32A-202 (3) BP-2022-0568
59 PHILLIPS PL COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-202-001 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-2022-0568 PERMISSION ISHEREBYGRANTE TO:
Project# ZONING Contractor: License:
Est. Cost: 93000 KRIS THOMSON CS084152
Const.Class: Exp.Date:04/09/2023
Use Group: Owner: BERCUVITZ DEBRA
Lot Size (sq.ft.)
Zoning: URC Applicant: KRIS THOMSON CARPENTRY
Applicant Address Phone: Insurance:
362 KENNEDY RD (413)695-6487
LEEDS, MA 01053
ISSUED ON:OS/20/2022 •
TO PERFORM THE FOLLOWING WORK:
REPAIRS & RENOVATION
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/Chimne':
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: i 19Diy
Q• , iyQ
Fees Paid: $604.50
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
I
RECEIVED 1
The Commonwealth of Massachusett, SAY 19 20 FOR
Board of Building Regulations and Standhrds
Massachusetts State Building Code, 780 CMR, MUN:CIPALITY
• �° USE
N DEFT OF Bu D NG INSPECTIONS. 1
Building Permit Application To Construct,Repair,Renqvate Ong°}ua,MA~sea Mai _011
One- or Two-Family Dwelling ��
This Section For Official Use Only
Building Permit Number: ,6P—A �� tb�y Date Applied:
0) I '. J/ (')/o
Building Official(Print Name) Signature 1 1 Dale
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
59-�h►llips ?la.c.Q_.
1.1 a Is this an accepted street?yes ec 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' Private 0 Check if yesq Municipal gt On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: '
l7chieAT `arCvVi '3—, -Fin re_tic•e__. -/tic. . OI06
Name(Print) City,State,ZIP q
4! via rh.Q,r t T 413.VIL• 6'4 1' tlb_er c_u v i-tz, Z Cot,,,tca st - VI.
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Buildingel4 Owner-Occupied 0 Repairs(s) 'l, Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units 2- Other 0 Specify:
Brief Description of Proposed Work2: e ' ✓ e, — c ' S
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ so;p pp 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ��b0� 0 Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 1 0 GU 2. Other Fees: $
4. Mechanical (HVAC) $ ) List:
5.Mechanical (Fire
Suppression) $ Total All Fees: $ 6 Olt 5.0
Check No.t'l3S Check Amount: Cash Amount:
6. Total Project Cost: $ 9 3,0 0 0 wriPaid in Full 0 Outstanding Balance Due:
City of Northampton
F , Massachusetts � svc'
a• w
DEPARTMENT OF BUILDING INSPECTIONS 1a
rw. Alaa, 212 Main Street • Municipal Building
Northampton, MA 01060 4 ?,``
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)
KY'1 5 1 " '+ ✓I S License Number Expu-aluoti Nue
Name of CSL Holder
List CSL Type(see below)
3 (
7 Z rk. e ti No.and Street Type • Description
) �Q� �( t /) o O C U) Unrestricted(Buildings up to 35,000 @u.ft.)
'�-"�`'4s ✓ l� S 3 �'I� Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mason
ry 4,
RC Roofing Covering
`,) 5 4ili.0,1,1etst iin G G p e,,� r WS Window and Siding
11-10%/' SF Solid Fuel Burning Appliances
41 3' 69S•4%4d 8 7 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
I 51/I3 tc /2.3
S HIC Registration Number Expirati 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 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 r j S ��
to act on my behalf,in all matters relative to work authorized by this building permit application.
e -S/1 2- -I 2_
P'nt wner's Nam lectronic Signature) ate
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 acc to e be f my knowledge and understanding.
5AZ/ZZ_
Print Owner's or Authorized Agent's Name(Electro c 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
~'= Massachusetts
v{a
, AlDEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 42:
b
'`w..,—r*.%
Northampton, MA 01060
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:
f7
Location of Facility: -- t'( 1 tC)�v
The debris will be transported by:
Name of Hauler:
� 1
Signature of Applicant: Date:) ( 7 J 22--,
, .
. .
,..---.:- The Commonwealth of.Wassachuserts
Dep
ortment of Industrial.4ceidents
1 Congress Street,Suite 100
Boston. 41A02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Buiklers)ContractorsiElectricians/Plumbers.
TO BE.FILL!)IA I Ill THE PERNItTfING A 1 TIIORITV.
.Anplicant information Please Prim Leoilill
Name;Bus in,:-,I:T!.inization lnidualr KY) ( > 4—T--- - /-7---'—a "---..S•0 1--N . ..
Address: 3 6 z-- le--v--tA t"-sz-A,
0 /c;,__ _.3 Phone P: 4:1:—/ ; ' 4=16)5. • (s;14--ZS 7 ..
Art you an eitipkir.ser!Check the appropriate hat:
1 y pc of project i required).
I.C3 I ern a emploseer with_____erripeoyees(full and:or part-time I." i 7.. El New construction
RII r.n a Auk proprietor in partnership and have no employers wortine ior nae in S j Remodeling
capacity[No workers'comp insurance required.)
4.. DetnolitiOn
„*I I am a horrieowner doing all work mysell.INN workers'comp,insuranoe require:ell'
10 El Building addition
4.0 i am a homeowner and will he limns contrasiors to csindmi all work on ms property. I,...II.
ensure that all contractor.either bast:workers"corripm.sation insurance in;LW MAC I I_El Electrical repairs or additions
proprietors with no employs:a,.
12.0 Plumbing repairs or additions
I am a yeneral contractor and 1 Fur 4:hired the sub-contractors listed on the attached shes-I
I 3.0 Roof repairs
These Atab-CI:miractors Misr mriployees and have workers'comp.insiarance;
14.0 Other
h.E.1 We are a corporation and its officen hate exercised deicer nee of exemption per teltiL c.
152,f 14 ill 1.and we have no employees.[No workers comp insimmee mythical
1 'Ar... :wink:ant that dials box il mint also fill out the section below showing their workers'compensation policy erdienuition.
1111-`04,Ven,who Slibitlit Liu affective mcheistiriE they art doing all work and then hire outside oontractors must submit a in:*affichis it indeizting such.
:ContraztOrs that cheek Iho.1-K.s MUNI ann.thed an sidditiOnai sheet%hos.,inF Els,:name oldie'sub-coramelors and state Wheihet or not those mirth:,heo.c
lol,ec, II ,1,..NO,_,, '„.; • !,..NV enirl,,,,,CC!,1 ilk...., 111UNI rt l 6 id,,tb I SA.of Leis'ounir poil,:y number
I am an emplo)-er that is providing worAers"compensation insurance far my employees. Below is the policy and job site
information.
Insurance Company Name: _
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site AddresS: CityState.,Zip:
Attach a copy of the workers'compensation policy declaration page(showing the polic, number and expiration date).
Failure to secure coverage as required under MGL c. 152, *25A is a criminal violation punishable by a line up to$1,500.00
and'or one-year imprisonment,as well as civil penalties in the form Lila STOP WORK ORDER and a tine of up to$250.00 a
day against thL ,.iolator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverw,2:: \....n I ieation.
I do hereby cerri i.under t and penalties of perjury that the information provided above is true and correct.
Signature: J.---.--- Date . /1 I2--
Phone#:
Official use only. Do not write in thi.% urea. to he completed by city or town official
('its or Town: Permit/License 4
Issuing,Authority(circle one):
I. Board of Health 2. Building Department 3.(*lay/Town Clerk 4.Electrical Inspector 5.Plumbing I ii yetlor-
[ 6.Other
Contact Person: Phone :
— .
City of Northampton
:0.7J ii
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Massachusetts .._
DEPARTMENT OF BUILDING INSPECTIONS
1.
go- +' 212 Main Street • Municipal Building �
sad
.rr
-g" Northampton, MA 01060 '1,-% '
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (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 and the project or workfor which I am seekingthe aforementioned homeowners'exemption,
in, f
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 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 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 day of , , 20_.
(Signature)
IV
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-NOTE-
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED.
LOCATION OF FENCES ON OR NEAR BOUNDARY LINES
IS NOT VERIFIED BY THIS INSPECTION.
NOTE:
PROPERTY LINES SHOWN ARE APPROXIMATE, A NOTE:
FULL FIELD SURVEY IS REQUIRED TO SUBJECT TO AND TOGETHER
ACCURATELY DETERMINE THEIR LOCATION. WITH EASEMENTS AND RIGHTS
OF WAYS OF RECORD.
89'±
I,
///// 75.08'±
w /garage/ BOOK 3744, +I
////°' PAGE 83
U
co� PARCEL II �
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1.1J 11 I #51
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(� / _/ BOOK 3744,
�� PAGE 83
O �`� r PARCEL I
I
90'±
PHILLIPS PLACE
TO:
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
-NOTE-
SURVEYOR: (krY\A-LV _L_ THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
-MORTGAGE LOAN INSPECTION PLAT-
� NORTHAMPTON, MASSACHUSETTS
/lb RANDALL \G�\ PREPARED FOR
IZER N DEBRA T. BERCUVITZ ET AL
f35o32 SCALE: 1 n=40' DECEMBER 27, 2021
Cys °� HAROLD L. EATON AND ASSOCIATES, INC.
SURVE-
REGIS I LRED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS
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