16D-008 (6) BP-2022-031 l
186 NORTH MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
I6D-008-001 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-2022-0311 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 RENO BATH & PORCHES Contractor: License:
HAYDENVILLE WOODWORKING &
Est. Cost: 24910 DESIGN INC 115879
Const.Class: Exp.Date:06/22/2025
Use Group: Owner: PETTI FORD LASHONDA &SARA P ROWAN
Lot Size (sy.ft.)
Zoning: URB Applicant: HAYDENVILLE WOODWORKING & DESIGN INC
Applicant Address Phone: Insurance:,
35 CONZ ST (413)665-7402 WMZ-800-8007423-2021A
NORTHAMPTON, MA 01060
ISSUED ON:04/04/2022
TO PERFORM THE FOLLOWING WORK:
RENOVATE 1ST FLOOR BATH &2 FRONT PORCHES
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: '
av • y9 •
Fees Paid: $162.50
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Department use only
oa „—.; o, City of Northampton Status of Permit:
�.,� of "�: Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
1 Room 100 Water/Well Availability
, ;r. Northampton, MA 01060 Two Sets of Structural Plans
_ � -� phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map /62 D Lot 0 0 2 Unit O 0 j
186 North Main Street Florence Zone (./Z13 Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Shonda Pettiford+Sara Rowan 186 North Main St Florence
Name(Prin Current Mailing Address: 413-575-8867
��,` 24 Telephone
2.2 Authorized Agent:
Haydenville Woodworking&Design,Inc. 35 Conz Street,Northampton,MA 01060
Name(Print) Current Mailing Address:
413-665-7402
\c Signat re ...fel-l------*- Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 17,410 (a) Building Permit Fee
2. Electrical 0 (b)Estimated Total Cost of
Construction from(6) I�
3. Plumbing 7,500 Building Permit Fee 6
4. Mechanical(HVAC) 1/) ,k)('')''
5. Fire Protection
6. Total=(1 +2+3+4+5) 24,910 Check Number
This Section For Official Use Only
Building Permit Number: 13P-2b2 - D31/ Date
Issued:
Signature: /17./P-7 /'4l- ZOZZ
Building Commissioner/Inspector of Buildings Date
Zinnia HaydenvilleWD.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [El Siding[O] Other[0]
Brief Description of Proposed Renovate first floor bath and two front porches
Work:
Alteration of existing bedroom Yes x No Adding new bedroom Yes x No
Attached Narrative Renovating unfinished basement Yes x No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Shonda Pettiford+Sara Rowan
, as Owner of the subject
property
Haydenville Woodworking&Design, Inc.
hereby authorize
to act on my behalf, in all ma -rs relative to work authorized by this building permit application.
L.. A if
31/i1/242Z
. , pat
/4 1I)U" I✓)ilk 1 Infoo'jq;OA6n/6 h1 ' /j1t✓ , as Owner/Authorized
Agent h reby declare at the statements and information on t e foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
2l rsf 4ii 5TMOn.l
Print Name
Signs caner/Agent 3 Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: Christopher Burhardt
License Number
35 Conz Street, Northampton, MA 01060 115879
Address Expiration Date
413-665-7402 06/22/25
Si re ` / Telep n
9.Registere Home Improvement Contrac or: Not Applicable 0
Company Name Registration Number
Haydenville Woodworking . n, Inc. 110732
Address Expiration Date
35 Conz Street, Northampton, MA 01060 Telgplr,§65-7402 11/8/22
SECTION 10-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 No 0
City of Northampton
Nj ' S-..
Massachusetts �
a ( ' •' DEPARTMENT OF BUILDING INSPECTIONS
` � kf c 212 Main Street • Municipal Building J� cD
}%-.� Northampton, MA 01060 j4/5, 3,),,`��
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered.
Type of Work: Renovate first floor bath and two front porches Est. Cost: 24,910
Address of Work: 186 North Main St Florence
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Haydenville Woodworking & Design, Inc. 110732
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply f a building permit as the owner of the above property:
Date r'0 ner N me d Signature
fir
City of Northampton
t‘x -t. ..t;,. ..i,,,
Massachusetts � 'e
•jy�] j DEPARTMENT OF BUILDING INSPECTIONS i� m
"]IC 212 Main Street •Municipal Building j CDC
� �f Northampton, MA 01060 �3'Nh. `^��
.. .)
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
186 North Main Street Florence
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
Amherst Trucking
(Company Name and Address)
_ .:()„,
Signatur of Per it Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
'...� The Commonwealth of Massachusetts
r
= Department of Industrial Accidents
— � Office of Investigations
E ,
-a - 600 Washington Street
Boston, MA 02111
\ykr=; , www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Haydenville Woodworking & Design, Inc.
Address:35 Conz St
City/State/Zip:Northampton, MA 01060 Phone #:413-665-7402
Are you an employer?Check the appropriate box: Type of project(required):
1.® I am a employer with 7 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
comp. insurance.: 9. ❑Building addition
[No workers' comp.insurance
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees.[No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: A.I.M. Mutual Insurance
Policy#or Self-ins.Lic.#:_WMZ-800-8007423-202 1 A 12/01/2022
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that 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 nd penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#:4 -6 y
402
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 one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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CARPENTRY PLUMBING
REPLACE VANITY SHOWER PAN WITH TILE FLANGE
REPLACE TRIM SHOWER TRIM
DEMO SOFFIT LAV FAUCET
ADD 4 SHELVES TO RIGHT OF SHOWER TOILET+SEAT(R+R EXISTING)
REPAIR ROT(ALLOWANCE)
REPLACE BATH DOOR(TBD)
GLASS SHOWER DOOR SLIDING WITH REPLACE FLOOR-TILE(GAZZINI SHABBY CHIC#i)
GLASS RETURN WALL ON WINDOW SIDE MOUNTAIN MIST 6xi2 PORCELAIN/CERAMIC TILE
SHOWER WALLS-2 SIDES
REVISIONS
�I: Haydenville Woodworking& Design,Inc. MM/DD/YY mums '�
I1 D Desig+Build-Genera!Contractors-Residential Construction-Since Ivtw 1 1O/z9/21 ZS O
FIRST FLOOR BATHROOM
3 __/--/-- ...
PETTIFORD 186 NORTH MAIN ST FLORENCE 4 __/__/__ -..
5 __I--/-- -
o
RIGHT HAND PORCH
r 1
(MAIN ENTRY) LEFT HAND PORCH
Replace rotten columns to `_ _ v> (SIDE ENTRY)
" Re lace rotten columns to
match existing. match right hand porch. s i
1 I pawl,
i
_ .
�_ �� _ _
4 ���
E _—
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e
''� REVISIONS
11 Haydenville Woodworking& Design, Inc. MM/DD/YY REMARKS '—'
1-1WD t1,l g +Build- Gcncrnl t onUac1 rs Raidcntia1 C.nsuu.Gon Sine.19fW 1 ti3/3��/zz 7S 0
PORCHES 2
PETTIFORD ROWAN 186 N.MAIN ST FLORENCE o _.-/__ / 4