39A-063 (6) BP-2021-2177
69 LYMAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
39A-063-001 CITY OF NORTHAMPTON
Permit: Addition
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2177 PERMISSION IS HEREBY GRANTED TO:
Project# SCREENED ROOM Contractor: License:
Est. Cost: 15000 THAYER STREET ASSOCIATED INC 045159
Const.Class: Exp.Date:09/03/2022
Use Group: Owner: LEVITT SAMUEL W & ELLEN L GOLDSMITH
Lot Size (sq.ft.)
Zoning: URB Applicant: THAYER STREET ASSOCIATED INC
Applicant Address Phone: Insurance:
8 Coates Ave (413)665-4018() WM28007499
DEERFIELD, MA
ISSUED ON:11/19/2021
TO PERFORM THE FOLLOWING WORK:
SCREEED ROOM
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:
itsi^, • ,2 . TAIT
Fees Paid: $97.50
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
z-OK
I RECEIVED
_a,,�, The Commonwealth of Massacht,setts
, i Board of Building Regulations and Standa-ds
NOV 1 0 2021 NLJNI�OIPRALITY
' .[ ; Massachusetts State Building Code, 780 CMR SE
4,;.::,.
Building Permit Application To Construct,Repair,Kenovsttc Or Dornolisr sPt=cTioNs ise Mar 2011
One-or Two-Family Dwelling NPTORTF HAMPTON.MA 010B0
This Section For Official Use Only
Building Pe it Number: �� 1 I 7 7 Date Applied:
E�,,� �� / Il- l9ZQ2(
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
C.09 V {ma(' SViceer
1.1 a 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)
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:
Zone: Outside Flood Zone?
Public EV' Private❑ Check if yes❑ Municipal I941 site disposal system CI
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Recotjl:
Name(Print) City,State,ZIP
Uq \_ c a s %� I-113-Sao• tgli S0.cY'@ 0 14 Marl . Cow
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) 0 Addition 0
Demolition 0 Accessory Bldg.a Number of Units Other 0 Specify:
!I Brief Description of Proposed Work': SCr.eer\ raolyTh
/SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ CIStandard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S_
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ Total All Fees
Suppression) ��qr�
Check No37° Check Amotusi� J, Cash Amount:
6.Total Project Cost: $ 15;coLD 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor,License(CSL) ego'51 SQ V COY r10C �Q,t r t.fl _ License Number l Expirati n Date
Name of CSL Holder
List CSL Type(see below) L)
coo Street No.and Type Description
i , j;' ,
c F7Lf2JL-t'(� \3,3 a Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,/Town, State,ZIP Restricted 1&2 Family Dwelling
y M Masonry
_
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-1,01#S-yore Verb i'hayerSN,feetc octa, s.Ca.,_ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ' 035 a Ala a '4-
VC'Y1 `\a<txc\�' HIC Registration Number Expirati n Date
HI C Comp y Name or HI egistrant Name
tS C0 S WA- Vev it f AANCu.te(Sh ee cuWz. vat .Corti
Email address
tiek.A VAA C ICSi 3 413-LADS-1-{Olt
City/Town,State,ZIP Telephone J
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 Issuancenc of the building permit.
Signed Affidavit Attached? Yes Pf 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,h- -, authorize
to act on my behalf,in all matters r lative o work a of d by this building permit plication.
' Cei c, -- - 111 Vo1W)a I
Print Owner's Name(Electronic Si 2 ature) 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.
Ver for r c\ 1\10
Print Owner's or Authorized A dot's Name(Electronic Si gnat re) ateD
g g
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
Massachusetts 4. -- �*
y t L
i DEPARTMENT OF BUILDING INSPECTIONS fT
rv` h','
212 Main Street • Municipal Building o �b;'
-"0 Northampton, MA 01060 "rs� `\
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 Facility: G_ OucvS er CDfTh SCGC
The debris will be transported by:
r r� ,
Name of Hauler: \-\\ \\- 0\50-C\ ``\S S Q C
Signature of Applicant: 1) Date: ////chUaJ
The commonwealth of Massachusetts
.- =I=•
Department of Industrial Accidents
...•911v"^". 61 1 Congress Street,Suite 100
w.ca 2 su
Boston,MA 02114-2017
i
wwwmass.gov/dsa
_ ...
1ii miters'4'onipensation Insurance Affidavit:Builders/ContractorsiElectricians/Plumhers.
14)BE FILED WITH THE PERMIETING AUTIIORITI
APplienitt Information Please Print Legibls
Name I Bustness ,.'I
Address: N4 CCOUA
City/State/Zip: ..)kk_ika _A kl\L..9.4t Phone P: ()3 -Cok) - • -(011
Are y um att employer?Cheek the lippropresie trot: Type of project(required):
1.7'itll 3 employer with - employees gull atniOr part-timer.* 7. (3 New construction
,...D 1-int a sole proprietor or partnership and have no employ yes 4(Actin; Burnie in K. c3 Remodeling
any capacity.[Nu workers'comp.mstiranor recant:T.1A
9. 0 Demolition
;.0 I am a hanneowner doing all work myself.[No worksas comp orsoratu..e reeptirerir
i 0 Ej Building addition
4:3 I am a itorneow net and 4 III be:tILI Mg eontraelors to continct all work on niy pmperty. I will
ensure that all contractors either has e workers'conmensation 1,1gslallE11›:el are ark 11 0 Electrical repairs or addition,
proprietors with no employers
i 2_0 Plumbing repairs or addition'
SCI I am a eenerai contractor and I hate hired the subscontractors lerkvi on the anachod sheet
130 Roof repairs
These sub-euntractors base employees and have workers'comp.insurance).
&El We are a corporation and its oftieers have eketctsed dam right of exemption pet WA.c, 14.C4sCithercreen rcrlyN
1.1,2.§114).anti we have no tarmloyees.[No workers'comp.insurance rapt/teal
Ar.applicant that cheeks hat 41 MIA also till out the section below show in their workers'compensation poi lec, i alormatron.
4.kit...meow nets who sunind this affidavit indwating they arc doing all work anti then hire wand&contractors most subirtat a new affidavit indicating such.
1Contractors that cheek this box must attached an•adchtional sheet hlv-warig the nano:of the sath-eontraetors anal state 4 hether or nut those entities Ita ,e.
,At tplovc,-, lithe sub-ektrtar.erors kiss:employ ecs.they most movide their wotkers"comp.ft...the:. IlL446:1
„ -•
I am an employer that is providing workers'compensation insura nce for my employees. Beluts•is the policy arid fob Aire
information.
Insurance Company Name: (--. ,-LCNC\ ___
Policy 4 or Self-ins. 1_ic. 4: kPI'C'N Qi,CIOWC)9 4 ctS - w R Expiration Date: 5Vt\
\
Job Site Address! UQN, \..„1.),MOL4N City/StaterLipf\ork\IY-alnX(X\ "4-AND
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 fine up to S1,500.00
arittor one-year iinprisoinnent,as well as civil penalties in the form ola STOP WORK ORDER and a fine of up to$250.00 a
day against the%iolator.A copy of this statement may be tOrwarded to the OtTice of Investigations of the DIA for insurance
CO%craw verification.
Ida hereby certif under the pai s andwenalties of pe - ty that the infOrmation provided above is true and correct.
Signature: Lank.,./k.. 10Atei."4- A.P.Z Date. \\\ k(A- C-Zi-A
Phone e: IA\-- - (0\DS—t-k0\'5?
Official use only: Do nor write in this area.to be completed by city or town official
City or l'own: Permitticenst 4
Issuing Authority(circle one):
1. Board of Health 2.Building Departuient 3.Cityclown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone 4: _........
, ,
CITY OF NORTHAMPTON
SETBACK PLAN
MAP:3 A LOT:_
LOT SIZE: t + e re eP
REAR LOT DIMENSION:
REAR YARD C� -I "'
4
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1„.3
SIDE YARD .. .. �. ,
SIDE YARD
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FRONT SETBACK
FRONTAGE 7 7, ' 1 S
DRAWING LIST
SHEET# SHEET NAME
AO PERSPECTIVES&TITLE SHEET
Al FIRST FLOOR PLAN&SECTION
A2 EXTERIOR ELEVATIONS
A3 FOUNDATION&FRAMING PLANS
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Title:
T�
r A THAYER STREET ASSOCIATES, INC. GOLDSMITH/LEVITY
69Lyman Rd Scale:
` s Coates Ave. South Deerfield,MA 01370PERSPECTIVES & TITLE SHEETA0
Date: 11/09/21
__ 413-665-4018 Northampton, MA 01060
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T&G ON INTERIOR WALL
•1 \ 4 6 �
CEDAR CLAPBOARD
SIDING EXTERIOR WALL b
X 16'-0" , / FENCE
n FIRST FLOOR PLAN
1
1/4"=ram
Title:
THAYER STREET ASSOCIATES, INC. GOLDSMITH/LEVITT Scale: As indicated Al
ril
8 Coates Ave. South Deerfield,MA013 0 FIRST FLOOR PLAN & SECTION
69 Lyman Rd
413-665-4018 Northampton, MA 01060 Date: 11/09/21
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4 1/4"=1'-0" 3 1/4"=1'-0"
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Elevation Rear Elevation Front
2 1/4"=1'-0" L 1 1/4"=1,0
Title:
TA EXTERIOR ELEVATIONS THAYER STREET ASSOCIATES, INC. GOLDSMITH/LEVITY , Scale: 1/4" ��
8 Coates Ave. South Deerfield,MA 01370
69 Lyman Rd
I 413-665-4018 Northampton, MA 01060 Date. 11/09/21
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2 0
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TYPICAL(2)2X10BEAMS 2X8LADDER *.`• 18'-0" SONATUBEFOOTINGS
TYPICAL FRAMING Z 4'-0" Ao, 7'-10 1/4" II T-10 1/4"•
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FIRST FLOOR PLAN _ FLOOR FRAMING PLAN FOUNDATION PLAN
3 1/4°=1-0 2 1/4"=1'-0" Ll .-1/4"= 1'-0"
Title:
Tk THAYER STREET ASSOCIATES, INC. GOLDSMITH/LEVITY scale: 1/4"=1-0..
8 Coates Ave. South Deerfield,MA01370 FOUNDATION & FRAMING PLANS
69 Lyman Rd
413-665-4018 Northampton, MA 01060 Date: 11/09/21