24C-046 (14) BP-2024-0951
345 ELM ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24C-046-001 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-2024-0951 PERMISSION IS HEREBY GRANTED TO:
Project# PERGOLA/STEPS 2024 Contractor: License:
Est. Cost: 13000
Const.Class: Exp.Date:
Use Group: Owner: POWELL, THOMAS E. & ALANE F. TRUSTEES
Lot Size (sq.ft.)
Zoning: URA Applicant: POWELL, THOMAS E. &ALANE F. TRUSTEES
Applicant Address Phone: Insurance:
345 ELM ST
NORTHAMPTON, MA 01060
ISSUED ON: 07/29/2024
TO PERFORM THE FOLLOWING WORK:
12X20 PERGOLA AND REBUILD REAR STEPS
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: 72_
Fees Paid: $98.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
SEC
Lam.-rya i I ci 11141 i 12e rthil. Cark
Joi O
The Commonwealth of Massachus is 2 3 Ca1
TT' Board of
lations and St
Massachusetts Statng eBu Building Code, 780 CrFub�oq�eUooNG�N M CPR ITY
roN sPF US
Building Permit Application To Construct, Repair,Renovate Or Demo t tired r 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: ot9'',2 4' 9S/ Date Applied:
410 Zo //& 7-29-zzy
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
lroperty Address:-N 1.2 Assessors Map&Parcel Numbers
34S cum. s r, W M rI-/gMProd c?.4-c 24c -o4,-oo/
1.1 a Is this an accepted street?yes ✓no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: 63..5- - ELr ST
Z4C gcSiDc.-xice. /O Z88 / 2.0 - wooDihlw,.lAvc-
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
ZS 4.-'8, ?_2 /6
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
�/ Zone: _ Outside Flood Zone?
Public(d Private❑ Check if yes6]� Municipal On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2Owner'of Record
Tt/DMfI S C A41)41E / PD Ccl_ IvpQ r-t-WripTo,t)/ I ) o/060
Name(Print) City,State,ZIP
34S- Gcri s7 860-4'56-7z9E dAomcisQIyu.7•ipowe/%•',G;/
No.and Street Telephone Email Address , c o,•".
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) B' Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. B' Number of Units Other 0 Specify:
IlaiikaailibasariptionaaWaspeoldies2:
• Aas I Z'X zoi P€ 6ot9 $6r/out) Joerrt ySY Co,cdF/Z A RCAA cFf/A4s6
6 /6"I'0FeTer( Y. 4' PeE-1) So.,)a7z4dFS use/6 Fo.t l=ou• o!1r,aJ
• i?cSi'Lb Re//2 srtOS A is sre v? us,NG SSE Pr'fiEesgseXc. Bur A+AT'7 (34ufs,dvs7
SECTION 4:ESTIMATED CONSTRUCTION COSTS C'nr
Item Estimated Costs: Official Use Only
(Labor and Materials)
o.0 + $ A 4 a o p• o c� 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ craw ❑Standard City/Town Application Fee
j ❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAG) $ List:
5.Mechanical (Fire $ Total All Fees:
4.
Suppression) __ -_ .-.- -
heck No. I 0 Check Amoun : C6 Cash Amount:
ota4-Project Cost. $ 13, o00.06 Paid in Full D Outstanding Balance Due:
(\
City of Northampton
��ecs r� Massachusetts {4?' t_ "..e
t.
-t. DEPARTMENT OF BUILDING INSPECTIONS 'AU
?, Mks 212 Main Street • Municipal Building
�-'•� Northampton, MA 01060 j1PYi ''�S
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.
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 . 0 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.
TI-1M C. Poc,,et zs z, a
�wner's or Authorize a(Electronic Signature) Date -Alia
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"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
r •'" ti; Massachusetts '�.
s� i DEPARTMENT OF BUILDING INSPECTIONS `
212 Main Street • Municipal Building
Northampton, MA 01060 Ei
. 3�
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: 0 AccEy K e c VCL,NC- Z 34 CASii/QMPTvw /CA
N O K y rid H ro/11 /9-
The debris will be transported by:
Name of Hauler: ,-iOn) ci2 4-4^/4)sc-AO,Av4
Signature of Applicant: ,v C.►�--tee Date: 7-zs--2o2¢
The Commonwealth of Massachusetts
-"= = Department of Industrial Accidents
_M I Congress Street.Suite 100
,, 1 Boston, MA 02114-2017
V www:mass.go)/dia
is orkers'Compensation Insurance Affidas it:BuildcrsJContractors1Elkctrician `Plumbers.
fU BE FILED%S 1111 I III.I'E I011 CI Est:At:1'HORiiI'.
-Applicant information Please Print Let:ibls
Thimmillibsiries.vorganizationlbutividualt: "ri'IDivtn s p0toG: L_
3 4s CL Sr
Cite State/Zip: Note r!in,'t,':z�Ae1R o' Phone#: 4340 —2s6— 7e95
Are yuu an entploser?Cheek the appropriate bus:
Type of project(required)..
l.a l am a employer with c'niployr es t t all and or part-tints)_' 7. D New construction
2C1 i ant a sole proprietor or partnership and have no employees working for use in 8.. O Remodeling
any capacity [No at'Ak'Akers'comp.insurance required.]
9. El Demolition
-.y..0 I am a hutrx'owner doing all woii myself.(No workers'comp.insurance required)'
10❑Building addition
11114.( 'ram a Iturrn+uwaer and will be hiring contractors to conduct all work on my property_ I will
.•��ensue:that all contractors eidwr have workers'compensation insurance or are sole I I.I Electrical repairs or additions
proprietors with no employees.
12.a Plumbing repairs or additions
5.0 I am a general contractor and I have hued the sub-contractors listed on the attached sheet..
These sob-contractors base employna and have workers'comp.moraine.: i 3 - Roof repairs
6.Q Vs area corporation and its officers have exercised their right of exemption per Mtil.c t 4.❑Other
152.*It el.and we have no employees.(No workers'comp,insurance required.(
*Any appts arrtthat clocks box al must also till out the section below showing their workers compenaatuan putsoy udformwtiwr_
r Iiomeawtaers who subunit this affidavit indicating they are doing all work and then hire outside contractors must..submit a new affidavit indicating such.
1Contracta+rs that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors base employees.they mist preside their work. comp,policy number.
I am an employer that is providing worllers'compensation insurance for my entployet s.. Below is the polity and job site
information.
Insurance Company Name:
•
Policy#or Self-ins.Lie.#: Expiration Date:
1t iiisid 3 4 s 6.---c rt s 1 City;State•7_ip: Al D T1./Qp)Prn^) /1/A 64464"
Attach a copy oTusz workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,g25A is a criminal violation punishable by a line up to SI,500_)0
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 tier insurance
coverage verification.
I do hereby certify under/the pains and penalties of p(uty that the information provided above is true and correct.
—51�11ti 4,under/
% 7" /r L (1 NYk` f 7 - 2 c- -- z o 2 4._
Pi`. .
Official use only. Do not write in this area.to be completed by city'or town officiaL
1 City or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.(:ity/'fot►n Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
(/ •HAM
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f Massachusetts �?' •
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i;• 4 � '( DEPARTMENT OF BUILDING INSPECTIONS y Ir
212 Main Street • Municipal Building
Northampton, MA 01060 'Pis lPV 7`• ^�.
etioMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVi''
-17-196D
1, 1 /-Jo,1/,, -.. Pc'.,�c c t_ (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. 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. 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 Z Slay of S u Y , 20
/77
(Signature)
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