36-092 (4) BP-4022-0925
837 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-092-001 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-2022-0925 PERMISSIONISHEREBYGRANTED TO:
Project# CONVERT GREENHOUSE Contractor: License:
Est. Cost: 236000
Const.Class: Exp.Date:
LITWIN, RALPH H.& STEPHANIE K. & CHRISTOP.
Use Group: Owner: MICH.&MELODY CHARL.FIGGE
Lot Size (sq.ft.)
LITWIN, RALPH H. &STEPHANIE K. CHRISTOP.
Zoning: WSP Applicant: MICH.&MELODY CHARL.FIGGE
Applicant Address Phone: Insurance:
837 FLORENCE RD
FLORENCE, MA 01062
ISSUED ON:08/04/2022
TO PERFORM THE FOLLOWING WORK:
CONVERT GREENHOUSE TO LIVING 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:
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: (�
2 • 11 •
Fees Paid: $1,534.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
/ - L.- /b 9pnal pl.trn
UG OThe ommonwealth of Massachusetts
\ 4• ,9p :lard Building Regulations and Standards MUNICIFOP TY
•:e 2e �/assa usetts State Building Code, 780 CMR USE
H ip/.�,.: re.•. Per, 't A lication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
N'ii of -) One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: .�,. ' P••-"(326 Date Applied:
/G $ 6 /20s //i..78-4-ZCZZ
Building Official(Print Name) ature Date
SECTION 1: SITE INFORMATION
1.2 Assessors Map& Parcel Nutn eysal
31 F Ore€ Rd. F(Drenre otoe.A 3 (JJ��'ff
1.1a 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 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
a Owner'of Record:
Recipin SttO t, , L at.tho ACe— , MAa►O�.
' Name(Print) City,State,ZIP
131 FbreA Ce R 73- 38'-;743). Rktit'v3%ntArncCil.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 ❑
Demolition 0 Accessory Bld . 0 Number of Units Other 0 Specify:
Brief Description of Proposed Wor
lake-daty 9rcen Inks u)140toS I r rP\ac,L LA)i1 A t.�\► do
ups
0.Y\d me-V.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
.1. Building $ �I au-0 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 17) 0 Standard City/Town Application Fee
0 Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $ 04
4
e o. Check Amount: 11. Cash Amount:
(jotal Project Cost_ $ a3b1Fill f 0 Outstanding Balance Due:
Ceecri‘k ,
City of Northampton
; ., riTt�r�� roc
Massachusetts :��
` a ` DEPARTMENT OF BUILDING INSPECTIONS 1
� � 212 Main Street • Municipal Building � 'V
Northampton, MA 01060 "tioN 14/ .'OC
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. 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. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW / private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
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 . 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,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
WCTION 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.
FOVA i9 Od'.n i L kkik/ 4 .0202a
Print Owner's or Authori_ed Agent's Name(Electronic Signature) MI
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered conttlactor
(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 fotlnd 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
Massachusetts �� '."
t.
1F DEPARTMENT OF BUILDING INSPECTIONS R'
,
� 212 Main Street • Municipal Building � � r?.
- y Northampton, MA 01060 sst• 1/".
0., QNSTRUCTION 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:
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date:
,.
, The Commonwealth of Massachusetts
-,,
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, 211A 02114-2017
www.mass.goWdia
Workers'Compensation Insurance Affidavit: Builders/Contractors/EllectriciansfPlumhen.
it)BE FILED VS ITII THE PERMITTING AUTHORITY.
Annlicant Information Please Print Leeiblv
Name 1 Business,Organization I mill,Alai r
— —
Address: • -,.#
„. . .
City/State/Zip: Phone #:
Are yoo on omoloyer?i heck!tic apprupriac hot:
Type of project (required):
In lam a employer with employees Iiidl and/or part-tune 1.• 7. 0 New construction
20 I am a wt.:proprictot or i\irinerthip and hale AU CIILlploWyekns*Orkin! flOW mr AI 8. o Remodeling
.,„,,,...,,,, tNo*mien:curnp.uthutanee required.]
9. 0 Cleint)litiOn
SO I an a lumnrowner doing all work myself.[No workers'comp.insoninee revoireii]'
it am a homeowner d will be hiring constachirs to con duct all work on raw property. 1 will
314/
1.0 C:1 Building addition
an
ensure that all contractors caber fuse workers"comperisautri insuranix or ere sole i i.12)Electrical repairs or iglititions
proprietois with no employees
12.0 Plumbing repairs or additions
5.0 1 am a gs-neral contractor:mil 1 bane hired the saib-eontracturs listed on the Ailatled shed.
13.EIRoof repairs
These sub-contractors base employees and hase workers'comp.insurance.:
.0
6,0 We area corporation and its officers have exercised their right of e 14 Other
xemption per MCI c.
1:t2.,;1141.and we have no employees.(No workers comp.insurance required.]
*Any applicant that eho.:ks brit al WWI also fill out the tion brim.% show nig then minicar,'eonmentation pulley utformattoct,
*Homeowners who submit this affidavit indium=they are doing all work and then hoe outside contractors must subnut a new affidavit iKati1ag iocii.
:Contractors that check this box must attached an additional sheet showing the name of the isub-etrimucuir anti auk whether or not thaw erititi.a Ita•ie
employees.. It the totr.eontractiw%haw employees.they rItilM pros idc their workers"comp.polic:.number
I um an employer that il,providing workers'compensation insurance far my employees. Below ia the policy and job.'die
utformation.
Insurance Company Name: _
Policy#or Sclf-ms. Lie.#: Expiration ant:
Job Site Address: CityiStateiZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to S1,500.00
andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of 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 verifution.
I do hereby certify ander Me ins and nail' •of rrury that the information provided above i...% true and correct.
IMESbate:
—5-3F- ), 3 a_
Official oat only. Do nut write in ilri% urea. to be completed by city or town offiLial It
City or Toss II: l'ermit/Lkense,E1 i
1
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.CitytTionn Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone 4:
City of Northampton
oNA�t' M ,.•,.
S..• �SI
4 Massachusetts ? '..�
DEPARTMENT OF BUILDING INSPECTIONS a, 1ff
212 Main Street • Municipal Building b,
Northampton, MA 01060 ram'
.._ '`Zahi 8rs
LJ WNERS'EXEMPTION ELIGiBILITYDAVIT
5\70 .Y11 1 r1 uxitol
(insert full legal name), born (insert 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 r•gulated 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 41 day ofi vIS-t , 20 22
070.t,..„
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fik- LANSING
BUILDING PRODUCTS Manufacturing
ACKNOWLEDGEMENT NT
Customer Quote Summary
BILL TO: SHIP TO:
LANSING MANCHESTER CT LANSING MANCHESTER CT III I II I Ilil III III IIIII I III I I
PO BOX 6649 730 PARKER ST Barcode
MANCHESTER CT 06040-2262
Phone: 804-266-8893 Fax: 8042616743 Phone: 860-649-6440 Fax:
QUOTE NBR CUST NBR CUSTOMER PO DATE CREATED DATE ORDERED ORDER TYPE
5370810 1141351 1133217 7/11/2022 Quote Not Ordered Charge
ORDERED BY STATUS SHIP VIA DELIVERY AREA
Jose None Whse Delivery Unknown Area
CLERK JOB NAME COUPON
msae -Matthew Saegaert Florence
LINE# DESCRIPTION OTY UNIT PRICE EXTENDED
10000-1 Vinyl Casement,Unit Size 71.25 x 48,RO 71.75 x 48.5 2 $1,060.14 $2,120.27
Unit 1:U-Factor=0.27,SHGC=0.23,VT=0.39,HII-M-38-03185-
00001,Size Options=Custom Size,Transactional Order Type=Charge
Order,New Construction,Inside Extension Jamb Receiver Pocket=Yes, f
Hinge Left,Simulated Meeting Rail=No n N.„
Unit 2:U-Factor=0.27, SHGC=0.23,VT=0.39,HII-M-38-03185- "I. N,
00001,Size Options=Custom Size,Transactional Order Type=Charge & N 7.
Order,New Construction,Inside Extension Jamb Receiver Pocket=Yes, ~N., -
Hinge Right,Simulated Meeting Rail=No ---36" 36"---
Frame Width(Inches)=36,Frame Height(Inches)=48 Ro-. .75'
Double Glazed,Double Low E,Argon Filled
Exterior=White
Program=None,Label Name=Harvey,Standard
Fiberglass Mesh
Integral J Fin,Inside Extension Jamb Receiver Pocket=Yes
Overall Frame Width(Inches)=71.25,Overall Frame Height(Inches)=
48,Overall Rough Opening Width(Inches)=71.75,Overall Rough
Opening Height(Inches)=48.5
Clear Opening Width=24.5,Clear Opening Height=42.25,Clear
Opening Square Footage=7.19
E.Star Zone:North=Yes,E.Star Zone:North-Central=Yes,E.Star
Zone:Nouth=Yes,E.Star Zone:Nouth-Central=Yes
Room Location: None Assigned
Last Update: 7/11/2022 5:34 PM Page 1 Of 2 Printed:7/11/2022 4:34 PM
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