29-175 (8) BP-2024-0043
175 BROOKSIDE CIR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-175-001 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-2024-0043 PERMISSION IS HEREBY GRANTED TO:
Project# GARAGE FIRE REPAIRS 2024 Contractor: License:
ATLANTIC RESTORATION &
Est. Cost: 166330 REMODELING 089199
Const.Class: Exp.Date: 07/11/2024
Use Group: Owner: HANLEY CHRISTOPHER J
Lot Size (sq.ft.)
Zoning: WSP Applicant: ATLANTIC RESTORATION &REMODELING
Applicant Address Phone: Insurance:
411 JOHN DOWNEY DR WC0870938
NEW BRITAIN,CT 06051
ISSUED ON: 01/12/2024
TO PERFORM THE FOLLOWING WORK:
REBUILD AND REPAIR GARAGE AND BREEZEWAY
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: $1,082.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
File #BP-2024-0043 3K
APPLICANT/CONTACT PERSON:ATLANTIC RESTORATION & REMODELING
411 JOHN DOWNEY DR NEW BRITAIN,CT 06051
PROPERTY LOCATION 175 BROOKSIDE CIR •
MAP:LOT 29-175-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $1,082.00
Type of Construction: REBUILD AND REPAIR GARAGE AND BREEZEWAY
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
I l
d'
Signati - 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.
11-j-^,-C.,,,,,..0 I 1 11 61--*--"-......__
1 JAAt
The Commonwealth of Majsachtjsetts 1 0 p024 i
JJ
Board of Building Regulations and dards FOR
Massachusetts State Building Regulations/
UNICIPALITY
?TkC4P7Nf IycpE Ti l , USE
Building Permit Application To Construct, Repair,Renovate-( � T jRevised Mar 2011
One- or Two-Family Dwelling '"- I
•--�
This Section For Official Use Only
Building Permit Number: 15 P-.of -.-if 3 Date pApplied:
I AI
Building Official(Print Name) ( Signature i Da e
SECTION 1: SITE INFORMATION
1.1 Property Address: f Cl +`i L. 1.2 Assessors Map&Parcel Numbers
1.1a Is this an accepted street?yes no Map Number Parcel Number
{1.3 Zoning Irnformation: 1.4 Ppr�operty(�tDimensions:
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:
Public 0 Private ElZone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1,Owned of Record:,
Name(Print) City,State,ZIP
" ri�,r k' 1 i)").. � .41, Lj t;t!'_ , 1 ` All ('y 1
No. and Street Telephone , Entail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing BuildingEI Owner-Occupied a Repairs(s) 0' Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 021,C xt‘Cd tf 116, , .t 1 t), Oa Mak\ CO, C r al if (1
(In
M,�.( CAN�� (3\ , cqv , It A)t \ NV)- - ,C -fle1iri one k)-1 ,1
o ut -{V kO 06 4 0. d\h
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ `t 5--.) 530 ,06 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ CA00, w
00 0 Standard City/Ton Application Fee
E 0 Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fee
Check No. N' Check Amount: 1� Cash Amount:
6. Total Project Cost: $ z
i' , (A) 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) pr V y�t Q(1 , \
hi \\ " C-1\e' 1, License Number Expi ati Date
Name of CSL Holder
5 t ` �� r\eAl) At")6 A v\` 1A' List CSL Type(see below)
No. and Street L�ti d Type Description
�t t M-W -. N1 {t+-�rt U Unrestricted(Buildings up to 35,000 Cu.ft.}
iV t t 1 1Kt1 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) 3 t
t c t 1 f t\O HIC Registration Number Ex iration Date
H C company Name ar HIC Re 'str nt Name
'1/44p
o and 5 et �n l y t ' Email address C, :(OM
City/Town, State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AIUDAVIT(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. .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 71 N. , . ,' `(C\ 1 Ut
to act on my behalf; in all matters relative to work authorized by this building permit application.
•
/P .kin .
t Clwner's Name(Electronic Signature) Date
SECTION 7b: WNER1 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 curate to the best of my knowledge and understanding.
Print 0 er s or uthorized Agent's Name(Electronic Signature) Da e
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.) (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"
n
The Commonwealth of Massachusetts
_,lui
_ t, Department of Industrial Accidents
1! 1 Congress Street, Suite 100
ma's. . _
1 ' Boston, MA 02114-2017
� ,,-I www.mass.gov/dia
mo
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): -IA\(\' I 1 ,, Q, Str< , \(\,(\ ( \<tMe `It, }\f\ ,,\
Address: AA\ {; \c1iij :,\
City/State/Zip: c' Q ) W\\(k1' ,. C Ci.M5\ Phone#: *QO - 2J-- V,115
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with employees(full and/or part-time).* 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8.^ ,Remodeling
any capacity.[No workers'comp.insurance required.)
3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. 0 Demolition
10 Q Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or arc sole 11.❑Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13, 'Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t p
6.❑We arc a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ' ` j(( $ ;` -\. (O
Policy#or Self-ins. Lic. #. � ,L• )cj t�C} i Expiration Date: G. 1 ()
iq
2 Li
Job Site Address: A ;i , t City/State/Zip:c 1 O(e('( PA- (;\OUR_
Attach a copy of the workers' compensation policy declaration page(showing the policy number and e>ipiration 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance
coverage verification.
I do hereby certify under Il pains and penalties of perjury that the information provided above is
}true and correct.
Signature: t/ , ---- _ Date: i a \ rA
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
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.,
Massachusetts ,��' "',-
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DEPARTMENT OF BUILDING INSPECTIONS TI
�1 �; 4 212 Main Street • Municipal Building J,
9t.— Northampton, MA 01060 ss�;JY .TO1���
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: .L cz''-> ,10 a, t lt'(yr 1s1,. Rti . ,.,4
)-
n ,..
The debris will be transported by:
7.Name of Hauler: / �< C (_, ,
/ .,,,,
2
,,,-
Signature of A Applicant/` 4Date: / ''� ' 2 3
pp ,% 2
To Whom it may concern,
Enclosed is the permit fee for 175 Brookside Circle, Northampton, MA 01062. You
can e-mail me with any questions regarding this permit application, which I have e-mailed
in.
�r f
Thank you,
Kelsey Honyotski
Kelseyh@atlanticrestorationct.com
860-426-1975 X112
The Commonwealth of Massachusetts
r
Department of Industrial Accidents
wit ti 1 Congress Street, Suite 100
vBoston, MA 02114-2017
- 6 www.inass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): \\(\'\k\C SAS ' U i f\ (26 Oy\l.i qi s '`N
Address: 4\ 7\1.\\R \ek,r\Mit\-1 Y
City/State/Zip: WV)VjA(\.\(k1\(\ , Ci 0251 Phone #: 93%O'A-2-Q' q1C:3
Are you an employer?Check the appropriate box: Type of project(required):
1 ❑I am a employer with employees(full and/or part-time).* 7. ❑ New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in $.f,Remodeling
any capacity.[No workers'camp.insurance required.]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]:
9. ❑Demolition
I0 Ei Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or arc sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5. am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 l Roof
These sub-contractors have employees and have workers'comp.insurance.: repairs
6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c. 14.❑OthCr
152.§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
('��-fin vey
Insurance Company Name: (tS,�,`(�,� ( U
Policy#or Self-ins. Lie.#: 11�1l t Y v 1 �� Expiration Date: q I 1 I�()2-t--f
Job Site Address: `1 C--) 'A(OY.:•)\& ( 1 I City/State/Zip:c l Q1(e f(k',+tv\1 - ( lf L.
\U
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$250.00 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 ce ify under th pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: aIAv ) A
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Sectional Building Plan `
- __...--Shingles
Roof Assembly: -----_____...----Pelt
Ban1u
Pitch- Rafter re> Roof Sheathing
Covering- AR_c4-/i>✓£C�'iMa, t SN-iA./ 1,t5 ?`Fuss
tin clerinyment.- Syn./TNE 1C fiPo,,
Tee Barrier- JC- 41-r4' G•no1CGv •
Ceilis>gJoist -
Sheathing I--- P-- Lc DQ.> : -- 4�
True-Cut Sleet Required �ClcarSpan to t#1oopposife support C; �`�'-
O
Rafter Size- .2 x l 6 ,0.c lr 1
Rafter Spacing- 12" 6' 19.2" 4"� ►1
IF after Clear Span- IZ-Frl,t"I -'* Ail hgp • •-
Rnfter Species= I)QOGLas Ptih- F` Siding - I a - _
Ridgm- 4�8U ,9c'xiD���r j-4 .
Ceiling Joist Site- P2``x C, " 2-' '0 C- Sheathing 4
Ceiling JoisC Spacing-72"16"19.2' Q"
Ceiling Joist Species- DOuGIr.S R r0- Tnsuiatfon
insulation-R 33
WaftFraming
Interior Finish.- tJ�I-' Jt St-)
Atlic Ventilation- 211DCrL � � • Interior Finish --� •
\V illS: >~
Siding- V r I- <Si1plNG . 1 .
Sheathing- " pL-JIvOOa
Insulation- l t2-1 e, -c
ti�'all Y rattlln a y (o"
ileadres- "x �"_ 4
h.
Interior Finish,- 11111 t-�NI.SI• r
h.
•
Floor:
Finished Fluor-(Sr'rIP9Tlti CcNCnF� Sub-Floor
Sub-Floor- (,ONC_Aei . •• _ �► _
Floor Joist Size- (OOC ?E SIA5 Floor ��
Floor Joist SptCEiug-12"IG"19.2"21 1 M DIstmos
Flour Joist Clem Span- I Cleat S pp ., �, hem Made.
Floor Joist Species- • IPam.W the opposite sa ott c•
73cam Type&Size- • `-f '
h. PS •
DistnnceFront Grade- fr : ,✓fi,•
Sill Plate , �''
a
r'oundation: i'oendation Anchor' ' Pi- t,;;;-�42
Sill Plate- i roundation Wall , `..- .� :y
Wall Type iC Site �‘ Va� b(�Qt1(�{Zk i••t.}t•.�K-i 'tr"�`;'`
Reinforcement- 4 �� '`f"'"
+�' -'�i�:S Reinfot�cmcn[ F l_�•�s�tiu:'rr :�
Concrete Floor Thiekneds- 1- i " .••.•'•f1/%�esv;p..,.
• . � r`'r9,j•
Vapor Barrier• ` ConeteteFloot ,•r '�!; r ;
Column 1'ad Size ) X '1' w•tr'IN :
cosy:•;`.. •j
. ._ -Column Spneiug- _ _ _ . •
-- •`. • • • ..• yw,�,:`' - -. ----.._.. ---
FUUttllg Width- az F T V1 r,} ~'
Vapor Barrier �'Cry
Footing Height- 10 " , •
Footing Depth Below Grade- R Footing • ;%}✓1'
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