23D-113 (6) BP-2022-0508
200 FEDERAL ST COMMONWEALTH OF MASS CHUSETTS
Map:Block:Lot:
23D-I 13-001 CITY OF NORTHAMPT N
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERE CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY F ND (MGL c.142A)
BUILDING PE MIT
Permit # BP-2022-0508 PERMISSIONISH REBYGRANTED TO:
Project# 2022 GARAGE/OFFICE Contractor: License:
Est. Cost: 20288
Const.Class: Exp.Date:
Use Group: Owner: J. THOMSON, SAMUEL M. &BRIENNE
Lot Size (sq.ft.)
Zoning: URB Applicant: J. THOMSON, .AMUEL M.& BRIENNE
Applicant Address Phone: Insurance:
200 FEDERAL ST
FLORENCE, MA01062
ISSUED ON:05/13/2022
TO PERFORM THE FOLLOWING WORK:
RENOVATION OF 1 CAR GARAGE, NEW WINDOWS, DOORS, INSULATION, SH:ET ROCK, ELECTRICAL OUTLETS &
MINI SPLIT
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 NORTHA PTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
•Ari•I.
Fees Paid: $131.82
212 Main Street, Phone(413)587-1240,Fax:(413) ,87-1272
Office of the Building Commissioner
File # BP-2022-0508
APPLICANT/CONTACT PERSON:THOMSON, SAMUEL M. &BRIENNE J.
200 FEDERAL ST FLORENCE, MA 01062
PROPERTY LOCATION 200 FEDERAL ST
MAP:LOT 23D-113-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $131.82
Type of Construction: RENOVATION OF 1 CAR GARAGE, NEW WINDOWS, DOORS, INSULATION,
SHEET ROCK, ELECTRICAL OUTLETS & PLl T
New Construction
Non Structural Renovations
Addition to Existing :0
Accessory Structure ��,�
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
X Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
Q?
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed Other Penn its Required:
Curb Cut from DPW Wa ter Ava ilability `-werAvailability
Septic Approval Board of Health _ Well Water Potabilit Board of Health
Penn it from Conservation Commission Permit from CB • hitecture Committee
Permit from Elm Street Commission Permit DPW Ston Water Management
Demolition Delay
L; � � , 5 I a/a�
Sign!turc of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to corn ly with all zoning
requirements and obtain all required permits from Board of Health, Conserva ion Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of M ,L 40A.Contact Office of
Planning&Development for more information.
E.- ::_:-=
The Commonwealth of Massachusetts
i„� Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
,--; o Imo-,Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Afar 2011
o i One-or Two-Family Dwelling
^> C�, This Section For Official Use Only
__..Buii .in 'P i nit Number: Zen-oo$ T Date Applied:
__� _-Li..I i , i' e .2, S Da3�a s
Building Official(Print Name) Signature
SECTION 1: SITE INFORMATION
1.1 Property-Address: 1.2 Assessors Map&Parcel Numbers
.ad t=F:1D0R-A/ Sf- 317 2_3 0 — /13 -- oa
1.la Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
015377. 0
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
10 I 64- AI i' _ 101 A- ,U I q- 1J/4 N/A
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 dyes':
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: ,,1,,"/Y1
S *-1�1 Ut-�L 7 a/4sen JVaRrlfft-M./2f 01 o G 2--
Name(Print) City,State,ZIP .
2 B 0 F P6 f AL S - Piez-365--434c 5 A K M t k-a kson e.G N a1 r ,c erti4
No. and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building IX Owner-Occupied ❑ Repairs(s) 0 Alteration(s) )11. Addition 0
Demolition 0 Accessory Bldg. Cl Number of Units / Other ❑ Specit :
Brief Description of Proposed Work': f204 1oU011- 4'F i- cAR- GAe/\CF j AI.Ew wiA/}powc
peag5 y 1NSu(Atfi91n , Shcd ci 1'-21cam+L a44-ffd-5 , /-ND Ai ,AI/
'SPI,r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
_ (Labor and Materials)_
1. Building $ /4 j 00 1. Building Permit Fee: $ /3 1.QZ Indicate how fee is determined:
2.Electrical $ 1 9'8U 0 Standard City/Town Application Fee
1 g-Total Project Cost; (Item 6)x multiplier 20,2-6 x C'.SO
3. Plumbing $ 4 2. Other Fees: $
4. Mechanical (HVAC) $ -q-L 300 List: i
.
5. Mechanical (Fire $
Suppression) _ J Total All Fees: Z
/3/. v
Check No.‘(6 U Check Amount:
6. Total Project Cost: $ Zd i z 90 ❑Paid in Full 0 O itstanding 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.)
_ 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)
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 ❑
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 perm t 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.
$k'i£1-0L 7'#d Olson 319 fa 2--
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 halfbaths
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"
The COININONWellith of Massachusetts
I.'`'= _!I Depart reNt ofIadusNialAccidents
.=1s1'- 1 Congress t,Smite 10
1�_. Stint,
MA 8Z114-2817
_, ,4 wwwrtetass.gov/dia
Workers'Coanpensadon Insurance Affidavit umbers.
TO RE FILED WITH THE PERMITTING AUTHORITY.
ADalkant Information Please Print Ladbly
Name( ): 6 t vc aw*T1A
Address: o `- L S--)
City/State/Zip: f,Sdllsr\ki , by -1-(a Phone#:
Are yes an eatpisyer?Check the spprapriate bee
Type of pnject(required):
1.01 am a employer with employees(dill aed+mr pact-time).* 7. New construction
20 I am a sok proprietor or partaeeship and have no employees working for me in 8.3 Remodeling
i°y apsc,ity_[No wakens'camp.ienaanae 'squirt.)
3 I am a homeowner all week9. ❑Demolition
doing myself.[No anthers'comp.ehttenn�aee required.]
1.E71 I am a homeowner and will be hieing ooelramn to carded all work an my Impiety. I will 10❑Building addition
t�1 enure thst all conaecto a either have sweets'oompeeumiom innumeae or see sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
50 I am a general contractor and I have heed the>ebrebrnractom limed on the attached sheet
Them smb.coatesdon have employees sad have seekers'core isdwnea: 13❑Roof repairs
Th
an we are a oorporatim and its have es eciee8 their right of exemption per MU c. 14. Other
152,41(4),and we have no easployaea.[No woeten`comp.hneuranoe required]
*Any applicant that checks bon el man also fill out tie section below showing their workers'compeaatioe pcMicy information_
i homeowners who submit this eillelavit indicating they are doing all wont and them hie amide contractors mum subunit a new affidavit indicating such.
:Contractors that check this box mat atbdhed an adeitiosd sheet showing the name oldie sub.comeactors and ease wihaber or not than entities have
employees. if the sub-contractors have employees,they aunt provide their watken'comp.policy smaller.
I am an employer that is providing workers'compensation interstice for my employees. Below is the policy and Job site
informals t.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
lob Site Address: City/State/Zip:
Attach a copy of the workers'compensatan 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 S1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 certifr under pains andpe.a151 s ofperjury that the tnfarudew above is but and correct.
Signature: A14.4 M l/IF/.bt, Date: g Z
1 Z
Phone#: gOZ 36 S - 434 S
Official use only. Do not write In this area,to be completed by city or town official
City or Town: Permit/License a
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 3.Plumbing Inspector
6.Other
Contact Person: Phone#:
.I! per
City of Northampton
Massachusetts
r fir kf < DEPARTMENT OF BUILDING INSPECTIONS kfif
212 Main Street • Municipal Buildingh
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY ' FIDAVIT
I, k k,-L M, i 71 n rn' 17 . (inse t full legal name), born_(insert
month, day, year), hereby depose and state the following: (_/Q r
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. .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 seekin: the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildi gs constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner" 's defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she reside. or intends to reside, on which
there is, or is intended to be, a one-or two-family dwelling, :ttached or detached structures
accessory to such use and/or farm structures. A person who c.' tructs 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 licen.e 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 •upervision in connection with any
project or work involving construction, reconstruction, alterati. , repair, removal or demolition
involving any activity regulated by any provision of the Massachuset s State Building Code.
5. If I engage any other person or persons for hire in connection with th. aforementioned project or work on
my parcel,I acknowledge that I am required to and will act as the sup•rvisor for said project or work.
Signed under the pains and penalties of perjury on this TA-day of d sr 202 Z—
64.4,,Aj
(Signature)
City of Northampton
O0.ti Ys .ih>J -Y-
I Massachusetts �.
g DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building A� 1`
�° Northampton, MA 01060 P '., 0C
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: 6--7 /..)P '1, 4D . % ' _ -02 o71
The debris will be transported by:
Name of Hauler: ---yo17S/0
Signature of Applicant: 1%\-41%1A-i-t, Date: 5 5'/ZZ.
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Wall C
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Wall D
32" 32"
ANDERSEN®200 SERIES WINDOW AND DOOR NFRC/ENERGY STAR® INFORMATION
This document provides NFRC certified U-Factor,Solar Heat Gain Coefficient(SHGC)and Visible Transmittance(VT)values for Andersen®products
along with the corresponding ENERGY STAR®Version 6,0(2015)climate zones in which the product and glass type are certified.
These products rated,certified and labeled y National Fenestration Rating Council® (NFRC)-a non-profit organization that provides fair,
1
=DM accurate and credible energy performance ratings for windows and doors.
Many of our products meet the stringent energy efficiency certification criteria set by the U.S.Environmental Protection
Agency and the U.S.Department of Energy. The certification criteria is based on the heat gain and loss of each product in
•°'!'' various regions of the country. Check the Andersen product performance available at www.andersenwindows.com for
-
units that are ENERGY STAR certified.
United States ENERGY STAR® Canada ENERY STAR®
Climate Zone Criteria Climate Zone Criteria
1"'p ENERGY STAR'
a In
Northern111 `:s ZONE 3
" ' UZONE2
North-Central ZONE 1
II South Central
aw
Il Southern r L'
Windows
Doors • -
Climate Glazing I
Zone Level
5 0.27 My Prescriptive upaque s 0.17 No Rating
=0,28 20.32 ' -'':Lila 50.25 50.25
Equivalent Northern wu,dows,ond Doors
a0.29 20 37 Energy North-Central s 0.40
ti Performance '"".Lae 5 0,30 — (ettectrve February 11,,z01 5)
Southern - g — — — —
=0.30 0.42 South-Central 2 s 0.25
Heating ! Minimum Maximum
` Air Leakage for SFding Coors 50.3 cf t' Zone Degree-Day Energy raring , u-Factor
s 0.30 s 0.40 Air Leakage for Swinging Doors 5 0.5 cfmRTz Range (nmdesa) w!n••K
s 0.30 s 0.25 �._ _ ��_ _
5 0.40 s 0.25 a asodo as or 1.20
Air Leakage s 0.3 cfmritz
'0turh ll=,F
'Solar Heat Gain Coefacient
rThe eRedive date for the Northern Zone prescriptive
and equivalent energy performance criteria for van doves
is January 1,2016.
For NFRC certifed total unit performance for units with capillary breather tubes,please refer to the High Akittude Information section for each unit.
'U-Factor defines the amount of heat loss through the total unit in BTU/hr•ft 2'4,metric in W/m2•K.The lower the value,the less the heat is lost through the entire product.
'Solar Heat Gain Coefficient(SHGC defines the fraction of solar radiation admitted through the glass both directly transmitted and absorbed and subsequent*/released Inward.The lower the value,the less heat is transmitted
through the product.
'Visible Transmittance(VT)measures how much light comes through a product(glass and frame).The higher the value,from 0 to 1,the more daylight the product lets in over the oroduct's total unit area.Visible Transmittance Is
measured over the 380 to 760 nanometer portion of the solar spectrum.
NFRC ratings are based on modeling by a third party agency as val,dated by an Independent test lab in compliance with NFRC rpogram and procedural requirements.
This data is accurate as of December 15,2014.Cue to ongoing product changes,updated test results or new industry standards or requirements,this data May changeover time.Due to variations in dealer and distributor
Inventory levels,products that were manufactured before December 15,2014that were designed,tested and labeled with different NFRC values may still be available,Check the labels on the product packaging to confirm NFRC
values. Ratings are for sizes specified by NFRC for testing and certification. Ratings may vary depending on use of tempered glass,different grille options,glass for high althude,etc.
All marks where denoted are trademarks of their respective owners.
10 2014 Andersen Corporation.All rights reserved.
This information is for reference only.
Performance varies by unit size and options selected.
For specific unit performance information,please contact your dealer or Andersen Sales Representative.
7 cv Feb g--r—AL Gjl 0 -ry)
ommonwealth o`rilamachamtt.4 Official Use Only
►'mElir, p_ cca�rr,� c� Permit No.C�2 22~6333
t- �_'' �_ y ..Uspartmant of,.tire )ervtcso
-"�_1' Occupancy and Fee Checked '2,5i%
' .; BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
v
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
LA:, All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
( JEASE PR.1 P fVT IN INK OR TYPE ALL INFORMATION) Date: 5/2/22
N CiWor Town of: Northampton To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location--Nreet&Number) 200 Federal St
__ ___ _ _Owner orTenOnt Samuel Thomas Telephone No. 312-315-3527
Owner's Address 1732 Rose St Berkley CA 94703 contact person Rob Thomas (father)
Is this permit in conjunction with a building permit? Yes n No n (Check Appropriate Box)
Purpose of Building - ` Utility Authorization No.
Existing Service Amps / Volts Overhead Ti Undgrd Ti No.of Meters
New Service Amps / Volts Overhead n Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Bring power out to an exsisting de attached garage being
converted into a home office space. Install new receptacle and lights. Install wiring for a mini split unit
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tf T
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above ❑ In- ❑ No.of Emergency Lighting
No.of Luminaires Swimming Pool
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal El
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 5/9/22 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: LIC.NO.:
Licensee: John T Bates Signature Wiz,Z,y, ,y. ,5 LIC.NO.: 10066E
(If applicable, enter "exempt"in the license number line.) l//J Bus.Tel.No.: 413-374-1083
Address: 26 Riverside Dr Florence MA 01062 Alt.Tel.No.: 413-584-4401
*Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $9� °'
Signature Telephone No. ,--