44-002 (3) BP-2024-0554
900 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
44-002-001 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-2024-0554 PERMISSION IS HEREBY GRANTED TO:
Project# ADD BASEMENT BATH 2024 Contractor: License:
Est. Cost: 19000
Const.Class: Exp.Date:
Use Group: Owner: JENNIFER BANDA,
Lot Size (sq.ft.)
Zoning: WSP Applicant: JENNIFER BANDA,
Applicant Address Phone: Insurance:
900 FLORENCE RD
FLORENCE, MA 01062
ISSUED ON: 05/07/2024
TO PERFORM THE FOLLOWING WORK:
ADD FULL BATH TO BASEMENT
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: 1/2.
Fees Paid: $124.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
i >
The Commonwealth of Massachusetts 3
MAC _ ?Q24 FOR
Board of Building Regulations and Standarkls
Massachusetts State Building Code, 780 CMR MUNICIPALITY
Building Permit Application To Construct,Repair, Renova§e Or _ ii;+bi "�;' r2011
One-or Two-Family Dwelling
"dnRTHAn -
This Section For Official Use Only
Building Permit Number: $(2-�`f- 55'�f Date Applied:
k..) I Z f��iG 5-7 ZO Z'y
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
Li Property Address: 1.2 Assessors Map&Parcel Numbers
900 Florence Road 01062
1.1a Is this an accepted street?yes X 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 Xl Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
. rPI QFERTY O►V ERSiHIP.'
2.1 Owner'of Record:
Jennifer Banda Northampton.MA 01062
Name(Print) City,State,ZIP
900 Florence Road 512-968-4890 jenncandoit@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply)
New Construction 0 Existing Building® Owner-Occupied IH Repairs(s) 0 Alteration(s) 0 Addition BI
Demolition 0 Accessory Bldg.0 Number of Units 1 Other 0 Specify:
Brief Description of Proposed Work2:
Adding full bathroom(toilet,walk-in shower,sink)to basement level next to finished bedroom.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 11000 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 1,000 ❑ Standard City/Town Application Fee Z,
�j
❑Total Proje s e 0 x multiplier x
3. Plumbing $ 7,000 2. Other Fe s: $ 12t{
4.Mechanical (HVAC) $ N/A List:
5. Mechanical (Fire
Suppression) $ N/A Total All Fe
Check No. L. eck Amount:
6.Total Project Cost: $ 19,000 0 Paid in Full 0 Outstanding Balance Due:
Jarnc.an e jmzi ( _ L.e-Y-,
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see belm%)
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 ❑
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.
Jennifer Banda April 5,2024
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 www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) 90 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"
The Commonwealth of Massachusetts
• I Department of Industrial Accidents
1 Congress Street,Suite 100
rer Boston,MA 02114-2017
WW1.;mass.gor/dia
vvinkers'Compensation Insurance Afridas it: BuildersiContractors/EtectriciansiPlu
'11)BE FILED W Fitt THE PERMIrriNc ALTIIORITE.
tmlicant Information Please Print L.euibls
Name I BusIness,'Organizationindividualy Jennifer Banda
Address: 900 Florence Road
City/State/Zip: Northampton,MA 01062 Phone#: 512-968-4890
Are)1111111 NI employer?Check the appropriate bex: Type of project(required):
101 ani anployn with , (full and or patt-t t mei.* 7. 0 New construction
:20 1 ant 3 sok proprietor or postientop and haw in employees working for Inc in 8. Remodeling
any capacity..No workers'comp,insurance regnant]
9. Demolition
„x0 AM a homeowner doing all work myself.No..er*:comp,anucance required"
0[J Buikiing addition
4.0 tam s tiuousissna anal will be hiring wet:odors to eanduet all week on my property. I will
ensure that all xx.naracioni either have workers'compensition insurance ex are Note i CI Elecuical repairs or additions
pityriktois ith no enployeni,
12.0 Plumbing repairs or additions
.s.C3 I Am a goncral contractor and I Inv e hired the sulwootractori listed on the;molted sheet
These sulwontractins haw employees and have workers'comp.ancerance2, 30 Roof repairs
6.1:1 We are a corporation and da officers haw entwined then right of exempt 14.0Otherion per MC&c,
1.2,41(41.and*c have no einploynew No workeva comp.insurance required.]
applicant that clinic%lxix a I main also fill out the section below show trig diva workers*ettogionation policy information.
lloincow nos who sohnut tins ntThItsIinilicaling they are Jong( tII work and then hire outiiiic nantractopi must submit a 1104"allidar it italic:ding sia:11,
;Cuntractum that check dna box aunt attorticd an additional sheet shouting the=be Of the stchwuntractors arid state*holier riot those inintica haw
implo',co, It tho mnitractors hate nIoccs.they most pro'.oic their Avikers°cotter robe),mantel
. ,
I am an employer that is providing worAers'compensation insurance fur nay employees. Below i the policy and job site
information.
Insurance Company Name:
Policy#or Self-iris.Lie.2: Expiration Date:
Job Site Address: City/State:Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under NIGI.e. 152.*25A is a criminal violation punishable by a fine up to S1,500.00
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 tnvestigat:uns of the DIA for insurance
COVeragCv erification.
Ida hereby certif. under the pains and penalties el-perjury that the information provided above is true and correct.
Sivnature:. 04/05/2024
Phone : 512-968-4890
Officiiit use only°. Do nut write in this area. to he tompleted hy city or town official
it or Town: Permitlicenfie
Issuing Authority (circle one):
I. Board of health 2. Building Department 3.Cits(tom n Clerk 4. Electrical Inspector S. Plumbing Inspector
6.(Niter
Contact Person: Phone ti:
_ „ .
City of Northampton
ow-r 4A HF:a
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f"° Massachusetts ��?5 4�
*
- 4 DEPARTMENT OF BUILDING INSPECTIONS
'' 212 Main Street • Municipal Building t ,
da, •
s/ Northampton, MA 01060 jay ,.-�14
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:
Most trash will be taken away by owning sub-contractors.
Location of Facility: Any misc trash will be in residential cans picked up by USA Waste&Recycling.
The debris will be transported by:
Name of Hauler: Tile/Shower surround-Wagner Flooring 302 East Main Street,Westfield,MA 01085
Signature of Applicant: Date: 04/05/2024
City of Northampton
S '
", ' Massachusetts ��s� _- •r��`t
1 ° DEPARTMENT OF BUILDING INSPECTIONS P
t r 212 Main Street • Municipal Building
Northampton, MA 01060 , ‘'t�
h:Q £OWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
Jennifer Banda (insert full legal name), born rs-ez(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 5th day of Apra , 20 24 .
(Signature)
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