30B-032 (14) BP-2023-1544
12 NORWOOD AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30B-032-001 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
Penn it# BP-2023-1544 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 ACCESSORY BUILDING Contractor: License:
Est. Cost: 1000
Const.Class: Exp.Date:
Use Group: Owner: NICHOLS GREGORY D&REBECCA J FLETCHER
Lot Size (sq.ft.)
Zoning: URB Applicant: NICHOLS GREGORY D&REBECCA J FLETCHER
Applicant Address Phone: Insurance:
12-14 NORWOOD AVE
FLORENCE, MA 01062
ISSUED ON: 11/03/2023
TO PERFORM THE FOLLOWING WORK:
INSULATE SHED
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
P-8------) r-\---7------..
The Cononwealth of Massach setts NO
Commonwealth - 1 2023
F
i 1 Board of Building Regulations and 'tan IC ALITY
' Massachusetts State Building Code, :0 F
a g aU1tn�n, SE iA, Building Permit Application To Construct,Repair,RenovateR' i°tiltwOPAcr vise Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: L%v-3'3' I c 9' j' Date A plied: _
4 ► , fie 1 1V3�(93
b
Buildin Official(Print Name) Signature ISate
g
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
14 Norwood 14VG V.lotcn ce,A44 o142
1.1a 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: 1
Public 0 Private 0 Zone: .— Outside Flood Zone? Municipal 0 On site disposal system 0
_ Check if yes
-- ____— __----_--- SECTION 2: PROPERTY�WNER.SIiII'' --------_2.1 Owner'of Record: — - — --
kr_ t. ^cp Aslk._....Vl°6P1._
Name rin City,State,ZIP
Ike‘tc'4.• )C Ay)• fletc.l,er.-t'�
n
12-14 Nbaonol Ave. ell 3-ril i-ColYS 9Yh41 • c•1"1
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building fry Owner-Occupied 0 Repairs(s) 0 Alteration(s) fial Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 13 Specify:_2.2.'X ZZr Skint - i
Brief Description of Proposed Work2: ._. .f_ _.____._...___.._.._._. .�_
_(, _ ��at i stt>ta�4: cats _2.2-._ ,-
Zt DLt+� _kteeA'
__t4>._3s.��._ re...g ti 'AN?t 4 99 ; � a. .:_lcs. ..7 ais_�ccn„�_.4�__Aar
-hi rbu5k .prawn: ihsitgC+dA- (We ►ivioA space amen,Ales . Graro. -�;ke sLett)
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ 1. Building Permit Fee: :_-___-_— Indicate how fee is determined:
2.Electrical $ 0 Standard City.'Town Application Fee
— 0 Total Project Cost'(Item 6)x multiplier _____x--_..__.
3.Plumbing $ . 2. Other Fees: $_ _
4. Mechanical (HVAC) $ List: ___--_
15. Mechanical (Fire
Suppression) $ Total.All f,PcFees,,: ...._ r�.-., -
Check No. j. 'heck Amount:IA '" .
6.Total Project Cost: I $ ./ ❑Paid in Full ❑Outstanding Balance Due:._ _
�
60024 ,1‘1*/,-,nfr ZIIJ9
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 I&2 Family Dwe1liag
City/Town,State,ZIP M Masonry
RC Roofing Coveting
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.
1k2,6 ecc F lei h.er 14- - — 0J. 30 20 23
Print.Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own wo-k,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: 22 x 22 ' Sped
Total floor area(sq.ft.) YSy s1 .F/ (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) a Habitable room count 0
Number of fireplaces 0 Number of bedrooms D
Number of bathrooms 6 Number of half/baths !�
Type of heating system D Number of decks/porches CU
Type of cooling system O Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS 7�
212 Main Street • Municipal Building
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
ohs
1, �/ehetet F.ela e-r— 67'C or) 04414 ,V""insert full legal name), born_(insert
month, day, year), hereby depose and state the owing:
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. 1 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. 1 qualifij 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. 1 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 perjuryon this 30 day of_ do o. _J 20 23
(Signature)
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: /V New- ,./aa 92Ae 1/i ce 41/9
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant 'Re4ecr& F/elc/rel--
Akv. .22 2023
Date Signature of Permit Applicant