17C-247 (13) BP-2024-0076
73 NORTH MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17C-247-001 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-2024-0076 PERMISSION IS HEREBY GRANTED TO:
Project# 2024 BARN RENO Contractor: License:
Est. Cost: 43500
Const.Class: Exp.Date:
Use Group: Owner: O'DONOGHUE PHILIP C&VALLE E DWIGHT
Lot Size (sq.ft.)
Zoning: URB Applicant: O'DONOGHUE PHILIP C& VALLE E DWIGHT
Applicant Address Phone: Insurance:
73 NORTH MAIN ST
FLORENCE, MA 01062
ISSUED ON: 01/29/2024
TO PERFORM THE FOLLOWING WORK:
INSULATE &FINISH BARN INTERIOR
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:
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Fees Paid: $283.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Buildinc Commissioner
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. " The Commonwealth of Massachusetts
': V Board of Building Regulations and Standards FOR
�: Massachusetts State Building Code, 780 CMR MUNICIPALITY
j USE
`o Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
4, One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 20'2)14-O 7 (a Date Applied:
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Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property A dre , / 1.2 Assessors Map& Parcel Numbers
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1.1 a Is this an accepted street?yes l/ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
LA k 13 ,455 ae 1-c„
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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ow er'of Record: MA
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Name( rint) City,State,ZIP
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No.and Street Telephone Email ess
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building IX, Owner-Occupied 0 Repairs(s) 0 Alteration(s) k Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description ofProposed Work':
1 A5w(cthoA 4 glIS1,1 WO c on ,aryl -- IO S u on-l-
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 35--; -j-- 1. Building Permit Fee: $ Indicate how fee is determined:
_ 0 Standard City/Town Application Fee
2. Electrical $ 57fa 0 Total Project Costa(Item 6)x multiplier x (�
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ 3 List:
5. Mechanical (Fire Suppression) $ Total All Fees: $ 2g3:o Yoll'e I 2,9zN012.41 v8!31
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ (f 3, 5-1)) ❑Paid in Full 0 Outstanding Balance Due:
City of Northampton
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Massachusetts
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` DEPARTMENT OF BUILDING INSPECTIONS
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212 Main Street • Municipal Building �:.. O
einv Northampton, MA 01060 �dti;... •
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
\ ate DLO fiiikt ((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.
Signed under the pains and penal ' s of perjury on this-221 day of ""\ , 202-s
(Signature)U4
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 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(H IC)
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: 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.
Idaf (e U) 6 11t2qLf
Print Owner's or Authorized Agent's Name(Electronic Signature)
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"
City of Northampton
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'' "--t ' DEPARTMENT OF BUILDING INSPECTIONS ar
�" ' 212 Main Street • Municipal Building Jti� a�
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'•'�Y�.�a0 Northampton, MA 01060 sNfy. \^
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: 11714 t-i 'g T 1 /14 0 ,
The debris will be transported by:
14
Name of Hauler: /V l ( CH1I'e j t 0 Q I/l, /
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Signature of Applicant: i Date: I , `'( I "
The Commonwealth of Massachusetts
-- Department of Industrial Accidents
/�ti I Congress Street,Suite 100
=srBoston, MA 02114-2017
4.44
r www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED%'1'I'll'I'HL PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name IBusiness'o ganization'Indniduall: Val (� t)w\ C
Address: N
City/State/Zip: °j'(e i AAA 0106 Z- Phone #: 4I3 -3 ass)
Are yen an employee( beck the appropriate boa:
Type of project(required):
1.❑I am a employer with employees(full and or part-tuna' 7. 0 New construction
2.0
I am a sole proprietor or purtncnhip and hats nu employees wurkutg for me in 1{ (�.R mtxlelmg
any eapxuy_[Nu workers'curnp.insurance n°yuir d.[ LJ
AO I am a uneowrer dome all oust m insurance myself.[Now utters'sump. in ur required.]
9. ❑ Demolition
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10 Q Building addition
4. ant a liumcow no-and will be hump oorira..tors to conduct all work on my property. I will
ensurt that all co tra:tun either lute wurkcn'cumpt-nstitut un.uranel or are sole 11a Electrical repairs or additions
proprietors with no employees. I2_a Plumbing repairs or additions
S.0I am a gtrocral contractor and I has c hired the sub-contractors listed un the attached sheet.
13.0 Roof repairs
These wbcuntrxtun hate cinpluyccs and hale krn wur 'coop.tnsurant:t.•
I4.0Other
6.0 We area corporation and its officer,hate exe'teosed taco nght of exemption per AtGL c.
132 1ll4).and we hose no employees.(No workers'comp.insurance reproof(
•Any applicant that chot:ka but al must also fill out the section bcluw show ins their worker'compensation policy mlunnatiun.
tlwney%nen who submit this atuida .t indicating they arc doing all work and hero hue outside contractors must subnut a nets atftilas a indicating such.
:Contractor that check this lot roust attaheil an additional sheet show mg the n:une of the sulrcourioturs and.tau:w le-iher or nut those Imbues line
employees. It the subcuntracturs hale employees.they ritual pru%ode their worker'coop.policy number.
l 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. Lie. #: Expiration Date:
Job Site Address: City/State/Zip:_
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MIGL c_ 152. §25A is a criminal violation punishable by a fine up to S1.500.00
and/or one-year impnsonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator. A copy of this statement may be forwarded to the 011ice of Investigations of the DIA for insurance
coverage verification.
I do hereby certi y un er the pains and penalties of perjury that the information provided above is true and correct
ODate I (zit (z K Signature: C'" .
Phone#: "[ 13 230? 6
Official use only. Do not write in this area.to be completed by city or town official
city or Town: Permit/License N
Issuing Authority(circle one):
I. Board of Ilealth 2.Building Department 3.City/Tows Clerk 4.Electrical Inspector 5. Mouthing Inspector
6.Other
Contact Person: Phone 0: