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12-036 (5) BP-2023-1202 164 NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 12-036-001 CITY OF NORTHAMPTON Permit: New Build PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1202 PERMISSION IS HEREBY GRANTED TO: Project# GARAGE/SHOP 2023 Contractor: License: Est. Cost: 70000 Const.Class: Exp.Date: Use Group: Owner: BEHRENS MICHAEL J Lot Size (sq.ft.) Zoning: WSP Applicant: BEHRENS MICHAEL J Applicant Address Phone: Insurance: 164 NORTH FARMS RD FLORENCE, MA 01062 ISSUED ON: 09/12/2023 TO PERFORM THE FOLLOWING WORK: NEW GARAGE 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: L, ! I NV I` ' Sr. Fees Paid: $346.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner -z -014 File #BP-2023-1202 APPLICANT/CONTACT PERSON:BEHRENS MICHAEL J 164 NORTH FARMS RD FLORENCE, MA 01062 PROPERTY LOCATION 164 NORTH FARMS RD MAP:LOT 12-036-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $346.00 Type of Construction: NEW GARAGE 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: 400 )( Approved Additional permits required(see below) drfr 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 a3 Sign 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. 4' S ., The Commonwealth of Massach efts rh '10/ Board of Building Regulations and an d Massachusetts State Building Code, 8Building Pert Application To Construct,Rair, • a evis d Mar 2011 One- or Two-Family Dwelling A'41'roN Mq PECri• oN3 This Section For Official Use Only r�O Building Permit Number: QjO-�.j .J.1 o p, Date Applied: & j� ` �� ► ir V*22 Building Official(Print Name) Signature / • Date SECTION 1:SITE INFORMATION 1.1 Property 1.2 Assessors Map& Parcel Numbers ��f dA�t 2 y - 2 3� 1.1 a Is this an accepted street?yes ‘/• no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: i G-eiC/q tdr- v G ,/c s'- --7,r— 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 Z oa ' 3 0 ' a ' 74 ' .."e, 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public IW Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system lSPV.--- Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner;of Record: Name(Print) City,State,ZIP Ili J✓ - 1X t-- .,,. ,_ <74..y- s J- 9 -i',,4 — No. and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Constructionxisting Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. Number of Units Other 0 Specify: Brief Description of Proposed Work': C/44° Kit, if1(s- Zr—d. " vC '/' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ C J� a!s 6 I. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ S--o O CI Standard City/Town Application Fee ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ — 2. Other Fees: $ 4.Mechanical (HVAC) $ — List: _ 5.Mechanical (Fire Suppression) S Total All Fees: $ �) Check No. Check Amount: Cash Amount: 6. Total Project Cost: } '::)e' 0 Paid in Full 0 Outstanding Balance Due: 4 City of Northampton f 1 ij Massachusetts *_�__ ✓ k DEPARTMENT OF BUILDING INSPECTIONS 1 i 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. 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 Z# 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 oi'fhe 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 wort thorized 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. j13 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.) "'yr (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" 1 CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: p REAR LOT DIMENSION: REAR YARD `r / XI 117.0 <110 • .per J ,�-� �J SIDE YARD �" SIDE YARD FRONT SETBACK a FRONTAGE � 7f f City of Northampton Massachusetts �„' ce, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 9� Northampton, MA 010601ti 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: (i•ee z f y ,fe-C>/cc"� The debris will be transported by: Name of Hauler: ' ' me-, Signature of Applicant: Date: i., 11 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston.MA 02114-2017 www.mass.govidin Wasters'Conipensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. to BE FILED WITH THE PERMITTE44G AUTHORITY. Annlicant Information Please Print Legibly Name I BusincssOrgantzationindividuarl: —- • — Address: City/State/Zip:_ Phone#: - , r— .4.re you an eniiikKser?("boil.the appropriate bot: Tv yr Of project (required I: 1.0 I..;.1:rnployes*Lill _ cmpluyees 01141 text or part-time LI' 7. J New construction 20 1....,-ale propn.ior or purtnerattp and have TIO efrIplaVyNK7s 4..often! for me in g. 3 Remodeling -ity.[No winters't:urnp.tnsurance required.] • 3 TI a homeowner doing all work myself.[No w mp_orkers'co insumaioe required.]' 4..... ‘14.0 I ant a homeowner and will be hiring oontractors to conduct all work on my property_ I will 9. El Demolition 1 0 0 Building addition ellISUCC that all contractuni either have swelters'corripen,ation mauranea or are sole 11.0 Electrical repairs or Ailditioris proprietors with no employees. 12_0 Plumbing repairs or additions 3.0 I am a germeral contractor and I have hired the sub-contractors listed on the anacbed ski.-et. These sub-contractors have employees and bare worker 8'comp.msoraire.: I.3.0 Roof repairs 6.0 We one a corporation and ira officers have exacised their right of exemption per h4CiL c. 14,-0 Other I52,§I f 41.and we have no employers.[No worker' s'comp.Insurance.reoutretil 'An',applicant that checks bun n1 mini IILlij till OW the section below showing their workers compensation pokey information. t'I Ili;ineowniers who submit this affishivit nisiscatinu they are doing all work and then hue outside itractors must submit a new affidavit intinaim5 :Contrackirs that cheil this box mu g arta:bed an,A=tritunal.beet showing the name of the sob-saantractors and state whether or not tho-4e entities ha.: employee*. If the titth-runtrtmori hate onplutoo..Oct.rural prt:0.1.1e them workers"comp policy number I am an employer that is providing worAers'compensation insurance for my employer'.. Below is the polio and job..ite informatiM tt. Insurance Company Name: — Policy#or Self-ins,Lic.#: Expiration Data: Job Site Address: City/State:Zip: Attach a cop", of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NIGL c. 152, §25A is a criminal violation punishable by a fine up to$1.500.00 andlor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5,50.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cover-due +.entication. i do hereby certify under the paha and penalti of perjury.that the( in fortnatios provided above A2rire fl f currect. kPhone : Official use only. Do not write in Mi., lifeli.to be completed by city or town official i ('its or Town: Permit/License# 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*: a City of Northampton �OaYH A A.Tp,,O Massachusetts n "4 DEPARTMENT OF BUILDING INSPECTIONS w» ' 212 Main Street • Municipal Building sf• B d `��- Northampton, MA 01060 sprjti. +` 1 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT j�,�� 1,/ �'c �J (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. i4f Signed under the pains and penalties of perjury on thin- day of V• , 20_2Z (Signature J' A/ A1F ( r CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: • ,#1I./ REAR LOT DIMENSION: 7cp REAR YARD i SIDE YARD SIDE YARD �'� ti FRONT SETBACK FRONTAGE 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 ❑ No . 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLET D 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 author' d 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. A/ 6.0 „6-1/2rmt.v3.2 Print Owner's or Authorized Agent's Name(Elhironic Signature) NOTTS: 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.) 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