36-129 (5) 287BROOKSIDE CIR COMMONWEALTH OF MASSACHUSETTS BP-2021-1749
Map:Block:Lot:36-129-001
Permit: Alts Renovations CITY OF NORTHAMPTON
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1749 PERMISSION IS HEREBY GRANTED TO:
Project# Contractor: License:
Est. Cost: $6500
Const.Class: Exp.Date:
HUTCHINS,EMME T&KENNETH W
Use Group: Owner: CASAGRANDE
Lot Size (sq.ft.)
HUTCHINS, EMME T&KENNETH W
Zoning: URA Applicant: CASAGRANDE
Applicant Address Phone: Insurance:
287 BROOKSIDE CIR
FLORENCE, MA 01062
ISSUED ON:08/19/2021
TO PERFORM THE FOLLOWING WORK:
CREATE NEW MASTER BEDROOM WITH BATH
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: 3-1
.; • ,
Fees Paid: S65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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_,,, 9 202/ , - Co onwealth of Massachusetts FOR
°• `w p, of oar. of uilding Regulations and Standards MUNICIPALITY
`•: 4" '. Nog? gUCQ�Nr,INsp Ma ..ch efts State Building Code, 780 CMR USE
oN Ecr
Bui 4'lipli tion To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
e-or Two-Family Dwelling
This on For Official Use Only
Building Permit Number: ai o I. Date Ap lied:
1. li
N. ' f ; . .4:
Building Official(Print Name) Signature e
SECTION 1:SITE INFORMATION
1.1 Propeity A 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 gining Informatioi 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% Private 0 Zone: _ Outside Flood Zone?Check if yes❑ Municipal In On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1_Owner'of Record: p
Iienncf� c�Sfn ran ae, ► u f CAPArl0(\ Mk. OI U 6.2
Name(Print) City,State,ZIP
1% 7 Bt,ovKSi` e Circle, 4(3-31u-7)47 KwCs thde 6,YckLIGOAles
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s)J11 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units , Other 0 Specify:
Brief Description of Pr.•• •. W 2:
Cfe�4 ' M !, -Non\ t co.r31n to.t4lr(G/, 4-u ro‘5IC r Led
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ..ov Q 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 51)0 ❑Standard City/Town Application Fee
0 Total Project Costa (Item 6)x multiplier x
3.Plumbing $ A S 00 2. Other Fees: $
4.Mechanical (HVAC) $ ' List:
5. Mechanical (Fire $
Suppression) Total All Fees $
Check No. its Check Amounl Uv Cash Amount:
6.Total Project Cost: $ 'I! r:: 6 Soo 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. it.)
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 /\ii&11 4i5 /144.to act on my behalf,in all matters relative to work authorized by this building permit application.
ke&, etc, (aSa tU4 4/ci/2/
Print Owner's Name(Electronic ) 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 i. Y i 11.11 '
Kam Kau 1i , & c ffrol _ •/ /Z
Print Owner's or Authorized Agent's Name(EKth-nnic 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 I/
Number of fireplaces ' 0 Number of bedrooms
Number of bathrooms 3 Number ofhalf/baths 16
Type of heating system BG;to r Number of decks/porches 'i
Type of cooling system A O RC Enclosed Open �.
3. "Total Project Square Footage"may be substituted for`Total Project Cost"
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City of Northampton
/i••.- A Massachusetts 4„?• i.. Q
'I (� #. x' rEPARSIMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 ; O°aC
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:
Ek./4- kc‘ tilrio, R�
Location of Facility: No rah kMj lon M
The debris will be transported by:
Name of Hauler: f<CAn(1H C61.1A) 1iic42
Signature of Applicant: Date: 8/ (2
City of Northampton
;�•►"� '' Massachusetts 4%
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f ' 1 P• A' DEPARTMENT OF BUILDING INSPECTIONS y
212 Main Street • Municipal Building C►
Northampton, MA 01060 \�`�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT /l y E
KMA 1z L Cgs- / 4,1 __- (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 PI-K) l t ,20�1.
(Signature)