36-301 (5) BP-2023-0465
829 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-301-001 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-2023-0465 PERMISSION IS HEREBY GRANTED TO:
Project# OFFICE SHED 2023 Contractor: License:
Est. Cost: 15000
Const.Class: Exp.Date:
Use Group: Owner: NICOLL PLUMB ADAM M&JENNIFER V
Lot Size (sq.ft.)
Zoning: SR Applicant: NICOLL PLUMB ADAM M&JENNIFER V
Applicant Address Phone: Insurance:
829 BURTS PIT RD
FLORENCE, MA 01062
ISSUED ON: 04/20/2023
TO PERFORM THE FOLLOWING WORK:
10X16 OFFICE SHED
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:
•
1l►
Fees Paid: $98.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
7-31
File #BP-2023-0465
APPLICANT/CONTACT PERSON:PLUMB ADAM M&JENNIFER V NIC)LL
829 BURTS PIT RD FLORENCE, MA 01062
PROPERTY LOCATION 829 BURTS PIT RD
MAP:LOT 36-301-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $98.00
Type of Construction: 10X16 OFFICE SHED
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
)( Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Specia Permit With Site Plan
Major Project: Site Plan AND/OR Special ermit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Varia ce*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from)CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
0 ; ,/, ` V 4 UJ/"/nJ.j
c/ .2
Sign. ure of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
ri—_ E _._._..1
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APR
1 8 2023 he C mmonwealth of Massachusetts
)
Boar of uilding Regulations and Standards FOR
hus tts State Building Code, 780 CMR MUNICIPALITY
ppt
icati
FT. 6 IIDING INSPEC_ 0 USE
ralirt P
DE n To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 6g.2 b 'ILK Date Ap lied:
i1 •
1
' /' : i . y D
Building Official(Print Name) Signature J 1 to
SECTION 1:SITE INFORMATION
1.1 Property Address: //� bur 5 RE (? 1.2 Assessors Map&Parcel Numbers
1.1a Is this an accepted street?yes no 1` Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq II) 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 CI Municipal_ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.4 Owner'of Record: AA
M-(u r 17,1 C3o r L 5 f
Ail
Name(Print) lest !l CC t l V 1 k �'State,Lt i5ZI$35 7 7 405 &JI G(fr/1 `�M/ ck ( l_
No.and Street Telephone Email Address / ( ,M
SECTION 3:DESCRIPTION OF PROPOSED WORK2(che k all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) Alteration(s) 0 Addition 0
,Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 1,t X/l_I c (,� )c
C7 ) (L S
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Matals)
1.Building $ i c D 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ C.)0 0 Total Project Costa(Item 6)x multiplier x
i
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ 200(.) List:
5.Mechanical (Fire $ Total All Fees: $ i 1
Suppression) 1
V`v Check No. Check Amount: Cash Amount:
Iiiit6.Total Project Cost: $ 0 Paid in Full ❑Outstanding Balance Due:
„ ,07-- r-a r
City of Northampton
{ _ fly,
Massachusetts -••,
f DEPARTMENT OF BUILDING INSPECTIONS A
212 Main Street ill 3 Municipal Building �; ,.�`:'
"�!� Northampton, MA 01060sr. �1�”
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.
V Construction Supervisor Lice
5: CONSTRUCTION SERVICES
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 0 No 0
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) Datc
• SECTION 7b:OWNER1 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.
el. _
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 mi 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"
CITY OF NORTHAMPTON
MAP: LOT: C
LOT SIZE: c\Ct c(�
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
1,0674
r 1,,,, N,,
City of Northampton
Massachusetts
4 DEPARTMENT OF BUILDING INSPECTIONS t•
lll"` 212 Main Street • Municipal Building �a"
Northampton, MA 01060 '4' `'°''
CONSTRUCTION DEBRIIIIfflinellik
(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:
Vc.\ 1 (e---) 6 c) i/15
Location of Facility: 11, c
u 1 t it )- t c,�� )�
The debris will be transported by:
A
Name of Hauler: "1
Signature of Applicant: Date: (i Z�
The Commonwealth of Massachusetts
Department of Industrial,4ccidents
e.,.
/ Congress Street„S'uite 100
Boston,MA 02114-2017
W#--' < W4141mas.s.govidia
---- IYOrkers"(7ampensatirsai Insurance Affidas it:Builders/ContractorstElectricians/Plumben.
TO RC FILED VS1111 111E PERMUTING AUTHORITY'.
Applicant Information Please Print Levi hls
Name(13usincssAktanizationAndieldual l: 4 cgt,?)
Address: (t-7 6u -(. ..r(P4 KA
CityiState/Zip:_ FID/te 4 (<- AAA o1bL-1—pholiv ,. (3 - 3 q- --i --ScS-
Art yen MI raapkayer?t lurk the apprupriak.booc:
11)pe of project(required):
I am a employ's with ,erriploykvs(fall arniur part-tom I.* 7. 0 New construction
Jim a sole proprietor or purnerAup and ba nu empkycts.working im Tmc in 8. 0 Remodeling
any cap:al:try_No Is.mircri Imnp.mum:ince rmtilmx1.1
0 I am lionsoau ner doing all wkni inyself.No 4 tarkers:ClIfty smiaranut rcti Mita"r
. a.a hati.....a.41 will be hiring contractors to conduct all work on my property. 1 will 9. 0 Demolition
10 0 Building addition
1rnun that all oontractuts miLvr have workers'A:nevi-711.1mm insurams or alit MAC II 0 Electrical repairs or additions
proprietors with no employers.
12.0 Plumbing repairs or additions
5 I am a guru-nil contractor and I him.c lured the sub-contractors listed on the adtaehod sheet
13 Roof repairs
These sob-etintractors'rave employees and hak e workers'comp.insurance.;
1 4_0°dun
kcj We are a,torpiwalmun and iti,Ofikelf5!UV,:.0:tlx imCd their right of excmptiun prr Malt_c.
I:52,§1 i 4 k and w e I,.r._r.,"e--nr,10:.....N,1\,,,'+', :.:•-.1-:Th'comp.11111.111MCC TINUtted.1
i
Any applicant that vita:6 boA 0 1 must atm.,(tit out the section ts:luu showing their workers'compensation polk--'«rarfornuitrun,
•Itnntowners who submit thus atridakit 014bVIU1)11 titcy an &an AU work and then hire outside contractors must submit a new aft-I/Java ndi Nuch
lewattactort,duir check this box mura attached an additional sheet hOwing the 21.11111:of the suls-emitractors ministate whether os not those saltines line
croolo;•,er. If the sub-euntractot lune oriplii;•re ..tlicy rutuA provide their workers"otx.. np.rolit,...., nt.mkti
1 ant an employer that is prodding'coders'compensation insurance for my employees, Below is the polity and jab site
information.
Insurance Company Name: _
Policy 4 or Self-ins.Lie.#: Expiration Date:
Job Site Address: City:State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required undcr NIG l c. 152, §25A is a criminal violation punishable by a fine up to SI,500.00
anilor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a line 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 NC ritication.
I do hereby evrtik gender the ins and penal 'es erites•dna i i -,,fa e.n1_ ' n -Med oihi,v is trite ad et-ea_
Official use only. Do not write in this area.to be completed by city or town official
(its or Ton: Permit/License a
IN%uittg Authority (circle one):
1. Board of Health 2.Building Department 3.( it y?Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
b.Other
t'ontact Person: Phone#:
_.,..... ..
City of Northampton ,
fr c , ,r
Massachusetts SICx
t.
t DEPARTMENT OF BUILDING INSPECTIONS
z.y - {y„ a 212 Main Street • Municipal Building mod;, =�»„b
Northampton, MA 01060 rVPh ‘"N'
OW1R- XEMPTION ELIGIBILITY AF si / 7
I, / (insert full legal name), born _ (insert month,
day, year), hereby depose an sta o owing: /r oku M y+ __\
1. I am seeking a building permit pursuant to the homeowners' exenption 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 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" s defined at 780 CMR 110.R5.1.2:
Person(s)who owns a parcel of land on which he/she resides r intends to reside, on which there is,or
is intended to be, a one-or two-family dwelling, attached or d tached structures accessory to such use
and/or farm structures. A person who constructs more than on home in a two-year period shall not be
considered a home owner. ,
4. I do not hold a valid Massachusetts construction supervision licens and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirem is for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in con ection 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 supervi$or for said project or work.
Signed under the pai • " " ties of perjury on this il day of_ftf:l 201-3
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