32A-239-001 BP-2024-1390
2 POMEROY TERR UNIT COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot: CITY OF NORTHAMPTON
32A-239;i 2a1
Permit: Atts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2024-1390 PERMISSION IS HEREBY GRANTED TO:
Project# 2024 BATH RENO Contractor: License:
Est.Cost: 20000
Const.Class: I{xp. [)ate:
Use Group: Owner: HANNAH ARBUTHNOT
Lot Size(sq.ft.)
Zoning: URC Applicant: HANNAH ARBUTHNOT
Applicant Address Phone: Insurance:
2 POMEROY TER,UNIT I (774)287-5042
NORTHAMPTON, MA 01060
ISSUED ON: 10/22/2024
TO PERFORM THE FOLLOWING WORK:
TILING GUEST BATHROOM, INSTALL NEW VANITY
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:
Final: 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: $301.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
0
The Commonwealth of Massachusetts
I' Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:'-202M~l 34t b Date Applied:
' //(tee i0 zZ- aY
Building Official(Print Name) S. ture Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
2 Pomeroy Terrace Unit 1 32/)-239—O(.7.F.
1.1a Is this an accepted street?yes V 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 Private❑ Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Hannah Arbuthnot Northampton. MA 01060
Name(Print) City,State.ZIP
2 Pomeroy Terrace Unit 1 774-287-5042 hannaharbuthnot@gmail.com
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':Remodel guest bathroom.Approximately 50 sq.ft.
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SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $13,500.00 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $1,600.00 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $4,900.00 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$.3c (CtCV',f,�
Check No.IN Check Amountti:VD' Cash Amount:
6.Total Project Cost: $20,000.00 0 Paid in Full 0 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.)
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
1,as Owner of the subject roperty,hereby authorize Dakota L. Cotton Smith
to my beh I matters elative to work prized by this building permit application.
10/11/2024
nt Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER&OR AUTHORIZED AGENT DECLARATION
By ent . g my name below.I hereby test under the pains and penalties of perjury that all of the information
contain n this application is true accurate to the best of my knowledge and understanding.
10/11/2024
Print s or Authorized Agent's Name(Electronic Signature) Date
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 g..4 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
Massachusetts *Vt. <<
(n J141W f .
`�* p I DEPARTMENT OF BUILDING INSPECTIONS a'.
' 212 Main Street • Municipal Building `.,• •
Northampton, MA 01060
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: Casella Waste Systems - 686 Main St., Holyoke, MA
The debris will be transported by:
Name of Hauler: Dakota L. Cotton Smith
Signature of Applicant: Date: 10/11/2024
The Commonwealth of Massachusetts
rt=—• l=!� Department of Industrial Accidents
E •
_ �_ -0 I Congress Street,Suite 100
:4 77
Boston, MA 02114-2017
,.. 4 www:mass.got/dia
1+1
1l eskers'Compensation Insurance Affidas it:Builders/(IontractorsiLlectriciansiPlumberi.
1U 1W FILED wrru cHF:PERMIJTIM: Al' tIORffl.
Applicant 1nrurmMi i Please 1'riut I_rtibls
Name(Business'tlrganirationindividual): Hannah Arbuthnot
Address: 2 Pomeroy Terrace Unit 1
City/State/Zip: Northampton, MA 01060 phone#: 774-287-5042
Are)ow as c.ipk et?Chi&the appropriate hoz: Type of project
1.a 1 am a.roploy or with employees(full and.*part-tins 1-' 7. CI New congruetos
2C 1 am a sok proprietor or partnership and have nu employ aces working for me is g ling
airy capacity.[No*tateri comp.Insurance requen.aij
10 lam a hu w,T doing all work myself (No comp.insurance required.] 9. Dtmolmon
ms,
10 D Building addition
4.(ram a ho.rn n w vwt and ill he hung omit:a tors to cundud all work om my property. I will
t ensure that all contractors either have workers'eumpernatwn insurance or are sole t i.a Electrical repairs or additions
proprietors w ith no employees. 12.a Plumbing repairs or additions
to I am a fcm7a an 1 contractor d I line hued the sub-eonuat.rs listed sin the attached sheet 130 Roof repairsu ihew sub-contractors have employees and hay c workers'comp.unurance.
6.D 14.0Other
N'c are a corporation and its officers have exercised nest of exemption pet M(iL e.
1.1141.and we lane no employees.[No workers'comp.instarame.required I
'An)applicant that chucks hot al must also fill out the section hekiw show ing then w otters'compensation pulley infunrutu m
11.mexswnrs who submit tams atlwhnit indicating they are doing all wink and then hire outside contrarian must submit a new affidavit indicating such.
:t untracion that cheek this box must attached an athtional shots show ing d►nana of the sub-euntra tors and state whether or not those minis hale
employer+. It the sube, arator.hen eitpknces.the trust provide their workers'crimp policy:umber.
her.
1 ant an employer that is providing workers'compensation insurance for my etnpla nos. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date: _
Job Site Address: C ity'State/Zip:_
Attach a copy of the workers'compensation policy dedaratlou page(showing the policy number sad espirado s date).
Failure to secure cos-erage as required under MGL c. 152.*25A is a criminal s iolation punishable by a tine up to S1.500.00
and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the s iolalor.A copy of this statement tray be forwarded to the Office of Investigations of the DMA for insurance
coverage verification.
I do hereby eerie der he pa and penalti perjury that the information provided above is true and correct.
signature: Date 1On /2024
Phone 77 -287-5042
Official use onit•. Do not write in this area.to he completed by city or town official
City or'foam: Permitll.icease
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City ifowa Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
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/;, Massachusetts ,4, -. '
ovAt
"
' • • DEPARTMENT OF BUILDING INSPECTIONS
t,A 212 Main Street • Municipal Building v`. D
Northampton, MR 01060 '51'1 jI WON.°
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 31 16 I
I, Hannah Arbuthnot (insert full legal name), horn _ (insert month,
day,year),hereby depose and state the following:
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. 1 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 qualifij 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 1 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 and the pains and penalties of perjury on this 11 day of O '( ' , 201
(Si a )