35-283 (8) BP-2024-0828
12 SYLVAN LN COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-283-001 CITY OF NORTHAMPTON
Permit: Addition
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2024-0828 PERMISSION IS HEREBY GRANTED TO:
Project# DECK 2024 Contractor: License:
Est. Cost: 16000
Const.Class: Exp.Date:
Use Group: Owner: O'NEIL ROBINSON MICHAEL D&ELLEN M
Lot Size (sq.ft.)
Zoning: WSP Applicant: ONEIL ROBINSON MICHAEL D& ELLEN M
Applicant Address Phone: Insurance:
12 SYLVAN LN
FLORENCE, MA 01062
ISSUED ON: 06/28/2024
TO PERFORM THE FOLLOWING WORK:
DECK ADDITION
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: ��i
eZ
D
Fees Paid: $104.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Buildinc Commissioner
2- D.V LZ
File #BP-2024-0828
APPLICANT/CONTACT PERSON:ROBINSON MICHAEL D&ELLEN M O'NEIL
12 SYLVAN LN FLORENCE, MA 01062
PROPERTY LOCATION 12 SYLVAN LN
MAP:LOT 35-283-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $104.00
Type of Construction: DECK ADDITION
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION
PRESE1�lTED:
t/AApproved Additional permits required(see below) For all projects that need additional reviews 0+' 'k0
as checked below,please see the Office of Planning& Sustainability Permit page or scan here - it ;
PM; 4Fia
PLANNING BOARD PERMIT REQUIRED UNDER:§ 0'
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Specia l Pennit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approva I Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Z8-7-OZY
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all
required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit
granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&
Development for more information.
/
1m(411 ( r 4Ar
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The Commonwealth of Ma .c 2/ O
�, Board of BuildingRegulations an. . a R
`,►"` � �0�� M IPALITY
Massachusetts State Building Code, 7:i 4o+A,i'-.,,� USE
vn Building Permit Application To Construct,Repair,Renovat- 4, ish ' ised Mar 2011
One-or Two-Family Dwelling °,cool,$
1 This Section For Official Use Only
Building ermit Number: 1 .?9�Yo)� Date A lied:
itv _>
4 /��C:-- 4... 62
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
Propeerty Addre 1.2 Assessors Map&Parcel Numbers
a Syl�l4r1 one 1I 0/66 2-
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
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public CI Private CI Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
th,,,N, . 'west O'k4`1 'F(ocorer, MA 016 6 Z
Name(Print) City,State,ZIP
• 12 S y f u4.4 UAL. 1 i 3 S 73,y6rd 46zoc'nkf 6-wt{hair 642 .E'cio
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) ❑ Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2 0 Cek A -1-;(/
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ /V'i 673r) 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All F
Check No. 01 Check Amount: Cash Amount:
dotal Project Cost: •(GQ ) 0 Paid in Fu I ❑Outstanding Balance Due:
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 enteri 'my name bel I hereb attest under the pains and penalties of perjury that all of the information
contain ii t1i1 a licatiin i true accurate to the best of my knowledge and understanding.
1 6- 2 7-26Z�
Print Own•r's r A o 'zed is Name ectronic Sign e) - "`"---- - -Date-- f a di
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
wwnv.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,fmished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halflbaths
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
CILC\1\4
N��
pEcIG w S •
SIDE YARD SIDE YARD
EC1‹.
\-430s 5(k
- /V
U1
FRONT SETBACK
FRONTAGE
City of Northampton
! of �. Massachusetts
14 l t (� !1 DEPARTMENT OF' BUILDING INSPECTIONS
t I '
♦ r K" 212 Main Street • Municipal Building
�' Air Northampton, MA 01060 ffbj'
CONSTRUCTION DEBRIS AFFIDAVIT +gi
(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: (1 Q at er-r(kAith � �J
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date: 6 -77 -Z 0
Tin' Commonwealth of Massachusetts
.61 Department of Industrial Accidents
ii - 1 Congress Street,Suite 100
�'• Boston,MA 02114-2017
.i t's` www.mass go►'/dia
• 11 in kers'('ompensation Insurance ARdat it:Builders/ContractorsiElectriciansiPlumbers.
iO BE FILED N 1111 Ink:PEkill EOM;AUTHOK1-11.
Applicant Information Please Print Leeibh
Name(Business organiratioa Individual l:
Address:
City/State/Zip:T Phone n:
Are yea an employer?('heck the appropriate bus:
Ty pe of project(required):
i.❑I am a employer wish___cnrployeea(full as ttur pa:minx 1.` 7. 0 New construction
2.E1 1 am a sole proprietor or partnership and have nu employees.working forme in 8. O Remodeling
any capar:tty.No workers'comp.insurance required.]
9. ❑Demolition
30 1 s a hunx cr ywwn doing all work m self.No workcws'comp insurance regain:!.)'
10 Q Building addition
g. am a hutrnvw ncr and will be hiring contractors to conduct all work un my property. 1 will ensure that all contraa:tora tither hate workers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors with no crrgrluycen.
12.❑Plumbing repairs or additions
sO I am a general contractor and 1 have hand the soh-contractors listed on the rarefied:beet.
130 Roof repairs
Tbi.N4 sob-contractor:have employees and have workers'comp.insurance.:
ri.o We a corporation and its of freers has c exercised their nub:of exemption pet AM(il.c 14. Other
152.4lt4t.and we line no anpluyees.iNo workers'comp.insurance reunited.'
'Any appbcnrt that chocks box al mutt also till out the section below,show ing their workers'conmensahon policy urfurma ion,
*llorneuwnera who submit this allidae it indicating they are doing all work and then hire outside cmitractors must submit a new affidaa it indicating such.
!Contractors that clack this lux mug attacbad an additional abort:busing the name of the cub•cuntractors and state w hethcr or nut those conies have
crnployhi If the stsb-contractors hove crttrluyces.they must provide their uorkcrs'comp.polio,nurnor.
I am an employer that is providing workers'compensation insurance for my employees. !snore is the policy and job site
information.
Insurance Company dame: __. —
Policy#or Self-ins.Lie.#: Expiration Date: a
i, Job Site Addref , '2 Geist" Lu CityrStatc Zip: f I./� ! ►P( 1 Ot 6 L-
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MOL c. 152, ,s*'25A is a criminal violation punishable by a tine up to S1,500.00
and/or one-year imprisonment.as well as civil penalties in the fonts ofa STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this,tatcnnent may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby ccrti fi ire r the pains r net a .s of perjury that the information provided above is true and correct.
tit "'"t.' e\i\ • .400 6 2-7 '20 2 -
Phone#:
Official use only. Do not write in this area.to be completed by city or town official
City or Town: Permit/License t$
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.('itylTown Clerk 4.Electrical Inspector S. Plumbing Inspector
Si.Other
Contact Person: Phone#:
•
City of Northampton
1 ",, Massachusetts
fi �} 1 at �:
d „, fit. , .: r
DEPARTMENT OF BUILDING INSPECTIONS �, i.
(r y.,
t\ 212 Main Street • Municipal Building J,i;•._,
T. • .d,:',''4 Northampton, MA 01060 rfYh; •6`1�
HeMEOWNERS'EXEMPTION ELIGIBILITYAFFIDAVI
I, llh.61,(.A gt.L 1h.S oY\ (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. 1 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. 1 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. 1 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 27 day of U.'i4 , 202
(Signs re) \N------------
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