29-428 (7) BP-2024-0861
78 GOLDEN DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-428-001 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-2024-0861 PERMISSION IS HEREBY GRANTED TO:
Project# DECK 2024 Contractor: License:
Est. Cost: 5000 LOUIS MONTGOMERY 013471
Const.Class: Exp.Date: 11/19/2025
Use Group: Owner: E. WITTING, PAMELA
Lot Size (sq.ft.)
Zoning: WSP Applicant: LOUIS MONTGOMERYE. WITTING, PAMELA
Applicant Address Phone: insurance:
PO BOX 951 413-268-2028
WILLIAMSBURG, MA 01096
78 GOLDEN DR
FLORENCE, MA 01062
ISSUED ON: 07/23/2024
TO PERFORM THE FOLLOWING WORK:
8X16 DECK
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: /2..
Fees Paid: $75.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
File #BP-2024-0861
APPLICANT/CONTACT PERSON:WITTING, PAMELA E.
78 GOLDEN DR FLORENCE, MA 01062
PROPERTY LOCATION 78 GOLDEN DR
MAP:LOT 29428-001 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: 8X16 DECK
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%
oir2it' i=i&
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION -T J3tscrc,
PRESE ED: W% ()260
5 Price
Approved Additional permits required(see below) For all projects that need additional reviews Ei
as checked below,please see the Office of Planning& SustainabilityPennit page or scan here
P 1:
41111
I 7 ...
PLANNING BOARD PERMIT REQUIRED UNDER:* ir)L�. { to;
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
/72 7- I0 -20
Signature of Building Official Date 7_ 23- z024 - APPe.aJ0D
Note:Issuance of a Zoning permit does not relieN c 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.
V E.=Cj
JUL
The Commonwealth of Mass:chu 8 2Q�4
�' mulFOR
':;0- ): Board of Building Regulations a•: tatiOntikonv� ICIPALITY
Massachusetts State Building Code,780 • A""ToN A o60,-, 1.. USE
Building Permit Application To Construct, Repair, Renovate Or Demolts a- _ . Rerised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: Date Applied:
Cvi ry ��5 //& —7-23-20 y
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Proper Ad ress: 1.2 Assessors Map&Parcel Numbers
.7 /Ji X't'
Li 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
YG'
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2 C%�vytye�- Re rd: w \ 1 i(?2 Goidwi Pk/ .
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:_ €v t
Brief Description of Proposed Work': Co".s T/t.e../ -7 S3614:: Q-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ,sQ40. 00 I. 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) $ List:
5.Mechanical (Fire $ Total All Fees:$" '''-
Suppression) �
Check No./u 7 Check Amount: Cash Amount:
6.Total Project Cost: $ SUo a . Ce 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
a t3y 7/ /1),qzs
G c., a,,J r /f2 e�. T G?a,zr<,c_, License Number Expiration ate
Name of CSL Holder / v List CSL Type(see below)
P- 40- , - ,mil
No.and Street Type Description
// U Unrestricted(Buildings up to 35,000 Cu.ft.)
i./f` 4 4, C�c/49' 1,4 0 la FG R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
'!ls 5:2Z O 160 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /75 8,1 J s��7/�.3"'
avdi,s /�1e,,,,T60 Imo' HIC Registration Number Expiration Date
HIC Company Name or H1C Rest am
.r'/3.0.7 , Ga,1 /— e /v1
No.and S�tpet Email address
A/iae.4.s•s /S✓.� -.01.4 4//3 T22-o/
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 E 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/ap hor�y this building permit application.
X w' U1/421-ti- c-
Print Owner's ame(El is Signa ure) 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 accur.?. the best of my knowledge and understanding.
Ld&' /frlo it,TaO ZJIL D-GcJzrjv'T/j/341Zt -770Y
Print Owner's or Authorized Ag:df.s Name( -, ''.nic Signature) ate
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"
They Commonwealth of Massachusetts
►' : !1/1 l Ue'purrment of industrial Accidents
1t ' I Congress Street,Suite 100
Boston,MA 02114-2017
- t/ www.mass.gor/dia
11 of kers'Compensation insurance ABMs%it:Builderslt:ontractorsltiectricians!Plumbers.
10 HI.I II_k )WITH I HE Pka(%II ITING AUTHORITY.
Applicant Information Please Print Lceibl♦
Name(Business Organization Ind iy'dual
►:
Address:
City/State/Zip:"__ Phone
Arc yuu Yu t'tnployerr!Cheek the appruprune tune
"1)pr of project(required):
a I am a employ a with employees itu11 and or part-tine)_• 7. New construction
:0 I am a sole proprietor or pannershrp and has c no employer-'workins for Mg m S. Remodeling
any capacity.[No workers'carp.rmuraneY nquirui_J
9. ❑ Demolition
3.0I am a homcvwner doing all work mare!!.[No workers'comp.insurance required.)
10 0 Building addition
QI am a hornevwext and will be hiring amtractors to conduct all work on my prupeaty. I will
c-nsure that all contractor%either have workers'compensation wurrncti ur are sole II 0 Electrical rernrs or additions
peoprictors w ith no.employees
12.0 Plumbing repairs or additions
S0 I am a general contractor aryl I have hued the sub-cuntractun listed on the anachcJ.&ti 1 Roof repairs
These sub-amuy.ton kitsc employee.and loss workers soap.InstnYxc
14.10Other/3
6®R'c arc a corporation and its officers have exercised then right of exemption per Ne.k.e-
i�!, and we have no eutapluyees.1!3o wutter,'comp insurance rcyuirs-.1.i
'Any applicant that chock%hot lot must also tin out the section below showing their workers'conipensaurun pulley mrircnutain
f Homeowners whit submit toui ailidas it indicating thus'%are doing all work and then hire outside contractors aunt sahrnit a new afTrda4 it indicating such
untrasetnn that check this box nuts.attached an additiurul sheet showing the name of the sub-eontraetots and state cs tether or not diose cnt111ie5 kuise
the sub-caitracton.luye -nil{ovees.the,.must pros ode their workers'comp policy nuaih i
I 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 Self-ins.Lie.#: Expiration Date:
lob Site Address: CityrStatefZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under\1GL c. 152, §25A is a criminal violation punishable by a tine up to S 1.500.00
and'or one-year imprisonment.as sell as cis ii penalties in the loan of a STOP WORK ORDER and a fine of up to S250.00 a
day against the s iolatur. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage seritication
1 do hereby cer►ify under the pain.s and penalties of perjury that the information provided above is true and correct.
Stbnatun: /L2� Tw 2� �uc�,t/7W' I)sate !!!��?�z
Phone r: C
Official use only. Do not write in this area.to be completed by ciiy or town official
( its or Town: Permit/Liceaae ltt
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.City/Tann Clerk 4.Electrical Impeder 5. Plurohilig Inspector
b.Other
Contact Person: Phone#:
City of Northampton
at M Mp,
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�� '' Massachusetts 4v -- '(e
►1 ;t
d-) -l. ail' fa
4 tL DEPARTMENT OF BUILDING INSPECTIONS a �,
4 -r' 212 Main Street • Municipal Building ti
±`°'Or'y=�:.A Northampton, MA 01060 ssPW '
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: S' ,/TI4 S T /V T .) , cr, 11?r re��y�<,7
The debris will be transported by:
Name of Hauler: de iQ t cJ a.-.- 7` --,,D-< 2*€ 1 - .'2"?o,,.-76o, y
Signature of Applicant: rtzJ tAl � 4i�4 Date: 7`i/2V
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