29-151 (5) 107 SPRUCE HILL AVF BP-2021-1548
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29- 151 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: demolition BUILDING PERMIT
Permit# BP-2021-1548
Project# JS-2021-002573
Est.Cost: $500.00
Fee: $30.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 66646.80 Owner: FUNGAROLI DONNA M
Zoning: Applicant: FUNGAROLI DONNA M
AT: 107 SPRUCE HILL AVE
Applicant Address: Phone: Insurance:
107 SPRUCE HILL AVE
FLORENCEMA01062 ISSUED ON:6/28/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMO SHED
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. >2 . (1-1
I
�r
Certificate of Occupancy si�;natt(-': '
FeeType: Date Paid: Amount:
Building 6/28/2021 0:00:00 $30.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
C>\
The Commonwealth of Massach .et1 , c../3 �/\
Board of Building Regulations and Sta,d1 FOR
W Massachusetts State Building Code, 780 , ,or' �'& CIPALITY
v jI)emol4
USE
Building Permit Application To Construct,Repair,Renova.-•sk. Mar 2011
One-or Two-Family Dwelling ?c2s,
7 0 on For Official Use Only �lo,°�o
d s
Building Permit Number:
Date Applied: �tis
Building Official(Print Name) I • , ' Si ture 7-1011 Da e
SEC ON 1: SITE INFORMATION
1.1 Pronerry Address: 1.2 Assessors Map&Parcel Numbers
/4 mac-. I e Ave _ 11 /6-
1.1a Is this an accepted street?yes V. no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
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.L 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❑
SECTION 2: PROPERTY OWNERSHIP'
2. Owner' . Repot d F!D�'n C� 0/D�a_
f vl�Co�il�� ( t`
Nam (Pnnt)� City,State,ZIP
0? S la/ Q 1-I-,g A-,,--,2-- - 5ici-3 7S(Lt
No. and Streel Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 4af Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: S L LQ
� .l ►vtU �
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $ .2")
Check No./7 0heck Amount -40A-1 Cash Amount:
6.Total Project Cost: $ 13 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 . 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
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: OWNER' OR AUTHORIZED AGENT DECLARATION
iBy 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.
bounce_ fr' )A aLd ro I i to •t1-1 •...1(
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
li
Department of Industrial Accidents
1 Congress Street, Suite 100
- _ Boston,MA 02114-201 7
WWW-mass.gov/dia
-...._
' 4.k'kers' ('orripensittion Insurance Affidavit:Buildervifoutractors/EkciriciansiPlumbers.
to HL 1 ILIED VI ITIl THE PERMITII\G.4.1THORITY.
Applicant Information Please Print Legiblv
Name tHosaness Organization lnd tvidual I: Cif mai C^ "%.4 G . E,/ '‘ i L'A ) k 11, (.41,obk-q. e I C
Address: ( k k Al /1-, e,f,„ ‘)--
t; 5 ( , 1 i . c/ 61 f
City State Zip: Cu— A, A le7 hone#: 4 .I _
kre:,..3111 in 1.1111041?i..`r:( haat,Iht apilroprtati het: Type of project(required):
1.Glitiaa a ertmloyer with — ternoloyees f full enriOr pail-Moo.* 7. C]New etonstruction
2r3..a sole proprierat or pannerabip and Inwe no einpkeyie,working for tne la S. CI Remodeling
ally carsoity.NU'4 fakers etartip.inilaitarna resaltaireail
9. aDemolition
.1..L3 I am a tionseowriez&nag all wink myself_[No wnekess*comp,insurance required.].
10 Ei Building addition
4.0 I am•
a henietalaones and will be taring orannionts to entabizt all work tat ite!a-popery. I will
halite that all contractors tither have workers.'convelisalion inisairatee es ate axle II.0 Eimirreal repairs or additions
pniprierais iiiai ro eirvii,ye,N.
12.0 Plumbilig repairs or additions
.. 0 I ern a general contractor and I have hued the subailanstractors hied on the attached sheet
o.riRoof repairs
These sub-cormakeron.hm,c employees and have workers',orrip.imaisnasce..;
14.[3 Other
6.0 We art a i.orportaint and it,officers neve exorcised their rgin af exemption pm MU e.
tot i.and we have DO arvloyees.NO woken'Witir anginas:ace reglaitisall
*Ait)api,11—‘1::11.i•,:,,,...1.,t,,,,,n:raw..ds.,1 fill our The yeetion he total shossing their Workers'eisrapcnsalion Wile!, aillontiatioai
*Firaineviancts a,tut satinal Lius aliadas al indaataig dal:,arc dhow ad work and in to versa&COILICICIOrls rialltA 5Ubrild a no.,at late.41.wrAilLaialt:ailo.:1:
:Camara:Am,that i:ileci.this INA trait allisidied an additional shest shiSaSing the name tit the ants-coraractors and stale tAitelfr:7 sa not those enlil les
,...ripi,,,,,:c.. li the sub-ectraraerors.hasc empio)ech.they'ming pio,adc their Workers'comp.poise:. 1(.21t,l
I am an einployer that is providing workers'conipensation insurance for my employees_ Below is the policy and job she
information.
Inswance Company Name: (?V 6 CL k _
Policy#or Self-ins.Lie.#: R 1.U C 9 1 ) 7 9 k Expiration Date: 7 /2 I
Job Site Address: t °' .r? 5 (vele( till 1 A v it. CityiState/Zip: F v-tb. c c frx A 0 i ‘.4
Attach a copy of the workers'compensation policy declaration page(showing the policy number and es `ration date).
Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a fine up to$1.500.00
andeor one-year imprisonment,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 %1 c,lator.A copy of this statement iney be forwarded to the Office of Investigations of the DIA for insurance
Cuv,..-raLl, ,e:111._.11.1,ul,
. . .
I do hereby certify tinder the pains and penalties a cm ation pro ri fled above is true and con-ect
ti 1
signature: Date: (2 A 1 / )frs- I i
Phone.1•,:`: 11 I )
.. .. ..
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authorit) (circle one):
i.Board of Health 2.Building Department 3.Cityrioss a Clerk 4.Electrical Inspector 5.Numbing inspector
6.Other
Contact Person: Phone 4:
- .
City of Northampton
Massachusetts —
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 SH . . y`
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: VAC f�� �,Q.�
The debris will be transported by:
Name of Hauler:
„La_
Signature of Applicant: Date: ' `c5 / 3-/
City of Northampton
Massachusetts '
tr � r. t
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
APPLICATION FOR DEMOLITION PERMIT
Attached are the forms required for a Demolition permit. Please fill out all of the attached forms
and submit them to the Building Department with the appropriate fee. Please make checks
out to the City of Northampton. (Cash not accepted)
Please be advised that disconnect signatures from the following departments must be submitted
with the application:
1. Eversource (Gas division)
2. National Grid (Electric division)
3. Northampton Department of Public Works - Water
4. Northampton Department of Public Works — Sewer
5. Northampton Department of Public Works — Storm water Management
6. Northampton Department of Public Works — Tree Warden
7. Northampton Historical Commission Review (if built prior to 1945)
*Proof of extermination is required to be submitted to the Health Department for all Commercial
demolitions and all abandoned residential properties. (Extermination may be required at the
Health Inspector's discretion if evidence of rodents exists).
Other required documents:
• Massachusetts Construction Supervisors License
• Copy of Workers Comp Affidavit
• Asbestos abatement report
A Demolition Permit will not be issued, and no demolition is to commence until ALL required
documents are submitted to the Building Department.
For further questions or information, please contact this department @ (413) 587-1240
ASBESTOS REMOVAL
All residential, commercial and institutional buildings are subject to Massachusetts Department of
Environmental Protection (MassDEP) asbestos regulations at 310 CMR 7.15. Therefore, owners
and/or operators (e.g. building owners, renovation and demolition contractors, plumbing and
heating contractors, flooring contractors, etc.) need to determine al asbestos containing materials
(ACMs), both friable and non-friable, that are present at the site, and whether or not those
materials will be impacted by the proposed work, prior to conducting any renovation or
demolition activity.
Examples of commonly found ACMs include, but are not limited to, heating system insulation,
floor tile and vinyl sheet flooring, mastics, wallboard, joint compound, decorative plasters, window
glazing, asbestos containing siding and roofing materials and fireproofing materials.
Failure to identify and remove all ACMs prior to its being impacted by renovation or demolition
activities, can result in significant penalty exposure, and higher clean-up, decontamination,
disposal and monitoring costs.
A DOS certified asbestos consultant must be contracted to determine if asbestos is present and
whether removal/repair is necessary. If the building is a state owned facility, contact DCAM and
DOS. DOS provides a list of licensed asbestos abatement contractors and consultants. You may
wish to inquire if a contractor has any history of violations. Only DoS licensed and DOS certified
asbestos abatement contractors and consultants may be hired to perform asbestos related work
in Massachusetts.
Received by:
Print Name Title
Signature Date
BUILDING DEPARTMENT
DEMOLITION PERMIT SIGN-OFF SHEET
Date:
Address: Building Use:
Owner: Phone:
Owner's Address:
UTILITY CUT OFF
(Signature of Authorized Representative of Utility Department required)
As required by the Massachusetts State Building Code (780 CMR), a permit to demolish shall not
be issued until a release from the utilities is obtained, stating that their respective service
connections and appurtenant equipment have been removed or sealed and plugged in a
safe manner.
Eversource (Gas)
Signature Title
National Grid (Electric)
Signature Title
DPW (Water)
Signature Title
DPW (Sewer)
Signature Title
DPW (Storm water)
Signature Title
DPW (Tree Warden)
Signature Title
DPW Director
Signature Title
Historic Comm. Review
Signature Title