38A-004 (16) BP-2023-0662
2 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38A-004-001 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-2023-0662 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 BATH Contractor: License:
Est. Cost: 15000
Const.Class: Exp.Date:
Use Group: Owner: WOODFIN ELIZABETH &DEIDRE CUFFEE-GRAY
Lot Size (sq.ft.)
Zoning: URB Applicant:
Applicant Address Phone: Insurance:
ISSUED ON: 05/19/2023
TO PERFORM THE FOLLOWING WORK:
BATH 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:
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:
‘,2 .(3)
Fees Paid: $97.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
4
The Commonwealth of Massachusetts
_ ° Board of Building Regulations and Standards 1 FOR
Massachusetts State Building Code, 780 CMR MAY 1 $ MUNICIPALITY
_ 2023 USE
Building Permit Application To Construct,Repair, Renove O r Demolish a Revised Mar 2011
One-or Two-Family Dwellingr-7-or�ol` ,�" ----- ---�
r ,C;INRp;^TIOi g
This Section For Official Use Only MA 01060
Building Permit Number:& 2 • to). Date Applied:
IC . /ce -9, I lb 5 _
Building Official(Print Name) ( Signature Date
SECTION 1:SITE INFORMATION
1 j Property Addr 1.2 Assessors Map&Parcel Numbers
2- &>^ Q+ Rd,N .12
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: II
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
ZjAlyvnerl of Record-:.
ialoau 1,00 it,,..;, De)kir 6.*-4-a) Nv l,ta„..„(-Am", MA v l o‘:,o
Name(Print) City,State,ZIP
2 5 -5 gk RA (A13)034.t L41o1 ,Cbw,
No.and Street Telephone Email Ad ress
SECTION 3:DESCRIPTION OF PROPOSED WORT 2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
o
Brief Description of Proposed Work2: — MO Y`t'_ 10. ,knn Y 1 D 'e - ail 05 i 12 p C gmA
— tiAO V CIO wa V1 -h Mzi)+l I tnA `-}-t)Gca--
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
AIM $ I ZU D 1. Building Permit Fee: $/1,5 Indicate how fee is determined:
0 Standard City/Town Application Fee
$ D 06 0 Total Project Costa (Item 6)x multiplier x
110.1111 $ 1 4(8 U v 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) Total All Fees: $ y7 sd
$ eck No. a/A Check Amount:
SI DOO Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts : "<
4
*, DEPARTMENT OF BUILDING INSPECTIONS
°
212 Main Street • Municipal Building _rC1�
, Northampton, MA 01060 k11�
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 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.
/
I
SECTION 5: CONSTRUCTION SEP1VICES
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.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP 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)
I-IIC 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 AFI'IDAVIT(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
I,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 Signature)(Electronic Date
SECTION 7b:OWNER'OR AUTHORIZED AG61--
DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
conta. d in this application is true and accurate to the best of my knowledge and understanding.S( 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 Numbe of decks/porches
Type of cooling system Enclose Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Contntonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.goildia
1$utkers'compensation Insurance Affidavit:Buildersit'ontractorviElectricians/Plumbers.
Itt Ht.FtLED With THE PLICSIIITINt;Atrf1401(111`.
Annlicant Information Please Print Leei his
Name(BiThinzss,Organs intim individual}:
Address:
C State/Zip: Phone
Are yin'ars employ et?check the a pprupriate hat: Type of project Irrquired1:
10 I am a employer*WI ern:Moyers(full and-or part-tianer• 7. 0 New construction
am a sole rtlpnetor or purtnerstup tout have ma ernployees woriang foe me in 8, 0 Remodeling
any 1,. pacity,[No*utters'comp,utsurance roomed I
9_ 0 DentaillOn
rammosta..3.1:1 I am a hortrcowner doing Ail WV&myself,INo workers'comp,annoranee turd)
10 0 Building addition
-1.V I am a learneo*.ner and vall bc borne contractors to e'er:Mud.all*lark IM my property. 1 wall
rA
;molar that all Wittracturs either hare workers'compx-itsatkv insurance irr are sole II 1:1 Electrical repairs or additions
propnetors*ids no employers,
1_.D Plumbing repairs or additions
10 I am a rencral contractor and I Ivor hued the aub-cuntraelun.toted on the attactird sheet
1 3_E]Root repairs
These lub-cuntracton Isa,,,c employers and Issi.e workers'comp.insurance.:
14_00ther
n,E]We arc a oinpurauon and its officers have exaosed their natal ot exemption pre MCA_
152,§ (11.,and no anployera.(No*orkers'comp,inaorance tegurred,t
'Any applicant that citsvIcs box ul must also fill out the section I•elov,shy*trtv then conipensation',Alley La tveinahon
Illumooscrten who submit dm affalakIr vadat:ming they arc dlru.J11'A Irk and theta hue411.1h1LIC 1Am-tractor,ITILrot s 111711111 a Dew affidav it mtheaung such
!Contractors that check tho bGx must:1C144:111:4.1 an thactiwatul fthcct in g the name of the stab-contractors and gate*hotter or mat riknit entait.'s KIVA!
If the st,..h-coniz Jaws bass employ rei, must pro..id,:thc ir =0, niartho
an.an employer that iS providing piwrAers'compensation insurance for my entployees.. Below is the policy and job site
Information.
Insurance Company Name:
Policy#or Self-ms. Lic. #: Expiration Date:
Job Site Address:
Attach a copy of the workers'compensation policy declaration page tslmwing the policy number and expiration date).
Failure to secure coverage as required under MGL e„ 152,§25A is a criminal violation punishable by a fine up to SI.500.1)0
and/or one-year imprisonment.as well as civil penalties in the corm of a STOP WORK ORDER and a tine sirup to S254.1.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage N.erification.
1 do hereb• - tify under the pains and penalties ofperfury that the information provided above is true and correct,
11111.11 511812.03
Official use only. Do not write in this area,to he 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
(',intact Person: Phone#:
City of Northampton
(1—
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Massachusetts ��"s`' _ `'e,;.
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DEPARTMENT OF BUILDING INSPECTIONS 1> h.
` 212 Main Street • Municipal Building '»�;. na,,
"--" Northampton, MA 01060 PSi�y �tA.
T
(FOR ALL DEMOLITION AND RENOVA JECTS)
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: Via v,P,. Rizc )(1,t1
The debris will be transported by:
Name of Hauler: C o rT 56/a-4,324/ _
i
Signature of Applicant: �---- Date: S iA acna3
a
City of Northampton
,__..:p s
7 �,, N
Massachusetts �? `c
,ItDEPARTMENT OF BUILDING INSPECTIONS ;
' 212 Main Street • Municipal Building
$';
Northampton, MA 01060
HOMEOWNERS'EXEMPTION EL IGIBILITY 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.
Sign the pains and penalties of perjury on this day of , 20_.
(Signature)
56"
shelves/ Shower: 36x36
hooks
Ceiling Height: 7'5"
17.5"
72"
19 1/8"
Wall Mount
r \ Toilet
12"
12"
32" Sliding Barn Door