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30C-088 (6) 377 FLORENCE RD BP-2021-1188 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:30C-088 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2021-1188 Project# JS-2021-001986 Est.Cost: $6000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(so. ft.): 19994.04 Owner: MIZULA DONALD G&PATRICIA A Zoning: URA(100)/WSP(I00)/ Applicant: MIZULA DONALD G & PATRICIA A AT: 377 FLORENCE RD Applicant Address: Phone: Insurance: 377 FLORENCE RD (413) 586-9134 () FLORENCEMA01062 ISSUED ON:4/16/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:ADD SHED ROOF TO SIDE OF BARN 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 UP N VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I i Q o �,Q 1 • r � 1 • Certificate of Occupancy Signature: I FeeType: Date Paid: Amount: Building 4/16/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ' ,\ gJ, The Commonwealth of Massac 9 liBoard of Building Regulations and ds 1s. " FQR r CIIlALITY ...1. Massachusetts State Building Code, �i/%� f SE Building Permit Application To Construct,Repair,Reno olish R sed Mar 2011 One-or Two-Family Dwelling ` "�sOF c This Section For Official Use Only N°so°ti,s, Building Permit Number: 60- I -it $I Date Applied: j, V‘ - Building Official(Print Name) Signature ) i te SECTION 1: SITE INFORMATION 1.1 Pro Address: 1.2 Assessors Map&Parcel Numbers �� 3DG 1.1 a Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: a.?-GboSOFr 6p, e- yse,ae 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 Provided 1.6 Water Supply: (M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ 2.1 Owner'of Record: ,40124/a//iPn e/e8 111/ /9 /1//1&/V /11A5s v/oGa2 Name(Print) City, State,ZIP 3 77 '=/a-Poc(9 /eri fi.3 SSG 7/35V No.and Street Telephone Email Address New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition A Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': .S 4'e e/ /?aeP S 1 C!F c, isile Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building ,ova 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ v 2. Other Fees: $ 4.Mechanical (HVAC) $ e9 List: 5. Mechanical (Fire $ Suppression) Total All Fees:�tl$ e Check Noci{g3Check Amoun :0 J Cash Amount: 6.Total Project Cost: $ 6, pa b 0 Paid in Full 0 Outstanding Balance 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 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 I Insulation Telephone Email address D 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 .❑ 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(Electmnic Signature) Date 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 Auth ize gent'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 p)t tithe 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" CITY OF NORTHAMPTON pit MAP: LOT: LOT SIZE: Zb©O REAR LOT DIMENSION: 7 e 36 REAR YARD go �r �r SIDE YARD SIDE YARD 3� FRONT SETBACK • 2 a FRONTAGE L60. `7' a r City of Northampton i j Massachusetts �� �� DEPARTMENT OF BUILDING INSPECTIONS y 4ilp ; 212 Main Street • Municipal Building vti a --- Northampton, MA 01060 �SNly 3,ON�`� (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: Il",-5T /11,4`rs,¢Cnfert.r S'o4'T/l LC7-4/h&41 4,4s,5 The debris will be transported by: Name of Hauler: DoI-2/z( P /Zvl/ Di/1rC2 Signature of Applicant: ' 19/7 , _ e/ Date: y- <3 '-2/ The Contmonnealtlt of Massachusetts A- gi Department of Industrial Accidents =.:�— 1 Coatg,•ess Street,Saute 100 =��� Bosroll, M-I O'114-?01" �: ! , srtm.mass.gov.Fdia 11 tickers' C ompen:anon Insurance Affidavit:Builder: Contractor:.Electrician:Plumber:. TO BE FILED I►ITH THE PERNITITDit?AUTHORITY. Applicant Information Plea:e Print Legibly Name Btuules.Or aac:.auou.lu andual1: A es Citt- State:Zip: Phone=: Are von co employee"Check tie sppropriaae box: Type of project(required): ❑I am a employer with ample;roe:i full and or part-ause t' 7.. ❑New construction :❑I an:a sole proprietor or partneriaip and Lat•e no employee:workmz for me Lit S.. ❑Remodeknr. an-:capa,cr; [No',porker;coup a:urance required] . 3.�I am a home owner doing all sat myself.(No**skis'comp m:uracce required.(' 9 ❑Demolition 10 IRI Building addition 4.tR I am a honutowner and will be hamng contractors to conduct all work :A m:+propom I will mum that all contractors either hnvworkes•cosopenutian insumn:a or are sole 11.0 Electrical repair,or addition: proprietor:with no employees. 1—'.❑Plumbing repair or addrnm. •❑I am a general contractor and num..hired the sub-contractor.lt:tad co the ar..a:ced:heat 13.Q1'iuof repair' There sub-contractor.have maplovee:and hare worker:'camp ca::.-once t 5❑Lt a area corporation and it:officer:have exercised their right of exemption par MI L c 14 ❑ . 132.{ILO).and snbaton°employee; [Qa worker.'comp :n:uranco required.] A applicantthat checks box aI must also fill out the-Action below:how mg their worker:.eaaa�u4-polio}m infotmatian Heaaaaowners who mbffiit this afLda ut:ndicatn thilV are doing all work and then hire oattsiia ems aan:u;cbm.t a aria a$idr:^iadicauax such : cntractars that check this box mutt attached an additional:Leer:howinp the name of the sub-cantractra:and:rate whether or not dho:e annual have .r41o70e: :Etta sub-,contractor:have employee:.61:47.•mutt pro..-tie their -:ricers'comp.policy=dm I am an employer that is providing+rockets S.compensation insurance for my employees_ Belou is the policy and Job sere information. In;titanie Conipan::Nauie: Policy at or Self ins.Lic. n: Expiration Date: Job Site Address:__ City State Zip: Attach a copy of the workers'cornpen:adon policy declaration page(showing the policy number and expiration date). Failure to:ectn a coverage a.iequit ed under MGL c. 152. 25A is a criminal violation punishable by 3 fine up to S 1.500.00 and or one-year u pre:onrnent. a:well a:civil penalne:in the form of a STOP WORK ORDER and a fine of up to S250_00 a day apaurt the violator.A copy of the. :taterent may be forwarded to the Ot aloe of in:'e:ligation:of the DLA for insurance co•:er-aee verification. Ida hereby certify under the pains and penalties of perjury that the information provided above is titre and con ect Simiattrre.: (�/CP�I�j�- Date: • ' —/6 —2/ Phone¢. q/3 Sao `?i� Official use Only. Do not*ante In dill atea, robe completed by city or town official. City or Town: Permit.license at I::uiugAuthority(circle one): 1.Board of Health :. Building Department 3.City Town Clerk 4.Electrical Inspector c.Plumbing Inspector 6.Other --_ Contact Person: Phone 4: City of Northampton �op:94;m �.- ,I'"� ti Massachusetts :1 t- A ' t . 4 DEPARTMENT OF BUILDING INSPECTIONS 0):. 212 Main Street • Municipal Building.ram Northampton, MA 01060 MEMMIIIIMINOWAMMIMMIMMIIMMINI I, DO#Z-BIC�/ /lfJzv/g (insert full legal name), born //-30-1/4.0 (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 requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection 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 aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of y" 16 , 20 at C20:17-weele("1//-c„e,/ (Signature) THIS PLAT NOT FOR RECORDING PURPOSES 1c 3 Plan Book 142 Page 33 Lot #6A i Lot #6 a' M • co rn 60 .8 ' 4B •28' Florence goad To: The Heritage Bank For Savings & The First American Title Insurance Co. HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES, AND BASED ON EXISTING MONUMENTATION,ALL EASEMENTS, ENCROACHMENTS ND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES. I FURTHER EPORT THAT THE PROPERTY IS NOT LOCATED IN A FLOOD PRONE AREA AS SHOWN ON FEDERAL INSURANCE MAPS FOR COMMUNITY UMBER 250167 ATED: December 4 , 1991 NOTE JRVEYOR: AA," THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES •a�1 NOT CONSTITUTE A PROPERTY SURVEY. • MORTGAGE LOAN INSPECTION PLAT Northampton, Massachusetts (is~ RtCHARD Prepared For J, ter, Donald G. & Patricia .1 LABkR6uE,sR. �" F Mizula t434605 i0 Scale: 1 "=50 ' IV Richard J. LaBarge, Sr., Registered Professional Land Surveyor 110 IGng Street, Northampton, Massachusetts 01060 1 , 1 411 / 44 o7 A '4M - , 7 (Z p/o‘o ,I / f.- ----------------------_ . 1 ' ----------,..— \ ; • . 6 X,ro 1 fitio. . i i / Ho eit,c . , 1 , , i / . • / i i / t 0/ i IN., ...1( , .b.--"'--- If--- / ' './-)///ic.9•"7-------„ . .1 i •C ‘ ' R': "' y / / i /. i 1 / rkIt) / ii . , / 1 . i t I 11 Gt! 'Ai Py/i/ Vo/../ Z,ZS kak -4 ©1 J.on/ ,_ . , A • zZ' t. . 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