48-013 (8) BP-2021-2118
�j LOUDVILLE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
48-013-001 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-2021-2118 PERMISSIONIS HEREBY GRANTED TO:
Project# SOLAR CLOSET Contractor: License:
Est.Cost: 800
Const.Class: Exp.Date:
Use Group: Owner: SIANNA LIEB&PATRICK D. MANNING
Lot Size (sq.ft.)
Zoning: RR Applicant: MANNING SIANNA LIEB&PATRICK D.
Applicant Address Phone: Insurance:
73 LOUDVILLE RD
FLORENCE, MA01062
ISSUED ON:10/29/2021
TO PERFORM THE FOLLOWING WORK:
BUILD SOLAR BATTERY CLOSET
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 r • )'l •
I '
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVED
1J, The Commonwealth of Massach etts
•
,, s, Board of Building Regulations and S dards OCT 2 8 2021 FOR
{t; -' Massachusetts State Building Code, 7 0 CMR MUNICIPALITY
US ALITY
Building Permit Application To Construct,Repair, enove.Or fem9eUsUsaEc-ic isec Mar 2011
One-or Two-Family Dwellin NORTHAMPTON.MA 01060
This S n For Official Use Only
Building ermit Number: j)i'1 1 " A I fO Date_A plied:
J� /J
EV N..� � K055 , ie Zq"204
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
7-1 "4. 4,04,4Vly6D /Lp a 4 g ei3
1.1 a Is this an accepted street?yes / no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
s C. /us,oc-�'iAc, g$ S I L1 19 7
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
hg 85/50 6z
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 I/ Municipal 0 On site disposal system IV
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
/'/,r210( /NA nV N1 riG t SlAYsii-)4 L I C-& f L v✓iGrs/ , /►lA 010 62.
Name(Print) City,State,ZIP
-7.1. . y o vn v,t.r,5. !26. go 8 -3 i`1-08 d6 !'Cbr-'1(4,/►1,4r/-+i,.r(, e 6mAI L .a 9n'
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction 0 Existing Building LIlT Owner-Occupied 0 Repairs(s) 0 Alteration(s) I Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: /3✓l 1.0'"6 So ttAA /3/41-T.GY G.to S&( 1,-, vr<f riv13'4&D
6JS6,M&'Y A/-4° FA/.ST./i2,{rva'7')s..-1 67" ,r,/t,td Srno)46 0 1acruil I,.1 SR►0 6W36►
To �..,,eu -,✓1?1 l 6vI A✓iJW Fv/1- L- SS 1,✓ST'11 LA-4r614t [v/3 Gr..9-164 c, 6h/14.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ S OO. 00 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 3 0 0 , op ❑ 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 $
Suppression) Total All �gs;
Check N . I(/' 11 Check Amount:b,
6.Total Project Cost: $ goo , '" 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 Issuannce of the building permit.
Signed Affidavit Attached? Yes 6 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER1 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.
/34r✓i&i< /I.�.i ✓J,46 I 0 ,Z6 1-0_6 z)
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"
The Commonwealth of.tlassachusetts
mici
l Department of Industrial Accidents
All I Congress Street,Suite IN
,-1,. Boston,MA 02114-2017
•
" www.mass.gnv/dia
11 oticers'('ompensation Insurance Affidav it:Builder ontrnctursnl:kc,rici ins Plumbers.
'10 BE FILED WITH 111k: 1'I.R11l71ING AI l 1lORil1.
Applicant Information Please Print Legibly
�),.�,4 I'`f
Name(Itat.tnness Argantratura lndivibrsl): /°/4��!L(C Address: —7 T "/, G ovdvl 14-L 2.
Ctty'State/Zip: ft /W" , ,,W 610 dZ Phone#: S a 8 --3'`"( -- o v°6
Are!MU an entplirt.W t beck the appinpriatr hex:
-1_y pe of project(required):
1.Q 1 am a crankier%ail arttplo_ioc>t full and or part-tinier• 7. a New construction
i L..J 1 an a wk proprtet.a or partncr.hip and hate no emplon ei-+worltnt for not in S. -2/R4:modeling
taprerty.IYSu+torkers ...Amp.tm it urance requed.)
9. ❑Demolition
3 1 am a hammy.nt.'s doing.all+toil msvll.1 YSo+torlce+.emir. uewrance n-yuind.I"
10 a Building addition
4.01 an a hunicow.nc-,and w ill be lining Contractors to conduct all wank on nit pn,pert}. I V.ill
tteura that all coruractur.caha hale wurla-r> corrtpcaxitnn iruuranc-e ea arc hole I l.a Electrical repairs or additions
pruprxtoo with no cinplosa..
12.0 Plumbing repairs or additions
50 I am a 1lrxaal contractor and 1 Irate hind the wb-contractor+lasted on the attached%heel. t�o Roof repairs1 heat wits-contractor+hate einplutiac- and hate w otter..cawnp.tniutan.:e.
6.0 ve c are a corporation and itt officers hat a excrci.cd thcu nc n ht of exemption pet Nitc.
14.171 Other
152.. 1141.and we louse no anplutee..INK"war►er.'comp.in.irance required.I
":.sin applicant that charl>hot al mutt akar Iill Out the+detain below.how ma that+tinker."compenaatiun podia uitorrnattori.
* lloirsoouiar++thu submit tIu>attt[hltit tndicatang th►s are d.nnr all work.and then hue.nit>ide ttintraetar+inn subnut a new.atfldas it Indicaunt:such.
t ontractor+that check thta boys mu>t attatad an additional.heft.htwinrr the name of the>ub-contactor.and.late*lather oa not stye chaotic.!Lase
eirnplotees. It the sub-contr actor+lease employ ocs.the% mod proside their +ta,rlan'warp.poke.,number.
I am an employer that is providing workers'compensation insurance for my employees Below is the polity and job site
information.
Insur.nrnc Company Nark:
Policy#or Self-ins.Lic. z: Expiration Date:
Job Site Address: City State Zip:
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 S1.500.00
and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S2S0.00 a
day against the violator_A copy of this statement msy be forwarded to the Office of investigations of the DIA for insurance
co.erage'enlikatiom.
I do hereby certify under the ins and penalties of perjure that the information provided above'kIlmtad lct.
i
Signature: Date: 0/-•2,°�ZO L)
Phone#: sad —3 l ti -- 0 5 0 6
Official use auil-. Do not write in this area,to he completed by ciit•or town official
( its or I os.n: Permit/License b
Issuing.luthorits (circle one):
I. Board of health 2.Building Department 3.( ityiiown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.OtherContact Person:Person: Phone":
City of Northampton
Oft HAM,rO. r.-
," '{<. 515...r...S�Q
I Massachusetts �t ,.
tt
f_.. 1 f DEPARTMENT OF BUILDING INSPECTIONS y
, r ` 4 212 Main Street • Municipal Building v� �
y.�.ar Northampton, MA 01060 s'J arD�s
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: / G.3f 4 77444vy°
The debris will be transported by:
Name of Hauler: "-JA "Atr'i1 t'`61"1r
Signature of Applicant: d'� Date: 4'24112'1
City of Northampton
`�,,,,:n�r,�rl. s s',.
Massachusetts ���,A _ /�'c�G
i. , y
DEPARTMENT OF BUILDING INSPECTIONS 'S
;', 212 Main Street • Municipal Building yeti Cam
Northampton, MA 01060 rs'{.W ION.%
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1 Z, 1961
I, �A ) c IC �� �'V J (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 2-* day of d c i°' ' , 20 L
1.
oe"...;1—,A----'
(Signature) //
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Walls and ceiling covered I. I 1. A
in 5/8" drywall. Floor, bare 8
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polished concrete. Y' -
Door will open out and be I • 106"
a solid core 6 panel wood 54"
door
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