23D-081 (10) BP-2022-0112
73 WARNER ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-081-001 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-2022-0112 PERMISSION'S.HEREBY GRANTED TO:
Project# DECK Contractor: License:
Est.Cost: 6000 GLENN GRILLEY 79910
Const.Class: Exp.Date:07/07/2023
Use Group: Owner: KERSTEN ELAINE RENATE
Lot Size (sq.ft.)
Zoning: URB Applicant: GLENN GRILLEY
Applicant Address Phone: Insurance:
40 KATHY TERR (413)374-4942
FEEDING HILLS,MA 01030
ISSUED ON:02/08/2022
TO PERFORM THE FOLLO WING WORK:
8X24 DECK
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: ,voiltx., . (AV
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildine Commissioner
Z—oR
File #BP-2022-0112
APPLICANT/CONTACT PERSON:GLENN GRILLEY
40 KATHY TERR FEEDING HILLS,MA 01030(413)374-4942
PROPERTY LOCATION 73 WARNER ST
MAP:LOT 23D-081-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Penn it Filled out
Fee Paid $65.00
Type of Construction: 8X24 DECK
(.51
New Construction
Non Structural Renovations 0
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN) ORMATION PRESENTED:
V Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:*
Intermediate Project: Site Plan AND/OR SpecialPennit With Site Plan
Major Project: Site Plan AND/OR SpecialPemiit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
OtherPermits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Tkk..) 'S P/37a'C)
Si ture of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
T
m
m
i� The Commonwealth of Massachusetts
Board of BuildingRegulations and Standards FOR
�: j• 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: v. a.A.if 2_, Date Applied:
4 i lv\itti\k, 2,
Building Official(Print Name) 1 Signature c
___c_v_p__?
SECTION 1:SITE INFORMATION
1.1 Pro e ty Address: ' Assessors Map&Parcel Numbers
�f'i 1.2
,, v --Fl e ua3D 081
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:
Public 0 Private CIZone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Recor,d;
i(aic)e- k 1(51-eln _ .v/grey,4e , fa14 O 106 2_Name(Print) City,State,ZIP ,'Qea C
• 13 ,\- ✓-61( Sdh-ee ir 41-► 3 Cq,5 A-1)o Z vr.o,-toy).v-)-e K
No.and Street Telephone Email Address
SECTIONCT 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 1 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:
Brief Description of Proposed Work2: ,
ertaiti:vj a aRc-14 --o-Ff- L• ut4A-5, Kr)0 a-ri - inti44 /et/4 - a' xvi t
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ I. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ 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 $ Total Ail F es:
Suppression) Check No. 0�Check Amount: LI7 Cash Amount:
6.Total Project Cost: $ (JW 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction C Supervisorer /License(CSL) 0791,0 j LLnOi Cr ley y License Number Expiration P- 7-Zrarion Date
Name of CSL Holder 77 �
110 d a y T List CSL Type(see below) (�
No.and Street Type Description
Falk tt 6�J WA
t/13v U Unrestricted(Buildings up to 35,000 Cu.ft.)
Ell l ��Irt N R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
(J 2 r' SF Solid Fuel Burning Appliances
/f7.J 7Y" qjT Z Grief*//3PO Din I Insulation
Telephone ail a dress D Demolition
5.2 Registered Home Improvement Contractor(HIC) 'Pk* Z15:-u
HIC Registration Number Expiration Date
HIC Com y e or Regis ant Name /
�d r �Gr I, 7 Cri r'(d0�1OnViiat eewr
No.Np /I�t f4litf 04
f1030 T f7-;7y—V$ z. E�►�i►address
City/////����"`own,State,ZIT 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 .ill
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 ri. I
to act on IfTin all matters relative to work authorized is building pe t applicati .
-"Reveit 4"tr 47e e) 1 --3c) -
Print Ownme(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 a to to the best of my knowledge and understanding.
21-ZZ
Print Owner's or Authorized Agent's Name ec onic Ignature 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
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Buildingy<,
„+k Northampton, MA 01060 .• tiK4,
,
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:
1l, - A �tKd In , sf S ;1 1
Location of Facility: V\ ( UV>/ 6/
The debris will be transported by:
Name of Hauler: le►1�1 C5r1O/tf fick-q +rtk
Signature of Applicant: Date: /--ZJ"ZZ
Ilte Commonwealth of Massachusetts
Department°pilau strial Accident
1 Congress-Street,Suite 100
Boston,Ati 02114-201-
www.mass.govidia
IA-utters'Compensation Insurance Affidatiti Builders/Contractors/Electtricians Plumbers,
TO BE TILED IITTH THE PERLUTTENSAUTHMITY.
Applicant Information Please Prifit Leib
same(Blzmess,Orguazaucabchviduarf: 6111 el (n1tty
Addres..s: ifoLOfh1 -FRT,
CitY/StatedZiPI M4 0030 Phone q(j-i 7 ti e
Ara!es as ammlayar"C kink tar oppropnitta bah: Type of project(required):
DI aut a wrip:oyar torrh ter-pitrilatitIarat pa.aala'.* 7.321New cointruction
2741 porta= parthorwoh al-sk, 012pkepni,workish forma is Rarcioaanz
apanty pit workart'coo= 1.11111raC4 tortotraril
1.0 9, Demolition 1 art a Woracorhar that all work=rad p.40 worittri"coo= ihiturama nottuad.1"
10 El Bnikiffig acklition
4.E3 nu aciaioana ana anti bi ham;oat:ninon to naiads=ah=oak as hay porton` I will
whom that all omaractora matzo Istac workers cotopanahas towahowt or 14161 11 Electrical repairs or additions
Timpuewriain thaployiata
12.0 Piranbing repairs or addition,
!.0 ittaitaai Ca:SITU-Mr hart 11.,.oad tha tok-carraorm Latad tisk attanitui 1.144:
13.DRoof repairs
naps tok-comoracton kayo tampiosioat anti haris orocion.comp.=slum:Ica t
14.00ther
15E3 Wa art t chipt.oacho anal in a-attract Imo,*monad=tit rigitdo s pro 101GL c
152,11(4k,ash ort haat ma scoplogaat [Ns 71Catiri'comp =am.istratrat.:
Any applicant that cloth hota t mart also fill out tha tortxon Wow showing hair workars'compausaticet poky ademenon
floasaawmars who tutnaut eat affulays sthicatat thay an doing ail work zad than him amnia raturachnt town rake=a saw Lffieurat iajCZakit MCI
ICCAtirKtOr.6.11 clap&/kis bat mast lttleetokli an thit*33/40#1624,lit4 IX=Of ta thb-costracrats tad vow whattar :to.:=ow ahriat ittw
acaploysai If tha tot-oositnctors It asapiayaat 6try resist protlaa=air wo=tri'c000p pcItcy=raw
lam an employer that is proei dins weaken caltipenstnion insurance for my entplowes. Below is the policy and Job site
infinmation
'mural:an Company Name:
Balky tt or Self-in- Lac EVITZTUNt Date
Job Site Adthe : CitylState2m.
Attach a copy of the workers*compensation policy-declaration page(showing the policy number and expiration date),
Failure to secure coveriee reclined under MCA_c. 152,§25A is a cuninal siolation punishable by a fine up to$1.500.00
amPor one-yeat firainmeminn, well as cnal pmine:in the form oh STOP WORK ORDER rat fine of up to S250,00 a
day a,,...7it the-4oLitor A copy of 13,2- .7,-thrr4 iWr be fora-Kited to the Office of =nom of the DL4 for insurance
coverage verification
I do hereby cern&under the pains and penalties ofpeun ty diet the informationituovided above is true and correct
Date- /-2 3-oz
Phone* l3— 7q-, qpyz.
Official use only. Do not write in this area.to be completed I city or town official
City or Town: Permit.License 4.
Lcuing Authority(circle one)
1,Board of Health Building Department 3,Cityrfasvu Clerk 4.Elettlical lirpector 14.,Plumbing Inspector
6 Other
C ontact Person: , Phone tu.:
City of Northampton
„. 9, ,
,�yd „.„ „<. .PI
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,,
Massachusetts _ r.;e,
A
DEPARTMENT OF BUILDING INSPECTIONS „{
212 Main Street • Municipal Building s
Northampton, MA 01060 1:1,3y .1-)04''
HOMEOWNERS'EXEMPTION�, ELIGIBILITY AFFIDAVIT j
I, F(a(1)C n�'-- V' � (insert full legal name), born �I 5 IIi'7 (insert
month, day, ear herebyd ose and state the ollowin :
y ), ep g
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 h Le:ally ZZ
(Sig re)"
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
C o nstrutOW4AtS'pery i so r
CS-079910 &pires:07/07/2023
GLENN E GRILLEY f,
40 KATHY TER
FEEDING HILLS MA 0103
Commissioner fi. Man1_.sa..,
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE: Individual
Registration Expiration
134876 02/15/2022
GLENN GRILLEY } t
GLENN E.GRILLEY
f' )
Construction Supervisor
Unrestricted -Buildings of any use group which contain
less than 35,000 cubic feet(991 cubic meters)of enclosed
space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call(617)727-3200 or visit www.mass.gov/dpI
Registration valid for individual use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
1000 Wa::hington Street -Suite 710
Boston,MA 02118
Not valid without
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