29-397 (3) 98 SANDY HILL RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1746
Map:Block:Lot:29-397-001
Permit: Addition CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1746 PERMISSIONIS HEREBY GRANTED TO:
Project# Contractor: License:
Est.Cost: $5000
Const.Class: Exp.Date:
Use Group: Owner: LORI NEWMAN LORI A NEWMAN
Lot Size(sq.ft.)
Zoning: WSP Applicant: LORI NEWMAN LORI A NEWMAN
Applicant Address Phone: Insurance:
98 SANDY HILL RD
FLORENCE, MA 01062
ISSUED ON:08/19/2021
TO PERFORM THE FOLLOWING WORK:
12X12 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.
Signature:
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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!- fir, 1.,._-;,, The Commonwealth of Massachusetts 1
1 ' ae° - Board of Building Regulations and Standards FOR
MUNICIPALITY
$1: >_ Massachusetts State Building Code, 780 CMR USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Fancily Dwelling
This Section For Official Use Only
Building Permit Number. Date Applied:
_ VliklitAk d 4 , .7 \ q.4
-
AZg4/11
' Building Official(Pnnt Name) Signature Ii
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map do Parcel Numbers
Q c,_-(\ -.- j ;\\ �& TAOAOLL.- 2, 34
J
I.la Is this an accepted street?yes t/ no ; Map Number Parcel Number
13 Zoning Information: - ' 1.4 Property Dimensions:
Zoning District Proposed Use Lot Arca(sq R) Frontage(9)
1.5 Building Setbacks(ft)
— T
Frost Yard _ Side Yards Rear Yard
_ Required Provided Required Provided ! Required Provided
1.6 Water Supply:(M.G.L c.40.454) 1.7 Flood Zone Information: 1 1.8 Sewage Disposal System:
Zone. Outside Flood Zone" '
Public UY/ Private O Check if yes❑ Municipal�On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' f Record:
CA-� \ k)e.1.0 t`na-`(1 \0 j k..r"` & +\ 0 \b(9 -)-
Name(Punt) City.Stale.ZIP
Ck`6 5OscN ,.\ \.\\\ ---- 1,kc))Uks U\6a) \)'&ybA1�1Q 00 ( c�\.t\ ft
No and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction Existing Building 0 Owner-Occupied 0 1 Repairs(s) 0 Alteration(s) 0 I Addition 0
t
Demolition I] Accessory Bldg. 0 Number of Units 1 Other 0 Specify:
Brief Description of Proposed Wott2: Dtc.\t vyctS Q.m Ng. fe .f J;k V U,l.)1 a,
_VIIIIIIILAu c..1 . 0e)14 Q -e i isk- 5 o f co-A 5 W A.e c�Q rbiA .
1
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1. Building S I. Building Permit Fee: S _ Indicate how fee is determined:
2. Electrical S 0 Standard City Town Application Fee
- 0 Total Project Cost' (Item 6)x multiplier ____x
3. Plumbing S 2. Other Fees: S
4. Mechanical (UV AC) S List.
5. Mechanical (Fire S- it
Suppression) Total All Fees:,S [f (f
Check No.i})3Check Amount: V _
•, 6.Total Project Cost: S -- QZ:) J 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.)
City/Town, State,ZIP R Restricted l&2 Family Dwelling
M , Masonry
RC Rooingcovering
— WS Window_Ind Siding
SF Solid Fuel Burning Appliances
l 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 INSURANCIAFFIDAVIT(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 AUTHORIZjJONTO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,'li eer by authorize
to act on my behalf, in ll-fitters relative to work authorized by this building permit application.
Print-Kner'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 undersi biding.
�1
Orizlu/ a nedurnuut 8/5/21
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.a. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the d'onstruction Supervisor License can be found at www.mass.<e.ov/dps
2. When substantial work is planned, provide the information below: b;
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 substitute tl. r"Total Project Cost"
FLird u tru
rHut rvv I .
231 Main Street
Easthampton, VIA 01027 2024 Old Fashioned Local Service
413-527-2693 • www.fleurylumber.com "So 9. ae Peaszel. tiai &ace 19427"
GO GREEN!
LUMBEREMAIL STATEMENTS AND INVOICES
CUSTOMER NO: JOB NO. PURCHASE ORDER: REFERENCE. CREATED BY: DATE/TIME:
'5 000 LORI NEWMAN DECK QUOTE LORI NEWMAN DECK QUOTE MK 7/24/21 10:53
1 CUSTOMER: DELIVERY ADDRESS: TERMINAL 552
1 "" CASH .,., 98 SANDY HILL RD SALESPERSON
FLORANCE TAx 001 MA Sales Tax
EXPIRATION DATE 7/29/21
01027
413-695-6153 ESTIMATE 9559/5
LN# QUANTITY UM SKU DESCRIPTION LOCATION UNITS PRICE /PER EXTENSION
1 1 EA PW425 PW SUP STK 4"X25' WDW&DR RL FLSH G1L1 1 9 79 /EA 9 79
2 11 EA 21012PT 2x10x12' PT #1 SYP S4S MICRO GC PT 11 52 69 /EA 579.59
3 5 EA 4410PT 4x4x10' PT #1 SYP S4S MICRO GC PT 5 22 99 /EA 114 95
4 2 EA 1816PT 1x8x16' D SYP S4S MICRO WAX AG PT 2 27.69 /EA 55 38
5 25 EA 54612SASS 12' SELECT SADDLE SQUARE TREX 25 36 99 /EA 924 75
6 3 EA 6371971 CORTEX TREX SADDLE PLUGS 100LF SCREW 3 94 89 /EA 284.67
7 1 EA Z622324 5LB 3-1/2" DECKFAST EPDXY SCREW PGS 1 39 79 /EA 39 79
8 SCREWS PGS
9 0 5 EA 541020KL 5/4x10x20' PVC TRIM KLEER .50 113 59 /EA 56 80
10 6 EA 73018553 6'x36" ORIG LEVEL KIT BLK RND WH RDI 6 198 99 /EA 1,193.94
11 2 EA 73019110 6x36" ORIG STAIR KIT BLK RND WH RDI 2 212 00 /EA 424 00
12 1 EA DEL DELIVERY EXPENSE 1 10 00 /EA 10 00 N
TAXABLE 3683,66
NON-TAXABLE 10.00
SUB-TOTAL 3693.66
TAX AMOUNT 230.23
TOTAL AMOUNT 3923.89
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ACCEPTED BY
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City of Northampton
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Massachusetts �,r �4
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f?( 4 DEPARTMENT OF BUILDING INSPECTIONS �I
y. `+.Josf7 212 Main Street 0 Municipal Building Jam• C��
"�' Northampton, MA 01060 j-113‘.kO
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT qs--11,0
(insert frill legal name), boar (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.I, 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. 1 qualifij 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. 1 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 ab day o
ors- , a Thirrat
(Signature)
City of Northampton __
4,-."1. ' ``�, Massachusetts 4is;• , !c,,
,if VA Nr
a.44: i�`,.qf 0. �at �. 212 Main Street • Municipal Building 1`l DEPARTMENT OF BUILDING INSPECTIONS �� ;,
4
Al -, C'
Northampton, MA 01060 '` �1.4
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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 FacilitGy: R. ` Or 4//e / ge(yel_e_
VibUmpbJ
The debris will be transported by:
Name of Hauler: Mom 60--- 1(
Signature of Applicant: CrDlr(. a IlIUATrrL.aJL Date: 8/5/21