17A-284 (11) BP-2022-0136
246 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17A-284-001 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-2022-0136 PERMISSIONISHEREBYGRANTED TO:
Project# 2021 RENO/REPAIR Contractor: License:
Est. Cost: 20000 NORMAN GLENN 039970
Const.Class: Exp.Date:06/28/2022
Use Group: Owner: DREW, JACOB B&JENNIFER A
Lot Size (sq.ft.)
Zoning: URA Applicant: GLENN BUILDING INC
Applicant Address Phone: Insurance:
18 Ashley Circle WVC-100-6022438
EASTHAMPTON, MA 01027
ISSUED ON:02/24/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE DAMAGED FLOOR, REPAIR SUPPORT JOIST, MOVE INTERNAL WALL BETWEEN UNITS TO ADD SMALL
ENTRYWAY
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTH AINIPION UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I • 9
J� 1 •
II
Fees Paid: $130.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-12'2
Office of the Building Commissioner
\, , S , .
1 The Commonwealth of Massachusetts
i iiy
IFif Board of Building Regulations and Standards FOR
\' V Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
,, I One-or Two-Family Dwelling
NThis Section For Official Use Only
Building Permit Number: ,P Wiz. 3 is Date Applied: Q2/11 !2-02.2-
i ‘ ' - 2/3,L0Q,
-B Official(Print Name) Signature 1 Date
SECTIO 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel
246 Chestnut St.,Florence MA 01062 17A 17A-284 17A-146
1.la Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
URA residential 30,927 sq ft 180
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:(MG.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public® Private❑ Zone: C Outside Flood Zone? Municipal I On site disposal system 0
Check if yell 1
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Jacob&Jennifer Drew Florence MA 01062
Name(Print) City,State,ZIP
246 Chestnut Street (617)935-6704 jacobbdrew@gmaiLcom
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) QSI Alteration(s) SI Addition 0
Demolition ❑ Accessory Bldg.0 Number of Units 2 Other ❑ Specify:
Brief Description of Proposed Work':
Replace floor to repair damage caused by appliance flood; repajr support joist that was cut by previous
owner to fit a plumbing pipe;move internal wall separating the two dwelling units one foot to accommodate
the addition of a small entryway.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only
I.Building $ I
6)Z, I. Building Permit Fee:$I3O Indicate how fee is determined:
y ❑Standard City/Town Application Fee
2.Electrical $ 5 (T 0 Total Project Costa(Item 6)x multiplier 0 x Zv
,
3.Plumbing $ ' 2. Other Fees: $
4.Mechanical (HVAC) $ 1 List:
Mechanical $ Total All Fees: $ 130Surres
Check No.721 Check Amount: 13b
6.Total Project Cost: $ 1( � 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.l Construction Supervisor License(CSL) 0399P10 /„` / 2
Np(zK ul L.: ).11,i 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(HIC) 1 0c19 ,
l�. 0
SA MCt HIC Registration Number E iration 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...........❑
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.
Jacob B.Drew
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 MG.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"
ate.\
The Commonwealth of Massachusetts
Department of industrial Accidents
• __•�� 1 Congress Street,Suite 100
=�: e Boston. MA 02114-2017
.t_ www.wrass.gmv/din
11 ur kers' Compensation Insurance Affrdas it:Built rrsl(`ontractors)'FkctriciansTlumbers.
7O BL tILLD N f1 II"fltk t+laC4ff1'fl\G Al t11U1i1I Y.
Anpticant Information Please Print [ruble
Name'Business tlrganrranou lndwidual):
Address:
City/State/Zap:_ ___ Phone#:
Artyaa an cmpler,meC1eek tlr appropriate hat: Type of project(required):
143 I am a employs with empkriees[lull and or pan-timer.• 7. D New construction
ID
t am a sole proprietor OF purtncrshrp and have no employes worluag for me in 8. o Remodeling
any c-apacity (Nu outlets'cutup.uhaurrmx nagoind-1
9. ❑Demolition
;.j t am a homeowner ilcang all work myself.[No voodlnis'cunt}+.arnurane n-yuaned.l"
4.o t am a and will be hum*contractors It.conductAt work on my property. 1 irvtll ld Budding addition
morn:that all eamtrtr:tura either have Morten'compensation utsurancc or arc vole 1 l a Electrical repair's or additions
p,rtgrrietuts with no employees. 12.0 Plumbing repairs or additions
50 l ant a general contractor aml I line hired the sub-euutraetors listed on the attached.mitt 130 Roof repairs
these sub-contracture have entt+loscca and love ourkers'coup.ue+urJn.e.
6.0 ix.:an omp a c o atiun and its officer.hat c eat-wised theirright..t cvengst.00n per%K:L e.
14.0 Other
I4'.F 1440.and we hate no employees.Pt wirier'comp.insurance required.I
*Am applicant that checks boar 1 must also tilt out the vection heloo shooing their o urkcrs'cumpematbiou pines} inforanatara.
t pi.nrkow nets oho submit this at3-ukhcat mdicautn they are doing all w oil and thin hue uubide contractors milt N.ubrnrt a new at6dav tt tridn.Jtantr such
:t ontractun that check this box must atta.hed an a+tttrtrunal shoot show mg the names of the tub-►urutacturs and tether or not those addles have
employees. It the sub-contrackas have einpkovccs,the ntu,.t provide then oorker,".-rump.polies tnanbet.
I am an employer that is providing workers'compensation insurance for my emplopres,_ Below is the policy and job site
information.
Insurance Company Name: —
Policy a or Self-its.Lie..a: Expiration Date:
Job Site Address: Cityi'StateiZip:
Attach a copy of the workers'compensation policy declaration page(slew ing the policy somber and expiratioe date).
Failure to secure coverage-s required under MGL c. 152,§25A is a criminal violation punishable by a fine up to SI,500.00
andlor one-year impri. -nt.as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A o of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
do hereby certify under ins and penalties of perjury that the information provided above is true and coned
Signature: T Date z//Q J RZ
Phone a: (617)935-6704
Official use only. Do not write in thiss area.to be completed by city or town official
(-it♦ or Town: PrrmitJI icense#t
Issuing.authority (circle one):
1. Board of Health 2. Building Department 3.City,Town('krk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
[ intact Person: Phone#:
City of Northampton
¢M l obit `S ,Ttr
• Massachusetts
c
,d' 1 1 •'t 4 1 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building yr,
/•' Northampton, MA 01060 s'sarD\���
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDA VIT
Jacob Benedict Drew 2/1/75
I, (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 t ins and penalties of perjury on this day of re 15,Nay , 20_22
(Signature)
City of Northampton
Pr0
Massachusetts ���'
o -
ff 1- �'
ki
1 {�,_t. •. DEPART1�Nr O£ BUILDING INSPECTIONS`! t �'+ F 212 Main Street • Munici al Building a�
� Northampton, MA 01060 �ssyw `^ti0
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: IQ
tuAL\1,,, Aq 610(6
The debris will be transported by:
Name of Hauler: (a-- \k1l€,,J
Signature of Applicant: Date: 2//�/Q2