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29-281 (7) BP-2024-1093 367 BROOKSIDE CIR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-281-001 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-2024-1093 PERMISSION IS HEREBY GRANTED TO: Project# SHED 2024 Contractor: License: Est.Cost: 17000 Const.Class: Exp.Date: Use Group: Owner: MARIE ZADWORNY ALLEN M& ANNA Lot Size (sq.ft.) Zoning: WSP Applicant: MARIE ZADWORNY ALLEN M&ANNA Applicant Address Phone: Insurance: 367 BROOKSIDE CIR FLORENCE, MA 01062 ISSUED ON: 09/05/2024 TO PERFORM THE FOLLOWING WORK: 14X24 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: 6/2_ Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner File #BP-2024-1093 APPLICANT/CONTACT PERSON:ZADWORNY ALLEN M &ANNA MARIE 367 BROOKSIDE CIR FLORENCE, MA 01062 PROPERTY LOCATION 367 BROOKSIDE CIR MAP:LOT 29-281-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $100.00 Type of Construction: 14X24 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: V'Approved Additional permits required(see below) For all projects that need additional reviews 74-3.1� as checked below,please see the Office of Planning&Sustainability Permit Dade or scan here y_. PLANNING BOARD PERMIT REQUIRED UNDER:§ El*1: Via: Intermediate Project: Site Plan AND/OR Special Pennit 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 j7/ E q. 5-zozLi 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. _ _ whin I r.21- - , ti. e/ntii I whin uGAUC 202 c 4 T Co monwealth of Massachusetts it . _ oar f B ilding Regulations and Standards MUNICIPOR ALITY PALITY g . -, r: hus tts State Building Code, 780 CMR _ ;�;,,�,tar - USE - - Bu►Fc' ° n To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This S on For Official Use Only Building Permit Number: '/ ', O• /0 e Date Applied: Jlewr►-) t` , Z‘z 9.-s•ZD7_t' Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 ' operty dress: 1.2 Assessors Map& Parcel Numbers 1.1 a 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 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 21\\ caner'of Rec rd• Mad n d Q 0 1 (�y��!9 Nam•(Print), 'ity, State,ZIP l 10 9 MNI h. 6(cJe HI - u8-oill Aad��7e Ctivif ! 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) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work'-: /L/x a S-4,62 - SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $EO00 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ 0 Standard City/Town Application Fee N000 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All F Check No4,1 a Check Amount:t Cash Amount: 6.Total Project Cost: $ 11 000 0 Paid in Full 0 Outstanding Balance Due: _ City of Northampton ,4 o _ to ar e cs . . ' I / "" "` Massachusetts _ :, .� 4 , DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street 10Municipal Building -,, ,Dt Northampton, MA 01060 i.r .4.)°'` PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS,ACCESSORY STRUCTURES, FENCES,(:ROUND MOUNTED SOLAR, ETC. 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specification of proposed work(digital and hard copy). 3. Site Plan with location of proposed structure(s)and setbacks. 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. 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. II.) R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Rooting 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 FIIC 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 is application is true and accurate to the best of my knowledge and understanding. 81°Z1( q Prin O er s or Author' d A Name(Electronic gnature) gai NOTES: I. 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 / o c \S ' Sl ./�' Y ti"1 Massachusetts ��'S �'! 1 PSIS !I: �'•'v DEPARTMENT OF BUILDING INSPECTIONS y 212 Main Street • Municipal Building Jh a: y " Northampton, MA 01060 �Sh ar) "'� H EOWN�E1RS''EXEMPTION ELIGIBILITY AFFIDAVITJI, Anna dV V (/ (insert full legal name), born l/ i (i1iu rt month, day, year), hereby depose and state the followi : 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 qualifij 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 supe isor for said project or work. Signed under the pains a penalties of perjury on this day of Jl q, 20 Ay ,. ,„. ,. Signa re) I ... < > + I .., la 1111111 I. 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(#1724075237742580-1 ) To zad777@comcast.net Hometown Structures 627 Southampton Road i (� III, T Westfield, MA 01085 LITi))T � 413-562-7171 RI:1 .1111E3� sales@hometownstructures.com Customer Order-Aug 20, 2024 Ship To Customer Name Allen Zadworny Order# 1724075237742580-1 Installation Address 367 Brookside Circle City Florence State MA ZIP Code i Email zad777@comcast.net Phone 413-548-6719 Mobile Building Info Size Color Style: Keystone Ranch Roof Dual Black - Roof Overhang: Standard Trim Red El Roof Material:Architectural Shingles 1 4' x 24' Siding Beige Q Base 4 x 4 Pressure Treated Skids 92.5"Walls Siding LP SmartSide T1-11 Sidewall Height IDmmesign Link & Notes Ues jnsLink https://www.hometownstructures.com/storage-sheds/customize-your-shed/?Ing=en- US#fd109dec5f986b2bff4eaa0bdedde201 ("1"111. Perspective Front Left 1 of 5 8/23/2024, 12:06 PM Xfinity Connect Here_s Your Custom Shed Design and Estimate_(... https: /connect.xfinity.com/appsuite/v=7.10.6-41.20240426.021437/p... Images Right Back 2 of 5 8/23/2024, 12:06 PM Xfinity Connect Here_s Your Custom Shed Design and Estimate_(... https://connect.xfinity.com/appsuite/v=7.I0.6-41.20240426.021437/p... Left 13 0 L U- W1 /D1k ► D2 ^!1 / ' \ • • 1'2" 2' 1'6" 6' 5'5" 3' 1'8" 2' 1'3" 24' Right SYMBOL LEGEND Wi 24"x 36"Single-Pane Window D1 72"T-D Double Door D2 36"F-M Door Closed Wall Description Quantity Amount Structure Details Style: Keystone Ranch 1 $10,960 Sidewall Height: 92.5"Walls 1 Included Size: 14'x 24' 1 Included Roof Overhang: Standard 1 Included Base:4 x 4 Pressure Treated Skids 1 Included Siding: LP SmartSide T1-11 1 Included 3 of 5 8/23/2024, 12:06 PM Xfinity Connect Here_s Your Custom Shed Design and Estimate_(... https://connect.xfinity.com/appsuite/v=7.10.6-41.20240426.021437/p... Description Quantity Amount Roof Pitch: Standard 1 Included Siding Color: Beige Included Trim Color: Red Included Roof Color: Dual Black Included Roof Material: Architectural Shingles 1 Included Doors& Ramps 72"T-D Double Door 1 Included Color: Beige Included On-Door Trim: Beige Included Around-Door Trim: Beige Included Hinges: 14" Hinge 1 Included 36" F-M Door 1 $325 Windows& Accessories 24" x 36" Single-Pane Window 2 Included Color: White Included Around-Door Trim: Beige Included Flooring & Interior Flooring: 3/4" Plywood Floor 1 Included Floor Joist: 2 x 4 Joists 12" OC 1 Included Additional Options Pre-Assembled (includes Overwidth Road Permit) 1 $40 Subtotal: $11,325 Sales Tax: - Total Order Amount: $11,325 Final Balance Due at Installation: $11,325 Signatures Customer Signature: Date Desired Delivery Date: Delivery Notes: Dealer or Manufacturer Signature: Date Pricing and options shown are subject to change at any time and may vary based upon current promotions, specials, or annual pricing adjustments. Current pricing will be included in the final quote and will require your review and approval prior to order. 4 of 5 8/23/2024, 12:06 PM lire Commonwealth of_lfassaclrusetts k1a z . ._.: Department of Industrial.�rcitlerr is _Iiiil Congress .Street, .S"nr"te 100 1 Boston, -1L4 0?11.1-201 i. +LIT - � tt'it'N•.nrass.go-rdia iv.ickers' Compensation Insurance Affrda'rt:Builders Contractor:Electricians'Plumber:. TO BE FILED WITH THE PERM:El-F G?lt'IHORIIY. Applicant Information Please Print Legibly Name,'Busivass(kgam tionIndi:idual): Address: City State Zip: Phone Are von as employer`Check the appropriate box: - Type of project(required): :.Q 1.a omp:oyer with ontp]oyties(frill aadicr part-time).* 7 El New construction 2.❑I a::a sect proprierc:c:pz-mac•aip an3 have no employees working for me b S Ei Remodeling 3a7:3p3•::17.[tic waken::'ccr=p.=so:ante rerc•:ired] ? I ar a hccownth r do=g all work=swat PA w•orkx:'ccaap.iasaraaco regained.]' 9 ❑Demolition El Building addition 4. I am a hecsaoa-ner and will be hiring contractors to conduct a:]work on mypccpart• I will azure that all coo a e-aeas ti workers'have orkers'compea a satiaa insurance are sole 11.0 Electrical repair:.Or ac litiou proptiotxas with no employees. -, 1 ❑Kumbiug.repair':or:additions `..D I az a genera:contractor and:have h_ed the sub-cc o tors hued ca the attt:hed:get. Those stio-ccazactxara have enip:ovoes and ha: :a-o Waders'cow =sunc;t 13.D�'ootrepair 6.111 we are a cc.-poratsca and its officers lave taw:cited their right of exempncn par'dCL, c 14'❑Other .'-.;44).and we la•.4:to=ploy=s.(No weds 'coo..7.Insurance:eq•(red.; 'Any applicant that chocks tote_:mns:also nil:out ties sect:.on be:ow:cm•i:s heir•kyle-'ccurpensaton poL•::.•mjormanoa .:icmeouners who submit this affidas:t x,dicaung uaov 37.0 aging all work and then hire.:v ts:de:ont:actct:musk v:.bn=3 now affidav: indicating such. cam:ors that:heel tkas bcx must arached as addiaona:thee:showing the na=a.:.f be 1u:•:c3nac:ors and s:u:e whether cc as those enntiss have emalctces :f the -ont ac:ors have employee:.they mutt prov:ie their workers coop pclic;n.mbar. I am an employer that is providing workers'rs'compensation insurance for my employees. Below is the policy and job site infotrtarion. Insutare a ComIsat'. `cane: Policy=or Self-ins..Lic.'n^ _: ��// I () bro_k -_ -ation Date: r Job Site Addre : �,�/11 (W L i lM, itt• . tate ).-4L 0 I V Attach a copy of the worker:'coinpen:ation policy declaration page(showing the policy number and expiration date). Faiiuu a to secure coverage a:required vnrlpr MGL c. 152. :25A is a cnniiva:violator:punishable by a fine up to S1,500.00 and or oiie-year imprisonment.a:well as civil pel:altie:in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator A copy of this :tatty rut may be forwarded to the Office of Investigations of the DLA for insurance coverage reification. I do hereby •y under a pains •,I d pe ral 'es ofpetjurs-that the information provided ab •i rue çndco,7ecL &mature: Date: Phone G Official use only. Do nor iesite in this area,to be completed bt'city or tow official. City or Town: Permit.Licen>e Issuing Authority(circle one): 1.Board of Health :. Building Department 3.City Town Clerk 4.Electrical Inspector Plumbing In:pector 6,Other Contact Per:on: Phone a: City of Northampton Massachusetts :- t 1' . ' DEPARTMENT OF BUILDING INSPECTIONS a `r1 9 ; 212 Main Street • Municipal Building ��� ��, s'" Northampton, MA 01060 'SPIV -11)\ 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 dis.tosed of i Lo tion of Fac ity: iv The de is • I be ansp•rted by. Name of Hauler: Signature of Applicant: ate: /� 2\ Li