36-048 (4) B -2023-0014
28 WINCHESTER TERR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-048-001 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-2023-0014 PERMISSION IS HEREBY GRANTED TO:
Project# BASEMENT RENO 2022 Contractor: License:
Est. Cost: 76342 LUX RENOVATIONS LLC 047809
Const.Class: Exp.Date: 07/22/2023
Use Group: Owner: BAKER CORIE E
Lot Size (sq.ft.)
Zoning: WSP Applicant: LUX RENOVATIONS LLC
Applicant Address Phone: Insurance:
60 SHAWMUT RD 781-821-0060 XWS57350449
CANTON, MA 02021
ISSUED ON: 01/09/2023
TO PERFORM THE FOLLOWING WORK:
BASEMENT RENO
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:
l Final: ;:.. Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Roughc: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VI I LATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
' +�' >0 • CI ``J
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Fees Paid: $496.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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The Commonwealth of Massachusetts'' `�q , , ";';;
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Board of Building Regulations and Standa#dk �. 'Mlilstl%4ALITY
.. r Massachusetts State Building Code,780 C ,,•G� �O / US),
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Building Permit Application To Construct,Repair,Renovates tz.,. olisliV R`evised, ar 2011
One-or Two-Family Dwelling '';��ca 1`
This Section For Official Use Only �°i0 rit-7\I'
Building P rmit Number: Date Applied:
�Ji, ) e ��i,2 1-Gizvz3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1Property Address: 1.2 Assejsors Map& Parcel lvj�nber-,F.j
1.1a Is this an accepted street?yes t/ no Map Number Parcel N umber
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 Waterr Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public E Private❑ Zone: _ Outside Flood Zone? MunicipalerOn site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
e//L1 f3ifk"r12 s �7 SZRFnArt.cwleZ 43,2514 a r1Pev. ,1114. e4-6
Name(Print) r City,State,ZIP
2g6.4; %e ;erz.. V/3.626's0S—
No.and Street Telephone 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) �(f
Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 7Z'she Ovf 0i</STANq w.-c. S # elt/ ' __Z-0(-)
i'y7 4 (2e-8A.1 / �r--i sr --c /C" t. '. eav w�uwt ee-2.z%�ew l
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ‘2ei 4,.._ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
6,3YZ ❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ /0 '`''' 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No.1C4 Check Amothqqii
6.Total Project Cost: ‘.,3 1-2.' ❑Paid in Full 0 Outstanding Balance Due:
City of Northampton 19
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Massachusetts / ? .
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DEPARTMENT OF BUILDING INSPECTIONS �Q� •
212 Main Street • Municipal Suil� � iis„
Northampton, MA 01060 _ °T Ai
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QI77341,
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414 o oso—At
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR I OWS,
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 specifications 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. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction(Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5,1,—C nstruction Supervisor License(CSL)
Yst-d 9 •2z-23
4�-c i✓.4q�4 License Number Expiration Date
Name of CSL Holder f nn
/36' 2/07I- ST List CSL Type(see below) U`
No.and Street Type Description
ivei//'S Ill/4 , G2e.Sli U Unrestricted(Buildings up to 35,OCO cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP _ M Masonry
�li®XI 0114/4+ D &C S`& 1. ce,- RC Roofing Covering
WS Window and Siding
7 / 8o f'e4�y J SF Solid Fuel Burning Appliances
T` I Insulation
Telephone Email address D Demolition
5.2 Registered Home hnproveme t Contractor(HIC) i 3 -�y3 2A74.3
HIC Registration Number Expiration Date
HIC paiwName or HIC Re •.. *' 1..i41 t Name
600 0 .
•e�'S�ru_
� �
No.ands;/treed �, a2d?( �r�'� �('a6t6L Email address
City/Town,State,ZIP Telephone i
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 Issuuance of the building permit.
Signed Affidavit Attached? Yes 11rnc 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 ` 8.-r.L6I�`.—`
to act on my behalf,in all matters relative to work authorized by this building permit application.
1- r'' 23
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I her atte under the pains and penalties of perjury that all of the information
c nti.ined in this application i o the best of my knowledge and understanding.
aC-19-- 4 /- s 23
Print Owner's or Authorized Agent's lectronic 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.2ov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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
Department of Industrial Accidents
1 Congress Street,Suite 100
4-1
Boston,MA 02114-2017
WWW.mass.govidia
'Hi'orkers*Compensation Insurance Affidavit:BuildersiContractorsiElectricians/Plumbers,
1-0 HE FtLED WITH THE PERMI Et IM; l
Applicant Information Please Print Legibls
Name (lino mess:OrganaLttion Indrvidnal):
Address: 40v441.7—City/State/Zip: ePrivita,-(-),. fir/Pr ?e'2 ( Phone #:
Are you aft employer?Cheek the appropriate hot: Type of project(required):
I.C1.1ra-rit tttttployer watt entathoyees;fail anitor rart-tintet.' 7. U New construction
2E3 I am a oak proprierim or partrierthip arid have ao employees:Wurkino for me ir; 8. Cakeinodeling
&112,elpscay. woistis' mama required]
9. Ej Demolition
30 I am a hornanwrier doing all work myself[N orarkers'comp.irsarante rcomartil]
10 Building addition
4.0 I am a homeowner and will he hosing contramorit;a conduct all work on my pit iperty. t Will
en-slate dtatallOi..vninmura either have Watiketl",.-atr4va..1,21atAt rititataftet or 110Electrical repairs or additions
proprietor:a with no employee&
12_0 Plumbin repairs or Additions
am a general contractor and I have hired the arab-contructicint hated tic the attached them.
Th s
em outtoenntractioro have employeea and have workers"corm.intarranca 31:j Roof repait
1, 4. Other
We are a amporanon and do officers have exercised thee tight at exemption per Nttat.
151.:§1141k and e hate itn employee&[No workers'camp.alai requoveill
*Any applicant that cheeks bat vl mum Ain till oat the wawa below oh-owing their worker&curapentedijm plaulo infialtiatirn
Homeowner ho areithiatt duo affittaalt moticating May are&nag 111WOrk and then hire eutaide contractara intat aiihroat a Ite.ot a Ludt...2E1:y „A,
4analtact4a%that check limo hex meat attacheil at,asktiwittat abed hoiv.,Ma the name of the aulammtramort amitraie wIttittlar or not thow..‘qtlAte:,..k.
cropieaveL,.,,,, ET the shhaimittraetara tilltritV«tea,the tavd.s1 pro,Os.:this..117 44AI-cm puficy itiatther
Jam an employer that Ls providing worhers°compensation insurance for my employees.. Below iS the policy and job site
information.
Insurance Company Name: <O.44l• (7•11g,SPrr-tr(j,--
Policy#or Self-ins.Lie. #: 4/1413 5-4.35-aa-V557 Expiration Date:
Job Site Address: 2e- kubve-A e-STer City:statezip: Nak-74%c•-•411\
Attach a copy uf the workers'compensation pulky declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MCI,e„ 152, §25A is a criminal violation punishable by a tine up to$I,500.00
andior one-yeat imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
co
a
hei‘fr.ley-certify a Cr the pains and penalties of perjury that the information provided above is true and cotTed.
• -
Signature: Date: - 23
Phone tt: (. doe&j,
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.CityTown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('outset Person: Phone AL:
City of Northampton
,,.... s
Massachusetts ��' '
P DEPARTMENT OF BUILDING INSPECTIONS �g
212 Main Street • Municipal BuildingyQ, ,
�� Northampton, MA 01060 -w`;�Q."
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: - � '` -MG'``P02
ctrt
Location of Facility: �' i'-v__S
The debris will be transported by:
Name of Hauler:
!^ 2
Signature of Applic Date:
City of Northampton
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Massachusetts .-'
a/ fj L �'
V\ DEPARTMENT OF BUILDING INSPECTIONS;.�� 212 Main Street • Municipal Building >'ate Northampton, MA 01060 g j‘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 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 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)
Baker,Cone
Szafranowicz,Dan t
I 28 Winchester Terr Customer Name{ _ Customer Signature
�NS Florence,MA 01062 —
SKETCH Contract Dated 413-626-5175 Sales Representativ Signature
CORNING - ATTACHMENT Customer Phone. — Contract Price > 7,4 3VZ.
1 2 3 4 5 6 7 8 9 10 I1 12 13 14 15 18 17 19 19 20 21 22 23 24 25 26 22 28 )9 30 31 32 33 34 35 38 37 38 3 40 41 42 43 44 45 48 47 48 49 50 51 52 53 54 55 56 57 58 59 60
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u NOTES: 'Each box equals one foot unless otherwise noted.This sketch is a good faith
representation of the work to be done,it is understood that all dimensions
derived from this sketch are approximate,and that all locations of outlets,light
fixtures,plugs,jacks and/or switches are subject to change if necessary.
Owens Corning Basement Finishing Systems
CORNING
of New England
Baker,Cone
Szafranowicz,Dan
Contractor / Agent Authorization From 28 Winchester Terr
Florence,MA 01062
413-626-5175
I, 57 cr .. c:, roc authorize Owens Corning Basement Finishing
Systems of Boston to sign the building permitapplication on my behalf, to perform the work at:
lot e �/ p ok
Home Owners Signature: /
Date: S a,
Q .. 1
Project Manager Signature: ) a
Date: / 5 -
60 Shawmut Road • Canton, MA 02021 • Phone: 781-821-0060 • Fax: 781-821-8552 • www.ocboston.com
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Supplement Carc
I I IX RENOVATIONS,LLC. Registration: 137943
DFE/A OWENS CORNING EASEMENT FINISHING SYSTEMS OF NEW Expiration. 02J04/2023
ENGLAND
60 S>-A 4tfr RD
CANTON,IAA C202-1
Update Address and Retur
of consumerAriaacs&Business Regulation
HOME iiMP OVEmailfr CONTRACTOR Registration valid for Individual use my
Rtgkliation before the expiration date. tf found to:
1379:3 0?/04/LiJ23 Office of Consumer Affairs and Bus Regulation
LUX RENOVATIONS,tir 1000 Washington Street -Suite 710
Boston 1!A 02118
[1S1A OWEN S coRNi1G BASEMENT FINISHING SYSTEMS OF
NEW ENGLAND
FETE MONAGI-Lm
60 SHAY JT fzD `"f""
CAKTON MA 02321
Undersecre y Not without signature
Commonwealth of Massachus tts
•
•
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Division of Professional Licen ure
Board of Buildin•
g Regulations and tandards
Constructio ` !�.1 & 2 Family
CSFA-047809 f, 6cpi es:07/22/2023
PETER M MONAGHAN' 3, r
136 RIDGE STREET
MILLIS IV 02g54 ;4t �! *�
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Commissioner 1 c l fi. tlCmciea�
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Basement Draftstop Detail
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