35-249 (5) BP-2023-0496
11 LADYSLIPPER LANE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-249-001 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-2023-0496 PERMISSION IS HEREBY GRANTED TO:
Project# Contractor: License:
Est. Cost: 30000 ALFRED EDMONDS CS-111927
Const.Class: Exp.Date: 12/09/2023
ROCHELEAU, ANN MARIE K. &KELLEY,
Use Group: Owner: MICHAEL T.
Lot Size (sq.ft.)
Zoning: WSP Applicant: A B EDMONDS CONSTRUCTION
Applicant Address Phone: Insurance:
127 SHELBURNE RD (413)535-8814
GREENFIELD, MA 01301
ISSUED ON: 04/27/2023
TO PERFORM THE FOLLOWING WORK:
BUILDING 28'X10'DECK ON REAR OF HOUSE
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: 0
,)444 411ACO
Fees Paid: $195.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
XT •2yXi 1 (zi9 ,,E)4ety
File #BP-2023-0496
APPLICANT/CONTACT PERSON:A B EDMONDS CONSTRUCTION 1 •Z D�Z
127 SHELBURNE RD GREENFIELD, MA 01301 (413)535-8814
PROPERTY LOCATION 11 LADYSLIPPER LANE
MAP:LOT 35-249-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $195.00
Type of Construction: BUILDING 28'X10'DECK ON REAR OF HOUSE
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
X Approved 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: §
Finding Special Permit Variajnce*
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 P tability Board of Health
Permit from Conservation Commission Permit froth CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
IT . . i-vd..7/;,3
Sign ture of Building Official f 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 public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standa s of MGL 40A.Contact Office or
Planning&Development for more information.
h,
The Commonwealth of Massachusetts
U i Board of Building Regulations and Standards MUNICIPALITY
Massachusetts State Building Code, 780 CMR FOR
USE
Bui�dtjg Permit Application To Construct,Repair, Renovate O`r Demolish a Revised Mar 20 1
o One-or Two-Family Dwelling
w This Section For Official Use Only
Building Permit Number:13P Zo2.3— p tf Cj(. Date Applied:
I gc. ,
,, , . .. 4i
Building Official(Print Name) Signature i , Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
(I ladle;pFer (4k0. g6-2AR -00 1
1.1a Is this an accepted street?yes J` no Map Number Parcel Number
1.3 Zonin Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) 1 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 fit, Private 0 Zone: _ Outside Flood Zone? Municipal% On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Name(Print) City,State,ZIP
1
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) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other K Specify: G K
Brief Description of Proposed Work': rt 0;10:‘,1 9i 'x V)• (.1-So Sc) Oec_l<
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 30 DOD 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ / 0 Standard City/Town Application Fee
— .__ 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire C4
Suppression) $ Total All Fees:$ i i
co
6.Total Project Cost: $ Check No. o�q2 Check Amount:19yJ Cash Amount:
30100 0 IS Paid in Full ❑Outstanding Balance Due:
City of Northampton
.Not-pi,.,. .
Massachusetts r:_ fto..
DEPARTMENT OF BUILDING INSPECTIONS
' 212 Main Street • Municipal Building ,.�'�
'+1'5.,. �r Northampton, MA 01060 pis i', TO
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 SERVIC4S
5.1 Construction Supervisor License(CSL) (5' I I q 2' 1 2
ir
e ofCS \,6 Mp. SLicense/Number Expirati nDate
me of CSL Holder //
Kd. List CSL Type(see below) U
/11 s11e1hr�
No.and Street K Type Description
�r r ev f e1 J / U l3O I U Unrestricted(Buildings up to 35,000 cu. li.)
(�J C /1 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF So id Fuel Burning Appliances
! 3-5-3b„i$(4 I Insulation
ulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 2 .�
I9O�67
HIC Registration Number xpir tion Date
HIC Company Name or HIC Registrant Name
q�i �l�dI j r ,I •c(IA
n
No.and Street Email a s
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 J- 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�4 ��1/.4)to act on my behalf,in all matters relative to work authorized his blding permit application.
MiXe (ifilt9
Print Owner's ame(Ele onic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjuty that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
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 S 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 `OO t
SIDE YARD SIDE YARD
Z
FRONT SETBACK
FRONTAGE
City of Northampton
;.i,„
�� Massachusetts �? '�-.
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building #.A. ,
--" Northampton, MA 01060 3' ,. \''
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: '
Location of Facility: Vol1/el
2 eC( GI iv1
The debris will be transported by:
Name of Hauler: I
Signature of Applicant: Date: 3__!/_/14/.
The Commonwealth of Massachusetts
,.. Department of Industrial Accidents
1.....,04.11....
Tratifti I Congress Street,Suite 100
---
Boston,AL4 02114-2017
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Workers' Compensation Insurance:liffidavit:BitiklersiVeiitractorsiElectricians/Plutuliers.
ID RE Ell ED MIII1Ttic PERMITTING AVTIIDR1fV,
Applicant I itiorniation Please Print Legihis
Name 4 attittliess:Orgastization,Ituits,!dun'. tt2 Eil,. .,,,,,,,d&,,,,,.. 021,5'1r,)c't,
Address: 127 SLetbo
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cityistatezzi,6,,,,,,A4, A44. 0:00j.„___.. . ion, -
P1 - - ., (i15 -5 55 ig 1
Are you sto employer?Chttit the Applvforiativ bot! Type or project(required):
I 0 I am a eintiktitv ts-tth ( itimihrweits(full miler part-time:Lt. 7. E3 New construction
1 WU a auk pratitiehar tat pribiterahip anil hatie atti empritapaca working tier ase in 8. 0 RctriOdOiirit;
any earweity„Nu warblers'ecanp.ciedirant* idoeiced„I
9. ID DeltlidlillOrl
30 l ant a Moneoe nes dour8 all work tityndif.[Nd wadies"emir trouratir.V rt.tuttol.r
to 0 Building addition
4E]I am a humeetitner and IA ill 1,.0 61108 Wait Ueliati ID eadditet all WAStk an my ploperty, I will
climate that all eineraLlUtti either base Wenireri4 COMPOIA311011 EISSIanila.Or aft'WIC 140 EIL-ctrical repairs or additions.
prionciais with nu employeas.
I 10 Plumbing repairs or additions
sal=a marcral I:roar-actor nail basic hired the subwmatiactors hated cm the anatehed sheet_
I 34:3 Roof repairs
These atib-tunitractois Vase employee and has e*token'comp.itinOrniacc.
14,—Fkli.lithei 1. •cl..<
Wc arc a,OTTXT2ILICIt and ill,isfiketa base exercised their rigid of cadetilibuit pet?AC&c.
3.'51 t.•II Si,and or trooc no empluyers..[No"%uric:1'camp,.itsurance roparrat
$ $
*Any appiteam that checks how 0 I nand Moo rill tort tfic wet:thin tic:km shit-wing their workers.'ethimciastition poky taidematuart,
t Riatheinteners who saileam this atlidas it thilicamar the)art deaug all work and than hire auto&evattirataitis atuiat aubritit a dete affidavit traticaung stxh.
ICiatatitacturs that cheek this box must Attached an additturtal sheet elineeelp the Mane of litc tails.ermiracletorned Mere Whellicr ce nut dame sat:hues hase
ctriploycc,. If the suit-etadraetitirs base tniarikwects,the!,must prusitle their wititers-...shim.ritlidy number
1 111/4 an employer that is prodding workers°compensation inshiance far toy entployeet Below is the policy anti/ob site
information.
Insurance Conmany Name: _
Policy Or or Self-in .Lic.n: Expiration Dale
Job Site Address: CityState'Zip:
Attach n cop of the workers'compensation polity declaration page(shelving the policy number and expiration date).
Failure to secure coverage as required under MOE c. 152,§25A is a cnininal violation punishable by a fine up to SI,500.00
andior one-year imprisonment.as well as civil penalties in the foam of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator. A copy of this statement may be forwarded to the Office or Investigations of the DIA Ibr insurance
cOVerage verification.
_
I do hereby c Pi('s ander the pains and penalties of perint that the information provided above Is true and correct
-1.------------- it Lib 9/2-3
. Signature.
Phone r!' Z1 )3 SZ 5 — 56S If
Official use only. Do not write in this area to be completed by city or town official
' City or Town: Permit/License A
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.C:try/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
: 6.Other
Contact Person: Phone ii:
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