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05-022 (2)
BP-2022-0940 266 AUDUBON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 05-022-001 CITY OF NORTHAMPTON Permit: Acc Structure PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0940 PERMISSION IS HEREBY GRANTE TO: Project# shed Contractor: License: Est. Cost: 15000 Const.Class: Exp.Date: Use Group: Owner: KLACZAK SAIDEL MARY A& MARTI A M Lot Size (sq.ft.) Zoning: WSP Applicant: KLACZAK SAIDEL MARY A & MART A M Applicant Address Phone: Insurance: 266 AUDUBON RD LEEDS, MA 01053 ISSUED ON:08/10/2022 TO PERFORM THE FOLLOWING WORK: 12X24 SHED 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 VIOL• TION OF ANY OF ITS RULES AND REGULATIONS. Signature: t Fees Paid: $58.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner SEC fi-_.- The Commonwealth of Mass. huse s AUG Board of Building Regulations . d St dards 8 2022 FOR Massachusetts State Building Co•e,7 R CIPA' W FPT of USE Building Permit Application To Construct,Repair;�Ret�gl3C • Rev sed Mar 2 11 One-or Two-Family Dwelling _--°^' ti+�oicsoo"� This Section For Official Use Only �'' Building Permit Number: 6P ).1— 9 Date Applied: i ►� . .'.� '► V�Building Official(Print Name) I Signature 'I hate SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 66 Au eAu hc,. l4C(, Leeceo C5-5— O.7, -- 1.1 a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public I� Private❑ Municipal 0 On site disposal system zJ"'"' Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of��nRec+ord• ^' �` p 0 d Marti Sc r �I it 1'(o. -FL k-kc k 2.hh An 12ct I L?�4. �A Name(Print) City,State,ZIP 2142 A-vBA,A, 4t, 91;-sg q-may ,,,kb,czc,J g ,j(q.o,coM No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition ❑ Demolition 0 Accessory Bldg.13Y Number of Units Other 0 Specify: Brief Description of Proposed Work': l 2'$ 2-4' Sked. I nstv‘(Prt ')'/ s ktyyo 0 +d-tu,L Au.P,wEs , `474' , M Al - SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ I S, O Oo I do 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ O 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ Q 2. Other Fees: $ 4.Mechanical (HVAC) $ 0 List: 5.Mechanical (Fire vd $ Suppression) 0 Total All Fees:�i Check No.12 heck Amount/, (J Cash Amount: 6.Total Project Cost: $ I OCC 69 0 Paid in Full ❑Outstanding Balance Due: 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.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP 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 y knowledge and understanding. "(4 g-(6//a2— 'Prin' t�wner's or Author'. ed A nt's a(Electron'. Si a 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 �O_YMPTO \S .rySI Massachusetts . w�s * c c. DEPARTMENT OF BUILDING INSPECTIONS Ian' .. .b. 212 Main Street • Municipal Building %) Northampton, MA 01060 syW...wO‘1�\ 44 c4d2A4 M4; 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: 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 •.• r Boston,MA 02114-2017 www.mass.gav/dia 'iS idlers' Compensation Insurance Affidavit:BuikkrsfContrractorstEkctrieiians/Plunibers. 'It)in:FILED% ITII TIlE PERM fl INt,AUTHORITY. Applicant Inforrttatiott Please Print Li-edits XName(i1usincss,Organization.'Individual): /' /4) etC Address: 5 i a G---itid,-La ?i City/State/Zip: Phone #: Are yens en employer?Cietik the appropriate boa_ Type of project(required): 1.0 I am a employer with employees(full andfot part-time).* 7. a New construction 2.0I am a sole proprietor or partnership and have no etimloyees working for Ira in 8. 0 Remodeling any capacity.[No workers'comp.Durance requires!] 93.0I am a homeowner doing all work myself.[No workers'comp.insurance required]a ❑Dt moli[iou n 1 am a homeowner and will be hiring otateractorsto conduct all work un my property. I will 71 10 Building addition ensure that all clattered r either hose workers'conip:nsataet ire ur-roe or are sole 11.0 Electrical repairs or additions proprietors,with no employees_ 12.0 Plumbing repairs pradditions i f i 1 am a general contractor and I have hired the subcontractors listed on the anached sheet 13❑Roof repairs y These sub-contractors lance employees and have workers'camp.insurance.: _ b.©We area corporation and its offnert have exerciser)their right of exemption per hIGL c_ 14.0(?thy 152.i 441,and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks but 41 mtatt also fell out the section below showing their workers'compensation puck' information t Llomeownen who submit this affuhrcit irubx-aMte they are doing all work and then hire outside contractors must submit a new affutas it iodic-atrag such. :Contractors that check this brat must attached an additional sheet showing the name of the subctzuractors and state whether or not those etttitiis hate employees.. It the sub-contractors base employees,they must protide their a tickers-comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below i.r the polity and Job site information. Insurance Company Name: — Policy#or Self ins.Lic.#: 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 MGL c. 152,§25A is a criminal violation punishable by a tine up to S 1,500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 verification. I do hereby certify rater the pains and penalties of perjury that the information provided ahoy is nee and correct. Signatu • Date: D 9' 2-2— Phone#: t 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): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone##: City of Northampton � Mp f ' ' Massachusetts �4{; sc�cc #': DEPARTMENT OF BUILDING INSPECTIONS ': `• 212 Main Street • Municipal Building ' 4. Northampton, MA 01060 ,,A HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, Mp1 /"/..K4 7,kefitiaA Ser (insert full legal name), born _ insert month, day,year), hereby depose and state the foll ng: /rkez4A_ a9.6, ae 4196z Sar� 008 o% /,99t 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requi ements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a proje,t 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 homeown=rs'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 C ' 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110. ' '.1.2: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on whi there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accesso , to such use and/or farm structures.A person who constructs more than one home in a two-year perio• shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent t t I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the .roject or work on my parcel, I am not engaged in construction supervision in connection with any project or ork involving construction, reconstruction, alteration, repair, removal or demolition involving any activity re: lated 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. fit Signed under the pains and penalties of perjury on this 9 day of 20 22 c a c 4 A CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: II IS &( )J.. REAR LOT DIMENSION: I.40 ?' CIS REAR YARD nin) teem.. 3 f5 h ecc story N r a 1 2-3 , SIDE YARD U SIDE YARD ✓ RCA_hC)-• w'I 1 FRONT SETBACK I S .166 FRONTAGE 11-S ► 4e* /!7( 0/053 .a (f</aezk CONE. RIDGE VENT - OPTIONAL Nt p N ASPHALT SHINGLES PLYWD.GUSSET EA. o - o SIDE OF RAFTER FASTENED w/ N ct N • 1/2' SHEATHING FASTENED (10) 16 GA. 1/2' CROWN x 1 1/4' STAPLES m o w/. 8d NAILS ;•: ::•;'*:;;•: . Z a U ,t1:: ac 3 W W 2x4 RAFTERS 0 16' Q.C. 12 16' n- o (3) tOd COMMON NAILS 7 V X -RAPIER TO PLATE CONN. -(2) ONE SIDE, (1) OPP. () z TOP OF WAIL '"' _ DBL. 2x4 TOP PLATE O Y 1x4 FASCIA FASTEN LOWER TOP PLATEP. ra4 I INTO STUDS w/ (2) 12d NAILS U 4" W 00 (2) 2x4 COLLAR TIES o Cl.) (SHEDS 20' LONG; 3 TIES 0 24') In a DURATEMP OR VINYL SIDING , 2x4 SAID WALL 0 16' O.C. OVER 1/2' CDX PUN. p -FASTENED w/. 8d NAILS-- E (1) 16d NAIL THROUGH BOT. OF Q 2x4 SOLE PLATE TO END OF STUD > �o ,.. N ,--I(2) 164 NAILS FROM SOLE 5/8' PLYWD. FASTENED w/. C.) Q.) TO WOOD FDN. (PER FOOT) 8d NAILS OVER Q I 2x4 FLOOR JOISTS 0 12' O.C. QQ FlN. PLR. T 1"'' P.T. 4x4 FOUNDATION BEAMS 11.4 Ill Ns ICJ 67 1/2" (2) 16d NAILS FROM JOIST TO WOOD FDN. (PER FOOT) / 2'-11' / 2'-94 2'- "T4 2'-11' / in o 1 SECTION o ~ A7.2 SCALE: 3/8"0.1 1'-0" o c ti 19 M (5 T co c m i2-o/ / 7 410 .D: I , 1 I 0 D T v P N J 'az at II °i IV. N ( 1K A t O Z I I r IRAFTERS a 16' 0.C. L - - - .-y-=- - - PROJ. # 20004 B&B STRUCTURES THE BACKYARD COLLECTION DWN. BY: RJE SEPT. 11, 2020 568 Gibbons Road 12' Wide PLANBird-In-Hand, Pa. 17505 Ph. $(717)656-0783 A-Frame 6' Wall & 7 Pitch A7 1