29-299 (11) BP-' 022-1046
315 ACREBROOK DR COM MONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-299-001 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-2022-1046 PERMISSIONISHEREBYGRANTEI TO:
Project# 2022 LAUNDRY Contractor: License:
Est. Cost: 4600
Const.Class: Exp. Date:
Use Group: Owner: COTE THOMAS M &MELISSA M RO:ERTS-COTE
Lot Size (sq.ft.)
Zoning: WSP Applicant: COTE THOMAS M& MELISSA M RO ;ERTS-COTE
Applicant Address Phone: Insurance:
315 ACREBROOK DR
FLORENCE, MA 01062
ISSUED ON:08/24/2022
TO PERFORM THE FOLLOWING WORK:
CREATE NEW LAUNDRY CLOSET
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 VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I ' / '
A -
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
____ RECE W
1
AUG 2 4 2022
DEPT OF DUILDING INSPECTIONS
mOriTHAMf TON,MA OtObU
`14 -TheiConunonwealth of Massachusetts
A Board of Building Regulations and Standards FOR
I 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
Buildiing.Permit Number:3P 2 a. -, l0 ((/ DateA ied:
/S El)II— �s 1/4:/ 6.24=2027
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address:� 1.2 Assessors Map&Parcel Numbers
3a 5 Ri.t'ir I4 l Ok -a.?
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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Rec d:
Mka;s- >be�,�'D� POrP,nee., MA. 0 I O(D a
Name(Print) City,State,ZIP
.315 erebkoc)K b1;0e u -582-IcpaE OA lobe+2i5COle.der, �. urn
No.and Street elephone 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)pr Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
1 o i t Y1cUI-t {, (IS i7`' ( _Cack)M�Yl
Q SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 5610
`63 1. Building Permit Fee:$ Indicate how fee is determined:
f � , co 0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ l f r J _oil
2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ 'J
Suppression) ccYy�� Total All Fees:$
6.Total Project Cost: $ the�/� t/" Check Noq?7 Check Amount:
lJ(/' 0 Paid in Full ❑Outstanding Balance Due:
•enrna;.{ Q rvr rbl�c 415cok-e rill`, I, cam,
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 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
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By enterin,m •ame below,I .ereby attest under .- .•. s and penalties of perjury that all of the information
conta',:.• 1. a..lica. .. a:.• :'• urate .the ?If my knowledge and understandin .
' •. a .er A . . T I S •.• _ l. ... e 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.uov/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"
`___ _ The Commonwealth of Massachusetts
,--ri; Department of Industrial Accidents
`'; 1 Congress Street,Suite 100
._
Boston,MA 02114-2017
V��..;„ ..
,,
t,
www.ntos s.gorldia
11 oilers'Compensation Insurance Affidas it:Buildersi("ontractors/Ekvtricians/Plumbers.
TO RE FILE!)N rill III 1'ER%IIIll G At!Tilt)MTV.
Applicant information Please Print I riiibis
Name iliastnress Urr:ltttrrtunindividual):J J( _5:Ar O(�biSj—CIODIC.,
Address: 1 S i c CC4)
City/StatclZip:qpileflat._.l� LL hone#: ��5_ -�(D _...._
Ate Yna an vnyaltnrr't btal.the appnvpriate hot: Type of project(required):
LEI I am a employer with emaapknoces(lull and or part-tiancl.• 3. Q New construction
s am 1 a woke pnapte iot or awfaa mhip and no a employ ca working for inc in
any cataacity_Itio vi ►ors'comp. required" •. �� Remodeling
car
30 I ant a honicow awn Joann all work any*rlt.(\o waarka c s' orny+.rnwrune rtataunad('
9. ❑i)cniulitiun
180 Building addition
4.5Z I am a ltaanaconnct and mat I.c hniarg c naeratiom to conduct all wink on my pngtvst. I w ill
nuuae that all nnYtation cinler luee w,oaka:aa'cvnapnwbewt nnntantti OS arc MA: 1143 1_leclrtcal repairs or additions
pt oprietois w ith a+nnplcr)cea.
;� 12.0 Plumbing rep additions,airs or additio ,
:%1 I am a tr nccral ctmnactor and I fame hind the subticmnaetoas listed on hate attached.ah.tt.
These sub-contractor.have mnrinyccs and have workers'comp.unurance, 13O Roof[ePairs
h.Li we ate a collimation and ita Akers hale exercisedthen tight or exemption tat Mt id e. 14.❑Other
12 ytt 14 i.,and wr has a no tstgtduyces.[tits winker'comp.inauaanec.required!
'Any applicant nut duals box 3I most alxa tell out the section blow showing then workari compensation polite nefaman:aioa.
+Homeowners who salnnit this attrkn it®adicaitte they arc doing all work and then hise etttsidc 1:0117rastra,smut submit a tam atlatae it indicating mach_
;Contactors that cheek this boas must attached an additional sheer slam Mg the name u1 the stel*-ctnuaactams and sine w hcihacr or not douse maitie,.lucc
nnployee-s_ if the sub-ctmlracti>ts leave employixs.they roam proside their winker,'riurip.policy nuanlsa
i urn an emp/ut-er that is providing worriers'compensation ins&ranee fur dry entplayees. Below is the policy and job site
information.
Insurance Company Nana:__._
Policy#or Self-ins.Lie.#: . ..: Expiration Date:.
Job Site Address: City/Statc2Zip:_
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requited under MGL c. 152,§25A is a criminal violation punishable by a fine up to SI,500.00
and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violator. • ,.y of this statement ma forwarded to the Office of Investigations of the DIA for insurance
coverage serificati .
i do here v 'e r' , antler II / ' a and penal' .rjus t that the information prarlded above is true and correc•L
Si'+ttalllt� t 1 Ili, G` W 1)alti:
!'tooth♦'`: at/1/J
se only. Do not write in this area.to he completed by city or town alficiaL
('its or Town: Permit/License#
Issuing Authority(circle one):
1.Board of ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Pluinhiira Inspector
6.Other
Contact Person: Phone#:
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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 150%.
Address of the work: s 15 R{?('C hr fOOk h?.l 02_ Pbreal-C--)4A
The debris will be transported by: NI, A- - fl it SA noe t bl vi
The debris will be received by:
Building permit number:
Name of Permit Applicant Mat SSA 6Wei-enIC
Date ign re of Permit Applicant
City of Northampton
`S s.
1" Massachusetts w;g tc`
, .
i ( I DEPARTMENT OF BUILDING INSPECTIONS S
r 212 Main Street • Municipal Building
Northampton, !a► 01060 j4'3 %\
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT S117I1 46
°7
(insert full legal name), born_(insert
month,day,year),hereby depose and state the folrilv ing:
1. 1 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 ii{l
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 anj
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•
my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Si: •' • the p' 'nd penalties o' t ury on this (day of 20 ,.I?'
VI
I! IA / VII
(Si:7 re) ,I
315 Acrebrook Drive, Florence, MA 01062
Melissa Roberts-Cote-413-588-1628
Renovation: Create 1St floor laundry closet
Window
I The outside box is the current
r v 3rd Bedroom has been converted configuration of the existing bedroim.
5. °o to Office Space The layout of the existing room/structure
0 o will not change.
0
1. Homeowner will build a wall(see t e
Office Space
XX'd space signifying wall)to divine the
room to create the 1st floor laundry closet
herein referred to as the laundry cli set.
1. XXXXXXXXXXXX 2. A door will be built in on the hall s de(see
Staircase the 00'd space signifying the door.
3. &4. 5. &6.
Dryer 3. Plumbing will run from the laund closet
Washer down to the stack in the basement.
4. Venting for the plumbing will run p
through the roof.
5. Electrical will be run from the ele i ical
2. 0000000000 Door to Basement box(220 volt)to the laundry closet
6. Venting for the dryer will run from the
closet down and through the existi g joist
Green: Work completed by homeowner to the exterior window extending ft.
Blue: Work completed by licensed
plumber see permit
Red: Work completed by licensed
electrician see permit