37-022 (39) 600 FLORENCE RD-24 MOUNTAIN LAUREL PATH BP-2020-1155
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37-022 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Permit# BP-2020-1155
Proiect# JS-2020-001949
Est.Cost: $1000.00_
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): Owner: MACLEOD PEGGY
zoning: Applicant: MACLEOD PEGGY
AT: 600 FLORENCE RD - 24 MOUNTAIN LAUREL PATH
Applicant Address: Phone: Insurance:
600 FLORENCE RD - UNIT#24 (413) 585-0402 O
FLORENCEMA01062 ISSUED ON.512612020 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 4 REPLACEMENT WINDOWS
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 5/26/2020 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Nfw mac'
_ Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Drivewav Permit
I r 4 212 Main Street O Sewer/Septic Availability
' Room 104'�.. 1 WaterANell Availability
Al + Northampton;MAb �Ps :, 04G Two Sets of Structural Pians
rrrphone 413-587-1240 Fax'4 ;J'272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE'UR`OEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
This section to be corrspleted by office
1.1 Property Address:
24 Mountain Laurel Path, Florence, MA 01062 Map Lot_a Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWN ERSHIPiAUTHORIZED AGENT
2.1 Owner of Record:
Peggy MacLeod 24:Mountain Laurel Path, Florence,MA 01062
Name(P'nt) Current Mailing Address:
g� -(u f1�
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-E&17MATFD CONSTRUCn N COSTS
Item Estimated Cost(Dollars)to be Official Use Orgy
completed by permit applicant
11. Building 1000.00 (a)Building Permit Fee
2. Electrical (b)`Estimated Total Cost of
Construction from 6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) l�
5. Fire Protection
6. Total=(1 +2+3+4+5) 1000.00 Check Number
This Section For Official Use Only
V "�!�� Date
Building Permit Num r. Issued:
Signature:
Building Commissioner/inspector of Buildings Date
@ C� a i � • ��'�
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aaplicabiei
New House ❑ Addition ❑ Replacement Windows Alterations) Rooting
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs Decks [q Siding[E3] Other[E:A
Replace 4 casement windows with new double hung windows
Brief Description of Proposed
Work: IJ- Ft - ZQ
))
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housing,complete the'follow na:
a. Use of building: One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS 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.
Signature of Owner Date
l Pe!4q U as Owner/Authorized
Agent hereby AheWe that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed der the pains and penalties ofp'ury.
Print Name
Signature of ner t Date
The Commonwealth ofMassaehusetts
Department of IndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
1lurkers'Compensation Insurance Affidavit:Builders/Contractors/Elechidans/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Intbrntation Please Print Legibly
Name(Business Organization/Individual): Cape
Address: /V,&V 0+CL(VA L0.L/11-& ( pet-
City/State/Zig: 'F [0 Phone#: YI 3 S3 0
Are you an employer?Check the appropriate box: Type of project(required):
1.Q I am a employer with employees(full andior part-time).'" 7. ❑New construction
2.[:]I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
4. ❑Demolition
3.O I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 L]Building addition
4.E1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 1 12.Q Plumbing repairs or additions
5.o I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.*
6.[:]We are a corporation and its officers have exercised their right of exemption per M(3L c. 14.[]Other
15' §I(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
IContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-contractors have cmployecs,they must provide their workers'comp.policy number.
I am an employer that is prodding workers'compensation insurance for mry employees. Beltnv is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/StateiZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requited under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisomnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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.
Ido hereby eunder the pains and p naliies of perjury that the informations provided above is true and correct.
Signatnre-. 74. z
C Date: 5 z v ZO
Phone#: 413-5 710 (92 If
Official use onlJt Do not H711e in this area,to be completed by city or t"W Official
City or Town: Permit/License#
Jssuiug Authority(circle one): ,
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: ,
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 'c�
Northampton, MA 01060
;`Y-F^TOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
he/she resides or intends 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."
The building department for the City of Northampton wants any person(s)who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection
(before work is concealed), insulation inspection (if required)and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
I, - I'A; —Zs r�C �t% understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date J 2�
Address of wor location y Iy ,,�k,ck./tzX P,L�
I I t X�/irl CQ- (Q Z-
City of Northampton
•�," Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street *Municipal Building
Northampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S541 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:
(Please print house number and street name)
Is to be disposed of at: n
V�c � Vc it C (;" � I F)6U
(PI se print name adcl addlocation of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
�20 -?A)
Signature of Per plicant 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.