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43-041 (6) BP-2023-0650 58 AUTUMN DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-041-001 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-2023-0650 PERMISSION IS HEREBY GRANTED TO: Project# ADDITION Contractor: License: Est. Cost: 21000 J C PRATT BUILDERS 061401 Const.Class: Exp.Date: 04/14/2025 Use Group: Owner: H MARTIN BRUCE S & SOPIE Lot Size (sq.ft.) Zoning: WSP Applicant: J C PRATT BUILDERS Applicant Address Phone: Insurance: 43 MONTGOMERY RD (413)568-4246 SOUTHAMPTON, MA 01073 ISSUED ON: 05/30/2023 TO PERFORM THE FOLLOWING WORK: ADDITION OF 12X14 3 SEASON PORCH 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: 52, , 1F • Fees Paid: $137.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Z - ak File #BP-2023-0650 APPLICANT/CONTACT PERSON:J C PRATT BUILDERS 43 MONTGOMERY RD SOUTHAMPTON, MA 01073 (413)568-4246 PROPERTY LOCATION 58 AUTUMN DR MAP:LOT 43-041-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $137.00 Type of Construction: ADDITION OF 12X14 3 SEASON PORCH 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 APPLIC&TION 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 Va nce* Received&Recorded at Registry of Deeds Proof Enclosd Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water 'otability Board of Health Permit from Conservation Commission Permit f4m CB Architecture Committee Permit from Elm Street Commission Permit DI'W Storm Water Management Demolition Delay LI .S—/a512 Sips.ture of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burde to comply with all zoning requirements and obtain all required permits from Board of Health, nservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict stand rds of MGL 40A.Contact Office of Planning&Development for more information. II l-i � � t r C0711-rat;" The Commonwealth of Massachusetts IVFOR Board of Building Regulations and Standards "0" i MUNICIPALITY Massachusetts State Building Code, 780.CMR o, (.70 / USE Building Permit Application To Construct,Repair, RenoV, er-Demoh a Revised Mar 2011 One-or Two-Family Dwelling 11�/-'', e" This Section For Official Use Only •'•;4,°, ;;oN • Building Permit Number: ,Q P`) 3 .0 Date Applied: / • ° s II* t 4% 1-7/6, ' 30 Building Official(Print Name) Signature ' D SECTION 1:SITE INFORMATION 1.2 Assessors Map&Parcel Numbers alirligillEW€)f lorence, k4A 1.1a Is this an accepted street?yes V 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 I Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.4 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIPS 2 Tice a+^ Sophie i-ok CA-.0-1-1.." c1 oren c.e M A ©t o co 2,. Name(Print) City,State,ZIP ' 58 A �urno 1b<<si rL 415-5$1-1-at\8 bcruce mark t►e% a cDmcas+,rle+ 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) ❑ Alteration(s) 0 alf Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: B ArAcL; -t'o n o£ ►a' x 1 4 ' 3-Aeascon Toc-c ► u,.) \ - . • • an. wln4Dvoc SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ads 000 . a 1) 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 000 • 0 Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:Check No. Check Amo \ f\ Cash Amount: 411111.1111.11111111 $ a 1 iDOO.0V 0 Paid in Full0 Outstanding Balance Due: /(..f;„, f 11.04S°"-► 4 City of Northampton Tr�r„ 14 r > Massachusetts ? ' ' DEPARTMENT OF BUILDING INSPECTIONS #,.. 212 Main Street • Municipal Building ,%, ' ' Northampton, MA 01060 r s >� �; 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: CONSTRI' ION SERVICES 5.1 Construction Supervisor License(CSL) o t a i LIN 6 s. C . P ram- "Su,.. \a e,t.S License Number Expiration Dat Name of CSL Holder List CSL Type(see below) Lk3 ion-l-gomeru, RIDack No.and Street Type Description u PAD n ,A n 0 1©� U Re trio ed d1 (Buildings up toel 35,000 cu. ft.) �-Yn � N,r` 6 R Restricted 1&2 Family Dwelling City Town,State,ZIP M M sonry RC Roofing Covering WS W. dow and Siding SF So id Fuel Burning Appliances 413- 585-1 Lt X1 I in lation Telephone .ail address D Demolition 5.2 Registered Home Improvemf Contractor(HIC) l!'Stl c ? -4# HIC Registrati Number xpira ion Date HIC Company Name or HIC Regi ame No.and Street Email address Y /rlp , . K YI 3r� � City/Town,State,ZIP 5/ O N ��/J�,4/O7 .Telephone SECTION 6:WO'4 1 RS(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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(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. v1/4..r..f.3' " I /f '‘l PIIIIIMMIrfor At, e• •_- s 'ame e + s _ . ure • NOTES: I. 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 he found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finishaad basement/attics,decks or porch) Gross living area(sq.ft.) Habitable rookn 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: S LOT SIZE: REAR LOT DIMENSION: REAR YARD 40 n SIDE YARD 1 SIDE YARD 5 \--yocon �roc�se, FRONT SETBACK FRONTAGE '/a • 1 U Fr City of Northampton Massachusetts .,I: �'-e .t, t c 44 DEPARTMENT OF BUILDING INSPECTIONS p A 212 Main Street • Municipal Building �� b Northampton, MA 01060 j41,1 A 'ON ' CTION DEBRIS AFFIDAVIT ik (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: „ kp-c>irii. ✓4 „v ' VD2 xt J The debris will be transported by: Name of Hauler: &1 1f 2 �-!L i 2/91 Signature of Applicant: C;7 '/ -/t1)`7 Date: ✓ ;: %•, 1 ----, The Commonwealth of Massachusetts Department of Industrial,4ecidents MN -...,...:d 1 Congress Street,Suite 100 ZtartIti,—_ ...„ Boston, 3 02114-2017 _.. 1A w is..w.mass.goWdia --- Workers"Compensation Insurance Affidavit:Builders/ContractorstElectriciansiPlumbers. TO BE FILED 5%El II'I IIE PERMI'llIN(;AUTHOR]IA. Applicant Information Please Print Legliblx Name 1 Hu.smes,s,Organization.intityldual s.. Cieik.kv‘,4- i3C.4.t 10k -le.-C Address: 4 3 1\1-CtiVe/6 C.ity,'StatelZi p: Sou .p.t..04) Atli-. Phone P: I "'" 4 /3 —579— ii3 -_S Are you AM esti-Alyce!Cheek the appnupriatr Nis: i' Type of project(required): i.0 I.an a employ-a 14 ail _,.... ,tallpitAtet-h l fa;Intim part-ti me 1..• ' 7, g"NeW construction 20(rat a sole proprietor or purinerahip and have no etuplasycv,working for me an /1_ a Remodeling any capacity Pita tkorkers'comp.mamma wonted.] 9. 0 Demolition a homaattner doing all work any,elf.(No*oaken,"emir irritarinee requited j* .0 I am a homer.aWILCS and va,ill be herrn8 samurai...tors to conduct all work on my property. 1 will Ille4 l 0 0 Building addition ensure that all 4:0113racuuti ettha have workeri'compensation utsurince or are sole II a Electrical repairs or additions proprietors with no canployco.„ I 2.0 Plumbing re-pairs or additions 3{:1 1 am a general cuntrictor and I haw hind the sub-cuntractors fisted tan the attached diem 13.Ej Roof repairs These sub-contractors kite employee.and h-art e v.titiers comp.insurance; 6.0 We an:a tsorporation and ita officers have curcised their right of caemption per Pail c. 14_0 Othei 152.§1 1 41 1.,and vre haw no intoplowes.[No A...wk crA'comp.urninance requital •Any applicant that checks box a 1 cant also fill out the,ection helot,showing then worker,'....-ontpcmation pulley information. Homeowners who Slab-anti this affidaYit indicating they are doing all wink and then hay mut&enntraeturs must MANIIII a new affidavit tnthuoarag luck It on tractors that ebeek thia box Mika ilnii bed am additional sheet show mg the name of the sub-eontractore and mate whether or not those amuttes have employee, lithe torb-connactort hate employees,they num pro,ide their workers'etamp.pulw-y number i am an employer that is providing worLers•compensation insurance fur my employees. Below is the polity and job sire information. Insurance Company Name: Policy#or Self-ins.Lie.4: Ex 'piration Date: Job Site Address: CityStateqip: Attach a copy of the norkers'compensation policy declaration page(showing the polies number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to S1,500,(X) arid:or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a line of up to S250.1X1 a day against the violator. A copy of this statiment may be forwarded to the Otlice of Investigations of the[HA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjttry that the information provided above is true and correct. 111111111 )C,TP- Illa 3—I l' 12-: Phone t: Official use only. Do run write in this area.to be completed by city or town official City or Toss n; Permit/License# Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town(lerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: .,,. AC OR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/16/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Elizabeth Carballo,CISR,CPIA NAME: Finck&Perras Insurance Agency Inc. (A /C,r o,Ext): (413)527-5520 FAX No): (413)527-5970 6 Campus Lane ADDREAIL SS: bcarballo@finckandperras.com INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURER A: Main Street America Assr Co 29939 INSURED INSURER B: J C PRATT BUILDERS INSURER C: 43 MONTGOMERY RD INSURER D: INSURER E: SOUTHAMPTON MA 01073-9597 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2351607240 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFI= POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL BADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE NIA MPJ3447H 04l07/2023 04/07/2024 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Proof of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main St AUTHORIZED REPRESENTATIVE /�1/ / ,/ Northampton MA 01060 eid v4. C.Q4 0 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Fik_ctL,r-= l". cd7p j 1-ip_ Mr_A,.T/NL' 2J.C■ PRAfl' S k cZ. r'gCv°f 5<�,,4 BUILDERS L n©4t_ i- 42,,,-deevy CONST. LIC. # 061401 • REG. # 115419 66044-D/v£ .&iS99'it/ /)i; a x /Y jd i5-s i?r. d k 8- )( <Z 1Jou6Ig_ C-A�y,ag i�J A-Ni t.% ?©2GL b e-u(�c.#L 3/,.� X 'i X sr/ 4'd v'/4--, / x 7-6- 61)"'lc 1 n u' 4- D 404_ WO J L s aZ Y 8 Nett Sr k i �J c. k - i ti. I ( . N. • I I E 1 i ril i I D- - - - ® l S�as il /vc�i 6E s y Jam¢ r i-c. >/ ?c`-.S / 12, 43 Montgomery Road • Southampton,MA 01073 • Phone: (413) 585-1627 IL-Le, 4 �n?k i /1 A-4'r`i•v / 2— WV V 3 -3t A o,u eox‘_.k. -5 A 4u4q4) P,-_ 5A � /,d ad �J �<7.) ©/O J.C. PRATT o� ni5�„t j Lae�A. � �2���/ � BUILDERS - CONST. LIC. # 061401 • REG. # 115419 .5 t ar- VdF u t 0 0 a.) kJ()_ . L e r-c <be 5fX - ' ��� ) `iz. — 1-z._ y ; c 6 'Arr7r-- 43 Montgomery Road • Southampton,MA 01073 • Phone: (413) 585-1627 bpi to f�vnso✓ Vg�J Dom _ --� J.C. PRATT � � 5��0� .0 /O6. BUILDERS CONST. LIC. # 061401 • REG. # 115419 Poor • • f 11-71 f ---� 7 - I, s,/00-77e-‘ ff=, l Li negp _o. /�i� C 43 Montgomery Road • Southampton, MA 01073 • Phone: (413) 585-1627 Audakt4) ,e_ s-e LC. PRATT -5- ect /ea°r•-•iatus/‹, LoeEA) lea. c2 tpLf BUILDERS 6 L 0Av r / -I( CONST. LIC. #061401 • REG. # 115419 S I D \ & 3 - S6,460 Ifiy 5I1 l -)c 024 J 1`t ` (ssG,vQedJ 15'4s A �G c- d i x,s 1 .Av7 h7 A. iy a X L1 WA-!lam a)9 w 1 MMce'u�4- f" oo w L-��j a-b E e S G b x w /% �` Rao f s/Ligsr46,CAv/r `I( !Cp A-rfit=,�S _s ROOF cg 7 0ulD 0 0--c-k 7---IL !Y ------------- 43 Montgomery Road • Southampton, MA 01073 • Phone: (413) 585-1627