17A-307 (5) BP-2023-0822
67 HILLCREST DR COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
17A-307-001 CITY OF NORTHA PTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A)
BUILDING P .RMIT
Permit# BP-2023-0822 PERMISSIO IS HEREBY GRANTED TO:
Project# DECK 2023 Contractor: License:
Est. Cost: 5000
Const.Class: Exp.Date:
Use Group: Owner: J JOR•ZAK ELIZABETH
Lot Size (sq.ft.)
Zoning: URA Applicant: J JORC'AK ELIZABETH
Applicant Address Phone: Insurance:
67 HILLCREST DR
FLORENCE, MA 01062
ISSUED ON: 06/21/2023
TO PERFORM THE FOLLOWING WORK:
REPLACE 9X10 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:
Tr, .
Fees Paid: S65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissi,ner
'53
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The Commonwealth of Massachusetts 'tiAG,
Board of Building Regulations and Standards v ,o1.
�{j� Massachusetts State Building Code, 780 CMR °A, `CIP ITY
�,To US
Building Permit Application To Construct,Repair,Renovate Or,D-9°;` , a Revise. ar 2011
One-or Two-Family Dwelling *o 0,
This Section For Official Use Only
Building Permit Number: 8P 3-3 — p dr- Date Applied:
1 S P
ie ♦ I ►.1
Building Official(Print Name) 1 Signature / ' Dat
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
4. 7 /f l -c F2s r 11; 1=LOREN1e
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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
ELJZAt E7i1 r So)?Zi c PLvlzfice < /TM biota-
Name(Print) City,State,ZIP
_67 .4 ILL cR. 1 DR 41? s136 -F3054 b /I,dio rczc,L7'j a M1;1.CA
No.and Street Telephone Email Ad e s
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Prded World
a c pL/4cE I ' x lb1 legiait 7)t/(
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑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.(DII I Check Amount: Cash Amount:
6.Total Project Cost: $ 1 0 a0 Paid in Full 0 Outstanding Balance Due:
f ' City of Northampton
: :::::::: : :
at
4 DEPARTMEN O :NSZCTIZ „
1" 212 Main trcp l
'rF
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.
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Numb r 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)
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 . 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(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.
EL,2AB£Ti/ 3: Jone2Al. I'i 1-1/WE 2oz3
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 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 rooth count
Number of fireplaces Number of be4lrooms
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
FRONT SETBACK
FRONTAGE
/
n
City of Northampton
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% �� __tt Massachusetts1A .DEPARTMENT OF BUILDING INSPECTIONS r 212 Main Street • Municipal Building .I
moo,
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.
The debris will be disposed of in: /(1/117//1:
Location of Facility:
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date: rYzo
'‘ .• \., The Commonwealth of Massachusetts
r ---airit.ljamont; Department of Industrial Accidents
—.-7;11111191='
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_ ...=:.;4,1— 1 Congress Street,Suite 100
1
Boston, MA 02114.-01,7
Wlilit.mass.goWdia
Vi uskers*('ompensation Insurance Affidavit:Builders/ContractorsfElectricians/Plumbers.
it)HL FILE1)WITH fIli.:PERNIITITSC ACTI10111 Ili.
Applicant Information Please Print Leeibis
Name 4 klusttscss,Organszit ton=Intl sci dttal):
Address:
Cityr'StateiZip: Phone #:
Are%on an rtsipkty et!Check the appropriate 11114:
Ty-pe of project(required).
ID i am a ealphaya A lib 4'111pot t full maul pars-time I," 7. r] New etlinStrtlaton
20 tarn a sulc peoprieran 1.11 tantnershnt and have nu enkplAre'el.,.".V4 orkrz4.: for me an 8. C] Remodeling
any capacity_(No often:COIrtp.ensunince mount/
9. Demo I am a humookatker doing all Avric myself.[Nu kstaliers'eorrip insurance requited 0 ln j'
1 0[]Building addition
4.5gram a likarnotxvncr and IA Al he hams ccanactors to conduct all work on my pnaperty, 1 will
ossiatc that all ctmsractura either have workers'conspensatton utsurankx or are sole 1 I a Electrical repairs or additions
proprietors with no cinployees.
i 2.EI Plumbing repairs or additions
!...0 I am a pc:axial contractor and 1 luxe hand the sob-contractors Listed on the attached street
These mit,--oliaractom have emplucx ye and has.r uurkers'comp.insurance.; 1 3.0 Roof repairs
14_0(LEI we are a corpecanakan and ill officers have exaciacd then right of exam/pea per MC&c. Other
.152,§I i 4 i,and'AL!it.11•42 r113 ensployx.va,(No Auk-kers'comp,insurance rekankretil
'Any applicant that cheeks box.41 mug also fill out the xascsion below slowing then workers'compensation policy utformattort,
+Hoarnamsers wbu stalanit dux ailidan critheauran they are doing all work and then tine tattsidc contractors most xubrnst a new affnlav it man:aline such
kuntracturs that check this box 1/111%2 attached an adabtrusud sheet showing thc name of the sub-consractoes and state N hotter cc not those satilri,- liaNc
employee. If she sub-curnractors hate employ ees.they mom pro..ide dm:. Of urkers'.ximp rult,..) mariber _
I um an employer that is providing waders'compensation insurance for my employees. Beloit-A the/who and irob Aire
inforatation.
Insurance Company Name:
Policy#or Self-ins.Lie,#: Expiration Date:
Job Site Address; CitvState'Zip:
Attach a copy of the norkers'compensation policy declaration page Ishon Mg the policy number and expiration date).
Failure to secure coverage as required under NiGL c_ [51§25A is a criminal violation punishable by a fine up to S1.500.00
and or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S.250.00 a
day against the violator. A copy of this statement may be forwarded to the()flice of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under 4 the pains and wnalties of perjury that the information provided above is true and correct
Siatu :gnre A Date•. y 2.-// 2-0 Z—>
Phone
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
' 6.Other
Contact Person: Phone#:
I
City of Northampton
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Massachusetts ' j., ....
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, l" * it DEPARTMENT OF BUILDING INSPECTIONS 1 .
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,y; a� 212 Main Street • Municipal Building C4.
--'"'s""""' Northampton, MA 01060 4'1,j '�,0
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (in•-rt 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' e emption 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. I am not engaged in, and the project or work for which I am seekin: the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings const �icted 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 .etached 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. 1
4. I do not hold a valid Massachusetts construction supervision licen a 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 co nection 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 day of , 20_.
A A--t-/ 1...._
(Signature)
Sectional Building Plan
font'Assembly:
`�
Felt tes
. Pi ?Znficr -mice Batriar
Cove - o: Roof Mingling
Truss
Underlay nt- f
Ice Barrier- Ceiling .
Sheathing- �` :''
Truss-Cut Sheet Requ Clears Y--"'f t A
Or A.,.the opposite rapport t
fter Size-
i
lta Spacing- 12" 16" 19.2" 4" . -.... >�t��( . .
Rafter ar Span-
Rafter Sp 'Qs- Siding 1 ii. •
r__
Ridge- C
Ceiling Joist Size- Sheathing hik
Ceiling Joist Spacing 2"16"19.2"24"
Ceiling Joist Species- Imitation , C
insulation-R • Wall Framing
• Interior Finish.-
ttic Ventilation- leterior Eif hth F 1
Wzt
Siding- t
I
Sheathing
Insulation-
Walt Framing-
•!leaders- t
interior Finish,- • •
t
4
Fluor: t ,
(y t
+w► Finished.Floor- `ref A(fir Situ-PlonrM
Sub-Floor- 5C — - .._._ --• "~
V. .Floor Joist Size- _ " i" — .. ._
' ' Floor Joist Sparing di 16".19.2"24" Floor foist il Dist.
FJoorJoist OtosSpa - l ClcxtrS tcomt3,xio
' Floor Joist Species- C Q�• ( per, tbeopp3sttc s rpport ^
•'Begin Type&Size- - " ;'' .
•
-Distance Frons Grade- gl sir Plate c, �,lljr•�yy�?:
ye
Foundation: — •
: _._ _Ponndatlon Anchor , k � `
Anchorage- _.. ti
Sill Plate- C1�� ( Foutsrtsintl 'Grail -"• ,•`.,: � '
.*mot all Type&Sipe,- (eve W a Of )i" 1." ' _,§... a
Yp �� J -4;" sh,.
Reinforcement- ite famemu,t 's; •`` ' �t,' ,i`•
Concrete Floor"Iitickness- "
Vapor Barrier-, t�Ottare�eFloor :, ' ..: �•,� .
Column Pad Size- X X • i,r 'Fr,'`t.
_.Column Spacing- _ �;•,-Ci • • _ ._._ ..... _..._.
Footing Width- Barri •
er � ~`
Vapor er ty Fdottttg Hcighfi- Fcwting
••...p`oottng Depth Below Grade- MI .at Iv , . e( 1-0t, w Il -
1, vls �jn 1 be(0,4) y2,, c ox,tt eAk / .