Loading...
SPRING ST APPLICATION PACKETCity of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ● Municipal Building Northampton, MA 01060 PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. l. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s) and set backs. 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. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. The Commonwealth of Massachusetts Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One- or Two-Family Dwelling FOR MUNICIPALITY USE Revised Mar 2011 This Section For Official Use Only Building Permit Number: _____________________ Date Applied: ______________________________ ___________________________________ ____________________________________________ ___________ Building Official (Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: ____________________________________________ 1.1a Is this an accepted street? yes_____ no_____ 1.2 Assessors Map & Parcel Numbers _____________________ ____________________ Map Number Parcel Number 1.3 Zoning Information: _______________ ___________________ Zoning District Proposed Use 1.4 Property Dimensions: _____________________ ____________________ 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) Public  Private  1.7 Flood Zone Information: Zone: ___ Outside Flood Zone? Check if yes 1.8 Sewage Disposal System: Municipal  On site disposal system  SECTION 2: PROPERTY OWNERSHIP1 2.1 Owner1 of Record: ________________________________________ _________________________________________________ Name (Print) City, State, ZIP _____________________________________________ _________________ ___________________________________ No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction  Existing Building  Owner-Occupied  Repairs(s)  Alteration(s)  Addition  Demolition Accessory Bldg.  Number of Units_____ Other  Specify:________________________ Brief Description of Proposed Work2:_________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building $ 1. Building Permit Fee: $_______ Indicate how fee is determined: Standard City/Town Application Fee Total Project Cost3 (Item 6) x multiplier _______ x _______ 2. Other Fees: $_________ List:_________________________________________________ ____________________________________________________ Total All Fees: $_______________ Check No. ______Check Amount: _______Cash Amount:______ Paid in Full Outstanding Balance Due:__________ 2. Electrical $ 3. Plumbing $ 4. Mechanical (HVAC)$ 5. Mechanical (Fire Suppression)$ 6.Total Project Cost:$ 40 SPRING ST FLORENCE MA 01062 SARAH GILLEMAN 40 SPRING ST FLORENCE MA 01062 413-218-3435 X INSULATION INSULATION, WEATHERIZATION FOR MA SAVE PROGRAM 11,000 11,000 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License (CSL) ________________________________________________________ Name of CSL Holder _________________________________________________________ No. and Street _________________________________________________________ City/Town, State, ZIP _________________________________________________________ __________________ ______________________________________ Telephone Email address _____________________ ______________ License Number Expiration Date List CSL Type (see below) _______________ Type Description U Unrestricted (Buildings up to 35,000 cu. ft.) R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation D Demolition 5.2 Registered Home Improvement Contractor (HIC) ______________________________________________________________ HIC Company Name or HIC Registrant Name ______________________________________________________________ No. and Street ________________________________________ ____________________ City/Town, State, ZIP Telephone _____________________ ______________ HIC Registration Number Expiration Date _______________________________________ Email address 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 ……….  No ………..  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: OWNER1 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. _____________________________________________________________ ______________________ 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 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” PATRICK MCDONOUGH 105 MARSHHAWK WAY MARSHFIELD MA 02050 617-512-1509 CLEANTECHPERMITS@GMAIL.COM 106150 5/24/2022 I CLEAN TECH CONSTRUCTION 190 FEDERAL AV QUINCY MA 02169 617-271-0768 196071 6/27/2021 CLEANTECHCONSTRUCTION@GMAIL.COM X PATRICK MCDONOUGH/CLEAN TECH CONSTRUCTION SARAH GILLEMAN (signed authorization attached)3/28/2021 3/28/2021 CITY OF NORTHAMPTON SETBACK PLAN MAP:_______ LOT:________ LOT SIZE:____________ REAR LOT DIMENSION:_____________________________ FRONTAGE_____________________ REAR YARD _____________ SIDE YARD______________ SIDE YARD______________ FRONT SETBACK_______________ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 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: ___________________________________________________ The debris will be transported by: Name of Hauler: ______________________________________________________ Signature of Applicant: __________________________________Date: ___________ 40 MESSINA DR BRAINTREE MA 02184 TROUPE WASTE DUMPSTER CLEAN TECH CONSTRUCTION 3/28/2021 Clean Tech Construction 190 Federal Ave Quincy, MA 02169 617-271-0768 6 x insulation 617-512-1509 x 9/18/2021 3/28/2021 FLORENCE MA 01062 TRAVELERS INSURANCE 6HUB4N6013080 40 SPRING ST 3/28/21 Tobman, Molignano & Weiner Ins Agency 21 McGrath Highway, Suite 303 Quincy, MA 02169 617-471-1123 617-773-2474 Clean Tech Construction LLC 190 Federal Ave Quincy, MA 02169 Norfolk & Dedham Mutual A P012011894 09/18/20 09/18/21 1,000,000 100,000 500,000 1,000,000 2,000,000 2,000,000 A 91972894A 09/16/20 09/16/21 1,000,000 1,000,000 A U20003464A 09/18/20 09/18/21 1,000,000 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCEDAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY Traveler's Indemnity Co of America B 6HUB4N60130820 9/18/20 9/18/21 500,000 500,000 500,000 127+$03721%8,/',1*'(37 $-&"/5&$)$0/4536$5*0/ r Construction S~pervisor Specialty Restricted to: CSSL-IC -Insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.gov/dpl Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite 710 Boston, M� -chusetts 02118 Home lmprovemear "'",,rtractor Registration 0 20M-05/17 CLEAN TECH CONSTRUCTION 190 FEDERAL AVE QUINCY, MA 02169 Lo/Z,, ?£./,nnuvw�,d o/ Aa-,J,;diuJ.d/4 Office of Consumer Affairs & Business RegulationHOME IMPROVEMENT CONTRACTOR rTYPE: LLC Registratio!'l Expiration 1-9607f�I..:--::·0612112021 -== - . ':1CLEAN TECH CON_STR\JCTION-' --; \";. ' -�,; ,:/WILLIAM DAVIDSON --, ; k / =-_/_,I..,,, 190 FEDERAL AVE,, 5s'�QUINCY, MA 02169 Undersecretary Type: Registration: Expiration: LLC 196071 06/27/2021 Update Address and Return Card. Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street • Suite 710 Boston, MA 02118 CLEAN TECH CONSTRUCTION LLC 190 FEDERAL AVE QUINCY, MA 02169 Undersecretary Type: Registration: Expiration: Supplement Card 196071 06/27/2021 HOME IMPROVEMENT CONTRACTOR Registration Expiration Office of Consumer Affairs & Business Regulation Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, MA 02118 Update Address and Return Card. Not valid without signature PATRICK E. MCDONOUGH 190 FEDERAL AVE QUINCY, MA 02169 TYPE: Supplement Card 196071 06/27/2021 CLEAN TECH CONSTRUCTION LLC Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration All businesses in the state of MA must develop a written control plan outlining how its workplace will comply with the mandatory safety standards for operation in the COVID-19 reopening period. This template may be filled out to meet that requirement. Control plans do not need to be submitted for approval but must be kept on premise and made available in the case of an inspection or outbreak. All individually listed businesses must complete a control plan, even if the business is part of a larger corporation or entity. 8 U S I N E S S I N F O R M AT I O N I please provide the following information -- Business name: Clean Tech Construction D Check if part of a larger corporation Address: 800 Matthew Ct,unit102 Braintree,Ma,02184 Contact information (Owner/Manager): William Davidson 617-271-0768 Contact information (HR representative), if applicable: Cleantechconstruction@gmail.com Number of workers on-site: 5 S O C I A L D I S TA N C I N G I check the boxes to certify that you have: - [l] Ensured that all persons, including employees, customers, and vendors remain at least six feet apart to the greatest extent possible, both inside and outside workplaces [l] Established protocols to ensure that employees can practice adequate social distancing [l] Posted signage for safe social distancing [l] Required face coverings or masks for all employees [l] Implemented additional procedures. Please describe them here: ______________ _ H Y G I E N E P R OT O C O L S I check the boxes to certify that you have: [l] Provided hand washing capabilities throughout the workplace [l] Ensured frequent hand washing by employees and provided adequate supplies to do so [l] Provided regular sanitization of high touch areas, such as workstations, equipment, screens, doorknobs, restrooms throughout work site [l] Implemented additional procedures. Please describe them here: Hourly tool disinfectant process With hand sanitizer hourly to employees. Change of tyvek suits hourly All businesses in the state of MA must develop a written control plan outlining how its workplace will comply with the mandatory safety standards for operation in the COVID-19 reopening period. This template may be filled out to meet that requirement. Control plans do not need to be submitted for approval but must be kept on premise and made available in the case of an inspection or outbreak. All individually listed businesses must complete a control plan, even if the business is part of a larger corporation or entity. S TA F F I N G & 0 P E R AT I O N S check the boxes to certify that you have: [l] Provided training for employees regarding the social distancing and hygiene protocols [l] Ensured employees who are displaying COVID-19-like symptoms do not report to work [Z] Established a plan for employees getting ill from COVID-19 at work, and a return-to-work plan [Z] Implemented additional procedures. Please describe them here: Weekly meetings with up to date Information for each phase of the state's instructions. C L E A N I N G & D I S I N F E C T I N G check the boxes to certify that you have: --- [Z] Established and maintained cleaning protocols specific to the business [Z] Ensured that when an active employee is diagnosed with COVID-19, cleaning and disinfecting is performed [Z] Prepared to disinfect all common surfaces at intervals appropriate to said workplace [l] Implemented additional procedures. Please describe them here: Hourly tool fogging with EPA Approved disinfectant and have one man on-site who's only job is to disinfect