35-280 (4) BP-2021-2196
106 WOODLAND DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-280-001 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-2021-2196 PERMISSIONIS HEREBY GRANTED TO:
Project# JS-2013-000039 Contractor: License:
Est. Cost: 7000
Const.Class: Exp.Date:
Use Group: Owner: ANDERSON DAVID
Lot Size (sq.ft.)
Zoning: WSP Applicant: ANDERSON DAVID
Applicant Address Phone: Insurance:
106 WOODLAND DR (413)493-4787()
FLORENCE, MA 01062
ISSUED ON:11/19/2021
TO PERFORM THE FOLLOWING WORK:
FINISH BASEMENT
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
. 4
The Commonwealth of Massachusetts
W
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:i6P• i• a./q& Date Ap lied:
I, '1 (
i ; I'i , I ►:tii II 4
Building Official(Print Name) i Signature I• to
SECTION 1:SITE INFORMATION
��` �� �' 1.2 Assessors3 Map&Parcel 3�be2 80 —6 O t
D g
1.la Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: /7 r
31,43
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 r Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Dispos _System:
Zone: _ Outside Flood Zone?
Public El/ Private❑ Municipal❑ On site4disposal system Q'
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.104v`r ofR vf44/4Q€ -s - Ft-og-Z 6./. /`Y 0(062.— 9°6 (7
Name(Print) City,State,ZIP
/06 ti,oves LA An Qh 11o8-Lae 6S-69 Alv"D.A..soc'R /$56- 4itcro.03rY
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
B ' F/N if'/-f 4.4-,re-,1&-"37
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) ,
1. Building'ice $ ,S/S-ero 1. Building Permit Fee: $ Indicate how fee is determined:
2 lectrical $ 1 �p� 0 Standard City/Town Application Fee
> / ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fee : $
Check No.. 7 Check Amount:—X
6.Tailliallillrile7 000 0 Paid in Full 0 Outstanding Balance Due:
44
' ea// 11) A-
`71 i'S rta
RECEIV �'
it of Northampton
fin41/
1
�, Massachusetts •
DEPARTMENT OF BUILDING INSPECTIONS .
r M1y
21; Main Street • Municipal Building ht ��t::
Northampton, MA 01060
OF BUILDING INSPECTIONS
NORTHAMPTON,MA 01060 1
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled out
by owner or authorized agent.,
2.One set of plans and specifications of proposed work(Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate(new /replacement windows).
7. Home owner's License Exemption Form(if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction(Gut/Rehab)requires a HERS Rater Affidavit
10.Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
J
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 1&2 Family Dwelling
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
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: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.
PAve D A-Mc?L�a�-. !( 02 t
Print Ownerirthotind Agent's Name c Signature --
NOT :
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.eov/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 Massachusetts
Department of Industrial Accidents
,t7.7 1 Congress Street,Suite 100
Boston, 31-1 02114-2017
woov.ntass.gov/dia
Workers'Compensation Insurance Affidavit:BuikierstContractursiElectricians/Plumbers.
111 Hk FILED WITH THE PERMIlTIN(a AtT11(TRITI".
Applicant Information Please Print lAviblv
Name (1311SMCS.S,Orpnaation2 Individual); PAV e /1/4 498'441010--
Address: /°L tA-20-a-e)14-I:6
City/State/Zip: 1Z-01E-v7)-'c'r riA 0 (c)G'2- Phone#:
Art!too an einploy et?Cheek tillE appropriate but:
I if project(required):
1.0 I am a entptoytx employees tfull andior part-time).." 7. TI New construction
20 I am a sok proprietor or partnership and haVeltra ettIctkryttei working for me in 8. cj Remodeling
arty capacity_[No workers'comp.insurance requiretil
9. C] Demolition
411Prill.ant a hurnaiwner doing all work myself No workers comp_insurance
1. 0 0 Building addition
41110trrant a homeowner and will t hiring sysuractont lit inanduct all work on my pruçanD I will
enstare that all contractors either hat e workers'compensation tresurance or I iif:3 Electrical repairs or additions
proprietors with no emplayeeL
1.2.0 Plumbing repairs or additions
50 tun a tjersaid contractor and 1 have hintil the ractors Listed on the atiatiled sheet_
These sub-contractors have employers and have workers*comp.insurance) i3{:1 Root repairs
14.0 Other
6.0 Vie are a corporation and tti officers have exercised their right of exereprion per WIL
152.§1(4).,and we have no employees.[No workers'comp.nisurance revtiare41.1
*Any applitt drat checks bon n1 nuts also fill out the section below showing their workers'compensation policy information,
ihniumwriers who submit this affidavit indicating they are doing all work and then lure outside contractors must sohnut a new idled:is it intlicatitt:;
:Contractors than cheek thin box must attached an.Ltita.ttna Sheet JX.nt,ing.the name,..tf the suls-contraciers and. ii Metter Or not Chow.,a11111...,
etriployeta, If the suh-otsittaekars h.1 tplo,,,L.-ea.they mum provide their *stickers' rap. rLcmil
turn an employer that is providing worAers'compensation insurance for my enip/orees. Below is the polies and job.sitt.
information.
Insurance Company Name:
Policy#or Self-ins,Lie.#: Expiration Date:
Job Site Address: City/Stale/Zip:
Attach a copy of the workers'compensation policy declaration page(shosving the policy number arid expiration date).
Failure to secure coverage as required under MCiL c. 152,425A is a criminal violation punishable by fine up to$1,500.00
andor one-year imprisonment,as well as civil penalties in the form i.vf a STOP WORK ORDER and a tine of up to$25(1.00 a
day against the tiolator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
co‘erage verification. .
I do hereby certify under the pains and pen altiri of petiwy that the information provided ohove is true anti correct.
„4—Z ii/117 Z02- I
Phonc '41-0 -
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority (circle oiler
I. Board of Health 2. Building,Department 3.City/Ton Clerk 4.Electrical Inspector 5. Plutilbitn! Inspcciur
6.Other
Contact Person: Phone#
" '
City of Northampton
Massachusetts °r-
f # Y,
441 I' T' DEPARTMENT OF BUILDING INSPECTIONS ft -`
212 Main Street • Municipal Building
' Northampton, MA 01060 sg- 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: VA Lit y , /c L1 234- ���ii-Afrrto-re-^1 •
The debris will be transported by:
Name of Hauler: ,&0t0 /4w0Q
Signature of Applicant: —� Date: I// /202- I
I
City of Northampton
Massachusetts
*
DEPARTMENT OF BUILDING INSPECTIONS
• 212 Main Street • Municipal Building
^. -'J•�.r°� Northampton, MA 01060 S!i�• , --,•
��'
. 'EOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
Avt0 i'��DE,-Se1-1 or/30�/ 9��
1, (insert full legal name), borriL (i sert
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.
�o
Signed under the pains and penalties of perjury on this A' c'E.r y.�day of , 20 21
(Signature)
106 WOODLAND DR BP-2013-0024
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 -280 CITY OF NORTHAMPTON
Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2013-0024
Project# JS-2013-000039
Est.Cost: $30000.00
Fee: $180.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 32931.36 Owner: ANDERSON DAVID
Zoning: Applicant: ANDERSON DAVID
AT: 106 WOODLAND DR.
Applicant Address: Phone: Insurance:
106 WOODLAND DR (413) 493-4787 ()
FLORENCEMA01062 ISSUED ON:7/13/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:FINISH BASEMENT & CONSTRUCT DECK -
ENGINEERING MAY BE REQUIRED
POST THIS CARD SO 1T IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: 11-pt./tS
Footings: Pk-- 7/7-47 r J
Rough. Rough:�'' )" /� House# Foundation:
c Driveway Final:
Final: Final: J ",
Rough Frame: (3. 3.- 17- PJ
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
„Or, r�r�tq
� (Qk
in
Final: Smoke: Fin-al:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAATION OF
ANY OF ITS RULES AND REGULATIONS. 14414:0
hicu• w•41•0
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 7/13/2012 0:00:00 $180.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner