17D-005 (8) BP-2023-1132
550 BRIDGE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17D-005-001 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-2023-1132 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS 2023 Contractor: License:
Est. Cost: 10785
Const.Class: Exp.Date:
Use Group: Owner: GILLIAN BRUNET
Lot Size (sq.ft.)
Zoning: RI/RR Applicant: GILLIAN BRUNET
Applicant Address Phone: Insurance:
550 BRIDGE RD
FLORENCE, MA 01062
ISSUED ON: 08/21/2023
TO PERFORM THE FOLLOWING WORK:
INSTALL NEW CEILINGS AND INSULAITON IN 3 BEDROOMS
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 Drive%ay 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.
Fees Paid: $71.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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The Commonwealth of Massac'usett,5 46, J i
Board of Building Regulations and :.•da ITY
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Massachusetts State Building Code,-780 •,if' '90 „44,4" 0 OR
US'
Building Permit Application To Construct,Repair,Renovate Or °et 1►. ' vised ar 2011
One-or Two-Family Dwelling 4o� 4
This Section For Official Use Only '
Building Permit Number: 6 l9.- 3.3- I I.3" - Date Applied:
it ue.J 4, ,// -- 6-Z)-2023
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
550 Bridge Rd,Florence MA 01062 /
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:
/ Zone: _ Outside Flood Z e?
Public 13 Private❑ Check if yesV Municipal LOn site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Gillian Brunet Florence,MA 01062
Name(Print) City,State,ZIP �/
550 Bridge Rd 310-633-0032 N gillianbrunet@mac.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) <Alteration(s) 131-Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: Install new ceilings and insulation in 3 upstairs bedrooms. Ceilings were
removed in asbestos remediation(permit filed with Massachusetts EPA,#100387912),leaving bare beams under roof.
Contractors will install new insulation and new ceilings in 3 upstairs bedrooms.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 10, SW 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
(�7 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5S.Mechanical (Fire $ Total All Fees 1
Suppression) 11 IF
Check No. Check Amoun :
6.Total Project Cost: $ ( 0 c){��f 5 0 Paid in Full 0 Outstanding Balance
pDue: #
t';A c,r e.(a`-4, , q w L r k -9 ?at)o r e-�C.k Li 1 �rt -Q-- r't-t
ZtnS :0A ..F ±1O1)
b rr : $ 2:r`( S
City of Northampton
3,6
Massachusetts
y a u s
DEPARTMENT OF BUILDING INSPECTIONS g
L ; 212 Main Street 4. Municipal Building
�i--! Northampton, MA 01060 rs......
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PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
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.
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.)
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.
1T/I-3
Print Owner's
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 Commonwealth of alnssnchusetts
? I. Department of Industrin!Accidents
1 Congress Street,Smite 100
r•$' Boston,MA 02114-2017
www.mnss.gov/din
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH'ME PERTh rrhNC;AIiTIIORITI'.
Annlicant Information Please Print I.ee.ihly
Name(Business Organizatiottilndividual): Gillian Brunet
Address: 550 Bridge Rd
City/State/Zip: Florence,MA 01062 Phone#: 310-633-0032
Arc Sou anenlplo)er?Cheek the appropriate base 'Type of project(required):
t 0 t am a employer with employees(full mdnor part-time).• 7. CI New construction
2.1n I am a sole pinprietos or panrnciship and have no employees w caking for rite in t(. 'Remodeling
any opacity.[No workers'canp. insui.' ntluind.) —+
9. ❑Demolition
3cj 1 am a honseouncr doing all wink myself.[No workers'comp.insurance required.)'
�/ 100 Building addition
&E 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'weripetualion ins wan xor arc sole I I.0 Electrical repairs or additions
poplietors with no employees.
1_2
0 Plumbing repasts or additions
SOI am a general contractor and 1 have hind the subcontractors listed on the attadwed ashen.
These subcontractors have employees and hose workers'comp.insurance.: 13 Roof repairs
6.0 We are a corporation and its officers have exarisatih their right of exemption per v1GL c. 14.0Other
132.41(1).and we have no employees.[No workers'comp.Misname required.)
*Any applicset that checks box oI must also fill out the section below showing theirworkars'compensation policy information.
t Iloineow tiers who submit flit affidavit indicating they are doing all work and then hire outside contractors Inlet submit a new affidavit nut icaimg such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees_ If the sub-contractors hove employees.they must pros idetheir workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
infornntion.
Insurance Company Name:
Policy#or Self ins Lk.#: Expiration Date: �1
\\.:lob Site Address: G Su 1 e 1`GC _City State/Zip: FL"f c-n H/dr U (O�j
Attach a copy of the workers' contpen. tion policy declaration page(shoming the policy number and expiration date).
Failure to seitsre coverage as required under MGL c. 152. §25A is a criminal violation punishable by a tine up to S 1.500.00
and/or one-year imprisonment.as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to S250.00t
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DEA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the informaiion provided above is true and correct.
onature: � Date: g/;- -2 3
Phones: 310 — Co 3 -- CCU 3?
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Perntit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.CityT1'ossn Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
, , City of Northampton
Sr4
Massachusetts
DEPARTMENT fir.
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�' DEPARTMENT OF BUILDING INSPECTIONS y=.
; � 'q� 212 Main Street • Municipal Building ` 4S ,�'P.
Northampton, MA 01060 `PivN.
Property Address: 5 5L 0 r d
Contractor
Name:ame: I* rK e(e CH(
Address: (cD Elk 5'—
City, State: kh' (J, M4
Phone: 40( 21 7 r 0 J 1 4(
Property Owner
Name: 1 o.n 13 r�
Address: 55c7 g ri D— R cQL.
City, State: it ' r&-r\C)2 ) M A o l U c'a_
I, /1V1 cK >+ (contractor) attest and affirm that the building I intend to
insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor signature
Date VI
72.4
3
City of Northampton
of ��e i
f••' Massachusetts •
k•
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Imo, ` DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building ti0' OC Northampton, MA 01060 I-`.`: .39^
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION S)
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 ppfacitlity, as defined by MGL c 111,(�S 150A.
o V IOC C��1 r Jl�s' / I n S�.J—at .D(\ (iJ C'.re-
- �j'2 e tm-t)V
a S S 5 r-e__ v 1 n () kip
c,..>0-s3�-e- c� 1 �c USA 6 G c l' 0-y5L.
The debris will be disposed of in:
Location of Facility:
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date: g / -Y11-3
City of Northampton
yi:7r/4r!/
Massachusetts ��?' •.
DEPARTMENT OF BUILDING INSPECTIONS 5
212 Main Street • Municipal Building
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, G r I( 10.n ts ru. (insert full legal name), born (insert
month, day, year), hereby depose and state the following: c
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 ( + day of A- A- , 20 2.3
(Signature)
180 Pleasant Street
Easthampton, MA 01027
LLC (413) 529-0200
"Right and Tight the First Time" r.-- - info@usasprayfoam.com
dfthar Brunet Thermal Boundary
Date
Preliminary Estimate
Aug 2, 2023
Project:550 Bridge Road, Northampton, MA Plan Set: Site Review:08/01/23 Total Estimate
Contractor will supply all:equipment, labor and specced materials, unless otherwise noted,to the Per Scopes Listed
specifications as described in the Scope of Work.Only listed Scopes will be installed.As needed:Permit below
Trash and Propane heat billed with final invoice.***Work areas must be empty,clean and exterior
substrates Dry. After 30 Days material
Scope of Work: pricing per scope
subject to increase.
Noted on final invoice.
Bedrooms Ceiling Insulation
- 3 bedroom ceiling sections
- Before sheet rock:Ceiling rafter slopes a nominal 5"/R37 closed cell foam in rafter bays short of face.
- After sheetrock:ceiling penetrations air sealed and damming with fiberglass as needed,install 18"/R60 $3,250 ceiling slope
blown loose cellulose in attics foam
$2,900 attic cellulose
Note:ALL work spaces empty,clean and dry. No other trades permitted in vicinity of spray zone.All
belongings/materials removed and/or protected by Client-GC
**Options:Additions/Alternatives:
1) install 2"closed cell foam against sheetrock, R14,to provide durability,vapor control and enhanced
thermal protection 1)ADD$1,750
Estimate is based upon the noted conditions being met. Prices exclude any and all terms and conditions not expressly stated. Payment
in full due upon receipt of final invoice. Estimate is ONLY valid for 30 Days:Sept 2 2023.Once accepted,please sign and return a
copy of the proposal agreement with a 30%deposit check to 180 Pleasant St Easthampton, MA 01027. Upon receipt your project will be
scheduled.
Client : Date:
Foam USA carries all required Workers Compensation and General Liability and will provide copies of insurance upon request.
We are a local company that provides benefits and excellent wages for our trusted employees. Thank you for investing locally. It
matters. HIC#190521
1
All Clean Environmental
1052 love(Slleet I Nostuo.MA 02'36 I P 617.970-25/2 __..
7/7/23
CERTIFICATE OF COMPLETION
I hereby affirm,to the best of my knowledge and belief, based on inspections, observations, and/or
testing,that this asbestos abatement project at 550 Bridge Road, Florence, MA 01062 is complete.The
asbestos abatement was completed in accordance with the MA DEP regulations.
CONTRACTOR INFORMATION
Kevin Goheen
All Clean Environmental Services, Inc
1052 River Street, Boston, MA 02136
allcleanenviro@gmail.com
(617) 970-2572
PROJECT NAME
550 Bridge Road, Florence, MA 01062
PROJECT DESCRIPTION
Removed and disposed of all second floor Popcorn ceiling material (approx 500 sq ft)from all second-
floor ceilings.
Completion date: 7/6/2023
alJ't A- Xake,,,ii, 7/7/2023
Certified by Date