25A-156 (5) BP-2023-1629
27 WOODBINE AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25A-156-001 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-2023-1629 PERMISSION IS HEREBY GRANTED TO:
Project# ADD BATH 2023 Contractor: License:
Est. Cost: 26700
Const.Class: Exp.Date:
Use Group: Owner: WIMMER MATTHEW R &AMY T TOULSON
Lot Size (sq.ft.)
Zoning: URB Applicant: WIMMER MATTHEW R& AMY T TOULSON
Applicant Address Phone: Insurance:
27 WOODBINE AVE
NORTHAMPTON, MA 01060
ISSUED ON: 11/20/2023
TO PERFORM THE FOLLOWING WORK:
ADD 1ST FLOOR BATH
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: (�
14 Fees Paid: $175.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
K`Lc9v�s rV�7e rJ i�1/ @ f -e1 .
mGtr114 •
The Commonwealth of Massachusetts
W Board of Building Regulations and Standari►. FO'•
Massachusetts State Building Code, 780 CM, Nw 1 7 MgOCUSE
I
Building Permit Application To Construct,Repair, Renovate Or P-molish a Revised 1'•2011
One-or Two-Family Dwelling Nr,tr�cPECTIONS
This Section For Official Use Only ' NoaTHAMP •
Building Permit Number:J p 5'l QZ, Date Applied:
IPA.po...> II2 11 -Z'Z0L
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Addrpes : 1.2 Assessors Map&Parcel Numbers
c27 Woa h1( /2vP
1.1 a Is this an accepted street?yes V 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 /ar 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 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2_1,attlAcRiti!r`Wewimer- Wor-fh m ri/ MA Ol Db 0
Name� (Print) City,State,ZIP
21 W Oocl b j, Ave A1 t3-z75-4525 - +C,CA1M021:5 9 1'Y1a11‘.GOWL
No.and Street Telephone Email Address!
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied,L3' Repairs(s) 0 Alteration(s) lr Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units I Other 0 Specify:
Brief Description p of Pro sedWork2: ) v i e!i H f&e L F/ol/ IiN)LM /r0 title 142
Alc e, ! Q roD ri1. eo,J/ye_ ),� / e it aterill 4,4 SU iI vI0(4„)
Lel/ a fit Lc, 'le 41 p ere(' 4 I 4 $4 i Lt kt ;+-- 11 clo-Oe SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $VGA 7o0'oD 1. Building Permit Fee: $ Indicate how fee is determined:
0 n 0 Standard City/Town Application Fee
2.Electrical $
3/S0o' 0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ t0, 00.0 J 2. Other Fees: $
4. Mechanical (HVAC) $ AM List:
5. Mechanical (Fire /
Suppression) $ /VI Total All Fe • $ O J�
Check No. glCheck Amount: ( I u• Jv
6.Total Project Cost: $a/ 70411 Q,9 0 Paid in Full 0 Outstanding Balance Due:
/
City of Northampton
Massachusetts ,
4 :n °a� DEPARTMENT OF BUILDING INSPECTIONS
"!)
212 Main Street • Municipal Building tea.
.,.. � Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. 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. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new/replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements(if applicable).
9. Energy Code—all new construction(Gut/Rehab) requires a HERS Rater Affidavit
10. 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 Unrestricted(Buildings up to 35,000 cu. it.)
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 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 work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
containe ' is application is true and accurate to the best of my knowledge and understanding.
n7/2023
Print Owner's or Authoriz gent s ame(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.Rov/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" /(/ ( S��
The Commonwealth of Massachusetts
les=2 Department of Industrial Accidents
=7..111
=1.1. I=
=mei cwcw.- 1 Congress Street,Suite 100
'NM
SIM= Boston. M,4 02114-2017
WW/C.mass.gov/dia
— orkeri*compensation Insurance AMdavit:Buildersit7ontractorsiElectriciansiPlumbers.
ft)BE EILE.D Whit THE PERNIIITING
Annlicant Information Please Print Legibls
Name Bus ines,sk Organization Individual •
•
Address:
CitylStatei2ip: Phone#:
,tre yam ins employee ChMi the appropriate boa: Type of project(required):
1.0 AM t17100:VeT Wit employees(full araleorpart-time)s 7. 0 New construction
.20 I am u sole proprietor ur frartzterslop and have nu ClIctoyet-x working for me in g. 0 Remodeling
an"!,rapaect ..[No workers'comp.insurance required"
9.doing all want myst4f.[No wortins*cUlnp.insurance rripur [I] Demolitioncill
o ri Building addition
iats i loinsoownia and will be hiring -etoes to conduct all work on my property, 1 will
OW=that all contractois either have workers'conmensation insurance-ur ane sole I 1E3 Electrical repairs or addition,
proprietors vi employM,
12.0 Plumbing repairs or addition,
jJ I am a general runts:beim and I Inv.e tonal the.itil-eantrueit.tM Listed on the attached sheet.
110 Root repairs
These sub-curgracton.6a,0e.employees and e workers'*:ostip.uhuraaix,:
14.0 Othei
We ucr a corporinum and its offieers have exercised then night of exemption per%kit.c
1±..1.§1I4),and we bask,nu crimloyees.[No workers'avinp.insurance requited!
'Any applicant that checks box c I most also fill out the section below show nag then NN triers'compeciaulion potty informatuuct
I foram%nen who submit this affiatailt indicating they AM doing all work rind then hoc outside contraettle*mita 4111/ccut a new affidavitatutlicalmigh.
contractom that cheek this Kra:cilia attached an additional sheet showing the nano:of the sub-contractors:dui gate Whrthel or not atom,.cradles Iisse
If the sub-confraicors enirlos ee.,the naha pmaide their workers'4.Vir1r.IN.,11,4::!.number
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.4: Expiration Date:
Job Site Address; C..ti 'Slat c.
Attach a copy of the worker e compemation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MCit.c. 152, §25A is a crinimal N iolation punishable by a fine tip to SI.50(1.00
antl'or one-year imitrisonment:as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigatiotts of the DIA for insurance
co',crage verification.
Ida hereby certify unik taut s am penalties ofperjurj that the Information provided abovee true(met eorreet
11: ' Date. I t / I /2°2-3
Phone
Official use only. Do not write in this area.to be completed b),.city or town official
City or Tow tr: Permit/License#
Issuing Authority i circle one):
1. Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Bier
6.Other
( on tact Person: Phone#:
City of Northampton
Ir/ �.- Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building ..',.. -$
Northampton, MA 01060 dr 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:
Location of Facility: Ui4-(1i ReC.1 Gl. i _
The debris will be transported by:
Name of Hauler: 9ee/tA k p?..enn,v, 61.4.,, 71.',/ ,'v- S�yvle... .-5
Signature of Applica Date: 1 1 /r7/2_02s
•
City of Northampton
Massachusetts iY
* DEPARTMENT OF BUILDING INSPECTIONS E
212 Main Street • Municipal Building
Northampton, MA 01060 14-�.1 ,. z,
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, M on'lf I-t ev R c w, vvl e r (insert full legal name), born5! (insert`ei 7 y
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 /7+c!ni of NO VeX i 6t. , 20 23
ignature)
e
; ,."7 WoOd6)4f 4,i
r -/ro re/tth, ,, or � p
a
HeW eti(4/4"1 T —I-7—
....:::: 1
-.1 xl
. 5 U ow (
(,.1 .
\s) 0 0
s.7.-tz.i N-) m
f -,,t 1.-._I '
1., %, v
L rt-i% — _ —
ice, r
., f$4. : <------k6u) 1 *.)06):114 .5
Stqa /ci, #II
ki
`P.'&416 Cs FL°P '
1.1 •o
lzs
1 til
5% :
I
pocI 1 c�a
s i�
L 11) 1
4�O.lYtSO, A3".�:°Yi. +....-. �..nY... .:.. Pr
•
1t.5I_i rx/S/ h5 cn E� , .p�''kt) .-,
Customer(Sell)
1040 21 West Street QUOTATION
r k 1 V4 I LB S West Hatfield,MA 01088
413 247 7454
LULU:\(. MAINAIAta %.rPLIZZ Christa Grenat
Creation Date ,
PARADIGM
11/16/2023 WINDOWS
BILL TO: SHIP TO:
Phone: Fax: Phone: Fax:
QUOTE NAME PROJECT NAME CUSTOMER PO# DATE REQUESTED
kevin lennon Unassigned Project
SALES REPRESENTATIVE TERMS SHIP VIA QUOTE NUMBER
grenatc@rkmiles.com 845546
Lineltem # Description Net Price Quantity Extended Price
1-1 $548.12 1 $548.12
Comment/Room: Product: 8300 Series,Double Hung,Rpl
RO:39"x 52" I[
TIT Overall Size:38.75"x 51.75"
TTT Unit Size:38.75"x 51.75"
Sash Split:Equal
Performance Level: Standard, F
Glass Options:Double Glazed,LowE,Argon,Tempered,DS
3/4"IG Thickness,Clear Opening:33.375"x 20.46",4.742Sq ft I 1
Ratings:U-Factor=0.28, SHGC=0.28, VT=0.52 7359„—
Vinyl Color: White
Locks: Standard,Double
Hardware: White,
Screen: Full Screen,Extruded-Fiberglass,White,Sash Options:Vent Stop,
Standard(Double),4",
Unpainted
Interior Trim:No,
Installation Options:Standard Sill Angle,
Last Update: 11/16/2023 3:14:29 PM Page 1 Of 2 Printed: 11/16/2023 3:14:34 PM
QUOTE NAME PROJECT NAME CUSTOMER PO# DATE REQUESTED
kevin lennon Unassigned Project
SALES REPRESENTATIVE TERMS SHIP VIA QUOTE NUMBER
grenatc@rkmiles.com 845546
SETUP: $0.00
LABOR: $0.00
CUSTOMER SIGNATURE DATE FREIGHT: $0.00
DEPOSIT: ($0.00)
38
We appreciate the opportunity to provide you with this quote! BALANCE: $$34.26
pp pp � SALES TAX: $34.26
SUB-TOTAL: $548.12
TOTAL: $682.38
Last Update: 11/16/2023 3:14:29 PM Page 2 Of 2 Printed: 11/16/2023 3:14:34 PM