38A-004 (7) 2 BURTS PIT RD BP-2018-0452
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map.Block: 38A-004 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:New Structure BUILDING PERMIT
Permit# BP-2018-0452
Proiect# JS-2018-000620
Est.Cost: $13000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NOAH GRUNBERG 069877
Lot.Size(sq. ft.): 11412.72 Owner: GRUNBERG NOAH
Zoning: URB000) Applicant. NOAH GRUNBERG
AT. 2 BURTS PIT RD
Applicant Address: Phone: Insurance:
PO BOX 476 WC
SHELBURNEMA01373 ISSUED ON.111612017 0:00:00
TO PERFORM THE FOLLOWING WORK:12X16 STUDIO WITH BATH DROOM
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department 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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 11/6/2017 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition Replacement Windows [Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. Demolition ❑ New Signs [p] Decks [M Siding [p] Other[[3]
Brief Descriptio of Prop sed
Work: f�X G Q It> k", 13-J"Ta Fc'c'R'A
Alteration of existing bedroom Yes-->"_No Adding new bedroom Yes No1111��
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll -Sheet T`
ea. If-New house and or addition to existing housing complete the following
a. Use of building :One Family Two Family Other Mvb 10
b. Number of rooms in each family unit:__ Number of Bathrooms
c. Is there a garage attached? _ i
P q 9 y 2. �� Dimensions 12+
d. Proposed Square footage of new construction. x
e. Number of stories?
f. Method of heating? (-A;yP- f-tNj>IAtQ T Fireplaces or Woodstoves �Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction Wpb EIZ/b1a
i. Is construction within 100 ft. of wetlands? Yes -)E No. Is construction within 100 yr. floodplain Yes'X—No
j. Depth of basement or cellar floor below finished grade ND 11%t-
k, Will building conform to the Building and Zoning regulations? X Yes No .
I. Septic Tank City Sewer --\l Private well City water Supply_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
a as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to worlVauthorized by this building permit application.
1() ,-`I 1-7
Signature of Owner V Date
I' -md "�A�-• l _t' (".. as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed u der the pains and penalties of perjury.
8 r WJ uP(;
Printf a
(0 -24 12
Signal:ure of Owner/ nt Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Noo^tt Applicable 0
Name of License Holder: I
License umber
AdcM Expiratio Date
33
Sig ature Telephone
9. RegisteredHorne Improvement Contractor: Not Applicable ❑
NZ)PLr, halt % NOW QP-vL:k��
Company Name 7—_ Registration Number
pD R1t) - 2-4- - 19
Addre / Expiration Date
- IFF Telephone l i� �!i Lj"p7133
SECTION 10-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...... ❑
City of Northampton
Massachusetts 'r
i ' DEPARTMENT OF BUILDING INSPECTIONS ,
212 Main Street • Municipal Building
Northampton, MA 010601v � �
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Atfairs and Business Regulation ("OCABR") regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC").
NI.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
.,Vote: If the homeowner hav contracted with a corporation or LLC,t/frit entity inust be registered.
Type of Work:___Nt.U'. :p& "'go At1 o. �' .�_ �V !_ Est. Cost: ` 1.3 4
Address of Work: L LLJ-�__. )-L _
Date of Permit Application:
I hereby certify that:
Registration is not required for the follow=ing reasons):
-- Work excluded by law(explain):__
Job under$1,000,00
Owner obtaining own permit(explain): _.....
-____._,..
Building not owner-occupied
Other(s ecif ):__�_ d'�, Stec
p y � N
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBI'T'RATION PROGRAM OR GUARANTY FUND
UNDER N.G.L.Chapter 142A. SUCH OWNERS ALSO ASSU ME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owlier:
10- 2 3 (7 NIOA111 �l�rs sa
Date � � Con tractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts `'
DEPAR2'WNr OF BUILDING INSPECTIONS 4
212 Main Street • Municipal Building x
Northampton, MA 01060 � fY
Massachusetts Residential Building Code
Section 1 10.85. 1.2
Homeowner: Person (s) who own 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 homeowner.
Section 110.R5.1.3.1
Any homeowner performing Nvork for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s)
for hire to do such wrork, then such homeowner shall act as supervisor.
Such homeowner shall submit to the Building Official, on a form acceptable to the Building
Official, that he/she shall be responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to
time, during and upon completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 Workers' Compensation) and Chapter 153
(Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts
General Laws Annotated, you may be liable for person(s) you hire to perform work for you
under this permit.
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02 111
www.massgov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print UL4bby
Name(Business/Organization/Individual): NDA" GF,0N96._6 / lyQP_ 5 60M., Lb(,
Address: Yb EOY +7(o 013
City/State/Zio:54f-L&ROE FAM MA Phone 4: S- 973
kre you an employer?Check the appropriate box: Type of project(required):
I am a employer with 3 4. n I am a general contractor and 1 6. New construction
employees(full and/or part-time).* have hired the sub-contractors 1%
❑ 1 am a sole proprietor or partner- listed on the attached sheet 7. El Remodeling
ship and have no employees These sub-contractors have 8. F1 Demolition
working for me in any capacity. workers'comp. insurance. 9. n Building addition
[No workers'comp. insurance 5. El We are a corporation and its 10.n Electrical repairs or additions
required.] officers have exercised their
❑ I am a homeowner doing all work right of exemption per MGL I Ln Plumbing repairs or additions
myself [No workers' comp. c. 152, §1(4),and we have no 12.[]Roof repairs
insurance required.]7 employees.[No workers' I -n Other
comp.insurance required-] I
y applicant that checks box 4 1 must also fill out the section below showing their workers'compensation policy information.
)meowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suwch
-itractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'ocimp.policy information.
of an employer that is providing workers'compensation insurance far Pty employees. Below is the policy and, ob site
irmation.
trance Company Name: 7-IZ—A-V VS
cy#or Self-ins.Lic. #: G MR, — 6 19917 6 2-3 . Expiration Date:
Site Address: �- 91NIT IS PIT Rtol) city/state/zip: NQtP*tAf1oA, .-NA A 010 ,O
kch a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
ire to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
)to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
stigations of the DIA for insurance coverage verification.
hereby cder the pains and penalties of perjury that the information provided above is true and correct.
azure: in Date:
'2
,– (0 .......
011cial use only. Do not write in this area,to be completed by city or town offkial,
ty or Town: Permit/Ucense 4
wing Authority(circle one):
Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
Other
intact Person: Phone#:
City of Northampton
_ s#r
r Massachusetts
f �
# G '
DEPARTMENT OF BUILDING INSPECTIONS h
212 Main Street •Municipal Building £a'
Northampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A
The debris from construction work being performed at:
PVR-I(s PIT Rc)A.A
(Please print house number and street name)
Is to be disposed of at:
bo pff'm- Vim /W!'TI W'S
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
i0 1
Signature of NQit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
ol� C9-0 '
File#BP-2018-0452
APPLICANT/CONTACT PERSON NOAH GRUNBERG fav
ADDRESS/PHONE PO BOX 476 SHELBURNE
PROPERTY LOCATION 2 BURTS PIT RD
MAP 38A PARCEL 004 001 ZONE URB000)
THIS SECTION FOR OFFICIAL UNLY:
PERMIT APPLICATION CUKCKLIST
LOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Iypeof Construction: 12X16 STUDIO WITH BATHDROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 069877
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF)RMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
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
7
Signature of Building Official Date / I
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.
t
Department use only
City of Northm Itoni Sta of Permit:
� Building Dep rt ent. Curl ermit
212 Main Stretilt r/Septic Ayajlabili
-� -� ::urs
r Room 1 DO 4406r"el.l Availability
Northampton, MA'01060 Two,Sots of structuraI Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Flans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: QThis section to be completed by office
vq� f 11 9-vA Map Lot � -Unit
Zone Overlay District
Elm St.District GB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ftp %tom tGFI D1�� CU S
Name(Print) Currgnt Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Nmfl GK-vti&GR-G f`7(Zlr Shf4;RVRrr �%►�U;S t3�a
NaCurrent Mailing Address:
TCX� :
f►s -62-L i S-3 / 6l7- 69q-LLS7A G�
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building Io int (a) Building Permit Fee
2. Electrical tk�c� (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2+3 +4+5)=(3 poo, Check Number
This Section For Official Use Only �,+
`t ��[
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
'q_ - Ynl>o '- i9 /3 :Y
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This col u°nn to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height °N/A
Bldg. Square Footage °o fSF
Open Space Footage 9'
0 17f
(Lot area minas bldg&paved �J{�
t i
parking)
#of Parking Spaces
Fill:
volmne&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:'..
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW 0 YES
IF YES: enter Book Page and/or Document #`
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, gradin excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NOX
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
2 BURTS PIT RD NMP-2018-00138
GIs#: COMMONWEALTH OF MASSA
(:—
a :B ock:Lot 38A-004-001 CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinz DO NOT HAVE ACCES S TO THE GUARANTY FUND(MGL c.142A)
BUILDING PERMIT
Permit# MBP 2018-0013 8
Project# 2 BURTS PTT RD
Est.Cost:
Fee:30 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NOAH GRUNBERG
Lot Size(sg.ft.): Owner: WOODFIN ELIZABETH&DEIDRE CUFFEE-GRAY
Zoning. Applicant. NOAH GRUNBERG
AT. 2 BURTS PTT RD
Annticant Address: Phone: Insurance:
PO BOX 976 413-623-3733
SHELBURN FALLS,MA ISSUED ON. 0811012017
TO PERFORM THE FOLLOWING WORK. 12x16 she d
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department 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. �-ic `1 (Zav'C4
. 17
Certificate ofOccupancy signature:
FeeType• Date Paid: Amount: Check Number:
Shed 08/09/2017 30 2712
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Conunissioner