38B-161 (4) BP-2023-1426
12 FORT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-161-001 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-2023-1426 PERMISSION IS HEREBY GRANTED TO:
Project# SUNROOM ADDITION 2023 Contractor: License:
Est.Cost: 29800 YEVGENIY SLOKHIN 108714
Const.Class: Exp.Date: 12/19/2024
Use Group: Owner: DOLINGER ABIGAIL M
Lot Size (sq.ft.)
Zoning: URB Applicant: YEVGENIY SLOKHIN
Applicant Address Phone: Insurance:
99 ALFRED CIR (413)485-8556 AWC-400-7036115
AGAWAM, MA.111-
ISSUED ON: 10/24/2023
TO PERFORM THE FOLLOWING WORK:
SUNROOM ADDITION WITH BATHROOM
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 ' , o
. Ts
•
Fees Paid: $194.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
File #BP-2023-1426
APPLICANT/CONTACT PERSON:YEVGENIY
99 ALFRED CIR AGAWAM, MA 0110(413)485-8556
PROPERTY LOCATION 12 FORT ST
MAP:LOT 38B-161-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $194.00
Type of Construction: SUNROOM ADDITION WITH BATHROOM
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
INFO TION PRESENTED:
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
//.4Z iO - i9• Z�Z3
Signature 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.
The Commonwealth of Massach efts OCT
W Board of Building Regulations and an.. ds 1 2 ZQ� F R
Massachusetts State Building Code, 80 (0.....? �F I ISPA�,ITY
R
Building Permit Application To Construct,Repair,Ren A P',k.1.::f.art 'evis Mar 2011
One-or Two-Family Dwelling 'MA 01pso°Ns
This Section For Official Use Only
Building Permit Number: CO* 3 ' /N4 t7 Date Applied:
a;
)0 /�€ e Z3_ZOz3
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Addrep: 5\ 1.2 A,e? rIgap&Parcel Numbers
1.1a Is this an accepted street?yes y• no Map Number Parcel Number
1.3 Zoning Information: 1.4 Pro rt'Djmensions:
Zoning District Proposed Use Lot Area(sCq t)) 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 k Private 0 Zone: _ Outside Flood Zone? Municipalq On site disposal system 0
Check if yes¢8
SECTION 2: PROPERTY OWNERSHIP'
2.1 ck n 'of Record: (vo \- J
( � k
1-\,-e_c ‘ cti\
Name(Print) S City,State,ZIP
413-262-6131
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) 0 Alteration(s) 0 Addition lSI
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: (fig SCG5oA S.4 n c oarm tiJ t(An trAAA c of lIA
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building S ( `_5 Q� 1. Building Permit Fee: $ Indicate how fee is determined:
c!� / 0 Standard City/Town Application Fee
2.Electrical '2 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ir S 00 02. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) 3 Total All Fees•
Check No. \�D heck o \`1, sh Amount:
6.Total Project Cost: S 2 ct i 800 0 Paid in Full Outstand a Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Constr ction Supervisor License( SL) q .l l� n Q L‘
��t �pkkA License Number Expira on Dt e
Name of CSL Hold
6 (� c I - List CSL Type(see below) tk
1 t Type Description
No.and�treet
`(�� G ��. r U Unrestricted(Buildings up to 35,000 cu.ft.)
Restricted 1&2 Family Dwelling
City/Town, te,ZIP �` ` R
M Masonry:
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
( OS 425 1c51. yco6klit'. ./akoo.uM I Insulation
Telephone Emdil address _ D Demolition
5.2 Regi t ed Home Improveme t C ntr(a�ctor,�(HIC) ‘II� „l I4 2'1
LK� e--t �O�O`^"\CtI\ HIC Registration Number Exp atio Date
HIC Comvan.y N IC r C Name
"l yOtellA S �ityk0 6O.c.OM
No.ate Stree ,�� I.{ f Email addre s
City/T'olltate,ZIP ' t l 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 it No 0
SECTION 7a: OWNER AUTHORIZATION TO BE C MPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIE F BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorize y this buil g permit application.
, .\ q ?,� 2 3
Print Owner's Name lectronic Signat ) I to
SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering i nam; ,elow,I hereby attest under the pains and penalties of perjury that all of the information
contained i, - is app ation is true and accurate to the best of my knowledge and understanding
Print Owner's • Auth i zed Agent's Name(Electronic Signature) Da
NOTES: a
1. An Owner who o. ains 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"
City of Northampton
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r Massachusetts
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DEPARTMENT OF BUILDING INSPECTIONS ,
a' 212 Main Street • Municipal Building �0 y�'
-- , Northampton, MA 01060 4s �,. �1�,
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:
W �. c1( Dv\
Location of Facility: 5 �� l�C �� ((/�/t G!
6
The debris will be transported by:
Name of Hauler: QGN,. ri—\—`Z�
Signature of Applicant: Date: 0
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
The('ttntitt011;vealth of Massachusetts
Departurent of Industrial Accidents
- .
ii
I Congress Street,Suite 100
S. 6
IN
' - — Boston, 3,1A 0211.1-2017
www.ntass.gorldia
,zi....g,..,
II olkers'Compeniation Insurance AlTida%it: BuildersContractors/Electricia RN;PlUmbers.
Tit)BE FILED WITH111F.PERM i I I INC AIrl'HORITY,
Annlicant Information Please Print I.e2ibl%
Name I Business.,tkvanizatio hc ,uali:_, Y_e_Jer\t%I • ga DIA in , ,/‘ _ ,
,, ,.
Address: Ct -1\ $247,,, (... k ‘
CityiStateiZip: Phone 4:
Ate err aa ciiipi ,er?Check the appropriate but: • Type of project(required):
I 2M A employer with rt..... employees i full,milor part-t.iinct_s 7. 9 New construction
2C3 I am a sole proprietor or pinsicrship:mil hate no ersipLoyeea working fm me In 8. 0 Remodeling
any capacity_[No workers'comp.insortm,e requirsal.]
9. 11 Demolition
AO i am a hint:cow=doing an*bit myself.Psio workers'comp.3[2$411111i1A:reginicd,)'
10 n Building addition
4.0 I am a hornetniner and will he hiring coeurasiors tu conduct all work on my property_ I will
master that an contractors either hase workers'compensation insurance or ate sole 111:1 Electrical repairs or additions
prapiitiars with no employees,
• 12.E]Plumbing repairs or additions
:5C3 I am a emend contractor and I brie hired the 2411,^Ckmtractor.listed on the militated 8kleti,
13.0 Roof repairs
These sub-contracters base employees and base workers'4:VITT.11UllIrli:C.)"
14.110ther
h.E]Wr are a corporation and its officers have exercised their richt of eximaption per teltiL e..
I SI ti it ilt,and we lt.a e no etTipluyees.[No ss or-Leis'ccarna.insurance recoils:ill
'Any applicant that ehstis ts.x r-i mast ais...1 li Li out du:miction ts:low show in g their workers.'comperwatiori pot iey informatism
e thienetismen,who submit this affida%it rmlicating they are sluing all work and then hire outside cormactors must submit a ne affislas it indicating such,
1Contracti.ms that check this box must attached an additional sheet showing the MUIR,of the sub-contractors anal state',a twiner or riot those clothes hass...L
irmplos. If the stsb-ccintracons Isis e emplcn,ees_they must provide their workers`comb.policy number
I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and jab sae.
information.
Insurance Company Name _ PCI\ \I\k tl\U- Cik —
Policy#or Self-ins.Lie.#. C— goo- el 05(c;kk Expiration Date.
Job Site Address: V1.- f:0(.. . CitylState,Zip: kOftuvotOONE riAtplok,0
Attach a copy of the workers'compensation polies declaration page(showing the policy number and expir tion ate,.
Failure to secure coverage as requinad ui er MCI.c. 152, §25A is a criminal violation punishable by a line up to S1.500.00
and/or one-year impriAinment,as well a civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a
day against the violator.A cpy of this atemcnt may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
_ .
I do hereby e erfiii•tt nth- i 'polo. a n penalties ofperjuly that the information provide,'above is tot told eiorrei.r.
Sienature: / 1)3.1% RW 15
I
Phone,v AVID tict5 g(7-5L
01/i,tin/14 W emly. Do not write in ti.'s area.to be completed by city or town official
City or Town: PermitTicense O •
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector S.Plumbing Inspector
4.(4ther
Contact PerNun: Phone#:
..11.4.
10/12/23,2:51 PM Screenshot_20230919-214327_Floor Plan Creator.jpg
15'
(proposed addition
225.1 Ft2
1.
72 Ft- I I _O
■
existing house
672 Ft2
23'3"
17'7"
front porch
160 Ft'
new all season addition structure
-4 pc 12 inch sonna tubes
-2x10 floor deck with 2 inch foam board on-the bottom and R38 insulation
driveway -2x6 wall framing
-R21 Insulation
-2x12 single slope roof deck
-3/12 roof pitch
-R 38 insulation
-electric baseboard heaters.
https://mail.google.com/mail/u/1/#search/12+fort/FMfcgzGtxKRZNjhfhfrTDDjGkgPXcDnL?projector=l&messagePartld=0.0.1 1/1