35-278 (8) 90 WOODLAND DR BP-2022-0152
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35-278 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Door Replacement BUILDING PERMIT
Permit# BP-2022-0152
Project# JS-2022-000264
Est.Cost: $3029.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RENAISSANCE BUILDERS 013302
Lot Size(sq.ft.): 37722.96 Owner: LAZZARINI ZITA
Zoning: Applicant: RENAISSANCE BUILDERS
AT: 90 WOODLAND DR
Applicant Address: Phone: Insurance:
P O Box 272 (413) 863-8316 Workers Compensation
TURNERS FALLSMA01376 ISSUED ON:8/9/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:DOOR
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:
Cas: 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.
I ;
'CI
•
Certificate of Occupancy signatt s r • .5.2 - ,1 •
FeeType: Date Paid: Amount:
Building 8/9/20210:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
/ ' //..4..N.'NiN''4.0�`
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The Commonwealth of ap is
Board of Building Regulations an c�O�J ICIPALITY
W
Massachusetts State Building Code,
ti�SA USE
Building Permit Application To Construct, Repair,Renova ish a Revised Mar 2011
One- or Two-Family Dwelling so tis
This Section For Official Use Only
Buildin Permit Number: 130' 1 /6'. .. Date Applied:
c-vl,J�o5S 1/. 8-9-zoz1
-
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 As ssors Map& Parcel Numbers
CYO Wondleui►d Dr.1 clorear.c,t,) htA 3b 7 g
1.la Is this an accepted street?yes / no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) No
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
)t✓%:c.t kii t+,r.`V l.c.-u e-% Tio rtn ce, MA 010 Cv 7
Name(Print) City,State,ZIP
CIO Woldland Dri 't 802-380-0810
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building$, Owner-Occupied b. Repairs(s) fa. Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: gPic1(kGe I t4�t-tnov dmr & d 'VYb,,A._ .c.;0w.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ .6,0 Z. 66 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ Total All Fees: $
Suppression)
h" Check No.Hlo1 Check Amount: IN°
2
6.Total Project Cost: ;,0F( •W 0 Paid in Full ❑Outstanding Balance Due:
• SECTION 5: CONSTRUCTION SERVICES
5.1. Construction Supervisor License(CSL) S-01220 8 `11
2-4
vud License Number Expiratiok Date
Name of SL Holder
�7 G _ ,k, t�., List CSL Type(see below) U
b !O y� 1 1�'lC lasALType ( Description
No. and Street
Unrestricted(Buildings up to 35,000 cu.ft.)^ 1
i'i 44 6\3cl-I R Restricted t&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
( / SF Solid Fuel Burning Appliances
l3'8�3'83140 1406 (� t)t(d•I1!k I Insulation
Telephone Email address D Demolition
5.2 !R�egistered Rome Improvement Contractor(HIC) 1
4141461
�gl1L�tn ivlot Corp. dba 12-Pr1tkiS5p.nLe, Gu-t(cif(S HIC Registration Number E. iration Date
HIC Company Dlame or HIC Registrant Name
No.and treet - L lY� 1�°hbut�'hPk
Email address
\.;rKa r5 c•BAVS 1,101--6137 4 1113_943-821 _
City/Town,State, ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.I52.§ 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 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 d{"i l''-- 6 ee4--,,14>oljd
to act on my behalf,in all matters relative to work authorized by this building permit application
pi'I1( 4 1 '� ll5�"�� 8/3 /�
Prin Owner's Name(E ectronic 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 his application is true and accurate to the best y knowledge and understanding.
CA 2
Nor top 85Print O� •�:or Aut rized Agent' ame( �Electronic Si ature) / late
NOTES:
I. 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. It) 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"
-1/'N
RENAISSANCE
1-BUILDERS
PO BOX 272, TURNERS FALLS, MA 01376,413.863.8316
INFO@RENBUILD.NET, WWW.RENBUELD.NET
February 5, 2021
Denice Hallstein & Zita Lazzarini
90 Woodland Drive
Florence, MA 01062
Proposal to Replace Doors in Home at Above Address.
Scope to include the following:
• Replace door from hallway to hot tub.
1000 GENERAL CONDITIONS
1520 Temporary Facilities
A. Provide portable toilet for workers.
1530 Temporary Protection
A. Provide floor and dust protection to work areas and provide a walkway to and
from work areas.
1730 Cleanup & Trash Disposal
A. Clean up all debris and leave the job site broom clean at completion of all work.
B. Legally dispose of all debris.
2000 SITE WORK
2220 Demolition, Exterior
A. Remove and legally dispose of existing door and frame.
2225 Demolition, Interior
A. Remove existing interior casings and save for reuse.
6000 WOOD & PLASTICS
6220 Casing & Base
A. Reinstall salvaged door casings.
7000 THERMAL & MOISTURE PROTECTION
7200 Insulation, Vapor Barrier
A. Install spray foam insulation around perimeter of new door.
8000 DOORS & WINDOW
8100 Doors, Exterior
A. Door to be Therma-Tru Smooth Star fiberglass door, 2-panel with window, Model
S206.
B. Set exterior door in bed of acoustical sealant.
Hal!stein & Lazzarini Proposal Page 2
C. Shim door at all hinges and all corners. All shims to be installed prior to
insulation.
8700 Hardware, Doors & Windows
A. Door hardware to be Schlage F series.
B. Door to have latch set and dead bolt keyed alike.
9000 FINISHES
9910 Paint, Exterior
A. Exterior door to receive two coats Benjamin Moore, Sherwin Williams, or
equivalent latex based paint, or equal.
9920 Paint, Interior
A. Fill all nail holes with non-shrink putty.
B. Door casing and door to receive two coats of Benjamin Moore, Sherwin Williams,
or equivalent latex based paint.
END WORK LIST
Renaissance Builders, PO Box 272, Turners Falls, MA 01376 License#013302, Registration#199409
8/2/2021
(r%\.1164.1.
Nomina The Commonwealth of Massachusetts
S Department of Industrta I Accidents
f
I Congress Street,Suite 100
1 ral'I I• 't
4, Boston, MA 02114-2017
..... . www.mass.gov/dia
%$'4o-kers' Compensation Insurance Affidavit:Builders/Contractors/EkctriciansiPlumbers.
TO BE FILED WITH THE PERNHTTING AtillORITY.
Applicant Information Please Print Legibly
Name (BusinessfOrganizatiorvindividual): ?...t.,VICki45.SCAMC,11_ -.)(3-.a4e..)45
Address: Pe• 2)0 1,. '2:1 2_
c ity/statezip: y‘e,c ..--kifd.k.,, t•-119-0127(p Phone At: 4 I 3 efo3 i3 2,162
Are you an ettiployer?Cheek the appropriate box: Tpe of project(required):
I. I am a employer with ,2,1i employed(full ainclior parttimel_•1 7. 0 New construction
I am a sole proprietor or partnership and have no employers working for me in 8_ Remodeling
any capacity.[Na workers comp.msurance required:1
9. Demolition
30 I am a hoinuserner doing all work myself.[No workers*comp_imuranv-e rcourred_J'
I 0 CI Building addition
4.0 I am a homeowner and will be hiring coniraoors to conduct all work on my property. I will
ensure that all contractors either have workers"compensation 1.11.AlraflLY or arc sole II 4:1 Electrical repairs or additions
proprietors with no einployees_
1 2.[D Plumbing repairs or additions
50 I am a general contractor and I have hired the sub-contrisciors listed on the attached sheet
I 30 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.;
14.0 Other
6.0 We arc a corporation and its officers haveh exercised their right tat exemption per hIGL c.
15.2,§1(41.and we hale no employees.[Nu workers'rump.insurance requireill
•Any applicani that checks box el must also fill out the section below shins ing then-workers'compensation Folic:" information_
' liorneirivrsers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affulas it indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contravtod and state whether IA not those'murk-,liase
ciriplu3 cc. II:Ix'sub-contractors has,:employees,they must providc their workers'camp.policy number
l um an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie. #. mu...2...c°2t001-{ci-7 2O 2...k A Expiration Date: 01 10 11 2.2..
Job Site Address: 9 o WOocl[avid Dr. citystatezip: 1,--(-0 yente I MO- OIOt 2_
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requires!under MGL c. 152, 25A is a criminal violation punishable by a tine up to S1,500.0°
arukor 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
,..:0%.cra,. c verification.
1 el to hereby certify , , •r the pains and penalties ofperjury(ha th nformation provided above is true and correct.
#
AI ,
Signature: 111.7147:q" Date: 6/212.-1
Phone#: 11/1-- $10'...3--82I 40
IOfficial use only. Do not write in this area.to be completed by city or town officiaL
( it y or l'own: Permit/license #
Issuing Authorit (circle one):
I. Board of Health 2. Building Department 3.("it!,(row n Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
AFFIDAVIT FOR DISPOSAL OF DEMOLITION DEBRIS
Supplement to Permit Application
As a result of the provisions of 1VIGL c. 40, s54, I acknowledge that as a condition of the
issuance of a Building Permit, all debris resulting from the construction activity governed
by this Building Permit shall be disposed of in a properly licensed solid waste disposal
facility, as defined by MGL c. 111, s 150A.
I certify that debris resulting from this demolition will be disposed of as listed below:
Job Site Location: ' O k1 ood(avl(' br, t '$(( ctt, M ft 6I (o 2
Name of Permit Applicant: Renaissance Builders
Disposal Facility: F & G Recycling
Address of Facility: 15 Mullen Rd., Enfield, Ct 06082
IF SAID FACILITY IS OTHER THAN WHAT I HAVE LISTED, I CERTIFY THAT
I WILL NOTIFY THE BUILDING OFFICIAL OF THE CORRECT LOCATION OF
THE SOLID WAS l'h DISPOSAL FACILITY WITHIN TWO MONTHS OF THE
DA lb OF THIS APPLICATION.
Signature of Applicant ate
RENAISSANCE
tBUILDERS
PO BOX 272, TURNERS FALLS, MA 01376,413.863.8316
INFO@RENBUILD.NET, WWW.RENBUILD.NET
August 2, 2021
Jonathan Flagg
City of Northampton
212 Main Street
Northampton, MA 01060
Jonathan,
Enclosed is a permit application to replace an exterior door and frame at 90
Woodland Drive, Florence. Stephen is the project manager. His cell phone number
is 772-9430 if you have questions or concerns.
Also included is:
❑ A Scope of the Work
❑ An Owner Authorization Signature Page
❑ A Worker's Compensation Insurance Affidavit
❑ Demolition Affidavit
❑ A check for $ 40.00
Please call Stephen if you have any questions.
Thank you,
Natasha O anyk
Administrative Assistant
natasha(a�renbuild.net