23A-093 (19) 17 FAIRFIELD AVE BP-2021-1117
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-093 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2021-1117
Project# JS-2021-001882
Est.Cost: $39655.00
Fee: $280.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KIM RESCIA 022464
Lot Size(sq ft.): 13242.24 Owner: GOTTLIEB SETH G&JENNIFER N
Zoning: URB(1oo)/ Applicant: KIM RESCIA
AT: 17 FAIRFIELD AVE
Applicant Address: Phone: Insurance:
311 Locust St (413) 320-1831 O
FLORENCEMA01062 ISSUED ON:4/9/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD EXISTING SCREEN PORCH WITHIN
EXISITNG FOOTPRINT, REBUILD DECK
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. CS)
Certificate of Occupancy Signature: I
FeeType: Date Paid: Amount:
Building 4/9/20210:00:00 $280.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
2-0K
File#BP-2021-1117
APPLICANT/CONTACT PERSON KIM RESCIA
ADDRESS/PHONE 311 Locust St FLORENCE (413)320-1831 ()
PROPERTY LOCATION 17 FAIRFIELD AVE
MAP 23A PARCEL 093 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
OSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid /40
Building Permit Filled out
Fee Paid
Typeof Construction: RE_BV ILD EXISTING SC EEN P H WITHIN EXISITNG FOOTPRINT,REBUILD
DECK C �X tOW) u,1
New Construction ✓J
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 022464
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INVORMATION 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
; '41 SI I
Sig,•ture of Building Official 0 Date
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.
REEEvE _ t
1
APR - 22021
• o���The Commonwealth of Massachusetts
-• �..:- .,; FOR
Board of Building Regulations and Standards
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: 6a. -If'/// 7 Date Applied:
c
L___1, a
Building Official(Print Name) / Signature / to
SECTION 1:SITE INFORMATION
1.1 Propetr Adijre,if 1.2 Assessors Map&Parcel Numbers
i t c,i t ;tkl /tv.th v-Z. )-3 A - O9 3- Da 7
1.1 a Is this an accepted street?yes x no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
/3,X5a f3L• S
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 31 Provided
!6 61 '/37.S.
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Flood
Public Private ElZone. — ChecOutsikif yes❑�no7 Municip
al Li On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Own,er'of Record:
j�}"► Cjol l-I; :t ' ,_)Ri.. �jo i� f1 L� Woi Akti t'(A oIoLV
Name(Print) City,State,ZIP
11 FAilT;e1c1 �1evi
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building') Owner-Occupied Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units , Other 0 Specify:
Brief Description of Pr posed WyQrk2: e • ) Q k i f",h e /ye• IN;P i
l �1 Qr�n-f. �i(G1 2kjt +� CYc . S .) V c ycv H"I�r� t'.Xi) iha C CcG.
r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ S � 1. Building Permit Fee:$ Indicate how fee is determined:
cc. 0 Standard City/Town Application Fee
2.Electrical $ YS l 3Q 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: o
No5210 Check Amount:•vi Cash Amount:
6.Total Project Cost: $ 9 S'S ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) q
C-S -02 Z`/6 Zp,ff-22
1/1 1 I1, ��%S(_( � License Number
� Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
C Q V 4_4 :--) 1 ) a 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
( 13 3 2 / 3 / I Insulation
Telephone Email address D Demolition
5.2 Registered How Improvement Contractor(HIC)
1447
Ki I Vt1 (c HIC Registration Number E pirati n Date
HIC Company Name or HIC Registrant Name
Th)l 1 )-a (
No.and Street Email address
-F ire InC? (tit. l J ( L 'I!3 '3 2 : l k 3/
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AlcItIDAVIT(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 o Issuance of the building permit.
Signed Affidavit Attached? Yes No 0
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 l /Vl ge—'{mil I KC,
to act on my behalf,in all matters relative to work authorized by this building permit application.
— 41/LIZ n 2 (
Prior-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.
OA re.-, >(_ i
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"
The Commonwealth of Massachusetts
Department of Industrial Acc idents
1 Congress Street,Suite 100
%"o ar ' Boston. MA 02114-2017
�-t.. www.mass.gor/dia
Workers'Compensation Insurance Aflida+it:Builders/Contractors/Electricians/Plumbers.
10 Ht.HIE W'nit'1'1W PERM II-rim;AUTHORITY.
Applicant Information Please Print Leeiblh
Name 113ustnc>s Clrt!atvsraUtiat lndsvitlual): +�j 1 � �G',,,- , c.t
Address: .-Z, I ( < i 4 S �l --t------'
City/State/Zip: J3re 14CQ (, 4 ci r 01 o Ea,Phone#: II /-- 37.) /��
Ansel'as employer?Check the appropriate beat: Type of project(required):
I.a 1 am a 0110,11.13 With _ Cnririuyees(full and%+tr part-time,• 7. 0 New construction
1 in a.suite proprietor or paint-rally and have nu employaca working for me m IL Remodeling
any rapacity.[Nu workers'comp.insurance nvtuirnsLj
3 1 am a homeowner doing all wink myself.[No workers'camp_mwrance required.]' g Demolition
i.Q 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition
ensure that all Contractors either have w(ntera"r-ucnaat,O%maurance or are hole I I Electrical repairs or additions
proprietors with no employees_
12-0 Plumbing repairs or additions
50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet_ 13 Q Roof repairs
These sub-euntractor%have employees and have worker,'camp.insurance.
Other
60 Vi o pa are a crat,un and its ulikers have exercised their right ut eterps[3im lsf(iL per e_ 14.u
152,#1(4),and we have tau employees.[No workers'comp.insurance required.[
*Any appticmi that checks boat a1 must also fill out the mectioar below show ing their workers'compensation policy information
t Horneownen who submit tins affidavit indicating they are doing all wutk and then hoc uut.ide contractors mint subnut a new atiruLr.it indicating much.
tCuntraetun that check the box must attached art aldrtional sheet shuts ing the nacre of the sulrcuraracuws and state w hether or riot those.arteries have
c-tttpluyees If the sub-contractors hase ctrtpluy ces.they must pmv idc their +aurkers".temp.padres nurnher
!am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
informations.
Insurance Company Name:_ —"_ —
Policy#or Self-ins.Lic.#: ------- Expiration Date:
Job Site Address: City/StateiZip:
Attack a copy of the workers'compensation policy declaration page i 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 1,5(0)"(X)
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of 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 an r pains d penalties of perjury that the information provided above is t ue and correct.
t..naturee: . /// -)e/f4 Date. (.,
/
1'I lone 4: 37 n /O -3 /
._ Z . . .. t
Official use only. Do not write in this area,to be completed by city or town owl
City or Town: Permit/License#
issuing Authorit (circle one):
1. Board of Health 2.Building Department 3.('it (loin Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
Massachusetts {S •.. e
DEPARTMENT OF BUILDING INSPECTIONS � 4212 Main Street . Municipal Building ZvE
Northampton, NA 01060 ssN 11
7`'Na
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: Htil
��lQ �� s���`�p �E ►-L (C .(A
Signature of Applicant: Date:
Northampton, MA : Assessor Database
Property Search:
Parcel ID: Owner Name: Street Number: Street Name:
23A-093 ... v
Search I I Reset I
Property Detail:
Parcel ID: Card: Street Name: Street Number: Zoning: State Class: Acres: Plot:
23A-093-001 1 FAIRFIELD AVE 17 Single Family Residence 0.30
Owner Information: Property tresses:
Owner Name: GOTTLIEB SETH G&JENNIFER N Picture:
Owner 2 Name: _ M
Owner 3 Name: _ ,.u,.-- V
Street 1: 17 FAIRFIELD AVE '� 1 4. _
City: FLORENCE - �, p
State: MA v{a : F ',. '°'
Zip: 01062 _ . 4 ,� t
Dwelling Information: w 7 -
Style: CONVENTIONAL ^ - .'.
Year Built: 1900 v �
Exterior Walls: FRAME „1 ° ;. iR '• *r - 1
Story Height: 2.0 _
i>N
Attic: PART FINISH "•w..... '4'..,"„ 'e 7z '7
Basement: FULL - t v
Bsmt Gar SPacas: 0 k -
,: .1' J
Total Living Area: 1972
Total Living Area Minus FBLA: 1972 Sketch: .s•Z
Finished Basement Area: 0 E,. a.. .a i
•
Res Room: 0 •
nau V
a a :'e,',wevvrr"seo rr 111 J
Heating System: GAS/STEAM 1'a,Zi e v r...`w
tle
Central Air. No �O wan
Fireplaces: I)Rooms: 7 '''..4...'''..4...0
Bedrooms: 4 x
' d
.Full Baths: 3 a ■/�G^T�y/
Half Baths: 2 V
Valuation: I r, CO
Appraised Land: $121,100.00
Appraised Bldg: S2137,700.00 , •
Appraised Total: $408,600.00 a
Out-Buildings:
Code: Description: Units: Year Built: Blast: Sise2: Area: Grade: Condition:
RGI 1 1901 1 320 320 C FAIR(Res)
RS1 1 1960 1 120 120 C AVERAGE(Res)
RS1 1 2003 1 240 240 C AVERAGE(Res)
The information delivered through this on-line database is provided in the spirit of open access to government information and is intended as an enhanced service and convenience for citizens of Northampton,MA.
The providers of this database:Tyler CLT,Big Room Studios,and Northampton,MA assume no liability for any error or omission in the information provided here,
Comments regarding this service should be directed to:JsarofinOnorthamptonassessor.us
Tue.March 30,2021:12:44 PM:0.05s:10mb bill
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: 13 4 LOT: 0 � ‘5
LOT SIZE: 13 d-SO
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REAR YARD 2
SIDE YARD 31 ' S SIDE YARD 6
FRONT SETBACK I`'
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