25A-137 (12) BP-2023-0806
20 GLENWOOD AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25A-137-001 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-2023-0806 PERMISSION IS HEREBY GRANTED TO:
Project# RENO 2023 Contractor: License:
Est. Cost: 7000
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: 06/22/2023
TO PERFORM THE FOLLOWING WORK:
INTERIOR RENOVATIONS -ELIMINATE 2 DOORS, INSTALL CLOSETS,KITCHEN CEILING
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:
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
•
illiiiiimm...RECE/ ED
MENNIE
The Commonwealth of Massachuse's I
2023
n ° p
Board of Building Regulations and Sta dar. FOR
:; Massachusetts State Building Code, 78 '�:°RT,E.3U/L,°oG''Nsp,Crlo ILISP• ITY
Building Permit Application To Construct, Repair, Renovate Or Dem. ' -' A 101411,4d 'r 2011
One-or Two-Family Dwelling
This Section For Official Use Only _
Building Permit Number:4 -) 3 ' gocp Date Applied:
, , , , "pig:03
Building Official(Print Name) t Signature Da e
SECTION 1:SITE INFORMATION
j,., ��oDD 1.2 Assessors Map&Parcel Numbers
L�
AtPC
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:
Public❑ Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2 . r
Name rint) City, State,ZIP'
Zo At cry Wow Pcv* W/3 g23 srl( dAh asw1, -wCkslivik.&..t.
No.and St eet Telephone Email Address lei
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify:
.11101111111111111111110_:r2lri-= ,0(7 7:4'
1WIS fr,ll GI°u 1-5
/ A 5 l,,j I ,C..1--c C(t( °?S
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1 $ 2L D 1. Building Permit Fee: $ Indicate how fee is determined:
2 2 $ — tt( 0 Standard City/Town Application Fee
5-""( • 0 Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (IIVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No.al l(o Check Amount: Cash Amount:
INNI101.11, ODD y Paid in Full 0 Outstanding Balance Due:
1710 oU
City of Northampton
":41:1'7'---4°-
' Massachusetts „ r
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: ��' DEPARTMENT OF BUILDING INSPECTIONS -7'
s
ts}4.` 212 Main Street • Municipal Building ,` .`
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.
• ':iV•; T4tiu ' ,
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). . N., . �L1, •C't•. ;
• c R11:1: Proca,4of,Water and Sewe�r,entry fees paid.(i ,�pp<liCably.). r , C L
t, ', it e , c.,J t ' itliU . f.ti .
�}r r
-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.
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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 Shcid 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 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 perjuy that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Own Authorized Agent's Name(Electronic Signature) ,'
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 rigt 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 roam 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
SIDE YARD SIDE YARD
4♦ •
FRONT SETBACK
FRONTAGE
City of Northampton
:t�' " ` Massachusetts :y.00)
ill:1
° F DEPART
MENT OF BUILDING INSPECTIONS., 212 Main Street • Municipal BuildingN"^�, Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVI_ ,,
(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: V Gtik Cti CAI
The debris will be transported by:
Name of Hauler: .Le,' C , K ej
h�
fSv., .y' ..
Signature of Applicant: Date:
. N
The Commonvealth of ilassachusetts
uni—=0 Department of industrial.Accidents
1 Congress Street,Suite 100
-11
Boston, Abi 02114-2017
' -!.,.•!..: j
www.mass.goildia
.%
IV otters'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
to HE FILID WITII'UBE:.PERNIITI'INC,Ati'lit)RIIN.
Applicant Information Please Print Lertibls
Name(Htt.siness'Organizationandividualr.
Addre* .. .
CityState/Zip: Phone#:
•
Are you an ettipht!,cr?t bee k liar appropriate 11,01: Type of project(required).
1.01 3131 a employa'ALAI , , ,,,,,,,,,,employees t full aiarior part-time(' 7. El Ne cc construction
2 fil 1 ara a stile proprietor or partnership and base nu enyLoyers workina tor me in 8. ij Remodeling
any capacity(No%Mar"'comp.oisuranix re4aired.1
9. E] Demolition
II i any El Igneous act doing all work myself[Nu worker.'curial iristiranix.revers-LI y
-
I 0 0 Building addition
illatd771 arn a tamseisw nes and will be hiring contractor to conduct In work on my property. I s.ill
eiiaun that all contractors caber have workers'4.-onsprasotio1l insursnee or are sole i to Electrical repairs or additions
propriethaft with no employees.
I 2.0 Plumbing repairs or additions
5C:3 I am a patent contractor anal haN.e hued the subsaintractur.Listed on the attached sheet.
i 3.[:]Roof repairs
These subs:untraeturs Muse employees and hour uurkers'comp.insurance.;
.
6.E3 We an:a corporaamun and it:.offreers have exereiaed thee eght of exemption per MGL e. 14 E.:lather
152.,§li 4 L.and we haw no employees.[No workers'comp.insinanix required.]
'Amy applicant that elsteks box al mist also tin nut the section hcluu showing their workers'eurnpensution pulp.),informatiim
'flointuunera who submit dos aflitlastt unto:aline they are ttornE all wink and then hire outside contractors ItILbi submit a new at IPLIAN IS Ind leaung*Leh.
ttontractors that check this boa itio:a atlas:bed an addattunttl sheet showing the name of the sub-eontraetor,and*tale whether or not those...wines!lase
employees If the sob-euntrsetors kn.,:C1110./ eeN.they must provide their nark,Ts ,:oitip rviv.:a marlher
1 attl an employer that is providing workers compensation insurance for my dmployees. Below is the policy and job site
information. ,,1, •
,• ...J., .
Insurance Company Name. -
_
Policy#or Self-ins.Lie,#: Expiration Date:
Job Site Address: City(StateeZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy 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,5(X).00
and,Or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and aline of up to 5250.00 a
day against the violator. A copy of this statement may Izse lolls arded to the Office of Investigations of the[HA for insurance
coveruur verification. •
...
1 do hereby certify ander lire pants and pi-n(111hr%ei I perjury hurt tire information provided,dhol'e iN true and correct.
afirr; , L 1 A4- 141 70 1-5
Officied we only. Du NW write'in tin'',area,to be completed by city or town official
•
i City or TON u: Permit/License fr-
1, Issuing Authority (circle one :
1. Board of Ilealth 2.Building Department 3.CityiTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
is.Other
Contact Person: Phone#:
/
City of Northampt n
Massachusetts A. ' C.
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DEPARTMENT OF BUILDING INSPECT ORS S x
212 Main Street • Municipal Build nq ,.., 't,
Northampton, MA 01060 $fr ,l's..'
HOMEOWNERS'EXEMPTION ELIGIBILITY VIT ! /!! 1 19�/
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I, 6/Li /r'‘ .4 rt'J , #✓ (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' ex•mption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1. .1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. 1 am not engaged in, and the project or work for which I am seeking he aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constru i ted in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner" ,s defined at 780 CMR 110.R5.1.2:
Person(s)who owns a parcel of land on which he/she resides it intends to reside, on which there is, or
is intended to be, a one-or two-family dwelling, attached or d•tached structures accessory to such use
and/or farm structures. A person who constructs more than o e 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 requirem: is for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in c• nection with any project or work involving
construction, reconstruction, alteration, repair, removal or demoli ,on involvinPany activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection wit the aforementioned project or work on my
parcel, I acknowledge that I am required to and will act as the supery sor for said project or work.
Signed under the pains and penalties of perjury on this day of 20_.
(Signature)
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