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36-018 (6) 23 FOREST GLEN DR BP-2022-0001 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-018 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2022-0001 Project# JS-2022-000001 Est.Cost: $10000.00 Fee: $95.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 14505.48 Owner: CAIRNS NAOMI Zoning: Applicant: CAIRNS NAOMI AT:T: 23 FOREST GLEN DR Applicant Address: Phone: Insurance: 23 FOREST GLEN DRIVE (413) 923-8099 () NORTHAMPTON MA01062 ISSUED ON:7/8/20210:00:00 TO PERFORM THE FOLLOWING WORK:SHED AND DECKS, REPLACEMENT WINDOWS 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I I „2 scs- 'I • • • 6 Certificate of Occupancy Signaturi ` I 0 FeeType: Date Maid: Amount: Building 7/8/2021 0:00:00 $95.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner - 0,� File#BP-2022-0001 APPLICANT/CONTACT PERSON CAIRNS NAOMI ADDRESS/PHONE 23 FOREST GLEN DRIVE NORTHAMPTON (413)923-8099 Q PROPERTY LOCATION 23 FOREST GLEN DR MAP 36 PARCEL 018 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid It? Building Permit Filled out ``�� Fee Paid Typeof Construction: SHED AND DECKS,REPLACEME WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION PRESENTED: i/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 /%Z 7-S-Zozi Signature o 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. j7 Z 1 1 � The Commonwealth of Massachusetts \. �. � '� Gl /!/' W Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR • MI1NI.•, �, , Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Ma `' s One-or Two-Family Dwelling 2'1a c, This Section For Official Use Onlyo , Buildin9Permit Number: 6&"��' 1 Date Applied: ,/ i E-V// ✓& / 8.204 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers e5ir biz() live ✓ �,cl? cAc:P- 3C0 a( 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: Public Private❑ Zone: _ Outside Flood Zone? Municipal EflOn site disposal system 0 Check if yes El SECTION`: PROPE'kTY OWNERSHIP 2.1 Owner'of Record: KlatMt Cut yciete (111 otcoa Name(Print) City, State,ZIP a3 fo(est C?Zen okr. 4iSc Z3$tq9 jiAtictirlanctii @ yahoo •Cam No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPO LEWORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied Ld Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. L1 Number of Units Other Q1i Specify: ((o X I(0 clez lc Brief Description of Proposed Work2:Jl p( map 5heti 0 406 ttk &IA SC-.10:icts(Dder. Att?UcL Pd 4"Stilt ocflow Q2'tMte windows •-a dc+of 44 ac,e 5 Aerr 6 2110.(4 M6nV ,otr►ik-W s x ko SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ Oa a 0DO 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees $ Suppression) Check No. 110(/Check Amount:#176 Cash Amount: 6.Total Project Cost: $ 1.O, 000 0 Paid in Full 0 Outstanding Balance Due: 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.) M Restrictedasonry1&2 Family Dwelling City/Town,State,ZIP �1' 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 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 (nti F to act on my behalf,in all matters relative to work authorized by this building permit application. L Print Owner' ame(Ele c ignature) Date SECTION 7b:OWNER1 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. Print Owner's or Authorized Agent's Name(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.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 oatHAMPT� 5 .V.. SI` Massachusetts ��5' c'e` DEPARTMENT OF BUILDING INSPECTIONS y; • ti. ry�� . 212 Main Street • Municipal Building �D aO•y'`�1 ,• Northampton, MA 01060 s y04/ �• 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: L.A1,1 g S Location of Facility: (414 e 12 8,1-64; /\ t'1 �oz- 1`A II G G,l9-,vi,4a1e IG—!- • -~F‘ Jt o(,-z- The debris will be transported by: Name of Hauler: Cxx.A.(N Signature of Applicant: Date: (012S 1-2_i the COMPHnntt'errltl, of Massachusetts �' Department of Industrial_4ccider,ts js_ 1 Congress Street, Suite 100 l�� 7 . Bosto,,.L1021t14-201- 5 .�- _f wtkwr.mass.goi`rlllia - Wurkers'Compensation Insurance Affida it:Builders'C'ontractor_Electricians Plumber_. TO BE TILED 11TFH THE PERRQFTLNG AUTHORITY. Applicant Information Please Prim Legibly 1.i hie ,: airs_Or7t=17 don imii ithro: Afire=s.: City/State.Zip: Phone=- Are sea as ezepla-er'C`rck the appropriate Ems Iype of project(required): 2.0i.z,.....,-...i.e. amp w:Gthi:asd cr pa Mr-el.,' 7. ❑New.zonstruchon 2.0I am s:cis puoprietcr cr?ammarWip lad hiss na empla amen worsiaa for the• S ❑Esanodskna any raper^,.[Nc:uric 'cccp.'m-aranc: roc-_irab] 3.gI am a he er&te all work .elf.[No waiters'comp.insnranca recraired.]' ❑Demolition 4.0 I a a hence•W„er.' uiil to hiring cca tn trtrrt to rondncc aJ wok.on ay rrcfrzrs. I wail 10 "��addition m ea:,zrs that 17 cantrartcr.either hate worker.'rampca.LLca is t uncc cr era zola 11.0 Electrical repair-, as a,MitiolL. pmpriehm: no employees_ 12.❑Pit ibine.moans or adthho+n-. 1.0I a€,a genera:caatrar-ur zed:hare bawd the nut-ccm:axstor.burl cm th,a attNhcd shwa. 13.0ROOfi'1eP3fiY: _ p Thew sub-:mathAnw.have o acioyoe:and lire:crier•wimp.'aL*mac;st y, [t 2e 5+�tkw� 4.0 We are a cc:paatice.and ir.o rr-:har•a a>A_-rinsed des iizi of ewe c par MGL c 1 u`�' er��CI(r q 152.144),and we haw no amp:or.,a:.[- owe:ice.'canqa.th-taance reg d.] Sk¢ta, -^n.e.1\t W L'K‘C`?S -T iAa•agh rhea: camt that ea:tea.-1 ma:;a1:o 5L ant the sect.ca te1ow:hcaias their Tien•ccsp:m:atha coli7 m:nmr ,rioa. `Home:a men who submit this aiiidxCt thdicat3:tss are dams ail work and then hire cc-r.ide r al actc•ma::-omr a new affidavit iadicz:iac:act catrac'.ur:that rhea this hex mint armemd as mdioana::tee:-howiac the name of he nth-ccrtrac:m.zed.-a-s whetter cr no.: moose sntizcs'Ma—,:a arakyees. If the;ua-ccaaxtor:han•a emphryeas,they ma t protiaie their=Arai.-cant?.pclir.,=ter. I a i en elttployer their isproviding workers'compensation Uf.SUFance for PM'employees. Below is the policy andlob sire information hisrluance Comps?dame: Policy=or Self-ice..Lic. Emviauon Date: - Job Site Address: City"State.'Zin: Attach a copy of the workers'compensation policy declaration page(showing the polio number and expiration date). Failure to secure coverage a required under MGL c 152 j ry5A is a rriminnl violation p ini:table by a fine up to S1 5C0_CO athor one—year Emprisorr„Rr.t.aa well as cavil penalties in the form of a STOP WORK ORDER and a fine of up to S250_CO a day again t the violator.A cagy of this:tatevoent may be forwarded to the Office of 1m—e-tieatioms of the DLL,for in ur iise coveraee verification I do hereby cenif under andpentdnes ofper uv thor the Enfoni.r ion!provided QF we is erne and correct Si-mature: ,k -- -�� Date: (,_' 12 5 1 Z I P one 9 13 42'S 'O 9`1 Officird use only. Do nor trite in &is area,to be completed Inc city or rota/official City or Toirn: Permit license= Issuing Authority(circle one): 1.Board of Health ., Building Department 3.Citti•.To ci Clerk 4.Electrical Inspector s.Plumbine Inspector 6 Other Convict Peron: Phone=: City of Northampton �HAAfT a, +M- ' Massachusetts � L !i� A-- DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building am.. C`b ` ,•, ',p ton, Me 01060 , Northampton, J HOMEOWNERS'EXEMPTION ELIGIBILITIAFFIDAVIT 1, gtC)i(V1l 0,1(n5 (insert full legal name), born 1 I11 (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 enalties of perjury on this IA day of J , 20 rgi (Signature) City of Northampton s Sys...".a�� Massachusetts g tom• hi * G wi M, DEPARTMENT OF BUILDING INSPECTIONS ?@ 212 Main Street • Municipal Building yvy.. -D ti Northampton, MA 01060 rsl.h0(� I, NV10611t aid r\S (insert full legal name), born 111 17q (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 enalties of perjury on this 'is day of �i , 20 gi (Signature) I t L. (( -L 4-04,40 ►,4„tiixr l�lg l -to nigi - , - T .--t— . 7/ -21a7 . ) ,', ..‘ -, I' 1 .11a _ sx1. 9 ),©!Q, 4 » a^w v , s \ _, _,, aML-IA�'S 1 - T .. yr �IIS(+., - - -. -- i 7 ' 14.....- )i a , 0 g -110 . ID(I 9-I -442N-- 4tQt- sok 8 4S�gyros/ N s . ' - ; Kil'ir 1,,ti, 1 iti: , ,. ,/ r i - _ Y ►° qq rt , ' d Map f 1 q2 r a vi. 371 _.j.`-b` 1- -. 1 CITY OF NORTHAMPTON MAP: LOT:LOT SIZE: / 0 t REAR LOT DIMENSION: REAR YARD t\ > 9O fr Ai to Shtci SIDE YARD 11.01 SIDE YARD 22 Ft- ►lp . 22 > decv-- r FRONT SETBACK FRONTAGE