10B-050 (5) BP-2021-2345
13 GROVE AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
10B-050-001 CITY OF NORTHAMPTON
Permit: Addition
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2345 PERMISSIONIS HEREBY GRANTED TO:
Project# ADDITION Contractor: License:
Est.Cost: 19500 STEPHEN CAMP 082531
Const.Class: Exp.Date: 11/23/2023
Use Group: Owner: FREEDMAN MEGAN L& MARC D
Lot Size (sq.ft.)
Zoning: URA Applicant: STEPHEN CAMP
Applicant Address Phone: Insurance:
46 EAST ST (413)527-7124 0 6562UB-5B90972
EASTHAMPTON, MA 01027
ISSUED ON:12/29/2021
TO PERFORM THE FOLLOWING WORK:
7X12 ADDITOIN
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.
Signature:
ityhtliL 3"4,1 •
Fees Paid: $127.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
File #BP-2021-2345 7-0,v
APPLICANT/CONTACT PERSON:
PROPERTY LOCATION 13 GROVE AVE
MAP:LOT 10B-050-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRE[) DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $127.00
Type of Construction: 7X12 ADDITOIN / l
New Construction 1
Non Structural 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
INFORMATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:*
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
MajorProject: 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 Wa ter Ava ilab ility Sewer Availability
Septic ApprovalBoard 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
)a/D54/al
Si., ature of Building Officilr 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.
! , Department use only
City of Northampton
-- Status of Permit:
r
Building Deparmer Ec Cfirb Cut/Driveway Permit
igfr t 'T-), 'f4.
212 Male Street 202/ Sewer/Septic Availability
Room 10Q-- 1 aterANell Availability
E -lir Northampton, MA q 611 Two Sets of Structural Plans
phone 413-587-1240 Fax 41 71474 Croor,1 Plot/Site Plans
Other Specify
rAPPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address This section to be completed by office
/, fv✓e.- A-(je Map Lot Unit
Gas tviA. Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
!VI xi e �rud,1„u,,,,,, f 3 6 v). -e- Ave,. Le-c4. nt...
/
Name(Print) Current Mailing Address:
Telephone �/
Signature 7
?�/r y 7 Z 18
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Y/3 S-2?- ?/zy
Signature , Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building )F (a) Building Permit Fee
f7, TO 4'. 0Y,
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee ( I
4. Mechanical (HVAC) Fj-(���
5. Fire Protection
6. Total=(1 +2+3+4+5) Ieif fop. a'' Check Number lsl
This Section For Official Use Only
Building Permit Number: �/7' A / ''a? 7S. Date
Issued:
Signature: 1 : Ia/9•9 t 't
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
e
•
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size I
Frontage _..
Setbacks Front 1
Side L: R:I L: ____.. R:__ a
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q , Date Issued:
C. Do any signs exist on the property? YES ® NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ] Replacement Windows Alteration(s) Roofing n
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [Q Siding[C1] Other[0]
Brief Description of Proposed
Work: 7 !Z ��IDi717< Z f 71.eJr cS ti,/ £,7fvypk, '' Le-
Alteration of existing bedroom Yes k. No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes x No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family ✓ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? / 1/
d. Proposed Square footage of new construction. 41 5-1 lel"- Dimensions 7�/�" �wS' $ -
e. Number of stories?
f. Method of heating? lez 64:- Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? X. Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS 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.
Signature of Owner Date
I, 5' `3"444t/ 64t1 , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
5`111/1
Print Name
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:� Not Applicable ❑
Name of License Holder: 57-fri evie {j3yi /
ffJJ License Number
y6 fpst- s � 2-70,6 /kid., a/ 1l - 23- z3
Address / Expiration Date
Signature Tel
9.Registered Home Improvement Contractor: Not Applicable ❑
514reasi 4474'r "� / 3 s lay
Company Name Registration Number
I/4 Z44-S�' 5 ,��� 3/ 3/ 2 2—
Address , /� ,/ Ex ation ate
ZA-j 43-(1 4� "-IA 0/0Z 7 Telephone Z 2- 2/ 2/
SECTION 10-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 X No ❑
City of Northampton
Sfr,
A Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
r � 212 Main Street ()Municipal Building
Northampton, MA 01060
Debris 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.
The debris from construction work being performed at:
/3 ve P-ve Z?Lifer Me,
(Please print house number and street name)
Is to be disposed of at:
VA [kV 2�c'(bd.,/
(PI se print name ancVlocation of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
6411 6,4 7`',I at 1' J v 4' 7/tc ��cf
(Company Flame and Address)
O vV 2 2/
Signature o Permit plicant or O e ate
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
_ The Commonwealth of Massachusetts
` 1. Department of Industrial Accidents
=el'= > 1 Congress Street,Suite 100
_'T = Boston,MA 02114-2017
0. www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name(Business/Organization/Individual): 5 A.4/ C-Av.,
Address: 4 S,1 5Y"v l'
City/State/Zip: 11,4-5 mit i'1p27 Phone#: I/ 3 S 2 7 " 7/Zr/
Are you an employer?Check the appropriate box:
Type of project(required):
l.Cd I am a employer with Z employees(full and/or part-time).* 7. af 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.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]'
9. Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
10 0 Building addition
ensure that all contractors either have workers'compensation insurance or are sole I 1.0 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. p
❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El 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: /ce / ciier‘Gs S
t'Flo
..s Z-4 . Co /,
Policy#or Self-ins.Lic.#: 2-Ur
J3-fig 2 7 - Expiration Date: //// a Z"
Job Site Address: /..1 6/O' City/State/Zip: IGCe1fj p/n C3
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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the painsin and penalties of perjury that the information provided above is true and correct
Signature: .31tt ( Date: f Z/Z ?/ Z
Phone#: 5-27- 7/2
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
•
,s src�
Massachusetts • e
* rG
( ` DEPARTMENT OF BUILDING INSPECTIONS �$
212 Main Street • Municipal Building
Northampton, MA 01060 3'0 1'1�
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion,
improvement,removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by revstered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: Alt`o/t piDA vu-v Est. Cost:
Address of Work: / g ��c�c/r /v'e Z.e.a,sr a c
Date of Permit Application: /2.2 7 21
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
/27 2/ s' 44.v✓ 64"I
Dale Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
° .. Massachusetts /
mi It
' � DEPARTMENT OF BUILDING INSPECTIONS SI. tt
212 Main Street • Municipal Building vy "tit
ms..� Northampton, MA 01060 10
Massachusetts Residential Building Code
Section 110.R5.1.2
Homeowner: Person (s) who own 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 homeowner.
Section 110.R5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s)
for hire to do such work, then such homeowner shall act as supervisor.
Such homeowner shall submit to the Building Official, on a form acceptable to the Building
Official, that he/she shall be responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to
time, during and upon completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153
(Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts
General Laws Annotated, you may be liable for person(s) you hire to perform work for you
under this permit.
Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527-7124
We hereby submit this Estimate For—7'x 12'Front Entryway/Addition
To start we will pour concrete in sauna tubes as needed.
The addition will be built and the roof system will be a step down from existing house
But will have the same pitch.
Roofing will be architectural shingles color to match existing house.
We will install a new front door and re-install the existing storm door.
The siding will be vinyl to match the existing house.
For the interior we will build a closet at the far end and build shelves as needed.
The Second floor room will be a office.
We will insulate and sheet rock the ceilings and walls.
The first floor will have ceramic tile and the office will have oak flooring.
The office will have a door with full view glass and the existing window will be re-installed
to the exterior wall of the office.
I will trim the doors and window and install base board to finish the job.
Trash removal and building permit included in my price
Price=$ 19,500.00
Contractor Supervisors License number 082531
Home Improvement contractor Registration number 135204
I propose to supply materials and labor-in accordance with above specifications.
This proposal may be withdrawn
By us if not accepted within 0 days
Authorized Signature ..-
Acceptance of proposal Signature / `^ '7�----
Submitted To : Marc Freedman
Phone- 774-219-4290
Address : 13 Grove Ave. Leeds Ma
Date-12-27-2021
C..") 1
sli
j
- i i''
4
70 9'
i.
i
•
.),11:•• ••.... j\1/4
el.
L�
J
`r-
1
-r
I
I
r '
•
\Tv
I
• 1
r. 0
i
1
%
, ...,
1
4r,
4 /
II 1I
I1
ofoa I
ki
ff J4 5 ' NI
o
I I
Ni
] .43---r- ---1—F747)-47 8)z E
0 - 1'Z i 1 1
, !
( I l
S" 1 I i _ _
N ' a / 1 4
N o
�w+ Ns N jaffddr)(11,A 1'10
N / 4fr"7 /064 14 7
rri
`
77A-6( /' Ql ' t'-\
0 fi ,
pv6(‘
A.b L5
/7 RA rl 1
14 ri 4 :____- 19 -_,.....___ _>
-? (7
,,,ivid
IN
1
1
c� V ,-