23A-144 (10) BP-2024-0859
121 PINE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-144-001 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-2024-0859 PERMISSION IS HEREBY GRANTED TO:
Project# DECK 2024 Contractor: License:
Est.Cost: 1500
Const.Class: Exp. Date:
SIPPEL ROBERT THOMAS &STEPHANIE L
Use Group: Owner: PASTERNAK
Lot Size(sq.ft.)
SIPPEL ROBERT THOMAS& STEPHANIE L
Zoning: URB Applicant: PASTERNAK
Applicant Address Phone: Insurance:
121 PINE STREET
FLORENCE, MA 01062
ISSUED ON: 07/10/2024
TO PERFORM THE FOLLOWING WORK:
REMOVE EXISTING DECK AND BUILD NEW, INSTALL NEW DOOR.
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: ri•
Fees Paid: $75.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
File #BP-2024-0859
APPLICANT/CONTACT PERSON:SIPPEL ROBERT THOMAS& STEPHANIE L PASTERNAK
121 PINE STREET FLORENCE, MA 01062
PROPERTY LOCATION 121 PINE ST
MAP:LOT 23A-144-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $75.00
Type of Construction: REMOVE EXISTING DECK AND BUILD NEW, INSTALL NEW DOOR.
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:
V Approved Additional permits required(see below) For all projects that need additional reviews E
as checked below,please see the Office of Planning& Sustainability Permit page or scan here *771161
PLANNING BOARD PERMIT REQUIRED UNDER:§
INT—
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
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.
RECEIVED W..( 4 -f--•
em L
JUL - 8 2024 The commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
�a ach setts State BuildingCode, 780 CMR MUNICIPALITY
ni). PT.OF BUILDING INSPECT USE
f _— Nn�� iT N' A op1 i Applti<�tion To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
S ion For Official Use Only
13ui1ding Permit Number: 4 i .4" air Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
loreu.c /k _ 234 - f cl ' C7C7 l
1.1a Is this an accepted street?yes / no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
aOl6ay go
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 Ge- Private 0 Zone: _ Outside Flood Zone? Municipal Ilbn site disposal system ❑
Check ifyes/2''
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
ob-evr S : , t 12. l F'; ,v C )
Name(Print) City,State,ZIP
l 2-1, c rve 5-t 1-1 1' '- .o6g 0 r { sop?e) �\itita� < c o vvt
No. and Street Telephone 1;nfail Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 1E1 Repairs(s) 0 Alteration(s) It7,1-Addition ❑
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: A'e1.1/tay.e 5,17 c'e C
c-✓GLsv/.4 Ile ad dpe',( f �^ `v, /csi vt J - s„iof
ciao r ,aiA o1 a.// . •its // n'
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ / 5-3-0 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ r List:
5. Mechanical (Fire $
Suppression) Total All Fees: $ -%5"=' 6 Check No.t(1 Check Amount? Cash Amount:
6.Total Project Cost: $ 0 Paid in Full ❑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.)
K 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
I elephone 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.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTE :
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"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
\AlCv
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
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<c r , • DEPARTMENT OF BUILDING INSPECTIONS Its 212 Main Street • Municipal Building O, C'
' Northampton, MA 01060 : `‘0
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
,ZA c"//962_
I, iSOJ,.Pv •-i- (insert full legal name), born _ (insert month,
day, year),hereby depose and state the wing:
1. 1 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 5 day of L/ 20 d.1
(Signature)
City of Northampton
Massachusetts •
A• •
DEPARTMENT OF BUILDING INSPECTIONS
Yt 212 Main Street • Municipal Building
OggrOY M '" Northampton, MA 01060 slq,(416‘�
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: VO, II-Q TeG ((ix � � A "
At
G
The debris will be transported by:
Name of Hauler: 5e( -i
S/pfe
Signature of Applicant: Date:
The Commonwealth of Massachusetts
Department of Industrial Accidents
__'`�l' 15 1 Congress Street,Suite 100
• 64` Boston, MA 02114-2017
.' www mass.gov/dla
- Workers'Compensation Insurance Affidavit:Bu[IdersIContractorsfElectriciansfP[umbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information / Please Print Le>tibh•
Name(imusinea&Organtzatiatylndividual): '1R0 19 C v S t (42 I
Address: Pt
City/State/Zip: *c-Ld Phone#: L( (� 3? �� C'6 lr n
Are Visa as employer?(petit the appropriate box: Type of project(required):
I Q I am a employer with __. employees(full and/or part-timrl-• 7. M New construction
20 I am a sole pr priaur or partnership and have no employees work mg for me in g. Q Remodeling
any capacity-[No workers'carp.insurance regwtni)
30 am a homeowner doing all work myself.[No workers`comp.inw rectum:di*rectwdi' 9. Q Dttrtuolition
4,0 lam a homeowner and will be taring oorttrectors to conduct all work on my property_ I will I U o Building addition
ensure that all canoal.tots either have workers'consprnsation insurance or are rule 1 la Electrical repairs or additions
proprietors with no employees_
12.0 Plumbing repairs or additions
50 I am a general cuntractor and I has c hired the sub-contractors listed on the attached sheet
These wib-contracwrs have employees and base workers'camp.insurance.: 13 Roof repairs
6 D we a Inv a corporation and its officers have exercised their right of exemption per AK,L c. 14. Other --
1 S2, 1(.0.and we have no employees.[No women'comp.insurance retuned.]
•Any applicant that cracks box CI mot also till out the accteon below chow ing their workers'compensation policy information.
t tianaoWners who submit this affidavit indicating they are doing all work and then hire outside contractors mart submit a new affidavit indicating such.
tCoruractors that cheek this box must attached an additional sheet stowing the name of the sub-contractors and state whether or not those entities have
employees. If the sub.eoatracton have ergiloyces,they must provide their workers'comp policy number
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site
inforaratlon.
Insurance Company Name:_
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation pocky declaration page ishowing 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$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 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 certify tinder the pains and titles of perjury that the information provided above is true and correct
Signature: Date: L
Phone tt: L( 3 (5-
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit license#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Cif)rTown(jerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone#:
-NOTE—
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONS IHUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
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PINE STREET
TO: FLORENCE SAVINGS BANK &
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
—NOTE—
SURVEYOR�arn,� Q ! THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
�N OF ,44,ss, —MORTGAGE LOAN INSPECTION PLAT—
NORTHAMPTON, MASSACHUSETTS
RANDALL c°l PREPARED FOR
E.IZER N R. THOMAS SIPPEL & STEPHANIE PASTERNAk
i3503� ,2
�� SCALE: 1"=50' MAY 7, 2014
�° suRv j/ HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
36" Kemove ana patcn existing aoor
New door 3-0, 6-8
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Ht at ledger 31"
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2 x 6 pt, 16" oc
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Ht. 34"joist top •--i
r 78"
10" x 42" poured footing �t M
4 x 4 pt post w/ connectors • ri
49-5/8"
130"
Sippel new deck construction: framing plan
121 Pine St
Florence, MA
Shed Roof `"--
4x4 fir post
Clad beam
36
69-5/8" Co
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1 °' Decking : 1" composite
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All post too be clad to 38" •
I Sippel New deck elevation
6" masonry pad,on gravel bed
121 Pine St
Florence MA
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