23A-025 (8) BP-2024-1498
35 PARK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-025-001 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-2024-1498 PERMISSION IS HEREBY GRANTED TO:
Project# finish shed 2024 Contractor: License:
Est.Cost: 9000
Const.Class: Exp.Date:
Use Group: Owner: LURIA LURIA, SARA &ISAAC GOLDSTEIN
Lot Size(sq.ft.)
Zoning: URB Applicant: LURIA LURIA, SARA&ISAAC GOLDSTEIN
Applicant Address Phone: Insurance:
35 PARK ST
FLORENCE, MA 01062
ISSUED ON: 11/12/2024
TO PERFORM THE FOLLOWING WORK:
Interior finishes to shed
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
t nderground: Service: deter: Footings:
Rough: Rough: House # Foundation:
l.inal: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimnep:
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: /6"2_
Fees Paid: $75.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
In—:--E----.07::----LV::. ,
1:1, I V ? e Commonwealth of Massachusetts FOR
'' } � 2024 1 :.. d of Building Regulations and Standards MUNICIPALITY
1 M.•4plication
,.chusetts State Building Code, 780 CMRUSE
L. rs ri• '• t To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
�ti•..: n, p• One-or Two-Family Dwelling
�, a y This For Official Use Only
Building Permit Number: Date Applied:
h�V1 "Coss /747 11- 12-2ozy
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address:35 Park Street,Florence,MA 01062 1.2 Assessors Map&Parcel Numbers
23A-025-001
1.1a 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 11) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
30ft 100ft Oft 6ft 10ft 100ft
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 8 Private 0 Zone: _ Outside Flood Zone? Municipal 2 On site disposal system 0
Check if yes12
SECTION 2: PROPERTY OWNERSHIP1
2.1 Ownert of Record:
Isaac Goldstein Luria 35 Park Street,Florence,MA 01062
Name(Print) City,State,ZIP
917.455.6203 isaacluria83@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 2 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':16x20 Shed to be insulated,drywaled,end finished interior with minispt,t for heating/cooling.
Electrical and Shed instal permitted via prior permits. R_ ()Awe 2,0
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $2000 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $3000 ❑ Standard City/Town Application Fee
o Total Project Cost3(Item 6)x multiplier x
3. Plumbing $0 2. Other Fees: $
4. Mechanical (HVAC) $4000 List: I
5. Mechanical (Fire $ ,Suppression) Total All Fees: $
Check No. Check Amount:
6.Total Project Cost: $9000 ❑Paid in Full 0 Outstan 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
iJ Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP M Restricted
stricte d 1&2 Family Dwelling
Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Insulation
Telephone Email address I) 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 .O
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.
Isaac Luria `•vim'. 11/6/24
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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
ww.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.Qov/dns
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"
The Commonwealth of Massachusetts
!11'r,=� 1 °I Department of Industrial Accidents
lido', •
I Congress Street,Suite 100
'��=y Boston. MA 02114-201'
„1c~ www.ntass.gov/dia
porkers'Compensation insurance Affidavit:Builders/Contractors/Ellectricians/Plumbers.
t0 141'. FILED WITH TilE Put.MIrTrj(: A1`"1'l101 ITI.
Applicant information Please Print Leeibh°
Name IBusincssiorgantzatumrindividual):TIsaac Luria
Address: 35 Park Street,Florence,MA 01062
City/State/Zip: Phone#: 917-455.6203
Are yea w napiev*r?Cheek the appropriate hot:
Type of project(required):
l.Q I am a employer with erripioyees'lull and or pact-flax t.• 7. El New construction
I am a sole proprietor or partnership and lase no employees working for ere in $.gRemodeling
an}capacity (Nu worker'comp.insurance required.)301 am a hurticvss net doing all work myself'.(No workers' i comp.insurance required.)'
9. Demolition
94
a homeowner and will br hiring ountm:tors to conduct all work on my property_ I will
ensure that:all conuaetun either hair workers'ecompensationcompensationutsnuariex o are ru 10 O Building additionle 11.0 Electrical repair or additions
proprietors w ith no empluyee
12.p Plumbing repairs or additions
Sn I am a general contractor and I lu.c hired the sub-eunuaetun listed on the attached sheet 1 3f"�Roof repairs
the.:sob-contractor haw employees and hate workers'rump.insurance.:
(mil
hD We are a corporation and its officers have exercised their right of exemption per A4GL c. 14.0 Other
132.i 1(4 i.and we hate no employees.(No waken'comp.insurance required.]
'Any applicant that cheeks boa al must also till out the section below showing their workers'compensation policy information
+Ilomcowners who submit this affidavit mdicatrng they are doing all work and then hue outside contractors must submit a new affsdat t indicating stub_
•t"unuactor that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hate
employees. If the sub-contractors have employees.they must provide their workers`caump.policy ntnnb er.
. - --
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/State+Zip:_
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 fine up to S 1.500.00
andkor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine oi'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
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: C�QCi Date: 11/6/24
Phone
Official use only. Do not write in this urea. to he completed h,y city or town official
City or Town: Permit/License#
1 Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
(i.Other
Contact Person: Phone#:
City of Northampton
o H�
Massachusetts o? - ;
` fJJ
( �` ; DEPARTMENT OF BUILDING INSPECTIONS �
212 Main Street • Municipal Building v
/""4' Northampton, MA 01060 S{%h......0
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.
N/A - no debris expected.
UR use, sacuukilti_ ?4-(014r
ccU D vet wrGer3,7
The debris will be disposed of in:
Location of Facility:
The debris will be transported by:
Name of Hauler: w l
(1--Cfi C`kl�
Signature of Applicant: `1Q "G L"it Date:
City of Northampton
��
MassachusettsS� 1
it_ ^ 1J DEPARM NT OF BUILDING INSPECTIONS 3
212 Main Street • Municipal Building J`, a�
\
�..— ■,�- Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, Isaac Luria 6/7/1983
(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 r:quirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connectio 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 aforementip ed homeowners'
exemption, does not involve the field erection of manufactured buildings constructed i accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 1 MR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to r•side, on which
there is, or is intended to be, a one-or two-family dwelling, attached or det. hed structures
accessory to such use and/or farm structures. A person who constructs more an one home in
a two-year period shall not be considered a home owner.
4. 1 do not hold a valid Massachusetts construction supervision license and, except to he extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for • supervision of
the project or work on my parcel, I am not engaged in construction supervision in con ection with any
project or work involving construction, reconstruction, alteration, repair, remov 1 or demolition
involving any activity regulated by any provision of the Massachusetts State Building I ode.
5. If I engage any other person or persons for hire in connection with the aforementioned • oject or work on
my parcel, I acknowledge that I am required to and will act as the supervisor for said pr.''ect or work.
Signed under the pains and penalties of perjury on this 6 day of November , 20 24 .
c1a4a.e.
(Signature)
Your Confirmation number is 20241107802302
Date of Confirmation: 11/7/2024
NOTE: When paying by ACH (Checking) it will take two business days for the payment to be debited from your bank account.
Your account number is not verified until this payment is presented to your bank. They have the right to return this payment if
unable to process this transaction against your account.
Your request for payment(s) of$78.95 has been received and is subject to approval by your financial institution. No email
was entered so a confirmation was not sent.
Account Information Payment Information
Name: ISAAC G LURIA Payment Type: Credit Card
Note: QUICK PAY TRANSACTION Payer Name: ISAAC G LURIA
Card Number: **************0247
Transaction Information
Transaction Quantity Amount Fee Payment Type
City of Northampton - Building 1 S75.00 $3.95 Credit Card
Department
Misc. QP
Permit Option: Building-Zoning-Sheet
Metal Permits
Full Name: ISAAC G LURIA
Phone: 917-455-6203
Property Address: 35 PARK ST
Notes: INTERIOR RENO OF SHED
Total: $78.95
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