23D-084 (5) BP-2023-1248
53 WARNER ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-084-001 CITY OF NORTHAMPTON
Permit: Acc Structure
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1248 PERMISSION IS HEREBY GRANTED TO:
Project# BARN 2023 Contractor: License:
Est. Cost: 64000
Const.Class: Exp.Date:
Use Group: Owner: DAVIS EMERSON, MURRAY
Lot Size (sq.ft.)
Zoning: URB Applicant: DAVIS EMERSON, MURRAY
Applicant Address Phone: Insurance:
53 WARNER ST
FLORENCE, MA 01062
ISSUED ON: 09/14/2023
TO PERFORM THE FOLLOWING WORK:
700 SQ FT BARN
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: I
S {P /� ► ,7
Fees Paid: $144.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
z-oiz
File #BP-2023-1248
APPLICANT/CONTACT PERSON:EMERSON, MURRAY DAVIS
53 WARNER ST.FLORENCE, MA 01062
PROPERTY LOCATION 53 WARNER ST
MAP:LOT 23D-084-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $144.00
Type of Construction: 700 SQ FT BARN
New Construction
Non Structural Renovations •
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
X( Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §.
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
/14114... ito /3i43
Signal re of Building Official / Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission, Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
i
Sep F4
The Commonwealth of Massac user
r, Board of Building Regulations and I•asp 93 F�R
Massachusetts State Building Code, 780 ,v6;44n�q,G, UNIU IPALITYE
U3
Building Permit Application To Construct, Repair, Renovate Or 11-N•°6 i soot's Rev•.ed Mar 2011
One- or Two-Family Dwelling
This SectnFor Official Use Only
Building Permit Number: _60-A3 -/4 Y Date Applied:
1 I il
i vIIP 1 • 1 #1i (41103
Building Official(Print Name) + Signature i Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
�3 W.f„et sf A/o. 23 D 2-3D—OV /
1.1 a Is this an accepted street?yes I pc.. no Map Number Parcel Number
1.3g' Zoning Information rl' 2.yProperty Dimensions: 2� 37
Zoning District Proposed Us Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1i-T-°°-p4- 8( -1- C 7 tc . 1 7 5-
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Ii-- Private 0 Zone: Outside Flood Zone? Municipal® On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
,iqJ Mi._ & U N�4k fin, ,v d 106 2
Name(Print) City,State,ZIP i
9-3 u.4Ac- st- eloNwl.�.�,a M",I.
No. and Street Telephone / Email Addre4/
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.dc7 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 'Po Sy -'-f- 6,,J'... on coA., 4..,b eA. tAii*Isiver i o Mil
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building �Qu 1. Building Permit Fee: $ Indicate how fee is determined:
1 / 0 Standard City/Town Application Fee
2. Electrical $ bo00 3
(Item 6)x multiplier x
3. Plumbing $ 6/�(� 2. Other Fees: $
4. Mechanical (HVAC) $ ``00V List:
5. Mechanical (Fire Suppression) $ 0 Total All Fees: $ /4y 00
Check No. ki"r Check Amount: Cash Amount:
6.Total Project Cost: $6 v 0v 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.)
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........... ❑
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.
0n4.4.- giN y7i/ 2-3
Print Owner's 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.eov/oca Information on the Construction Supervisor License can be found at wwwv.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 halflbaths
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 Massachusetts
Department of Industrial Accidents
.....- 1 Congress Street,Suite 100
7'" $
Boston, MA 02114-2017
s•-•.... • www.mass.govidia
Workers'Compensation Insurance Affidavit:Builders/ContractorsitieetrkiansiPlumbers.
TO BE FILED WITH THE PERMITTING AtiTHORITY,
Applicant Information Please Print Legibly
Name(gusints%siorganizationAndividuan:
Address: 93 (AW-i^-es , T
. ,)___4, ,
City/State/Zip:City/State/Zip: r71'17 fir.ik-o , Phone#: 21- 4 gt)-Z- '5 9 7 ,An yaw as employer?Check the apprap late boat Type of project(required):
1.0 lam a employer with employees(fhlt araVor part-tinte).• 7. cj New construction
20 I ant a sole peopnanor or partnership and hart no etimloyees working for rue in K. Ei Remodeling
any capacity.[No workers tromp.insurance required.)
9. 0:Demolition
liS I am a homeowner doing all weak myself.[No workers'corm.insurance required"s
I 0 El Building addition
! 4.0 I ant a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers*convensation iroarrance or are sole 110 Electrical repairs or additions
pm:igneous with no employees.
121:IPlunibing repairs or additions
:50 I ant a general contractor and I Itive hired the sub,ecintractors listed on the attathed sheet.
I 3 CI Roof repairs
These sub-contractors have employeei and have wotters'comp.insoranceji
! .
6.E3 We are a comet-anon and its officers have exercised their right of exemption per MGT.c. I 4 0 Other
In,*1(.0,and we haw no attploynt.[No workers'comp insurance required.]
Any applicant that cheeks box 41 must also till out tlic.section below showing their w Lukas'compensition policy information.
t.flumeowners who submit this affidavit indicatinig this are doing all work and then hire outside contractors mug submit a new affidavit mdtuaung such.
:Contractots that cheek this box must enriched an additional sheet showing the name of the sub-contractors and state whether a not those entities have
einployees If the subcontractors hive employees,they must provide their workers'comp.policy number.
I am an employer that is providing vorAers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: _
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/StatelZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under 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 fine of up to$2.50.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification
I do hereby certify under the j .s and penalties ilperjury that the information provided above is true and correct.
Si mature. — Date.:
Li_, i
..)
Phone#: 9c)2.---- 7 t-t`77 —1 J y,
. ,
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License 4
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector •
6.Other
Contact Person: Phone#:
City of Northampton
teH"Hq r
r 4A y�S Massachusetts C? . 'cyy.
Oot DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 31-
4* Northampton, MA 01060 4:P'4Y , `y
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: V (( /
l�
Location of Facility: (1 ✓ 4 _
The debris will be transported by:
Name of Hauler:
Signature of Applica • Date: yNZ
3
City of Northampton
a�Fd P MP>
Massachusetts
= I DEPARTMENT OF BUILDING INSPECTIONS ,
212 Main Street • Municipal Building . 4t
n Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
USV'/ !z (insert full legal name), born _ (insert month,
day, year), reby 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 an p' alties of perjury on this day of 5 e-f F 2023
(Signature)
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