24C-124 (2) 118 FRANKLIN ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1950
Map:Block:Lot:24C-124-
001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1950 PERMISSIONIS HEREBY GRANTED TO:
Project# ADD LAUNDRY Contractor: License:
VILLAGE CARPENTRY AND
Est. Cost: LANDSCAPING 109919
Const.Class: Exp.Date:04/03/2022
Use Group: Owner: HENSON, DEBORAH M.
Lot Size (sq.ft.)
Zoning: URB Applicant: VILLAGE CARPENTRY AND LANDSCAPING
Applicant Address Phone: Insurance:
45 PLEASANT ST SHWC199270
SOUTHAMPTON, MA 01073
ISSUED ON:09/28/2021
TO PERFORM THE FOLLO WING WORK:
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:
I ,
V . CAIRFees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
CE-1 Ifs:— #'
Sep 2 7 T Co onwealth of Massachusetts
20oar of B ilding Regulations and Standards FOR
sp Mass chu tts State Building Code, 780 CMR MUNICIPALITY
NooF-0 s •
USE
i. ,t, lica ion To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
•MA 01060 S ne- or Two-Family Dwelling
This Section For Official Use Only
Building P rmit Number: &0"�I'/g,)V Date
'Applied:
L V IJ Z5 l�1 q- 2 ZOzi
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
118 Franklin St 24C 124
1.1 a Is this an accepted street?yes no -
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
URB 14000 66
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
NA NA NA
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:
Deborah Henson Northampton Ma 01060
Name(Print) City,State,ZIP
118 Franklin St 504-232-8884 deb@deborahmhenson.com
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) Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: Moving closet walls to install laundry plumbing
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:
2.Electrical $ 1000 ❑ Standard City/Town Application Fee
❑Total Project Cost3 (Item 6)x multiplier x
3.Plumbing $5200 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All F et:A
Check No0 AV Check Amount/4 Cash Amount:
6. Total Project Cost: $6200 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-1009919 04/03/2022
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.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-824-0204 wynterweather@gmail.com 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 villadecarpentrvmaadmail.com
No.and Street Email address
Southampton Ma 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 Issuannce of the building permit.
Signed Affidavit Attached? Yes fl 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.
Deborah Henson 9/22/21
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.
���# � 9/22/21
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. 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"
City of Northampton
HAmpr�
Massachusetts w
DEPARTMENT OF BUILDING INSPECTIONS ttiet
,°
212 Main Street • Municipal Building 0% rb
Northampton, MA 01060 .'' - �~4
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: 9/22/21
, ,fi >, r'
The Commonwealth of Massachusetts
: Department of Industrial Accidents
I ('ongr M e ssSAtroe 2et 1.,IS:2ito7 e 100
Boston,
‘,...:....., 7,
www.mass.gov/dia
%Yorkers'('utiipensatkin Insurance Affidavit:Builders/Cenrattora/EJectriciansfPlunshers.
TO RE FILED WITH I HE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(ausiness,Organizationfladtvidual): Village Carpentry and Landscaping „ . .. . .. .
Address: 45 Pleasant St
City/State/Zip: Southampton Ma 01073 Phone #:
Art you tea employee Cheek the appropriate bac Type of project(required):
JO I am a employer with 7 employees(fall asitkor pan-time).* 7. CI New construction
21:71 I sin a sole pcopriaganer or partnership and have no employees working kin me in 8. 53 Remodeling
any capacity.[Nu workers'comp.ileAl Mite required"
9_ 0 Demolition
I am a homerianer thing all work myself.[No workers'comp,insurance moaned]°
ID D Building addition
4.0 I am a hoineounei and will he hiring coittractars to conduct all work on my property. I will
ensure that an contractors either have workers'compensation insuranu or are sole 1 1.0 Electrical repairs or additions
proprietors with no employees..
12_ Plumbing repairs or additions
501am a pmeral contractor and I have hired the suls-oanuticsars hated on the attached abut.
These sob,ek.intractors have employees and have wafters comp.insurance.; 13 Roof repairs
Other
6.E:I We are a comoranun and its officers have eitercised then sight of exemption per MOL e. 14.0
132,i1(4),and we have no employeea.[No%teeters'comp.insurance required.1
*Any applicant that chucks bin 41 must also fill out the section below showing their%A-kaki-is'Cl3nremation poi icy information.
t Homeowners who submit this affidavit Mikan*they are doing all work and then hue outside omiractors ioust submit a new affidaN it ilidicatietir such.
;Contractors that cite,.I.this box mum attached an additional sheet skunk mg the name of the stils-i:ontracturs and staze aliether or not thus.:sfintics h.:ie
itripliiyek.-, f r the M..11,-0..11ifaCkit%has.:eanpk:.ees.tlicy al pros ide their worker,':oily ?min:).noniEvr
, , „ , —4•1!!
I am an employer that is providing ororAers°compensation insurance for my employees. Below is the polity and job site
information.
Insurance Company Name: NorGuard
Policy#or Self-ins.Lie.#: shwc199270 Expiration Date: 9)6/202a,
Job Site Address: 118 Franklin St City/State/Zip: Northampton 01060
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration 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
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 Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains am(fri'nnines of perjury thin the infrrmaiiim provided above is true and correct.
Signature: /,ci/,_ , -W.
Date:
Phone#:
. .. .
Official use only. Do not write in this area, to he completed by city or town°Ale
City or Town: Permitilicense#
Issuing Author it (circle one):
1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
Massachusetts .:,
, DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 �•.. yi4ti
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
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 , 20 .
(Signature)