30B-024 (4) BP-2022-0712
21 LIBERTY ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30B-024-001 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-2022-0712 PERMISSIONIS HEREBY GRANTED TO:
Project# RENO/ADDITION Contractor: License:
Est. Cost: 110000 IRA CURTIS 113741
Const.Class: Exp.Date:04/18/2023
Use Group: Owner: CURTIS CURTIS IRA& HILARY
Lot Size (sq.ft.)
Zoning: URB Applicant: IRA CURTIS
Applicant Address Phone: Insurance:
21 LIBERTY ST 413-270-2336
FLORENCE, MA 01062
ISSUED ON:06/16/2022
TO PERFORM THE FOLLOWING WORK:
REMOVE KITCHEN, MUDROOM AND REBUILD,ADDING 1/2 BATH. NEW SIDING.
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
y2 . 51--°1
I '
Fees Paid: $715.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Z-0k
File #BP-2022-0712
APPLICANT/CONTACT PERSON:IRA CURTIS
21 LIBERTY ST FLORENCE, MA 01062413-270-2336
PROPERTY LOCATION 21 LIBERTY ST
MAP:LOT 30B-024-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $715.00
Type of Construction: REMOVE KITCHEN, MUDROOM AND REBUILD, ADDING 1/2 BATH. NEW
SIDING.
New Construction
Non Structural Renovations
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
INFORMATION PRESENTED:
',/ Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Perm its 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
1 Ir
v . ?, I /04(i/. .a
b,
ture of Building Officia I e 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.
-1r _c) al& 0 ns
RECEIVE )
The Commonwealth of Massachusetts
JJ1422 Bard f Building Regulations and Standards FOR
MUNICIPALITY
M ssac usetts State Building Code, 780 CMR USE
PECTIONSPp
PFPT OF
It Cation To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
NORTHAMPTON.MA 01060 One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:61 a.3-' 712 Date Applied:
cW31/4-6AAL 5_? . %I
Building Official(Print Name) Signature V to
SECTION 1:SITE INFORMATION
1.) Property irezt‘..1 5..iI 1.2 Ass soars Map&Parcel Numbers Oa
1.la Is this an accepted street?yes X no Map Number Parcel Number
1.Zoniinng 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 Private 0 Check if yesA Municipal X. On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
24 Own 'of ecor
I0 Uri. ,s lt-ta uk FI ce fa Dlo-62-
Name(Print) City, State,ZIP
'2-1 1,1 SA-. Hr222162S36- 117.46% -(i, ebli +•N\
No. and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Constructi• Existing Building% Owner-Occupied Repairs(s) P Alteration(s) 0 Addition OK
Demolition lli Accessory Bldg. 0 Number of Units Other 0 Specify:
d Brief Description of Proposed Work2: �[� tC�l.f� `L► VMAOOW�, TL I EX
l-t+ A Ntlnrntm o n A t,tvl►.rb.(aorn A 1) �i;�, n-,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ gesocno 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ cs 0 Standard City/Town Application Fee
0 Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 1.C� 1.50 2. Other Fees: $
4. Mechanical (HVAC) $ 1 (53b List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No.`V)Check Ainoun . all6 Cash Amount:
6. Total Project Cost: $ I( 0,Oe d 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor Licen e(CSL)
CS-113141 Z.
IP-A i i )s License Number E irat n Date
Name of CSL Hol
I 1.1614,1 cAs
List CSL Type(see below) IA
No.and Street Type Description
notztvidu NIA, 0-0,� U Unrestricted(Buildings up to 35,000 Cu. II.)1"/ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
„ 1 SF Solid Fuel Burning Appliances
13 21D 2 0 IR� .Cy a- 6 ',1-to J_�� I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I'56 I 2 2
70�
It-Pt 64ry 15 HIC Registration Number Ex irat n Date
HIC Company N e or HIC egistrant Name //��A I.
Nt d Street Email address
8 VIA a I�z cir5 2l'e3� 3b
ity/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 .15ANo . ❑
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
K.sco
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
ntained 'n this appl. 'on is e and accurate to the best of my knowledge and understanding.
oa 6(i zl 2e ZZ
Print Own is or Auth ed 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"
City of Northampton
K, d7€Y) .qH.,
r q Massachusetts f ° r
s
l� s , DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building %.'a<� ,,C
'' Northampton, MA 01060 "„„ `.tb
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: Vk111 I G () 1 -V2Li '�WIrt171'1 D
tijOr:t1-14414eN1Mi, 6(O b6
The debris will be transported by:
Name of Hauler: c'd 0'11--- itt,,mH.e 4A ‘A'
A4-11•fL)
Signature of Applicant: Date: 1 iv,-,z_
1Zs.\.. The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Sweet,Suite 100
IMO.
...h
t I=Ail
Van ....',...• Boston, MA 0114-2017
www.mass.govidia
Wolters'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name t Bus iticssilOt ganizatia miludivitlum I : (I2-A C;`1‘.nktc.,
Address: -2- ( Li(ve--1-249 ,
cityistatezip: flev....n....e,: : thk,, Phone#:elo2.., e 1.11 221-6 3• =3'
Are you an employer?Clark the appropriate box: Type of project(required):
LO lam a employer with empleyees Volt arielar part-time).* 7_ 9 New canstnietion
29:1 I am a sole proprietor'or partnership and have no einFiloyees working fist ime in K. Remodeling
airy rapacity_[No workers'way,insuranee twinned.] k-.
9_ Demolition
3[J I am a homeowner doing all work myself.[No workers`comp illSlitatiCe required.)'
109 Building addition
4.0 i am a homeowner and will he hiring etiaradera to toriduct all work 1:41 my property. 1 will
ensure that all cermet-tea either have workers"ournpensamon tietWIEICe or Me sole [la Electrical repaint or additions
propridors with no employees_
12.0 Plumbing repairs or additions
sr]I am Rimier-el etintractor and I have hued the sub-committers hoed on the eithiath011 sheet
13C Root repairs
These sub-contractori have employees and have workers'camp.intsurance'-'
l 4_(1:10ther
613 we are a corporation and its officers have exercised their right of exemption per MC&c.
I SZ*IVO,and we have me employees.[No workers'coup.insurance requisredi
*Any applicant that checks boa 4'1 mini alto fill can die auction below showing their workers'compensation policy information_
+Iltrincowners who submit this atfildavit indicating they are doing all work and then hire outside contractors must submit a new affirim it indimiting stack
1Contraetors that check this box must attached an additional sheet show ing the name of the sals-caritracters and state'whether or not those entities have
employees, lithe ha,curstrackv.hase ernplOyEICS,the must provide their workers'amp.policy :norther,
I am an employer that is providing workers'tvmspensation insurance for my employees. Below is the policy and job site
information.
Insuiarice Company Name: _
Policy#or Self-ins. Lie.#: Expiration Date
Job Site Address.: City/State/Zip:
Attack a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MCiL c. 152, §25A is a criminal violation punts/table by a tine up to S1.500_00
and/or one-year imprisonment,as well as civil penalties in the firm of a STOP WORK ORDER and a fine or up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certi under the pains and pimr ofpelietry that the information provided above is true and correct.'
Signature: )f---- C..7"‘'\ Date: .,//
Phone#: L1-27 .2-7 "a -2--- •&'
Officio/use only. Do not write in this area,to be completed kr 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#:
CITY OF NORTHAMPTON
SETBACK PLAN
00
MAP: LO :
LOT SIZE:
REAR LOT DIMENSION:
rr' I'REAR YARD ,r
SIDE YARD SID YARD
I
1
FRONT SETBACK
FRONTAGE 04'