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29-308 (11)
BI-2022-1090 374 ACREBROOK DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-308-001 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-2022-1090 PERMISSIONIS HEREBY GRANTED TO: Project# SHED Contractor: License: Est. Cost: 5000 Const.Class: Exp.Date: Use Group: Owner: J NATALE JAMES F JR&CLAUDIA Lot Size (sq.ft.) Zoning: WSP Applicant: J NATALE JAMES F JR&CLAUDIA Applicant Address Phone: Insurance: 382 ACREBROOK DR FLORENCE, MA 01062 ISSUED ON:09/01/2022 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 VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • .52 x Fees Paid: $58.00 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner in The Commonwealth of Massacliusettr-—.--0y" te., Board of Building Regulations and Stan rds FOR (7VIUNTCIPALITY Massachusetts State Building Code, 780 M$EP _ � ZQ ; USE Building Permit Application To Construct, Repair' Ren vate Or Demolish a Revi.ed Mar 2011 One-or Two-Family Dwelling nr-a1 I OT Aki-r NG mt3PECTlONS ` This Section For Official Use On�y`�`�rHAti.__ n� ��A nt Building Permit Number: t�'•.4 a- /C de7 0ate Applied: BuildingOfficial(Print Name) Signature ✓ Date gn S CTION 1: SITE INFORMATION 1 eke 1.2 Assessors Map& Parcel Numbe �s a l.la Is this an accepte 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 ❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2 Mad/ fe/Z° A. O/06 Name(Print) Cityd;; State,ZIP Gri 41CRISted.,fik, -o7fr Ca- /0-44 -F P91/20 No. and Str e6 t Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply) New ConstructionM' Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 •• — - 0 Number of Units Other 0 Sp ify . _ . . . ... -. , . . Evf/e/ cc„..., iz' x cAV' / SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire `$ Suppression) Total All Fees:A n 44S Check No.4 b IdEheck Amount: Cash Amount: 0 Paid in Full 0 Outstanding Balance Due: • I. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 SA it-4) Boston.MA 02114-2017 ,... www.rnass-goviditt Workers'Compensation Insurance Affidavit:Buiklers/ContractorsiElectriciansePlumbers. 1,0 BE FILED 1A all THE PERMITTING AUTHORITY. Applicant Information Please Print Utility Name i Bus iniesk-Otgan=Ito tk[Minn I l - jth . Address: grok14649 ied (0 n,(C.,_ City/StratetZip:,E4/ eA/U...)A 0/06'7-1Phone#: 47( -Or,r5 4 ir Art you an votplirstr',,('hies,h.titst a proinpriatt bin: Type of project(required): Lip 1 ant a antpioy,r Mill uuwity.fees(full a/1°4'ot pm I.* 7. ."4, New construction 2fl1.. a lulu ptrupnetof u(r mitirientop and hare no enriployeet working. for nue in . sairossay„[No workers'comp.thsurance required] I am a b OrtIcovoa doing all work mykelf.fN is worker s,'4:.tr l f Et Iff i MAI rat iOg,..i,,,ar 4000 8, ci Rerriodelnig 9. E3 Demolition 10 E3 Buildirig addition din I am a hornisiwarir and will he brinng contractors to coroluct all sivork on my property_ 1 will enetire that all OxttraCturs either have workers'emismeniation insurairme or are sole I I.C3 Electrical repairs or aiiditiorn proprietors w ith no employees_ ILE]Plumbing repiiits or additions 5.C3 lam a general contractor and I Mere knell the dih-contractiors listed ors the atthithed sheet I.30 Roof repairs Thene tub-contractors hese employem and brave workers'comp.insoriescei: I 4.0 Other 6.0 we art a curporation and its officers hat e exercised area right of eiteinption per MGL c.... 151,11{4),and we Mom is,i erne kr;:cis.[No A of isers's-,ri its.insurance required] Any applicaut that CbaCiLi ham al mat abal till Oat the wectron Mimi showing thew workera einimenindron palmy information, t.Homeowners who submit this affidavit indicating they amassing all work and then hire mind&coortmetors mini inland a new affulavil intim-aims 2,(aull. :Cum-3mm that check this box mud attached art idaitional sheet show trig the name of die tub-contractor*and ante whether or not(Ittase outiric-4 he erriployees.. If the sob-contrackisra balW canctioyet.N,thee rtaita ppm ide their workers'conm pokey number.. I ant an employer that is providing work,ers'compensation insurance for my employees. Belo W is the policy wit/jab site information. Insurance Company Name: _ _ Policy#or Self-ins.Lic,Sit: Expiration Date: Job Site Address: CitylStateZip: Attach a cup of the workers'compensation policy declaration page(showing the policy number and expiration date. Failure to secure coverage as required under MGE,c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00 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 v .lication. I do hercht ifit undrr I tins and, . allies of perjury that the information provided a e lsy and correct. 14 il j , , 4 , ir'' lit Date: Of 0/ (9-0,9-2-- 4,,...\i ,..r, hone- •'. ) ,c-7' - alrf Official use only. Do nor write in MAIN area.to be completed by city or town official ,=. , City or Town: Permit/License ,-; issuing Authority(circk one): I. Board of Health 2. Building Department 3.Cityffown Clerk 4.Electrical Inspector 5 Plumbing Inspector ! 6.Other t On tact Person: Phone-4: 4 ' ' . • City of Northampton <�-Amr�t,�t Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 CONST1UJC"TIQN D AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATIO ACTS) 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: 1,42:47 acycli The debris will be transported by: Name of Hauler: Signature of Applicant: Date: 0 2 JurpV iI1.L 447 rpy5'1' t,9( lxle i, Jokivo j 00.6,6teivp_d par' 11(1 ; 13i , ,hoi;h {�, ''K<4r ' r ,© �vht “ilav -u aD 'xe ,Lot 'VCR V ICJ 9?DVf „i. o 9/ /h *e ��.r a1 t fva l2 ,)(ke joi la 1 u . (-el ,be,i .1j19y0,eV V A4 ' il 1 / <-;-Y' bhilioy / CV 4/1/1 /4 1 City of Northampton F y _ Massachusetts 't } N',11. 1,i it."4. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building yJ �'Ca Northampton, MA 01060 'Py4.4 • 1 ' IltDMEONIOSf EXEMEillaiiiiiiiiiiiiinsib I, Vy/;, A /Q l// 0/ . P3, /9 i9 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 assachusetts 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 home. ers'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 MR 110.R3. ' 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110. F .1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on w 1 'di there is, or is intended to be, a one-or two-family dwelling, attached or detached structures access•ry to such use and/or farm structures.A person who constructs more than one home in a two-year pe od 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 ains and p ties of perjury on this 61/ day of ,ender. , 20)-v ( . titre) CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: /7-/ LOT SIZE: a Jli c f <" REAR LOT DIMENSION: REAR YARD ‘7?)j'ajk SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE or ' SECTION 5: CONSTRUCTION SERVICES 5.1 Consruction Supervisor License(CSL) J 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 Telephoner 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 poperty,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 co,• ed in this appli n is truetr an acitirate to the best of my knowledge and understanding. _I i � - a "^'// a 49-r)-2 -r's or Au east's Name(Electronic Sign ). • 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"