15B-049 (13) BP ► 022-1537
259 CHESTERFIELD RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
15B-049-001 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-2022-1537 PERMISSION IS HEREBY GRANT, D TO:
Project# FIRE REPAIRS Contractor: License:
Est.Cost: 2000
Const.Class: Exp.Date:
MELNICK DANIEL W&MARY HEL:NA
Use Group: Owner: SIMMONDS-MELNIC TRUSTEES
Lot Size (sq.ft.)
MELNICK DANIEL W&MARY HEL I A
Zoning: RR Applicant: SIMMONDS-MELNIC TRUSTEES
Applicant Address Phone: Insurance:
259 CHESTERFIELD RD
LEEDS, MA 01053
ISSUED ON:12/05/2022
TO PERFORM THE FOLLOWING WORK:
TEMP TRAILER FOR FIRE REPAIRS
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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 1 Q ��
X1 .
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
I RECEI - -) 1
iZ, The Commonwealth of Massachusetts
'1;.Q:.ti Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR FO?►k>fiY'', 22
USE
Building Permit Application To Construct, Repair, Renovate Or Demolish Mar 2011
One-or Two-Family Dwelling DI PT FCTIONS
.OF SUILDINO,INS�C No,IrHAMI,,nr,'
_ rr 01060
This Section For Official Use Only
Building Permit Number: 4P2 A .- ( 6?1 Date Applied:
4010 a5 f7.--2 11 3O-ZaZZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
)-r°t C A 4 Ta.^-14;-211-Q 4 f,$"- is O y 1 J D d
1.1 a Is this an accepted street?yes >c no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) ,v/r - r-c-.v, o tiA, N o v t i,Nav
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 Privates pone: Outside Flood Zone? Municipal 0 On site disposal system „IxCheck if yesd
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
D4,./at • „et, ( K L Lc .4-0 - 0► Ul-2
Name(Print) City,State,ZIP
r9 CNe sre/1- y/' - 5-7 7- b $1 o•►,.e 1,r ik 7)_& A,...,,,,,,t,cd,v.
o.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other SI Specify: re -r.p d/LA fl
Brief Description of Proposed Work': A PA)'I r f,
P1.Aca- e+-,db'�G', "r4>A II¢la on t,,-¢ ro rj/.ate✓ P(i`'''
—4 0,t, I.,o,.,,e u„J,... -7- 0 I-" we '- 0-e- t).e,IA, /.D.r.L i1 40,2-.
"a Sr-Oka/
/1-o..-. -"‘-ieue 04^^!°cfc.
SECTION 4:ESTIMATED CONSTRUCTION COSTS eV jA
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determned:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No.61 I Check Amount: G4 Cash Amount:
6.Total Project Cost: $ t/ A ❑Paid in Full 0 Outstanding Balance Due:
b /4i'y
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
,Q
") — /02 C-�✓`/`; t��T'l °C) License Number Expiration Date
Name of CSL H�lder
✓P-Cr-ee.,
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
1 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 0 No .4
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 ppli on is e and accurate to the best of my knowledge and understanding.
C)C11/\ l, �
�c ,a.�g a rn�N k
!I J1,
Print Owner's or Authorized Agent's Name(lectronic Signature) ate
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 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"
AS—BUILT DIMENSIONS Existing distribution box ('p")
y 40 mil poly barrier
"A" to "C" = ill`- '-3" "8" to "C" = 69'-6" 1 (3 sides)
"A" to "0•' = 25'-0" "B" to "0" = 46'-3" / / / / / / / / "8"• Title-5 sand
"A" to "E" in 77-2" "B" to "E" = 85-8" / /
• "A" to "F" = 77'-4" "8" to "F" = 80'--10" / /
•
A" to "G" — 80.-3" "B•. to ..0.. _ 78'-6" / Existing / / .. !•.`• .. • • :�:
,. - .• / 3 bedroom / -'-4 j. .1!.4 .::1 ,1• `I' NI. ;I (:
r — ril = y8 ,o A — K - 36 s / /
• . Reserve area: ";••'•.
r — L� S5--a a r} -C= $ / / . . .;�r"••• Inspection
7 --I / •, : ,I 'J• .(: • '••I• .' •1 1.•).•s:� •' 6 ports
(--- .. ..•Reserve area
/ Existing 2 / .�.
/ garage / / A. I • I. :.lr
Existing i r•,.J .'a_1_1:.:
well location � "0 �`, •• .' -�
/ ...13. orch ,
/ / / / 48ft. '�
r �
4" pvc solid pipe •
3 5ft. ,. r
01)
,Le- R -
Driveway E fisting septic tank
• Pump out man-hole ("C")
INFILTRATOR LEACHING TRENCH SYSTEM
3 Trenches with 12 Infiltrators/trench
- - b AS—DUILT PALM
259 CHESTERFIELD ROAD
FLORENCE, MASSACHUSETTS
"cRFILELD ROAD — NORTHAMPTON, MASSACHUSETTS
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