37-083-031 (2) BP-2022-0309
266GROVE ST UNIT 31 COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
37-083-031 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-2022-0309 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 RENOVATION Contractor: License:
HAYDENVILLE WOODWORKING &
Est. Cost: 17625 DESIGN INC 116208
Const.Class: Exp.Date:04/13/2025
Use Group: Owner: ANNE-LOUISE SMALLEN
Lot Size (sq.ft.)
Zoning: URB Applicant: HAYDENVILLE WOODWORKING &DESIGN INC
Applicant Address Phone: Insurance:
35 CONZ ST (413)665-7402 WMZ-800-8007423-2021A
NORTHAMPTON, MA 01060
ISSUED ON:03/29/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE BATHROOM FIXTURES &FLOOR
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 NORTHAMPTON UPON VIIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
14 !al 52 To, .
Fees Paid: $117.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Department use only
C
:I.�ri�l City of Northampton Status of Permit:
Building DepartmentCurb Cut/Driveway Permit
., 212 Main Street Sewer/Septic Availability
w Room 100 Water/Well Availability
; �
jNorthampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
ry Other Specify
APPLICATION 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
Map '3-7 Lot 083 Unit 0 3 (
266 Grove Street#31 Zone U R 13 Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
AnneLouise Smallen 266 Grove Street#31,Northampton,MA 01060
Name(Print) / Current Mailing Address: 240 994 1789
Telephone
Signature
2.2 Authorized Agent:
Haydenville Woodworking&Design,Inc./Zinnia Stetson 35 Conz Street, Northampton, MA 01060
Name 'nt) Current Mailing Address:
4)49)1'Th- 413-665-7402
ign ur Telephone
SE TION 3-ES ATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 5,675 (a)Building Permit Fee f 7 OD
2. Electrical 815 (b)Estimated Total Cost of
Construction from (6)
3. Plumbing 11,135 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection N/A
6. Total=(1 +2+3+4+5) 17,625 Check Number 200
This Section For Official Use Only
Building Permit Number: OP-202_O 3 en I sssuu
ed:
Signature: //./Z 3- 29- Z02 Z
Building Commissioner/Inspector of Buildings Date
zinnia @ HaydenvilleWD.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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
Frontage
Setbacks Front
Side L: R: L: R:
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 O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O 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 O NO O
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 ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [p Siding[0] Other[0]
Brief Description of Proposed replace bathroom fixtures and floor
Work:
Alteration of existing bedroom Yes X No Adding new bedroom Yes X 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?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? 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 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? 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, AnneLouse Smallen , as Owner of the subject property
hereby authorize Haydenville Woodworking&Design, Inc. /Zinnia Stetson
to act on my
behalf, in all matters relative to work authorized by this building permit application.
re of Date J 4$ e L
I, Haydenville Woodworking&Design, Inc./Zinnia Stetson 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,
Zinnia Wu Stetson
Print Name
0
_ n.tu e o °w�'.ent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Zinnia Wu Stetson
License Number
35 Conz Street, Northampton, MA 01060 116208
Addres - Expiration Date
j_.:6____.
04/13/2025
ig alum Telephone
413-665-7402
9.Registered Home Improvement Contractor: Not Applicable 0
Haydenville Woodworking & Design, Inc.
Company Name Registration Number
35 Conz Street, Northampton, MA 01060 110732
Addre Expiration Date
Telephone413-665-7402 11/02/2022
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 0 -
City of Northampton
r
� ►a ri�lr� Sys s�-/
Massachusetts �k
I'
�. DEPARTMENT OF BUILDING INSPECTIONS 9
';i0 s 212 Main Street *Municipal Building /- c
, Northampton, MA 01060 st,Jv ,.w�
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:
266 Grove St, #31 Northampton, MA 01060
(Please print house number and street name)
Is to be disposed of at:
Valley Recycling, Northampton
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
. '
Cigna ure of P r Applicant or Owner Date
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
-�1 1 Congress Street,Suite 100
*al._ Boston,MA 02114-2017
N. . www.mass.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):Haydenville Woodworking& Design, Inc.
Address:35 Conz Street
City/State/Zip:Northampton, MA 01060 Phone#:413-665-7402
Are you an employer?Check the appropriate box: Type of project(required):
1.�✓ I am a employer with 5 employees(full and/or part-time).* 7. ❑New construction
2.01 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.]t
9. El Demolition
10❑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 are sole 11.Q Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5C1 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.:
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box 41 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:A.I.M. Mutual Insurance
Policy#or Self-ins.Lic.#:WMZ-800-8007423-2021 A Expiration Date:12/01/2022
Job Site Address:266 Grove Street#31 City/State/Zip:Northampton MA01060
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 pains d penalties of perjury that the information provided above is true and correct.
Signature: < _A____, Date:
Phone#:413-665-74 2
Official use on y. 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#: