28-008 (4) BP-2023-1194
336 SYLVESTER RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
28-008-001 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-2023-1194 PERMISSION IS HEREBY GRANTED TO:
Project# GARAGE RENO 2023 Contractor: License:
Est. Cost: 5000
Const.Class: Exp.Date:
Use Group: Owner: MARIE VANASSE STEPHEN FRANK &JOANNE
Lot Size (sq.ft.)
Zoning: RR/WP Applicant: MARIE VANASSE STEPHEN FRANK &JOANNE
Applicant Address Phone: Insurance:
336 SYLVESTER RD
FLORENCE, MA 01062
ISSUED ON: 09/01/2023
TO PERFORM THE FOLLOWING WORK:
GARAGE RENOVATIONS
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
The Commonwealth of Massachusetts
qs) Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:GP-- 3.3-- I I 'c 1_ Date Applied:
,/i2 qt. I 7021
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
'33(a S yLvesreez.
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 0 Private 0 Zone: — Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner'of Record:
Sr&twist. ,c i41.#15sc- 5aa•d'. vh /-2,gxe..ie. f ,9i9 O/c5Z
Name(Print) City,State,ZIP
6 syI 1 "'ow?, y13-626 64/v/45V'2 74i�9/ /Ca'
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building El, Owner-Occupied ❑ Repairs(s) Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Jy
/ICJieP L/CG 1iJ.Lidael!. ¢- / /cs � lZ'�` �'/ ,f7-7I79.27/Z �,C+Om . G'Z 'l�16
7, (,Pv�irr wit s?Ai, Cjr .= -8— i- u.a47E /i5 CcZ 3 S
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ av Op 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ctG CI Standard City/Town Application Fee
/5 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire �
Suppression) Total All Fees' $ f�+,/
r
04, Check No Sj CI, Check Amount: lY J
6.Total Project Cost: $ sQ ❑Paid in Full ❑Outstanding Balance Due:
City of Northampton
q " z`• Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 sslIN 30°'
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:
Location of Facility: ��/� Ale rilAty
The debris will be transported by:
Name of Hauler: -' 0,"
Signature of Applicant: ter ' :; 2 Date: '-/ -Z
City of Northampton
oa-
4 fig
Massachusetts
d i 1 ;' •
� DEPARTMENT OF BUILDING INSPECTIONS
4 212 Main Street • Municipal Building
Northampton, MA 01060 sslw N�`�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, S 18' r 1 .4ssc . (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.R5.1.3.1, 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 SePr. ,.....4d-7;"/4-T
20.Z3
(Signature)
The Commonweahh of Massachusetts
Department of Industrial Accidents
illif
1.*11=out'* -) 1 Congress Street,Suite 100
Boston, MA 02114-2017
www.ntass.govidia
V1 orkers Compensation Insurance Affidavit:Builders/ContractorsiElectricians/Plumberv.
TO BE FILED NYv fill THE PIERMIITING AUTHOR11-V.
Applicant Information Please Print Legiblv
Milne 4 B us Iness'Organizationilndividual): .....
Address: 33G 5 YZ-VE67ER /?c,i0940 _ __
City/State/Zip: _ir-20.eeFA)ce: tip? a06z, Phone #: -1-//5- G26-
Ate yam MI employer?Check tIll:a pprviorbile bac I Type of project(required):
1.0 lam a employer with employees tfull=riot part-time i.• 7_ D New construction
2E1 lain a sole proprietor or pumership and have no erriployeirs w•orking for nu:in 8- Iv: Remodeling
t
any capacity_[Nu workers'comp.insuranix requires:LI a.
I 9. E] Demolition
',.0.1 am a homeowner doing all work myself.{No workers'corm_IIIAMIILIA:region:ill
0 El Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all skink on my property_ I will
inure that all oantracturs Mier have 111,tektrs.cosivensauem utsurance or are sole II a Electrical repairs or additions
proprietors with no enapluyees.
i I 2.0 Plumbing repairs or additions
!AO I am a general contractor and I have hired the sub-contnicturs listed cm the attached sheet_
I ID Roof repairs
These sob-contractors have employees and leave workm comp.insurance.;
14.00ther
(LE]W.::17,..a cmporation and its officers have e' wised their right of ezenmtion per MOIL c.
1.•2. '..,II.:i.and we!i..,:no erriplo:.ecs.I NO VI toilers'comp.insurance required.'
•Any applicant that cheeks ha. .1 most also fill out the neciwan below showing their worker,'...onipensation policy odormation.
t Hoiriooserser,who submit this affulai it indicatine they are doing all work and then hire siotside eon-tractor,must submit a new affidr,it indicating such.
;Contractors that check this box mum atta.lied an additional sheet showing the name of the:.uh-crantritetars and state whether ta not those entities have
employees lithe sub-connactorsha..e eirrployees.the) most pro.ode their workers.'...-oinp wire:.non-Aver.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: /..iii I _
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City.+StateiZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required itnetor MGL c. 152,*25A is a criminal violation punishable by a fine up to$1.500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violar_ A copy of this,,,,..11,..!!!,..rit may be forwarded to the Office of Investigations of the DIA for insurance
i:overdwi•\en Iii-iniinfl.
Ida herd,' certify under the puitt.N and',mollies r)/perjury that the infOrmation provided above is true and correct.
Sienalurn: .,...01i2i0 ) /e--- .--"* "--- "'"-"" Da tc: _-,c--/4.-:/17e6,,--2 A 2023
Phone#: //3-'"
Official use only. Do not write iro this area.to be completed by city or town official
CI I. or Tim n: Pertiiii/Licertse#
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspeillir
b.Other
Contact Person: Phone#:
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 ❑ 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 perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
R 9-/- 23
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.govioca 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"