 /2-- `"- Lr 1, _ s(( c4-------\i 1 `- I O T 0 D �� Ti a w -- �` _ Vx `"0 t-/ -r ,-,__A, S S —' ` crl Zo _ T 0 00 E.:?( .6d21--1 IA 5 V-i'ouSe, ..=- ------> k • 1 • 60 3A0\ c-T.-e ,ps o F P r9 C 1 G l2 y t Y P� � mi , ` q OeCK C{ c( trOA wD4 Qtri ve TIt 57(/ C e30 DPr. r. 't Nditl'''P _li 1 1-- 0.- 1 i -t) __r, 1 5 :53_-e_ i 1/2_, \ 0, = 1 .F:t r - -'_ _, • l=X `S)0 g EEC i 5-1-;`A *Oo�v�° .?.. ---7 r)( . I . .________..„.___A____ ..___.— . _ .. F.....4N.„. . .L., • ) ) a - /Ouot e601-re 3 -)4,( 9\ish, ____ \\NN, 4b1-1-',. i \ N., i 2.x /D c)fi / 6 OC, , le-PO5.tor Milill 1 -ers - ' • i , 1 X . ilek.„) (-tot( cy cv\it6 e6L. 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