22D-056 BP- 022-1407
32 LIBERTY ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30A-056-001 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-2022-1407 PERMISSION IS HEREBY GRANTED TO:
Project# siding Contractor: License:
Est. Cost: 21450
Const.Class: Exp.Date:
Use Group: Owner: DOEHNE ZINK MICHAEL&ANDREA
Lot Size (sq.ft.)
Zoning: URB Applicant: DOEHNE ZINK MICHAEL&ANDREA
Applicant Address Phone: Insurance:
32 LIBERTY ST
FLORENCE, MA 01062
ISSUED ON: 10/28/2022
TO PERFORM THE FOLLOWING WORK:
SIDING
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:
s . j -' �1 •`
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•
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
R E V __ _
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IIL, The ommonwealth of Massachusetts FDR
„ ° OCT 2 8 2022 B.4 rd o Building Regulations and Standards
M.ssac usetts State Building Code, 780 CMR MUNICIPALITY LSE
ERT OF • !it'" pecrioNsppli'ation To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
_____-NORTHAMr roN MA o,oso One-or Two-Family Dwelling
yy,, This Section For Official Use Only
Buildin Permit Number:' 9�`/107 Date Applied:
evi....) (c,,,
// ID-28-20Z2
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
Property Address: 1.2 AssessorsMap& Parcel Numbers
2 .L3r
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 ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
l.1 Owner'td Record
tc, iae Yk X AkdK0. LbeWvle_ rekce 1 f1Ai 010 62.
Name(Print) City,State,ZIP
32-L aVert7 ,St 413--69S -7147 71141c meskr e a;I •c.ou
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building d Owner-Occupied if Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Pr posed Work': rl
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 2114 So I. 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: $
Check No. Check Amount: ��
6.Total Project Cost: $ 2 I4&0 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
�6°'' Massachusetts
7*
DEPARTMENT OF BUILDING INSPECTIONS 4
6;.�yW �g ' 212 Main Street • Municipal Building *.��,.
'--? Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS, RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
1. Building Permit Application signed by legal owner and filled out
by owner or authorized agent.
2. One set of plans and specification of proposed work(digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new/replacement windows).
7. Homeowner's License Exemption Form(if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code-all new construction(Gut/Rehab)requires an HERS Rater Affidavit.
4-
The Commonwealth of Massachusetts
ii
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,:i1A 02114-201
: . R ' is ws.rn tss..go /ilia
31ruSkrrs'("omprnsatiu.Insurance.tffedasit:BuiklersiContractors•I'1ectricians Plumbers.
10 BE }1LL1)11 ri111 rt1E: PER111'1-11Nit;Atr iIU )RI 11.
I• trti**1- • Please Print 1. ibls
E%:::lalijtion 1* tt: .t _t I I. L ate -Z6aw`<-
statteizi .-TioroAce_ k�� 0(06Z Phone 4i3— 69s _7( 47
'arx •t4 2,4 aar►imte r't :..,.I. it t .tF•l.n..true.Iyerk_
type of project(required):
. ... _.._twit r.r,;i •si:7.l :-cnpii+yc.s quit matt ur pat!-trtn.:l.• f. ® Net. construction
. .¢c;s,a.t.Vrorkil:.-t:+r ut i:-.lup uti1 have na.cnnpittveev'irking tint LIR:an 0 Remodeling
I'IY xl4..r; •_ixzip.rs.tt c .rnue reyue ua!I
- 9. ❑ Demolition
< r i u.to w v i t wire au . tta tttyvett 1:t1.Fvrtls.'...nip. snKutiultec rutUned.l'
T ti i in�a.�wne F -nut •ell l ti ter tag urrrtrrttut, ,tuln.t t work am my property. l w:II
10 El Building atld,ttott
7 C'Yia 14.e;It: rutcot ncrartsteit oft tnxutancc os ark:sole 11.71 Electrical repairs or addit:ons
(r .Pith to .:rt7E+l.n.e,
12.D Plumbing repairs or additions
a,tnc a> aa.:d.ai n l;x uru3't bat,:h ital IL.-tut,t.;._ufrjo t,It%kxt am tilt:attached sheer.
139.b, 13.0 Roof'Nub- ...efrat t"t+Lk cut�iere!s eY:}Oil hat.M ush.t t �+'6tip.insurance'
icpairs
.:
14.0Ot11ct
'1%6 are.1,eo :Fur:In :gat 1h Aticirc tY7ti'e owtc1'n:d thctr rich:ut ti4nIptron rka StKiL
'`144t.AV.'.R•ti eteglupc,c».I!.*N miters-comp Insurance requ.trl.d.l
is; 410u:int d-led ar3.i-!•hex ! -alter Aso till.nti etc+ stun bclua wtitnoinl th+:ar Hurktrs'.+rittpeitwtaun pultcy tittunn4Liun.
I t.!-r.w'••!-act,.WI'a+nsi•rtrtt'.fiin• attt;LiFtt irtdl.aring fire~ate dtrtnu ail w a+rk and than Lure uulsidc c4.411iracturt MUM:tubuu,a iF Fa:altl,l:tt at itedtce itue
t:rr, ttuc inn, nine kid ark aathriuiwt shed%boning the num:ut the niEr-cuntru.ktot and start*hailer 4:1 in r rhusa attires.hay,
It tic tltev nru,%pt+ni ie their nu b.t.
I mar rent employer thaf is prim-idiom workers'nwrrpetasllsir n insurance for my employees, Below ir'the polity and Job site
itrJorer ifirw
1 t-i:::ara:c C'tactrratt \irru: —
I'.•.o-s:. a� 5slt-Env.LLc_ Expiration Date:
City State
%tie.di ar copy of dale isurkers'compensation poll() declaration page(shwsing'tlie policy number and expiration date).
1 :se:etire,:ep•etat a 3s required under MCA_e. I52_y25A is a criminal violation punishable by a tine up to S i.5t..$i 14i
tlm:J.."r lotto:-yet.0 II i .r -'•[rr. x1I.•ts ttdI as ate it penalties in the turret olu STOP WORK ORDER and a tine ol•up o S25f1.tx1 a
1 arn41 the ca at..K. A..op' e this'.ratement err, be forwarded to the O1.1iee ot"Investigations ut'the DIA for insurance
r r:;;rr:rt:t ..i r ri; 'i pants and penalties of perjury that the information provided ohm•c it true am!correct.
114 ti
-
1}:sti 10/27/ 2022-
'- 13- bgts --7/k(7
I
r I ,iaf to a r»nly. Un resat x+rirr in this arra. to be completed by cit►•or 1ow-n official.
:I ;ar l ct+r►.ri:: _ Permit;License It
Is.wing.'Authoriti 3circlr tOrleI_
I. Itst:3:rt1 n(Ili-allll 2. I sikhat DepArtment 3.City-loon('Ierla 4. Electrical Inspector 5, Plumbing Inspector
I�. I1t1u'r
t tlttrtq ,Ptr+eaea_ Phone 4:
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
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
1,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 my knowledge and understanding.
10127f 2022
Print Owner's or Authorized Agent's Name(Electronic 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
\v\\��.IflaSS.gov_oca Information on the Construction Supervisor License can be found at
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"
err
City of Northampton
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Eyy Massachusetts
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' { q DEPARTMENT OF BUILDING INSPECTIONS i
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212 Main Street • Municipal Building Q
V +iNorthampton, 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 1
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: Valk(' Q�(t�G 0 234 cf� Ncm O '6" 1 it i
y U
The debris will be transported by:
Name of Hauler: YN 04,
i j r /2-02Z-
Signature pp
of Applicant: Date: 0 [
City of Northampton
�i..' • .
t/ Massachusetts '�
jJ dt DEPARTMENT OF BUILDING INSPECTIONS ,x,
*,�r rJ 212 Main Street • Municipal Building
Northampton, MA 01060 `Xi,,, I�`1
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
Ktotte-L- t�- zCIA o9�0e/1970
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 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 qualifij 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
qualifij 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 27 day of OC 01ce-1( , 2022.
gruL
(Signature)