30B-028 (6) 269 RIVERSIDE DR BP-2022-0050
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:30B-028 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ALTERATION BUILDING PERMIT
Permit# BP-2022-0050
Project# JS-2022-000087
Est.Cost: $6500.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WYNTER HOWLAND 109919
Lot Size(sq. ft.): 43995.60 Owner: THOMPSON MACGREGOR
Zoning: URB(100)/ Applicant: WYNTER HOWLAND
AT: 269 RIVERSIDE DR
Applicant Address: Phone: Insurance:
45 PLEASANT ST (413) 522-1012 WC
SOUTHAMPTONMA01073 ISSUED ON:7/19/20210:00:00
TO PERFORM THE FOLLOWING WORK:DEMO MIDDLE WALL & CHIMNEY, ADD
SUPPORT BEAM
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. Is >2 7),
Certificate of Occupancy Signature: 1
FeeType: Date Paid: Amount:
Building 7/19/2021 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
The Commonwealth of Massac 464, Q O
W Board of Building Regulations and St. 1r c R
Massachusetts State Building Code, 780 <'•'o�� S ITY
Building Permit Application To Construct,Repair,Renovate ' y s., •lish . R.'ised Mar 2011
One-or Two-Family Dwelling °7°6,6>o,
This Section For Official Use Only
Building Permit Number: g P- .?2—Sid Date Applied:
l6 Al
BuildingOfficial(Print Name) Signature I i -e'
� �
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 : essors Map&Parcel . •
269 Riverside Dr Florence Ma 01062 30 B 028
1.1a Is this an accepted street?yes no • -r .. 'umber
1.3 Zoning Information: 1.4 Property Dimensions:.
URB 45,700 99
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:
Zone: Outside Flood Zone?
Public 0 Private 0 Check if yes❑ Municipal 0 On site disposal system El
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Julie and Mac Thompson Florence Ma 01062
Name(Print) City,State,ZIP
269 Riverside Dr
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) J
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ITT Addition 0
Demolition Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
Demolishing a middle wall+chimney of the house and putting up a support beam in its place
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 6500 l. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression)
Check No. O
$ Total All Fees:n Check Amount:t
6.Total Project Cost: $ 6500 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
° Massachusetts :,, .,
1 ,C
k DEPARTMENT OF BUILDING INSPECTIONS ( ))
Northampton, MA 01060s'
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. 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. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction(Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-109919 04/03/22
Wynter Howland License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
45 Pleasant St
No.and Street Type Description
Southampton Ma 01073 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
413-824-0204 I _ _ Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
191955 08/06/2022
Village Carpentry and Landscaping HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
45 Pleasant St villlagecarpentryma@gmail.com
No.and Street Email address
Southampton MA,v 01073
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 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 Village Carpentry and Landscaping
to act on my behalf,in all matters relative to work authorized by this building permit application.
MacGregor Thomson 07/14/21
Print 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.
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"
it's\
The Commonwealth of Massachusetts
11 e Department of Industrial Accidents
g
'''' 1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gotwitlio
Workers'Conipensation insurance.Affidas it:BuiklersiCoritractorsAketriciaris/Plambers,
41)BE FIELD Nii I Ill tilt, f.titstrt-riNt,AtTlIORtri.
Aunlicitnt Information Please Print Legilils
Name lilusthess'Organization Individu ,:, Village Carpentry and Landscaping
Address: 45 Pleasant St
City/StaterZirSOuthampton MA 01073 Phone#:
Are you SAI employer?Cheek air appropriate li,nt... Ts pe of project(required):
a.41 arn a ployer wait, ,9 .., , rillpik”AetN(fa and UT parminaeli. 7., Ei New c,thaktnietitha
21:11=a sole proprietor or pannen„faip anti have no erraptuyees,working for ft*in R. -IiRemodeling
any carthethy[No worker; mip.lahmarma reguarda]
9. [j Demolition
30 I am a horrItmwrim&mg all hurt myself.INo waiters`eornp ansunratce requared r
100 Building addition
4E31 aria a hertieowner and A.ill be ilmsig budibbbiori tt,oanduct all work 4)111 en property; 1 will
ensure that all c4rntractors either have,mathrts-compLmoatirra insurance or are sole 1 i,E3 Electrical repairs or arklitions
proprietors iikeitit no eretployce.%,
12.E]Plumbing repairs of additions.
5{73 I Attn.a INmemleontractor and I Ism.v his the Aub-csvaracknt,fisted kill the main:bed sheet
1 3.[D Roof repairs
The ar*,hat.temtrisztaim hew employees and haw workers* ,,,orrip,nunnuicc.
141:101itet
6E3 We are a corporation and its officers wve exercised their right or'exertoner per MOL,e.
152,§Ifill,and we haw rie ertmloyers.[No%writers oraap.msortnee requiretil
*Any applicara dim cheeks boa Si maim Mae fill our the itiCeti011 below siawving then workers'etannermatiou policy inferthathath
+itinianiwriers who submit this affidavit Urdicaung the' are doing all work and then hue outside cornita.thars mien submit a;sew affidm a indicating suck
:Contractors that check this lior,most athethed an additional thLVE skvising the name of the iab-c,,,,,uar,..ior and mite.whether 04 not chum tanitim he
employees lithe sal,--4.7onlr.i:tor,-,base chmloyech.thc:.4 nema prokide their *oath;eorrip.Imitol raardsct
I if ni on employer that ils providing workers'compettsah'ion insittonee for my employees. Belo W lA the policy and job!sire
infionnation.
Insurance Company Name. NorGuard
Policy#or Self-ins.Lie. //: shwc199270 Expiration Date, 09/06/2021
Jon Site Address,: 269 Riverside Dr Citylstuezip: florence Ma 01 062_
Attach a copy of the workers"compensation policy declaration page(shooing the policy number and etpiration dote).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a line up to$1,500.00
andOr one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of InviesAigations of the DIA for ithsktran...-c
coverage verification.
I do hereby certify under the pahrs and peftakks of perftuy thol the infOrmarion provided above is tray and currec-t.
Siitriature: Date.
Phone*
",... Official tor unlr. Du nut write in Mix tto-rot,to be completed by en)'tor town official
City or Town: Permit/License*
Issuing Authority(circle one):
I.Board of Health 1 Building Department 3.City frown Clerk 4.Electrical Inspector 5.Plumbing Inspector
1 6.Other
1
/
Contact Person: Phone*:
City of Northampton
4Cj
Massachusetts
t L14 * "
DEPARTMENT OF BUILDING INSPECTIONS
4'1 OW,_
212 Main Street • Municipal Building �f ,,2
Northampton, MA 01060 as' "'
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: Valley Recycling
The debris will be transported by:
Name of Hauler: Village Carpentry
Signature of Applicant: Date:
City of Northampton
1. �t.... SJ
Massachusetts ti `fie
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 3y+, • `
Northampton, MA 01060 ► ��$�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_(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 ,20 .
(Signature)
1:!
206 SF TOTAL• •EXISTING WALL TO
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• BEAM TO BE ADDED:
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