35-292 (8) BP-2024-0813
109 WOODLAND DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-292-001 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-2024-0813 PERMISSION IS HEREBY GRANTED TO:
Project# screened porch 2024 Contractor: License:
Est. Cost: 32000 CORBIN CHICOINE 113093
Const.Class: Exp.Date:02/16/2025
Use Group: Owner: S ARMSTRONG KIPP S&PATRICIA
Lot Size(sq.ft.)
Zoning: WSP Applicant: CORBIN CHICOINE
Applicant Address Phone: Insurance:
45 UNION ST (413)214-4659
EASTHAMPTON, MA 01027
ISSUED ON: 07/05/2024
TO PERFORM THE FOLLOWING WORK:
REMOVE 14X20 DECK AND REPLACE WITH 18X14 SCREENED ROOM
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: f7" _
Fees Paid: $208.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
File #BP-2024-0813
APPLICANT/CONTACT PERSON:CORBIN CHICOINE
45 UNION ST EASTHAMPTON, MA 01027(413)214-4659
PROPERTY LOCATION 109 WOODLAND DR
MAP:LOT 35-292-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid S208.00
Type of Construction: REMOVE 14X20 DECK AND REPLACE WITH 18X14 SCREENED ROOM
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
PRESS ED:
Approved Additional permits required(see below) For all projects that need additional reviews rYaRO
as checked below,please see the Office of Planning& Sustainability Permit e or scan here
1?ag
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
"7. 6- zozq
Signature of utlding 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.
-0, , l Ernail ( RECEIVED
The Commonwealth of Massachusetts JUN 2 7 2024
t,t) Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CUR MUNICIPALITY
DEPT OF BUILDING INSPECTIONS USE
Building Permit Application To Construct,Repair,Reised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: 4o- 1-N- e/ Date Applied:
Z5 5-zotki
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.t��pe �l X. �/ /G 4 1.2 Assessors Map&Parcel Numbers
1.1a 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
4/°' 4 7S' if.
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private 0 Zone: — Outside Flood Zone? Munici
Check if yeses P On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 wnert of Record: (v
�6/ri c'1a d,eirlSTovG /!/ vGe /Ll/9
62
Name(Print) City,State,ZIP
/a 7 kt)O')A 44/Vo ,j r; 1/43- 25 10-3 gi?
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)' Alteration(s) 0 Addition.Z
Demolition JZf Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 7 fg E(/S TiitlL�nyk(
LiKe 725 fee trio vC 77te lyn )l W o 4 me c x ut) lee/ cc"
. .7- G) /f k A /g' Ky' ( o v e Rc h &CK / 45Cre e i gavel
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 2 3,QO() 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ / 0� ❑Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ _- 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $' Total All Fees: $
Suppression)
Check No. Check Amount: ,RO
6.Total Project Cost: $ 3 2/ zo 0 Paid in ull 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervi or License(CSL)
Corm/, CI JroiNC 45 //�93 --�6—as—
License Number Expiration Date
Name of CSL Holder Uhi�1 32. ` '
2 ^tr/NC P�N ',v� List CSL Type(see below) V
No.and Street Type Description
� ,T�/�J��� A7� D/ 7 U Unrestricted(Buildings up to 35,000 cu.ft.)
G1 �'/ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
1/3 a/y . O'�� �f &) / SF Solid Fuel Burning Appliances
� I Insulation
Telephone Email address !//3., Corn D Demolition
5.2 Registered Home Improvement Contractor(HIC)
4i✓ '//Co//V& CYVi a-y-ass
HIC Registration Number Expiration Date
HIC Corn any ame or C Res�' Names
� GA)Ce 7r ei /I V L- 6izc�v g/csi&v//die y/3. Cam-,
No.and Street Email address
��s777397ri�r✓ PIA V/3 a/y y45-7
City/Town,State,ZIP U/D&'] 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 (10/Q/3/A/ chi/'Co/,l/C
to act on my behalf in all m ers relat've to work authorized by this building permit application.
<--pofe; \Gt� ` G .A' )bZ1.--(
Pn t Owner's Name(Electronic Signature) � Date
SECTION 7b:OWNER1 OR AUTHO D AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
ntained in this application is true and accurate to the best of my knowledge and understanding.
,scl
6 -A-
-{i
Print is or Authori 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.) S`U SP /o,/CA (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
-, HAM�Jo �5 S�
�?•' Massachusetts , - o,
fcq . �� DEPARTMENT OF BUILDING INSPECTIONS y `j„
212 Main Street • Municipal Building uti•. pD
_' Northampton, MA 01060 J:pi;h 3 j�.N.J
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:
r
Location of Facility: V,q/ c ,G l c / li
The debris will be transported by:
Name of Hauler:
Signature of Applican • Date: ^���J
m " The Commonwealth o/ %Iu.ssuchusett'
- Deportment of Industrial.-1 ccidents
L a l congress Street,Suite 100
t; Boston. MA 02114-201
► is'ii:mass.gor/din
)1 otkers'Cotnpensation Insurance flida%it:Builders/Contractors/Electricians/Plumbers.
'tom: E1Ll:1)v%1111 1 IIF PERMUTING ArtIIOKITI'.
Applicant information �" Please Print Leeibh
Name {I3usirtess'i)rgatilutioa'lndividtiat): _ 5LAJ C/F .('
(� t O///�
Address: L[.- VN/O s� S T
14Z7
City/State/Zip: Phone #: l$ o�y 7G '�
Are yea am ettteplarer?Cheek the appropriate hos:
Type of project(required):
aI am a employes.Nish employees(full and'or pie•uate I.• 7. D New construction
41114,41 am a sole proprietor or partnership and have no employees N ortmg for me in 8. Remodeling
/ any capacity (Nu Not—tr,'comp.insurance mini.!
9. i Demolition
30 ant a homeov.net doing all Nurk myself.[No wooers'comp.insurance moored]
d[ i I am a hornoms nor and N it l be hiring walrus-tors to conduct all N ork on my property 1 N ill i O D Building addition
ll'��eti>,urc that all cotittac-turs either have welters•compensation insurance of arc irk I i a Electrical repairs or additions
proms:tors w ith no employees 12.0 Plumbing repairs or additions
SC:3 lam a general contractor and 1 has c hued thesob-contractors listed on the attached sheet- ID Roof repairs
These sub.tuniracturs has employees and hasc wooers"comp rn,urrrwe_
ba we arc a corporation and as officers hay c excreiscd their right of exemption per MC 14..a Other
152.I1111,and we have no employees.[No Nutters'comp.insurance rcyuin:d,l
'Any applim it that chocks boa pt must also till out the section below showing their workers'compensation pulley information
f Ifonxvw•ners who submit this affidavit indicating they are doing all wink and then hire outside contractors must submit a new aftida'It indicating such
:Contractors that check this box must attached an additional sheet showing the name of the sub•vontractors and state whether or not those entities Kaye
employer,- If the sub-contractors has curiose's.they must provide thew workers'coop-policy number-
/am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Sclt=ms.Lie.#: kxptratwn Date:
Job Site Address: CitylState'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 MGL c. 152,§25A is a criminal violation punishable by a fine up to S 1,500.00
and'or one-year impnsonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 do hereby c an r tit d penalties of perjury that the information provided above h true and correct.
Signature: �� l).tte
Phone#. 9/3 , // O'S
Official use only. Do not write in this area.to he completed be city or town Vidal
( its or hossn: i'ermit+l.ieense ty
Issuing!.tuthorits(circle one►:
1. Board of Ilealtb 2. Building Department 3.Clty/Tow•Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phoee#:
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