23D-213 (8) BP-2023-0868
65 WARNER ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-213-001 CITY OF NORTHAMPTON
Permit: Agricultural All
Bldgs
PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-0868 PERMISSION'S HEREBY GRANTED TO:
Project# PORCH ADDITION 2023 Contractor: License:
Est. Cost: 43500 LOUIS MONTGOME Y 013471
Const.Class: Exp.Date: 11/19/202
Use Group: Owner: ALVE , KATHLEEN &KING, PHYLLIS
Lot Size (sq.ft.)
Zoning: Applicant: LOUIS MONTGOMERY
Applicant Address Phone:, Insurance:
PO BOX 951 413-268-2028
WILLIAMSBURG, MA 01096
ISSUED ON: 07/03/2023 •
•
TO PERFORM THE FOLLOWING WORK:
4 SEASON PORCH AND DECK ADDITION
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
p 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 i Q . CF11
• V i S�
1
Fees Paid: $280.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissi.ner
- c'''CEI\LE-__P-
11
The ommonwealth of Massachusetts
3 VI Bo rd o Building Regulations and Standards FOR
,u� Ma ach etts State Building Code, 780 CMR MICIP
USEALI
TY
' • • • ica n To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
V1a 01'°° One-or Two-Family Dwelling
torm - This Section For Official Use Only
Buildin Permit Number: 4;49'.4 3- !7: Date A plied:
k„ice/i ss9.
_Ke7 3-ZoZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
6,5 4v/y 1jy,7ir s' T
1.1 a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private 0 Zone: _ Outside Flood Zone? Municipal On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
1 Owner'of R cord: D�6
--1j 1Ptti Alvle5 i t$ Y\.1.�( Ftev,a,„tee, AtA._
Name(Print) City,State,ZIP
AtVI cflr'ec4— __i-VII k a Ives @ solaC.
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 181 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of D.
Proposed Work':A D / 'Tv 4st&1 F ClamsftAix T S/
Sot 470N /7 0/LGN /3c.i/R'��ip/1cox- g ' }C /U r N.CG'/� "IA/0, ,. 6n
.4/30�ry Gn/[of.�
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 53 aoo.O D 1. Building Permit Fee: $ Indicate how fee is determined:
r 0 Standard City/Town Application Fee
2.Electrical $ 'el/ o e2C1, b D 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ /V/A- 2. Other Fees: $
4.Mechanical (HVAC) $ 6s'00. 00 List:
5.Mechanical (Fire
Suppression) $ /V//4 Total All Fees al
Check No.`K Check Amount: Cash Amount:
6.Total Project Cost: $ V3,,_,3-e'D o 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
=r,
Massachusetts rr
r
DEPARTMENT OF BUILDING INSPECTIONS *1W ' `
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.
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.
lir
5.1 Construction Supervisor S LicenseECTION(CSL)
5: CONSTRUCTION SERVICES
O/ 6/71 // /2-.S-
/0 cv/S /lid",( coc)/tf-4 7' License Number Expiration Date
Name of CSL Holder
cps(
CSL Type(see below) (J
No.and Street Type Description
�j` U Unrestricted(Buildings up to 35,000 Cu.ft.)
�l` "(4 0-2 S/5 c.) 'tY ,i( a 07(' R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Rcofing Covering
WS W ndow and Siding
SF Solid Fuel Burning Appliances
.5ZZZ-0/6,0 15-j¢,.II dS ATGo.it Gesr/tier I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ? V/ -7�L7�f
Lac,/g /V0,y,1`6,0 4'-( - HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
Bir 9rr
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 L4 b 11 /47o 7—ow/ore), .4 c r /01,2,T w
to act on my behalf,in all matters relative to work authorized by this building permit appplication.Q' ZZ.,.p-z"2.-----
14-1n(eeM Alve , R��t°r7cs 6 f Z9/Z3
Print Owners Name(Electronic Signature) f left. ate
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECL:1 • TION
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.
4,o iS rile ,Thor y /guts fi1/ZiT kJ,C',.%t c/ ZiZ''Z G/Z-7f Z3
Print Owner's or Authorized Agent's Name(Electronic Signature) ate
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.n. t 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
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
Massachusetts ? t,,.
p; DEPARTMENT OF BUILDING INSPECTIONS 4{y ,
,' 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.
The debris will be disposed of in: 5,r /7 '-
Location of Facility: ��,./r/ ^r
The debris will be transported by:
Name of Hauler: /'!?2 (T c� ftN t.1-�A-L,z-e-/-5',041/ 7-4_,-,c.1C
Signature of Applicant: ‘-ei7<1 Date: 7 ��
The Commonwealth of Massachusens
41111114,11.10.M./.0.11.1
kil=.1••• ••••••=PN.iii Department of Industrial Accidents
,t..
1 Congress Street,Suite 100
4.-,„- ."•:',.ilq— -4` Boston,MA 02114-2017
, ..... •1111= '
V,.. . .. W W W.mass.goildia
-,,.• 03,
- %NUJ-kers*('ompensation Insurance A flidas it:BuildersiContractors/Electricians/Plumbers.
,....•
111 BE FILE1)1S1111 I Ili-,11-.KNI I El'INC Ati'll(tRII'N I .
.Noitlieant Information Plea i.e Print Lerlihl%
Name tetistnesaUrgattiziationlndlindual 1:
Address:
CityiStateiZip: Phone#:
Art pa*tut employee Cheek the appropriate bac Type of project(required):
1.0 t ain a emplsiya with „employees(full=dim part-timet* 7.fig New construction
2[3 I am a auk proprictiar ot Fortnersinp and have no employer:vi,orktieg tor MC in 8_ 0 Remodeling
any capacity,[Nu ourkers'comp.ritornmee required.]
9. 0 Deimilitiori
30 I ant a homeowner doing all ksork myvelf.[No*miters",.on ant mince
1 0 ci Building addition
40 I ant a.homeowner and will be hiring contractors to cionhact all work on my property. I will
ennum that all contractor%either have workers'eon/Ix-mown insurance or are sole I I 4:3 Electrical repairs or additions
propneleis with nu employees.
12.0 Plumbing repairs or additions
50 I am a smieral contractor and 1 Eerie hired the suit-euntructuts listed uo the attached sheet.
i 3.0 Roof repairs
These sub-euntraetors hose employees and has e VIOrkera.comp.insurance.;
,,21We are a...Adoration and ita officers tut k C exercised then right•af eaerriptiest per Will_ . 14,0 Othei
152,,§1t4t,and wit Lase MO tansployers.[Nu Valricrs"cornp.inmarance required.]
i
'Any applicant that sinks but P I must also till out the sectiun below ahuvrinp their workers compensation Folk"infutinutrun.
t lionwoomers who sutnrul this affiskiN it nulteatustr they are doing all work and dont hire ucasicie evatractors must stibrast a new affulai it tridivatinkt sod-.
oat:actors that cheek this bus must attached an additional sheet shoo toe the name of die suts-contraetors and state whether ur not Liaise onmes hai e
uniplmy cc, It the suls-ckinIT:ictor hate mink).cc:t.Ob..), allot prt,ide ihoz .,,urkecs"eomp,puliey utanber
I um on employer that is providing teorAers'compensation insurance for in,, employees, Below is the policy and Job site
information.
Insurance Company Name:
Policy 4 or Self-Ens.Lic.ti: Expiration Dale:
Job Site Address: City,'State,Zip; . _
Attach a copy of the workers'compensation polk) declaration page(showing the polies number and expiration date).
Failure to secure coverage as required under VIOL c. 152,§25A is a criminal vitiation punishable by a fine up to SI,500.00
kaidlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up.to S250.00 a
day against the'violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA Ibr insurance
coverage verification.
Ida hereby certify under the poilas one penalties of perjury that the information prokitled iihove is true and correct
Sienature'. ei-,e...s /1-7/' t7'-'t.—.) ,-7,-/-=r,z -z1e..2_ Date: /
Phoric:'::
1
'., Official use only. Do nut write in this area,to be completed by city or town offiriaL
('its or Town: Permit/license
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.t'it,iTos$n Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
['unmet Person: Phone#:
City of Northampton
Massachusetts ,t7(gt
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t "
DEPARTMENT OF BUILDING INSPECTkONS
Ag
, 212 Main Street • Municipal Building
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBIL AFFIDAVIT
I, (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' exemption 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 seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constru ted 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 .r intends to reside,on which there is,or
is intended to be, a one-or two-family dwelling, attached or . -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 licen— 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 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 wit, the aforementioned project or work on my
parcel,I acknowledge that I am required to and will act as the superv'sor for said project or work.
Signed under the pains and penalties of perjury on this day of 20_.
(Signature)
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