29-367 (9) BP-2023-0958
61 AUSTIN CIR COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
29-367-001 CITY OF NORTHA PTON
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-2023-0958 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 RENO Contractor: License:
Est. Cost: 5000
Const.Class: Exp.Date:
Use Group: Owner: PETER&JENNIFER CARBERY
Lot Size (sq.ft.)
Zoning: WSP Applicant: PETER JENNIFER CARBERY
Applicant Address Phone: Insurance:
61 AUSTIN CIRCLE 413-519-4297
FLORENCE, MA 01062
ISSUED ON: 07/24/2023
TO PERFORM THE FOLLOWING WORK:
REPLACE 2 EXTERIOR DOORS, RENO FINISHED BASEMENT
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: 10 Q
/ yQ . ''1 •
II
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissi.ner
L-------)l
1
The Commonwealth of Massachusetts
► , , (7 Board of Building Regulations and Standards
FOR
,{ _ Massachusetts State Building Code, 780 CMR MUNICIPALITY
Pul USE
_1 Puilding Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
fig iThis Section For Official Use Only
r= 1 Bur`lhing Pirrmit Number:SP 22O23-0462 Date Applied:
Ev i,v Kos .//& 7 2ti'Zz23
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
61 Austin Circle Florence,MA 01062 2,4_3(. 7—OO I
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
(,ASP .344 acrc
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 0 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: 111
0ek,.J .(s Jennifer and Peter Carbery Florence, MA 01062
kr, �� Name(Print) City,State,ZIP
CI
r`' �� 61 Austin Circle 413-519-4297 plcarbery@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building® Owner-Occupied ® Repairs(s) 0 Alteration(s) IR Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: I
We wit be replacing two exterior doors(front-main/side-secondary),and removing damaged paneling,drywall gnd insulation from our basement.
Remediation was not warranted.and we(the homeowners.and Jennifer and Peter Carberv)will be performing the work without use of any outside contracting.
A dumpster will be on site to help with disposal of materials.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $5,000 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/To Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire Total All Fees: $
Suppression) $ ,-0 0
Check No,?fp 6 Check Amount: (65.---
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
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 . 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.
Jennifer Carbery 07/20/23
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 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"
The Comntonwealth of Massachusetts
Department of Industrial Accidents
mis .
=1:11110217 I Congress Street, Suite 100
Boston,31A 0114-2017'
WWW mass.govidia
II it/kers Compensation Insurance Affidavit:Builders/C7ontractors/Ekctrichins/Plumbers.
ID BE 1-11.f.1)Wifli 1'11E1 PE RAI'TT iN :talc HOREIN.
Applicant Information Please Print Legibls
Name(Business,OrpritzationArtrixviclual):
Address:
City/State/Zip: Phone#:
Are5r uu*a employer?I heck the appropriate but: Ty pe of project(required):
10 1 ani a employix with empioyeirs kfult and'or part-tirne • 7 0 New construction
2.17:1 am a MAC proprietor or Ft.txtum4isp anti have nu curpiuyees vomiting tor me in 8. C.) Remodeling
1.-apAtii)..../No workers,'comp.erisuramm required.]
9, 113 Demolition
AM a hunoWahltet-doing all w ink myself.INo woitexa'comp,insurance roquircd.r
l()El Building addition
4 71 I ant a homeowner and Will bc hums oontractors to conduct all work on my propmty. 1 WI
i.nsure that all cOsaratitit's either have workers'compamsalson insurance os are sole /I fj Electrical repairs ur additions
proprietor%w with no eniployeea..
2.0 Plumbing repairs or additions
I am a genenit catitricior and 1 fuse hired the sub-contratiors listed tm the attained%heti_
13 ROOf mpatrs
these sub-contraettns have employem and have workers'comp.insurance.;
14.ciathe.
h.0 We Are a rtrrixirstman and ill officers have eximised their rsglat of eAenspboa per SKIL c.
I 52, 441.and we have no employees.[No workers'comp,inausliner requireell,
'Any applicant that riter6 hot T41 1321b1 also fill LILA thr iJn e,:hrio, showi then worions.'CLVIIP.Tbanoci puirry 131.14.111113LUX1
t Rueneowners who%Limn dna affidavit tnelmatarta they an:doing all work and then hire twaside eon ir.letors mum stint a new ai.iitit indicating auch.
;Contractors that cheek this box must attechml mm adelstional sheet showinN the name of the wutt-eon.:ta..:tor,and state Whether is nut!ILIAC attars:A have
employee-s. ff the Alab-enitrAelorA have ianployees.they trula proid Ve their workera-re.)rrip.poliry lumbrr.
on! an employer that is providing workers'compensation insurance or my entployees. BC/OW is the policy and job site
information.
Insurance Company Name:
Policy ±or Self-nts. Lic.#: Expiration Date:
Job Site Address: CilyiState,Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under NIGI.c. 152. §25A is a criminal teiolation punishable by a fine up to 51,500.(/0
andlor one-year imprisonment,as well as civil penalties in the loan°fa STOP WORK ORDER and a tine of up to 5250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investi!!.1[1011S of the DIA fur insurance
coverage verification..
I do hereby certify under the pains and penalties of perjury that the infOrmation pro ride ithe)i.t°is true and correct
SI!,111atinc. Jwe-C44,67 07/20/23
Phone t:
Official use only. Do not;write in this areit to be completeil by city or toa a official
City or Town:
Issuing Authority(circle one):
I.Board or Health 2. Building Department 3.('it /Town Clerk 4.Eledrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone 4:
City of Northampton
Massachusetts . i_
r
rr
n DEPARTMENT OF BUILDING INSPECTIONS 4 �,`
ti 212 Main Street • Municipal Building -',.
Northampton, MA 01060 "if W -s‘N'``
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 BP-zo23-oq5l' 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: to be determined by waste managemnet service-USA Waste & Recycling
The debris will be transported by:
Name of Hauler: USA Waste and Recycling
Signature of Applicant: ��� Date: 07/20/23
City of Northam ton
Sys
Massachusetts
WI
Wi
DEPARTMENT OF BUILDING INSP CTIONS ,`j„'
212 Main Street • Municipal B ildinq IA
�K
Northampton, MA 01060 1�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, Jennifer Carbery (insert full legal name), born292(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 1 0.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 seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactur•d buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"hom:owner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/sh• resides or intends to reside, on which
there is, or is intended to be, a one-or two-family d elling, attached or detached structures
accessory to such use and/or farm structures. A perso who constructs more than one home in
a two-year period shall not be considered a home own:r.
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 Buildi g Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in cons ruction 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 Ma•sachusetts State Building Code.
5. If I engage any other person or persons for hire in connectio with the aforementioned project or work on
my parcel,I acknowledge that I am required to and will act the supervisor for said project or work.
Signed under the pains and penalties of perjury on this 20 day of July , 2023 .
5( gnatu