23A-136 BP-2023-0022
25 MAPLE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-136-001 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-2023-0022 PERMISSION IS HEREBY GRANTED TO:
Project# EGRESS WINDOW 2022 Contractor: License:
Est. Cost: 10000 LOUIS MONTGOMERY 013471
Const.Class: Exp.Date: 11/19/2023
Use Group: Owner: KELLY THOMAS F
Lot Size (sq.ft.)
Zoning: URB Applicant: LOUIS MONTGOMERY
Applicant Address Phone: Insurance:
PO BOX 951 413-268-2028
WILLIAMSBURG, MA 01096
ISSUED ON: 01/06/2023
TO PERFORM THE FOLLOWING WORK:
INSTALL EGRESS WINDOW IN BASEMENT
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 VI I LATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
ECEIV : �)
The Commonwealth of Massaghu ettsQN - 6 2023
izI
j Office of Public Safety and Inspections
Massachusetts State Building Code(780 RPEPT OF BUILDING IN SPF lON
Building Permit Application for any Building other than a ne=--or �PBiily Te g$
(This Section For Official Use Only)
Building Permit Number: 3- 804 Date Applied: Building Official:
SECTION 1:LOCATION
ZSM4plQ Sr N 'to ►v D/DyZ.
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration $ Addition 0 Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No jEZ
Is an Independent Structural Engineering Peer Review required? Yes 0 No f ffi
Brief Description of Propose Work: 2�s7 /i,-,7? /_7 c//LC afs G�1 nr fvuJ l N /S Q,l'C ��T
6fl��oowi .�X UC .
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 ❑ A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4❑ H-5 0
I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile 0 R: Residential R-1(sj R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2❑ U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA ❑ HE CI IIIA ❑ IIIB 0 IV ❑ VA 0 VB 0
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information Sewage Disposal: Trench Permit: Debris Removal:
A trench will not be Licensed Disposal Site 0
Public W Check if outside Flood Zone 1S Indicate municipall8 required❑or trench or specify: /\G`iQ
Private 0 or indentify Zone: or on site system❑
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable p Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No Jill Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: • Special Stipulations:
Design Occupant Load per Floor and Assembly space:
r„,i.,:r..,...,.„ ,,
, ,.._,, .<A
City of Northampton
:r r
Massachusetts _. ';
* 'c
DEPARTMENT OF BUILDING INSPECTIONS S °
�' • ` 212 Main Street • Municipal Building 6 ti�
Northampton, MA 01060 ,,pc 1.
•
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL &
MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS
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 & Hard copy).
3. Site Plan with location of proposed structure(s) and setbacks.
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 CSL and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (if applicable).
8. Note any Conservation and/or Special Permit requirements (if applicable).
9. Driveway Permit (if applicable).
10. Proof of Water and Sewer entry fees paid (if applicable).
11.Trench Permit (if applicable).
12. Initial Construction Control Documents filled out and signed by the Registered Design
Professional in responsible charge.
13. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton
OwnerSECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property 744,'r,aS /(.t 1 ie y 2 S "/../ /,-s T 1/4 .0...<.-r c 2 01 c'c L
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
I�A/O14/4 S /cam//€ z� ,,,J,,2 _27- �IOK.e../c r4tr l O/ z
Name Street Address City/Town State Z'
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit pplication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Ex ' ation Date
10.2 General Contractor
/n X J- h1/ /1..e ref/t. )w/e12/`vv/s rk/o,..T&,iu'/AOS
Company Name
L.o v'S' Rid/Y T(,5(D
Name of Person Responsible for Construction License No. and Type if Applicable
3`I Az. e7, c, A r t7,if 124/ w, ///4 /3u,.. , �/a
Street Address City/Town State Zip
q-7.4b'- zv i y/ - --z_- O/4 0
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildng permit.
Is a signed Affidavit submitted with this application? Yes 0 No '®
SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ /(J/ GO U
Building Permit Fee=Total Construction Cost x_assert here
2.Electrical $ /.j appropriate municipal factor)=$ .
3.Plumbing $ /tl 4 4.Mechanical (HVAC) $ iv/jl
Note:Minimum fee=$ !11nU1 (contact municipality)
5.Mechanical (Other) $ /1///`1 Enclose check payable to
6.Total Cost $ /if dab (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I her.y attest under the pains and penalties of perjury that all of the information contained in this
application is true and a ram.. - •: • . y knowledge and understanding.
dolor-
la c-',s /1e04,7-> .,=•.t..7.pi/2rrw ey7,A/0/2,M /2,2S q/s_lc Z O,-Lk'
Please tint and sign name Title Telephone No. Date
Piill w/1//4 IS/30i17 /Mt' __d /ac/<'
Street Address City/Town State Zip Email Address
fill out this section upon application a royal: ✓ /2 /" G ZvZ3
Municipal Inspector to p pp pp
Name Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
ir
l � 1 �'o
5�
/Z
SIDE YARD SIDE YARD
''Iv
601
Kqw' oc
QPS�' toy' P (�
W i Nt tomtigo tes5
FRONT SETBACK
FRONTAGE
City of Northampton
�Massachusetts 44
DEPARTMENT OF BUILDING INSPECTIONS tt
212 Main Street • Municipal Building
Northampton, MA 01060 s91'4
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: /V/4
Location of Facility:
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Q, 1 Congress Street,Suite 100
Boston,MA 02114-2017
•
www,ntas.s.govidia
- %Vat-kers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTFIORITV.
Applicant Information Please Print Letiblv
Name iBusinrss Organization.individual 0:
Address:
City:State/Zip: Phone#:
tre you an employee!Check the appropriate hot: Type of project(required):
I.D I am a employ's-with ertie**tVY(full:wads part-tunet.' 7. a New construction
2..D I am a wile propnetor or partnership and have no employees worksisg for me in 8. 3 Remodeling
an2.capacity.1No WOrkeTS'comp.insuranor required]
43 I ama hurnanStier doing all work myself.[No workers'corm,unurance required]' 9. U Demolition
I 09 Building addition
4.0 I am a homeowner and will be&roil;contracturs to conduct all work on itry property. I will
ensure that all contractors either has,e workers'Centrem.3.31aon insurance Ot aft auk I 10 Electrical repairs or arlditions
proprietors with no employees.
12.0 Plumbing repairs or additions
%j I ara a general contractor and I have hired the tub-contractors hated on the attached sheet.
-anee. 3.0 Root repairs
ilcs4:sub-contractors Pose employ el,^Y Ind c workers'comp.ilblit :
I 4.El Other 5,os.tmov 7-
We are a corpus-4nm and it3 officers have exercised their right(:=1 eterciption per MIGL
152.§lr4i.and we base no arsployces.[NO*arkers'comp.insurance requuesii ef" 4,12 1W-titrk.")
'Any applicant that checks bit al must also fill out the section below showing their workers'compensation policy information
t Homeowners who submit thai affiam it indicating they are diming all work and then hire outside contractors mail Auhran a new utiid.ii itindiLaing
:Contractors that check this biritilLig attached an 24(1.1thinni*heel ihowing the name of the sub-contractori and state v.hether or riot rhos.:enntie-s
ortplo...‹..: It the Aub-c ontractins base cat 'I I itS th,.i ento.lrio,,ide their Workers'Ci irir ItI 1.. nuaribcr
I am an employer that is providing warier%'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Nante:
Policy#or Self-Ms.Lic.#: • Expiration Date:
Job Site Address: CitylStateeZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL.c. 152, §25A is a crun mai violation punishable by a tine 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 fine of up to$250.00 a
day against the violator.A copy of this statement may be tirwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certif.) under the pains and penalties of perjury that the informaliOn provided above is true and correct
Signaturc: /ZSL kt./ 7,7"/ Date:
Phone;•:.
Official aVe will. Do not write in this area. to be completed by city or town officiaL
City or Town: PermittLicease
issuing Authority (circle one):
; I. Board of Health 2.Building Departures( 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing inspector
6.Other
( outset Person: Phone 4:
r .
Initial Construction Control Document
It',,,\'., /..:1
t,i ,
To be submitted with the building permit application b - a
Registered Design Professional
r` for work per the ninth edition of the I
Massachusetts State Building Code, 7S0 CMR, Section 107
Project Title: Date:
Property Address:
Project: Check tx)one or both as applicable: New construction Existing Coast 'on
Project description:
I MA Registration Number: Expiration date: ,am a registered design pro fessinal,and I have
prepared or directly supervised the preparation of all design plans,computations and specifications concerning :
Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Buil g Code, (780
CMR), and accepted engineering practices for the proposed project. I understand and a�that I (or my
designee)shall perform the necessary professional services and be present on the construction Site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, s ples and other
submittals by the contractor in accordance with the requirements of the construction d ents.
2_ Perform the duties for registered design professionals in 780 CMR Chapter 17, as applic ble.
3. Be present at intervals appropriate to the stage of construction to become generally '''ar with the
progress and quality of the work and to determine if the work is being performed in a consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)togeth with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a 'Final Construction Control Document'.
Enter in the space to the right a"wet" or
electronic signature and seal:
Phone number: Email:
Building Official Use Onhj
Building Official Name: Permit No Date:
Note 1.Indicate with an'x'project deli..u plans,computations and specifications that you prepared or directly supervised If'othe: 13
chosen,provide a description.
Version 41 01 20 13
Appendix 1
Construction Documents are required for structures that must comply with 780 CMR 107. The
checklist below is a compilation of the documents that may be required. The applicant shall fill out
the checklist and provide the contact information of the registered professionals responsible for the
documents. This appendix is to be submitted with the building permit application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
1 Architectural
2 Foundation
3 Structural
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing(include local connections)
9 Gas(Natural,Propane,Medical or other)
10 Surveyed Site Plan(Utilities,Wetland,etc.)
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Access Review(521 CMR)
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified
must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the
authority having jurisdiction.
Registered Professional Contact Information
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address
Registration Number
Street Address City/Town State Zip
Discipline Expiration Date
Please follow this link for construction control forms to be used by Registered Design Professionals.
From:
�e,-/v/S /1'706,/6.d Yi1, ,fig �r /J J
To:
Jonathan Flagg
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10, I request that you
grant a modification to waive the requirement for construction control of the project at
?S ,44,4/,)/Az s' T ,-7,..) C wr y
because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire
safety, and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,
r#72 r u// Y 71 /.)2i 7� P/2 S ��