10B-084 (4) BP-2022-1464
220 MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:LoI:
10B-084-001 CITY OF NORTHAMPTON
Permit: Addition
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-1464 PERMISSION IS HEREBY GRANTED TO:
Project# DECK ADDITION Contractor: License:
Est. Cost: 6000 LOUIS MONTGOMERY 013471
Const.Class: Exp.Date: 11/19/2023
MACDONALD MICHAEL&MARGARET M ARRAJ
Use Group: Owner: &MEGHA A ARRAJ &NARAYANI J DEW
Lot Size (sq.ft.)
Zoning: URB/WP Applicant: LOUIS MONTGOMERY
Applicant Address Phone: insurance:
PO BOX 951 413-268-2028
WILLIAMSBURG, MA 01096
ISSUED ON: 11/10/2022
TO PERFORM THE FOLLOWING WORK:
DECK ADDITION
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: ' 3),„5,
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
File #BP-2122-1464 2 V 0l<
APPLIC• /CONTACT PERSON:MACDONALD MICHAEL&MARGARET M ARRAJ&MEGHA A
ARRAJ & i ARAYANI J DEVI
220 MAIN.T LEEDS, MA 01053
PROPER LOCATION 220 MAIN ST
MAP:LOT 10B-084-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING CORM FILLED OUT
Building Permit Filled out
Fee Paid $65.00
Type of Construction: DECK ADDITION
New Con:truction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
JApproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Findng Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
f
5,43.1k 5.1 411. ,
1/10/201,
Srgn4ture of Building Official I Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of publiclrks and other applicable permit granting authorities.
*Variancare granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning Development for more information.
/ ht.0.,
The Commonwealth of Massachusetts 4/ok
t ri Board of Building Regulations and Standar - FOR
9CIP
Massachusetts State Building Code, 780 Ckf 20(.149 M USITY
Building Permit Application To Construct, Repair, Renovate 04* a R ised Mar 2011
One- or Two-Family Dwelling ? Tn"`'Msp�cr
This Section For Official Use Only ' ` �o��c •
Building Permit Number:I ?"-"i4(0 Date Applied:
h5,1 , II ii i.Building Official(Print Name) Signature -� ' Dalte
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
Zzc414/AK S r L/'/2'S
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:
Zone: _ Outside Flood Zone?
Public Private❑ Check if yes❑ Municipal Jii On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2. wn ` R � A - kr- Z?� A4 , 1. 9/ - % 4.4'0,
Name
nnt City,State,ZIP —itiaj
melor....t
- 41 — g7 gai, ) urX06
No.and trees Te ephone Email'Address It-,
SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 13u,/� ,f'}r /O' ,9T 29 /C"- ". 4'U,-4/'Z c'
/2 V$'/S tr s-A., /-7P-r--.['Af_._
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only
1. Building $ .00 0 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:kii
Check No. `50 Check Amout , Cash Amount:
6.Total Project Cost: $ 6, a 0 0 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
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Massachusetts ' -'ce;.
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building -4> �tr
Northampton, MA 01060 li,r -)%
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)
a/SZ/1/ ////i/e s
La(/'S Aed,,,f T(c�U/4r.4�� License Number Expiration Date
Name of CSL Holder
9,51 List CSL Type(see below) Li
No.and Streettr /�- Type Description
U14,1 L! i ,4,'-t1 Oc'u y year 6/01 R Unrestrictedesced12 Family upel 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
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Lov'/s o/vTGd / 73e/ / 3h7 23
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
eY Cl'1'/
No.and Street Email address
Gi'i/1,, (r.0 , !4 Z b 20is'
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 40 viS' 7'o.Y/6o1°1%1 y 101/7 sw, Cq, - -
to act on my behalf,in all matters relative to work authorized by this building permit app ication.
I
n Owner's me(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.
L/
ot....,s Ate iV 7,OM-09, // / Z?iPrint Owner's or Authorized Agent' Name(E:=1.1
ec c Signature) / ate
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 7 v
[0'
w
t a
SIDE YARD /d 0 5\5 ` SIDE YARD
f'‘i. 54/
FRONT SETBACK / Z
FRONTAGE
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 • ‘�0
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:
� �C-Y c✓i ,
Location of Facility: ���/� sr � To 6 � `/?y �
The debris will be transported by:
Name of Hauler: /1174 -?2 Z%vis ✓1'�a,vT o,c7
Signature of Applicant: Date: / / g 2
•
, The Commonwealth of Massachusetts
Department of Industrial Accidents
...., ,
tp 1 Congress Street,Suite 100
Boston, AR 02114-2017
wwocmass.goWdia
Workers'Compensation Insurance.Afridavit: BuildersiContractors/ElectriciansiPlumbers.
10 BE:FILED WITH THE PERMITTING ALTHORITV.
Applicant Information Please Print Legibly
Name(BusinessiCliganizatiort Individual 0:
Address:
City/State/Zip: _ , , Phone#:
Are ion:Or eraphr.,et?Cheek the appropriate fro t: Type of project(required):
1.0 I am a employer with employees troll and'or pini-time I' 7. pi New con.structi
2.0 I am a auk profanes:a or partnerthap and have no employees working for Frac in 8.. [3 Remodeling
any t.-apacir 2,[No workers'comp.insunince required]
9. Ell DettiolitiOn
.1.0 1 am a homeowner doing all work myself.[No workers corrc insurani.v required.]s
i 0(3 Building addition
4.E1 I aut a homeowner and will be harms:matadors to conduct all%IA(on any patsperty. I will
ensure that all ractors either have woirkers'Orptrurt ataarasli.V Or are Sok I ICI Electrical repairs or additions
pi:mu:dots with nu employees_
i 2..0 Plumbing repairs or additions
3C1 Ism a grnscral cuatraclOr and I have hired the sub-eonrractors listed on the auached sheet.
These 44th-contractors have employees and liae*urieri'comp.insurance.: 110 Roof repairs
14.0 Other
6.1p Vie are a tharporation and its officer,have esdctsLsi then nista of eiterrzptitat per!WA c.
l 52,..§It 41.and we&lit tao :....e,.[No winters'comp.insurance required.]
'Any applicant that cheeks box 41 aiL.. _,:fill out the section below showing their waiters'compensation policy information.
*lionaciawraers who submit dui affida,it imiacalany the are doing all work and then hue outside contractors rraka submit a new affidavit imdieamtg such.
:Contractors that check this box must attached air .1,1711UEllii 11,...vi.-loing the name irf the sub-contra,:kr,and,thit whether or not those entitie$has c
oriph.l:VCCS, it the lob-contractors NA.r. L-mplu.ers,they rnuN1 pro id e their worker,'...%,inp puitc:.nitratxr
I ant an employer that is providing workers'compensation insurance for my employees. Below is the polity and job.site
information.
Insurance Company Name:
Policy#or Self-ms.Lie.#: 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 rue rage as required under NIGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00
and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to 5250.00 a
day against the violator.A copy of this statement may be forward,:d to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify and the pains and penalties of perjury that the in formation provided above 1.1 Sr e and corrert.
Signature: I Lite: /4/5"-- '7-2—
/------
Phone.. • ----
I
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 if:
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