09-010 (6) BP-► 022-0802
410KENNEDY RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
09-010-001 CITY OF NORTHAMPTON
Permit: Acc Structure
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2022-0802 PERMISSION ISHEREBYGRANTE I TO:
Project# 2022 ACCESSORY BUILDING Contractor: License:
Est. Cost: 37500 WILLIAM LAMORE CS-076123
Const.Class: Exp.Date:05/23/2024
Use Group: Owner: TRUSTEE SCHOLZ WHITNEY
Lot Size (sq.ft.)
Zoning: WSP Applicant: LAMORE LUMBER CO
Applicant Address Phone: Insurance:,
724 GREENFIELD RD 413-773-8388 6H UB0248N 1 5A22
DEERFIELD, MA 01342
ISSUED ON:07/07/2022
TO PERFORM THE FOLLOWING WORK:
BUILD 20X24 ACCESSORY BUILDING ON CONCRETE SLAB
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 NORTHAMPTON UPON VIOL• TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I
j'• 52I; •
1 •
Fees Paid: $100.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office.of the Building Commissioner
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11-��-�" � 4- in I
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-? c. The Commonwealth of Massachusetts
•.I r— ( Board of Building Regulations and Standards FOR
i i [� Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building brit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 4011
N
Q One-or Two-Family Dwelling
ry This Section For Official Use Only
Bui)d g Pei ' r: Date Applied: 07 0612 o 7�
i- 7//.97
Building Official(Print Name) Signature I - IJate
SECTION : SITE INFORMATION
l ropertsrAddre 1.2 Assessors Map&Parcel Numbers
n ,p
IfI O Ke v►eeir eqk oq-ol o-OD (
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
(,OS P /9. Gposacres
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 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
'PAW S 12-cvdc46 c- 172i-t57 i-l=CV S, MA d / U s'3
Name(Print) City,State,ZIP
yiv I-cw,"lOy (9, 'fi377131i/
No.and Street 1 Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction Er Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. Et' Number of Units Other 0 Specify:
B r3 pttbti ro(ios' oi-Tc NA:, laa ZO' x Z9' accessory bNi1dZ.5 * i-1'Vt
incre . S1a - N1411LLAI'l_A
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building j,:,,,,,a o.- $ 3&, C:)u 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ !r 5 op 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ — 2. Other Fees: $
4. Mechanical (HVAC) $ — List:
5.Mechanical (Fire $
Suppression) — To'�tal�Fees: $ (00 ;�
''v iltil.c c No 2' t c c so�unt: /00,— Cash Amount:
6. tal Project Cos. $ 3 7 5,;v . 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts4v.tt
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 �syEy '`�titi
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW / private land by Building Dept.
13. Stretch Energy Code -all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS— o1G 123 o s'ZZ312o2‘f
(,J 1 LLI A ' f. ( A M a License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
ZS WAS HBt&gaki A t.'L.tC
No.and Street Type Description
6 it CEN LZD , M� 0 3 I U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
913 7'13 Sift Lay.iore e.?os}-be sot•c,.., 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 12.0 0 SZ I Zo23
Gill—AA AIM K. LA n4.o1R.>E. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
724 G t2— J'F►Ft-p A . Lot vrc.re G`J p ash beams. c,K,
No.and Street Email address
DrEKF 0-0 , o134.2 `( (3 1Y3 &388
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 .❑
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 LNn&cR.E LAW AM (Z. DSA LAMo.E LukBtaZ co
to act on my behalf in all matters relative to work authorized by this building permit application.
'Df G5 EU cgbt.- littts1-
Ta LAM 1T SG Z 112MSrrEC 1 1 S 'Z.p 2-2-
rint Owner's a e ctro is Signature) Date
SECTION 7b:a' �'OR AUTHORIZED AGENT DECLARID
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
co ained in this ap ication is true and accurate to the best of my knowledge and understanding.
DI►445 1►ocAec a Tgusr
V.t_ cv 'rrek/y 5 • Tiemxre I S �
n " Ter's o uthorize 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.) tf$o (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"maybe substituted for"Total Project Cost"
TY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD -E 4 .
SIDE YARD 61 0-v r SIDE YARD r
FRONT SETBACK Lf(i„ F'f .
FRONTAGE 3C-" 'Ff".
e.g,...,
The Commonwealth of Massachusetts
I�.` " _= Department of Industrial Accidents
N LT: 1 Congress Street,Suite 100
Boston,MA 02114-2017
�— www.mass.gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Business/Organization/ Name: QrY)Cfe, OLLtLa m . 1)811 ;!arr ,rr, i_ur- kLr-- CD
. )
Address: r Li 6--i- e 1"Zi`7 e/d k L a c 121-e.. `j .a /0
City/State/Zip: FC rr r 6 id IPA- 0/342,Phone#: 14 13 •`I%3• b'Y
Are you an employer?Check the appropriate box: Business Type(required):
I.0 I am a employer with employees(fill and/ 5. ❑Retail
or part-time).* 6. ❑Restaurant/Bar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incI.real estate,auto,etc.)
employees working for me in any capacity.
[No workers'comp. insurance required] 8. ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment
their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing
no employees. [No workers'comp.insurance required]*'*
4.❑ We are a non-profit organization,staffed by volunteers, 11.0 Health Care
with no employees. [No workers'comp.insurance req.] 12.P Other
"Any applicant that checks box d l must also fill out the section below showing their workers'compensation policy information.
"If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box 41.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name: `T"(f,'tl`C.l e i-. jr 1.d re{-ii co_ �}
Insurer's Address: I f��- I l '`l,(/2 I e.I' j I JY51,1 Q`C{1`X%Pi'7 , P6 r5� `1, 05
City/State/Zip: t L(.i ODd , rn A Ci,Z c1 U ---, ca 03
Policy#or Self-ins.Lic.# `0 Hi (./ . Or y FA//.`) ,A_ ?.Z Expiration Date: /144/e 121 iz 3
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby ce fy,under the pains an l6eties of perjury that the information provided above is true and correct.
JuA
Signature: , i/6,-;1`' ' �� 4.
- " � i7'1" \--er--- Date: ,���
/LtfUt. ;1% ,
Phone#: '" /mil / N� ,' .�7 %�
s.
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.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
City of Northampton
. -,fi, Sys — sc
Massachusetts
G
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building Jy
Northampton, MA 01060 r yy`Y ‘
lIONSTRUCTION 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: VA U, 12-ecLI Cun/G
The debris will be transported by:
Name of Hauler: Eowi►f
Signature of Applicant: t- Date: 1 (r) zozz
, •
The Commonwealth of Massachusetts
Department of Industrial Accidents
01.11•••fliteM111.11.if
SIMMIIIN ":=J I Congress Street,Suite 100
NM WWI.
...4 Boston, MA 02114-2017
www.mass.goWdia
%Yorkers'Contpen‘ation I murance Affida%it: litiiklerSiCutiti:IctOri/Ek•Ctriciatts/PliiMberli.
i I)BE I-11,ED Vk tin 1 IlF. 11 RMITTINC.‘ I 110Rtrti.
tnnlicant Information Please Print 1.e2i1)1%
Name(BusinessiOrganizationlIndivicluali:.,,jYktA)C S 9._cv 0 cav2,LE- Tozms-i- ,
Address: 410 k-e.v1 neoty 52-ot •
CityiStatetZtp: Le eak 5, IsAA 0 10 53 Phones: Li 13 1-19 3i i I
Ate yeti an employee!t iks i..fin.,appropriate but: Type of project(required):
1.01am a employer*i la rriplOYCC)t fait an ifet par t.-tirric 1..• 7_ a New construCilun
IC]I ant a sale proimetur or i•arinerstrip and hate is earioyem uorking for me in S., cj ReraUdeling
an L.2Frac i r.,..[No-workers'comp.insurance required]
4 I sin a homeowner doing all v.tirk rnyielf_[Nu workers;'comp,insurance requited.]
i 9. 0 DettstAition
'., 10 CI Building addition
, Er,ant a harnetrwrier and will he hiring Lvritracnits to...viaduct at work ens or*,pairperry.. 1 will
ensure that all contractors either hare iiniicers cinispensation uuurance ce WV sole ,, 1 1,C3 Electrical repairs or additions
proprietors,with nu employee:.
110 Plumbing repairs or additions
5C3 1 am a general contractor and I have hired the itals-euntraelors listed an the aaavhed sheet_
These lub-euntracton,have employees and hare workers'comp.insurance.: 1 3-Ej Root repairs
14.0 Other
60 Yiie art a vorporation and at°Liken have exaciseil their right of exLquptiun per NIGL c.
1 t.:."......,,114I.and we haw no anplinets.1:No*oilers'‘-'1.1113Ft.Insurance require&I
An:.applicant that ch,...v..ks box=I must aba all out the secuint below showing their*Crii1T1*compensation polic!,..intiirmahoirL
f liomeownwra who sublint this affidavit indici.tang they are doing alt work and then hue inaside<ix/in-Actor*MUM SlIbIlla a new Istrolxv n antivating such.
:Contractors that cheek this box must attached an alchtionai sheet ihoumg the name of the%ub-euntraetors,and state whether or not those entitles hate
emplo!,ec, It 7.1.A.,"adh.-eittitractor,bat:entrlo?...eo„the. mum priv.ide their *orkers-comp.pitlist number
1 am an employer that is providing 'oilers'compensation insurance for my employed. Below is tire polity and job site
information.
insurance Company Name:
Policy 4 or Self-ins.Lie.4: Expiration Date:
Job Site Address: CityiState:Zip:
.tttach a ciip of the slorkers-comileMlition 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 imprisoinnent.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Odic c of Investigations of the DIA for insurance
co' in1,4e‘r ri fi ca t ion.
1 do hereby certi 1. and r the(Pala\ and ii altie.A of perjury that the information provided abort is trae and ctorree f.
;\
MM. 7/c12022,
. LI \ 3 /1`1(21‘k
Official use only. Dv nut write in:hit urea.hi he completed hi:city or town Offiddi
City or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5, Plumbing Inspector
6.Other
Contact Person: Phone 4:
Commonwealth of Massachusetts
Division of Occupational Licensure
Board of Building Re ulations and Standards
Constlon�Svisor
.3s <
CS-076123 ' f�c�pires:05/23t2024
WILLIAM R LAM -I ,t p
28 WASHBURN •14x;
GREENFIEL
`•130
��JIJ,tldil�
Commissioner , a,;.o; #. S&,dj ,
•
Construction Supervisor
Unrestricted-Buildings of any use group which contain
less than 36,000 cubic feet(991 cubic meters)of enclosed
space.
Failure to possess a current edition of the Massachusetts
•
State Building Code is cause for revocation of this license.
For information about this license
Call(617)7274200 or visit www.rnass.govidpl
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Individual
Registration: 120052
WILLIAM R, LAMORE Expiration: 10/09/2023
724 GREENFIELD RD
DEERFIELD,MA 01342
Update Address and Return Card.
SCA 1 0 20M-QQ05/117F7
'Tf>ifYe o��o�§�Sm�f KNat7s& ,tj�if(€�'s�(fe(�il�ation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Individual before the expiration date. If found return to:
• Registration Expiration Office of Consumer Affairs and Business Regulation
120052 10/09/2023 1000 Washington Street -Suite 710
WILLIAM R.LAMORE Boston,MA 02118
WILLIAM R.LAMORE /1
724 GREENFIELD RD rn+r •('zeisa 4'
DEERFIELD,MA 01342 Undersecretary Not valid without signature
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