22D-033 BP-2024-1067
35 CLARK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22D-033-001 CITY OF NORTHAMPTON
Permit: Acc Structure
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-1067 PERMISSION IS HEREBY GRANTED TO:
Project# goat shed 2024 Contractor: License:
Est.Cost: 3000 KRIS THOMSON CS084152
Const.Class: Exp.Date:04/09/2025
Use Group: Owner: HEIN JENNY MIRIAM
Lot Size (sq.ft.)
Zoning: WSP Applicant: KRIS THOMSON CARPENTRY
Applicant Address Phone: Insurance:
362 KENNEDY RD (413)695-6487 SOLE PROPRIETOR
LEEDS, MA 01053
ISSUED ON: 08/22/2024
TO PERFORM THE FOLLOWING WORK:
280 SQ FT GOAT SHED
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: $84.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
N�xro To 10
File #BP-2024-1067
)Pr- Ca0, tBrlre
APPLICANT/CONTACT PERSON:HEIN JENNY MIRIAM
P O BOX 833 NORTHAMPTON, MA 01061
PROPERTY LOCATION 35 CLARK ST
MAP:LOT 22D-033-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $84.00
Type of Construction: 280 SQ FT GOAT SHED
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:
1/Approved Additional permits required(sec below) For all projects that need additional reviews ID+;*l_+•,•-�:;p
as checked below,please see the Office of Planning& Susta inability Permit page or scan here -ti_ 11
PLANNING BOARD PERMIT REQUIRED UNDER:§ CI
Intennediate to:
Intennediate 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
8 22-2ozy
Signature of Building Official Da lc
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.
1 mG i l )I /k M?4/
The Commonwealth of Massachusetts
°�, B rd of Building Regulations and Standards FOR
\. 2 0 2024 M ssachttsetts State Building Code, 780 CMR MUNICIPUSALITY
1 Building Pe mit pplication To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
e ,l;;I rw INSPFC TmNc One-or Two-Family Dwelling
'TON'MA 01060 This Section For Official Use Only
Building Permit Number: •' 4)-1' /10& 7 Date Applied:
K'el.),go < Z, /7��� �Z 2-ZdLH
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pro erty Address: 1.2 Assessors Map& Parcel Numbers
35� clack 3&t-, FIocencc_,Pi DJO(a2 22P 033
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: Z75
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:
Zone: _ Outside Flood Zone?
Public Er Private❑ Municipal LE/On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: ,A
"'SWIM{ ,1►n► ci4Wk '(;501A Oeci64Af'btn , MA OIO(o1
Name(Print City,State,ZIP
PO lbok `6 .3 (n5 -1oz. .
No.and Street elephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.,I14 Number of Units Other 0 Specify:
Brief Description of Proposed Work Z530 s t—P-i- se.a..- S Yl EA.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 3 b o t) 1. Building Permit Fee: $ Indicate how fee is determined:
�\ 0 Standard City/Town Application Fee
2.Electrical $ V 0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 0 2. Other Fees: $
4. Mechanical (HVAC) $ 0 List:
5. Mechanical (Fire $ O
Suppression) Total All Fees: $
Check No.0) Check Amouil CbtA Cash Amount:
6.Total Project Cost: $ T 0 d 0 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts j?0 _ ���
i DEPARTMENT OF BUILDING INSPECTIONS U
`. iti
� f ' 212 Main Street • Municipal Building fc*a
cep- Northampton, MA 01060 sip,—....C1
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 Supe or License(CSL)
1� i c,s_a$i-1s 2 9 2s
r' S �Vl S'Z'j License Number Expiratio Date
Name of CSL Holder
Z v, d
� List CSL Type(see below) l�ci
land Street Type Description
e s J V t/�/� , 0 10 5 3 • U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
tyM Masonry
RC Roofing Covering
-x6c3v.^L t'n^ r I WS Window and Siding
4/3(^ (O / Y O 7 �''N SF Solid Fuel Burning Appliances
�-1r p ' I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I ' 5 4-3
StT v"V`' HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
KnsThortSe"Cdt fnti\I a q&;\.c�vv._
No.and Street Email ada ss
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 k,-, S O 14%3 r.-
to act on my behalf,in all matters relative to wor authorized by this building permit application.
N�, ins ova, $'
Print Owner s lame(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 ap lication is true and accurate to the be of m knowledge and understandin .
?-:=r----
Print Owner's or Authorized Agent's Name(Electronic Srgnat D to
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: Z 2' D LOT: b 3 3
LOT SIZE: 3 .3 actc5
REAR LOT DIMENSION:
REAR YARD 2 S
a-\-kac td ,tea
•
SIDE YARD 141 0 • SIDE YARD T O
FRONT SETBACK I 2 •S '
FRONTAGE 21 5'
City of Northampton
?°„ 4- � Sy
' Massachusetts s _ 4
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r . -A�Al u2 ice,
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DEPARTMENT OF BUILDING INSPECTIONS at
_
+r 212 Main Street • Municipal Building J��,., �a�
M � Northampton, MA 01060 Sb�P ` O
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:
N A
Location of Facility: VA_ C� i J e lM O
The debris will be transported by:
Name of Hauler:
cs,..
Signature of Applica Date: `6
"., The Commonwealth of Massachusetts
Department of Industrial Accidents
Milk—
=_:. t— I Congress Street,Suite 100
r T Boston,MA 02114-2017
. w►4'w.mass gowilla
'Winters'Compensation Insurance Affidavit:BuildersfContractorsrFlectriciansli'lumbers.
ro RE FILED WITH I HE PERM 1-rth(;M IIO1t1 rt.
Applicant Information Please Print LeLibls
Name(Business'Oe anization/Individual): `('A (7 V-- _________
Address: 3 ( Z
City/State Zip c }ik 0 L - Phone#: 4 ' V-) b
1-1-c(- /
Are you an Employer'('heck the appropriate box:
Type of project(required):
1a I am a employer with_..._.....,___,employ'ees(full outer part-dined.` 7. 0 New construction
1 am a sole proprietor or partnership and have no employers worsting for else in 8.0 Remodeling
y cap►eity.[No workers'comp.insurrinee rewind.) p-�p
AO I am a homeowner doting all Willi:m}pelf.[No workcxs'comp.insurance nauseal.)'
9. t._t Demolition
eo
4.0 lam a haetrw•ne and will be hiring contractors to condw.t all work on my property. I will10 Building addition
m
ensure that all cxmrra fors either haver workers'compensation insurance or are sole I I.0 Electrical repairs or additions
proprierxrr�w-ith no rnrployec�s. 12.0 Plumbing repairs or additions
S;,q i I aon a ge7teral connector and 1 have hired the sub-contractors hated on the attached Sheet 13. Rcwf re: .li
rLz_.4
u These sub-contractors have empluyein and have wur4;en'comp.insurance.: _
6.0 We are u e}urpareation and its officers have exen:ised then right of exemption per MGL c. 14. O[Ilt'r
132.y Itoi.and we have no employees.[No workers comp.insrrranc:mquired.!
'Any applicant that chocks boa al must also fill out the section below showing their workers.'compensation,poticy information.
t Homeowners who submit this affidavit indicating thdy8ry doing all work and then hire o aside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additiirnal abaft showing the name of the eub.eontracturs and state whether or not those entities haw
employees. If the sub-contractors have employees.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
information.
Insurance Company Name: _
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City;StatelZip:
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 tine up to S1,500.00
andlor one-year in prisomnetnL 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
covera*, •rilication.
I rho hereby errsN note r lilt pain. and penalties of perjury that the inliwtnation provided ab ye is true a d corre'ct.
Signature: Date: . e ap 7..
x-i-____
Phone#: "- ( _ ' (ciic/ 5 ' L
• Official use only. Do not write in this area.to be completed by city or town official
City or Town: Permit/License b
Issuing Authority(circle one):
I.Board of Health 2,Building Department 3.f"ity/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
! ,'— t,,: Massachusetts 'r
* �C
t (K; ' DEPARTMENT OF BUILDING INSPECTIONS 1�
3!► �` 212 Main Street • Municipal Building
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (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. 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 day of , 20_.
(Signature)
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