25A-137 (11) BP-2023-0785
20 GLENWOOD AVE COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
25A-137-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0785 PERMISSION IS HEREBY GRANTED TO:
Project# ENCLOSE PORCH 2023 Contractor: License:
Est. Cost: 10000
Const.Class: Exp.Date:
Use Group: Owner: ERVIN ERINN R
Lot Size (sq.ft.)
Zoning: URB Applicant: ERVIN ERINN R
Applicant Address Phone: insurance:
20 GLENWOOD AVE
NORTHAMPTON, MA 01060
ISSUED ON: 06/13/2023
TO PERFORM THE FOLLOWING WORK:
ENCLOSE PORCH TO CREATE 3 SEASON ROOM
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: , Q `1'I
•
Fees Paid: $130.00
212 Main Street,Phone(413)587-1240,Fa : (413)587-1272
Office of the Building Commiss oner
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The Commonwealth of Massachusetts /,?
W. Board of Building Regulations and Standard 16..Pr �� Mi1NICIPA ITY
Massachusetts State Building Code, 780 CMR gp toil, N USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a oN•R4 ,4,.r 201
One-or Two-Family Dwelling °
This Section For Official Use Only
Buildin 7I Permit Number: "A 3• 1/6" Date Applied:
E i,v 4 13-26z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
ss: 2' 4 .rtv 04 Aug_ 1.2 Assessors Map& Parcel Numbers
1.1 a Is this an accepted street?yes ✓ no t 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:
Public El Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
.1 Owner'of Record: al
72-,, gre-i„J ifJ04 ✓4—
Name(Print) City,State,ZIP
Z Cj/f J JVC ki. yr3 f Z3 7(.. 44►+casuocK AEI') e. t 1- - (''V
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WO 2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repai s(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units I er 0 Specify:
Brief Description of Proposed Work2: 1
E,-J(_L o$6 6lci 5 7,.J S 7AC/c li'o rc L— 4-17 w- k r—
o. 3 ��-5 o rb o,nv-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
a 1. Building. $ / 6 u00 l 1. Building Permit Fee: $ Indicate how fee is determined:
/ ❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All 40.0
Supp ssion) lees
Check No. 4% Check Amount:
NEWierrii)grailfel $ /0 Duo 0 Paid in Full 0 Outstanding Balance Due:
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City of Northampton
yiaa'4,
, Massachusetts �. %
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building .�
Northampton, MA 01060 t�SI'hi 1,-,E\
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
i n,• 4
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.
/ r
SECTION 5: CONSTRUCTION SERVICES
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.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
. 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)
HIC 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 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 ❑ 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.
re (/JN CK J i 0-J i-5 7 0Z3
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 not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important infornation 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"
The Commonwealth of Massachusetts
Department of Industrial Accident's
=,too I Congress Street,Suite 100
rii zsa 4.,. Boston, MA 02114-2017
,- 111 fi
ww)v.mass.goildia
‘1,4.0 kers i'ompensation Insurance:iiffidas it: Builders)ContractorsfElectricians/Plumbers.
TO BI:FILED WITH I III t'LltNIIIIING AUTHORITY.
A p plica lit Inform:I don Please Print Letibls
Name(Husiness)Organi talon individual):
Address:
City/State/Zip: Phone /4:
I
Are}on to employ re.'Cheek the appropriate hot: i Type of project(required}
1 El I aro a empkyer with __ .. employees Oa motor part-tirmet.' 7. D Neu construction
..,.1 I am a aok proprietor or p.irtru=stop and have 110 employees working tor me in 8, 0 Remodeling
an)cdpecit!,.[No wurkes-a*comp.insurance required j
9... D Demolition
CiI Arn hOmoowncv doing all WU&myself.!No woriass'comp.inaurance renuttedl'4
-1. am a hum/cono'and will be hum contractura to cooduct ull work on It property I as ill ti I 0 0 Building addition
ensure that all contractors either have%sr-niers'consperelotion insurance or art sole i 1 I.C3 Electrical repatta or additions
pruonesas with rio Linployees, 1
11E]Plumbing repairs or additions
general contractor SSILl I hose timed the sub-tuntracturs listed on the Attached sheet
w i 3.0 Roof repairs
These ab-cornici w tsois ha employees'am!liat.e. orkert.eomp.insurance,
1-4.0 Other
o 0 We ere a L-orporation aro!its officers ha exercised their right°ream-vim per Wit.o..
114.2,;.•1141.and VS g hose no employees.[No workers'Comp.insizartec required]
'Any applxlast hut cho:lia,box tl I mini at,sts till eel the soiretaan below diow ins.thins A Orlser,'et,illpsm‘alxin policy informatwo
tlioneuo tiers u.tio!minim dos oftiodao.it insficaling they ant doing all work and then hire koilsode ems-tractors moat subnot a new affair it indicating such.
:Contractors that check this box must attached an exhimunal abed 41011.ing the ruins:of the sub—zontractors and gaits;%helixs'ut nut those entities haw
employees. if the suh-cormacturs base employ ces,tits rasti,,,1 pi,,',,isle their worLers"comp.p.,hey number
I am an emploper that is providing worien'compensation insurance for my employees. Below iA the policy and job site
inforimarion.
Insurance Company Name: _
Policy#or Self-iris.Lic.# Expiration Date:
Job Site Address: City1Stateqip:
Attach a copy of the workers'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 SI.500.00
and one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA far insurance
coverage verification.
/do hereby certify under the pains and penakles of perjury that the infirrtnation provided abate is true am!correct.
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mulummi)J'04_ I-3 WZ- 3
Phone t:
, Official use only. Do not write in this area.to be completed by city or SOWN official
City or Town: Permit/License 4
Issuing Authority (circle one):
1. Board of Health 2.Bonding Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
— — ' -
City of Northampton
'"Massachusetts
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,e DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
, Northampton, MA 01060
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.
I
The debris will be disposed of in:
Location of Facility: JA-liel V-0 C lC-Iv`
The debris will be transported by:
Name of Hauler: ''C/ 2 \ ti Ci l VA- ( C>e- ( 6
Signature of Applican Date: ALM"- ( 51-5
City of Northampton
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DEPARTMENT OF BUILDING INSPECTIONS
\ F 212 Main Street • Municipal Building xr =" -
Northampton, MA 01060 ss
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HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIII
I, !4' of N e 62_J ,
(insert full legal name), born— (insert
month, day, year), hereby depose and state the following: 1 I i ,e 5.--(1
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.
Signed under the pains and penalties of perjury on this J 3 day of J J ,20
(Signature)
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