30C-084 (12) BP-2023-0743
134 CLEMENT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30C-084-001 CITY OF NORTHAVIPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0743 PERMISSION IS HEREBY GRANTED TO:
Project# DECK 2023 Contractor: 1 License:
Est.Cost: 12000 KUEL MCQUAID 051394
Const.Class: Exp.Date: 12/11/202
Use Group: Owner: TRUSTEES MILNE KEITH C&CONSTANCE E
•
Lot Size (sq.ft.)
Zoning: SR Applicant: KUEL MCQUAID
Applicant Address Phone: Insurance:
131 FERRY ST 41335375063 SOLE PROPRIETOR
EASTHAMPTON, MA 01027
ISSUED ON: 06/12/2023
TO PERFORM THE FOLLOWING WORK:
NEW DECK
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:
.i. • ' ' . .52 31,,,,,
1 od
Fees Paid: $78.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissi ner
Z-oR
File #BP-2023-0743
APPLICANT/CONTACT PERSON:MILNE KEITH C& CONSTANCE E RUSTEES
134 CLEMENT ST FLORENCE, MA 01062
PROPERTY LOCATION 134 CLEMENT ST
MAP:LOT 30C-084-001 ZONE
THIS SECTION FOR OFFICIAL USE OILY:
PERMIT APPLICATION CHECKLIST
ENCLOSED I REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $78.00
Type of Construction: NEW DECK
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:
XApproved 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 Enclose,;
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 fro CB Architecture Committee
Permit from Elm Street Commission Permit DP Storm Water Management
Demolition Delay
61
Si_,1 ature of Building Official Date
/ �
Note: Issuance of a Zoning permit does not relieve a applicant's burden comply with all zoning
requirements and obtain all required permits from Board of Health,Co servation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standa is of MGL 40A.Contact Office of
Planning&Development for more information.
1
�� ti
=,i: G�The Commonwealth of Mass. us
„�� ) 40F a
1t4, )7 Board of Building Regulations and ,n`4 it. Citrd ICI�ALITY
Massachusetts State Building Code, 780 N.1. o�� E
Building Permit Application To Construct,Repair, Renovate . - . 'sh a Revi d Mar 2011
One-or Two-Family Dwelling q0 o�ro
This Section For Official Use Only
Building Permit Number: €)O_)_-3 - 744 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
c /31/ iEA>7 ST. 3,e - ogy-�/ _30c -'(fay- no/
1.1 a Is this an accepted street?yes l---- 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.$Sewage Disposal System:
Public Private El Zone. _ Outside Flood Zone?
Check if ye Minicipa Q'On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner'of Record: "[,t/L c,veay 772i/sr �/ OMName(Print) /��7 (/!�¢— ►ty,State,ZIP / 7
/311 C/'fe.►rr-.S g/r48 gy3q kY/Ivy Q NA,L ,
No.and Street elephone 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) t . Addition l
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:Brief Description of Proposed Work2: ,4' ,l / f:7 k a..v.a(. q..,laud- ,544. Ss
C4 4 4 1, coAd. ca. . 5;.�� oV }�,..P. J4 oc sue_
G
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ )2 O 0 6 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ l. 0 Standard City/Town Application Fee
❑Total Project Costa (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire X
Suppression) $ Total All Fees:$ /6 o
cg Check No.139(o Check Atrount: Cash Amount:
6.Total Project Cost: $ Goala R Paid in Full El Outstanding Balance Due:
1 City of Northampton 0
Massachusetts ?" '°
1 Tit
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building "�i -?"-^ Northampton, MA 01060
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.
rii � �
a
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C_C) 13 7Li( 'Z//i I L
iM (1 P� ,L o ct i A License Number Expiration Ila�ZLte —1
Name of CSL Holder
13
List CSL Type(see below) U
No.and Street fr(_scStreet G 5—�—
Type Description
E cc ,t^ D t O2_7 U Unrestricted(Buildings up to 35,000 cu.ft.)
�'" R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mtisonry
RC Roofing Covering
WS Window and Siding
(� r � SF Solid Fuel Burning Appliances
-1 13 - 37-r-M 7 g. . ei 69 Uti0. I� .cokk I Insulation
Telephone Email address D Demolition
5.2 egistered Home Improvement Contractor(HIC)
/"` ek.;I HIC Registration Number E iratio Date
3�mpanyName orJJ HICRegistrant Name �/,, N.
N ndStr fet�rl/ ""'CP✓411 kC,(t0 cf knatk �4✓t
G_s ,AA.A. �p� AAA. 4)5j-. 3-7 SO4 Email addressL
City/Town,State,ZIP ) lD 27 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 0 No . ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1
I,as Owner of the subject property,hereby authorize, 0...fie Q /c441 ( 4,5744'(Z'O V
to act on my behalf,in all matters relative to work authorized by this building p rmit application.
&Id C. Nutt 4/,S/Jo.1.3
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 perj ur
y that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
it Aed /4c. C�,t' 6/ 'J7.a 3
Print Owner's or Authorized Agent's Name lectronic Signature) to
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 tol 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 IC)O`
SIDE YARD SIDE YARD 2 -
Istor. cobs^ 110
IA0 6 e, ivie-)›j
FRONT SETBACK 3 0
FRONTAGE
/
City of Northampton
Massachusetts �_
IP C
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building rs
�,
Northampton, MA 01060 ' s\'''
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: vc.0,�-yG �i' " c 6_ c,I,,e_
Location of Facility: Poc-44-CoAAVov\_f N A-
`
The debris will be transported by:
Name of Hauler: i‘e_t L lX�a
Signature of Applicant: Date: 6 S/2D23
The Commonwealth of Massachusetts
Department of Industrial Accidents
fI 1 Congress Street,Suite 100
%au Boston,MA 02114-201
wpit mass.govidia
Workers'Compensation Insurance Affidavit:BuildersiContractorsfElectriciansiPlumbers.
°III BE FILED!Sit II THE PERNIITIING AUTHORITV,
Applicant Information Please Print Le",ihis
Narrle 411usinessakesurizationlndivichia1): X. e-1_, ariga-t_zw
Address: / 3 I rc,s-
eitystatc Zip. "kvivtAl /OA Phone#:
Arc)00.0 ephitoer?Cheek the appropriate bot:
I 0 1027
'fy pc of project(required).
I a ma corphiyin with employees(full and partinnel.• 7 NrNew construction
LIZI 1 am a sole proprietor in mramership and bore nu eraphryens workirri tor tricm . Remodeling
airy capacity_tNia worker omp.nisuranet requited.]
9. Ej Demolition
'NO I am u homeowner lining all work myself[% OrOltenj Cump insuram:v required]*
I C]Building addition
4.17:1 I am a hurneownct and will be hiring santEta.cluri ta,cvan.luct all work on my property. I will
ensure that all contractors either boseworker. ccliugA.it3atunt insurance or ate sole I a Electrical repairs or additions
prupmetois with no oriploccs.
2 Plumbing repairs or additions
1:11 ant a goicra1 contractor and I hirre hired the sub-cimuncton,listed on the attached sheet
I 3.Li Roof repairs
nu-se ub-,,,..rtstractor.have employees and has cs rakers'comp.insurance;
14.0 Other
are eurporatrun IOW offteces have e xrreiserl then tight of il.teruption per hiCiL e,
1i it,and c h.n. no einployees.[No wurhczx'comp.insurance regumei1.1
'Any applicant that checks bus=I must alau till uut the section hely.*showing their workers'compensation policy infriniattion,
Huencowners who submit dus athdasa inthandmii thel are cluing all work and then hoc vutsidc contractor's nama submit a new,affidavit old:rating suck
1.1\mm:room drat cheek this box mug attar:her'an additional sheet showing the name of the subecontracturs and state whether us not Chose
r.-mployees., II the sub-vocaractors have employees,die, must pro,ide[hen worlo..1**comp whs..) number ,
/am an employer that is providing'corkers'compensation insurance for my employees. Below is the policy and jab site
information.
Insurance Company Name:
Policy i or Self-Ins. Lie. 4: Expiration Date:
Job Site Address: CityState,Zip:
Attach a copy of the workers'compensation policy declaration page(shwa ing the policy Humber and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a tine up to SI,500.00
antVor one-year imprisonment,as well as civil penalties in the fonn ofa STOP WORK ORDER and a line of up to S250.00 a
day against the violator.A copy of this statement may be forysarded to the Office of investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and pen a tries of perjury that the information provided above is true and correct
Sienature: 11 Date: 6/ <-/20z
Phone e: 4113— ML- 6P1"-117 7 o6 3
Official use only. Do nut write in this area to be completed by city or town official
nity or Tovin: Permit/License#
Issuing Authority (circle one):
I. Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
('ontact Person: Phone#:
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