31B-085 (9) BP-2023-0503
65 HENSHAW AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31B-085-001 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-2023-0503 PERMISSION IS HEREBY GRANTED TO:
Project# bath reno 2023 Contractor: License:
Est. Cost: 43169
Const.Class: Exp.Date:
Use Group: Owner: SCOTT JACQUELINE L &RICARDO B METZ
Lot Size (sq.ft.)
Zoning: URC Applicant: SCOTT JACQUELINE L&RICARDO B METZ
Applicant Address Phone: Insurance:
65 HENSHAW AVE
NORTHAMPTON, MA 01060
ISSUED ON: 04/28/2023
TO PERFORM THE FOLLOWING WORK:
2ND FLOOR BATH RENO
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:
i• 7-1.1
s
Fees Paid: S281.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
�- 20 The Commonwealth of Massachusetts
APO 2 Board of Building Regulations and Standards FOR
4 sachusetts State Building Code, 780 CMR MUNICIPALITYS
lr3t>< tttgPP�iiit'Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Q7P•.23- S(T3 Date Applied:
41) ay5.i
1.4.2s_zz5
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
65 Henshaw Avenue, Northampton MA 01060 31B 085-001
1.1 a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
URC One Family Dwelling 5663 sf/0.13 acres 57 ft.
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
10 ft. 20 ft. 10 ft. 12 ft. 20 ft. 53 ft.
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public li( Private 0 Check if yesl21 Municipal XI On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Jacqueline L. Scott& Ricardo B. Metz Northampton MA 01060
Name(Print) City,State,ZIP
65 Henshaw Avenue 413-348-0011 jacquie_scott@yahoo.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building ctit Owner-Occupied (1 Repairs(s) 0 Alteration(s) Q9 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work: Updating of existing approx. 6'-8"x 12'-0" second floor bathroom.
New plumbing fixtures, new wall- ceiling -floor finishes, new lighting.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building S 34,000 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 3874 ❑ Standard City/Town Application Fee
❑Total Project Cost3 (Item 6)x multiplier x
3. Plumbing $ 5295 , 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All FeesCf
Check Noe. Check Amount:Zi o_ Cash Amount:
6. Total Project Cost: $ 43,169 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Typt(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R estricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC oofing Covering
WS I indow and Siding
SF Solid Fuel Burning Appliances
T 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 .❑
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 application is true and accurate to the best of my knowledge and understanding.
Jacqueline L.Scott, Owner April 21, 2023
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,fini ed basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable m count
Number of fireplaces Number o 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
SETBACK PLAN
MAP: 31B LOT: 085-001
LOT SIZE: 5663 sf/0.13 acres
REAR LOT DIMENSION: 100 ft.
FRONT REAR YARD 20 ft
frontage = 57 ft.
❑ ❑ ❑ ❑
SIDE YARD 12 ft SIDE YARD 12 ft
rear lot line 100 ft
REAR i9 'SETBACK 53 ft
FRONTAGE 57 ft.
City of Northampton
i
Massachusetts
c
/ *
DEPARTMENT OF BUILDING INSPECTIONS 1/4:w
212 Main Street • Municipal Building J� "e
Otarkar, Northampton, MA 01060 44 C
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: Casella Waste Systems/Transfer Station (686 Main Street, Holyoke MA)
The debris will be transported by:
Name of Hauler: 413 Dumpster Rental Service, 6 W State St, Granby, MA 01033
i \tkVI J April 21, 2023
Signature of Applicant: } Date:
City of Northampton
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/Y4- - " '1, Massachusetts iteys 4 s,
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p ' 3' DEPARTMENT OF BUILDING INSPECTIONS S'`, ,j�,°
212 Main Street • Municipal Building yO, cs
1e '""- Northampton, MA 01060 .r ,_ O.
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
April 8, 1965
I Jacqueline Leigh Scott (insert full legal name), born _ (insert month,
day, year),hereby depose and state the following:
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.R5.1.3.1, 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 the 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"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use
and/or farm structures. A person who constructs 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 license 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, 1 am not engaged in construction supervision in connection 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 supervisor for said project or work.
Signed under the pains and penalties of perjury on this 21 day of April , 20 23.
9,(,:bit\L-kfri..C1,1
(Signature)
II General Notes:
All Walls to be tiled floor to ceiling with Florida Tile Amplify
12x24 in White Matte(ceramic). Over k Schluter
Kerdi-Board.
CLOSET All rFloorlan)beertiled with
ut r-eBar BHellaat SDaoc Grayele 9x9
(porcelain).Over Schluter-Ditra-Heat-Duo with electric
heating cables,over new(plywood)sub-floor.
10' perim.
5.2 sqft Replacement Dry-wall ceiling.Paint color=Benjamin
0 Moore Regal Select Satin N550(untinted).
Construction Plan Notes:
ik �I v 6 I 1. 24`Tubular Metal,Mitered,Towel Bar(2),
v_, 2�-6° Brushed Nickel Finish.Provide blocking in wall.
L ( ® 2. Build out jambs at opening to existing alcove.Tile at
jambs and header and floor/jamb depth only(i"w/
grout over Z'kerdi-board over 2x4 wood studs).
) - 3. White Oak T&G flooring,White Oak Shelves(3)with
0 LED strip lights under lip and at edge of ceiling(four
Alapprox e strToips).
let
4. Alpha Bidet Toilet UXT Pearl.12°rough-in,at
location of existing toilet.
` ,, 5. New GFCI Outlet for Bidet.
� 6. Existing Water Supply Line for toilet,at floor.
ID 7. Toilet Roll Holder,Tubular Metal,Mitered,Brushed
( 0 - Nickel Finish.Provide wood blocking in wall.
8. 60"X 22"Wood Vanity,with drawers.
�.a 9. Wall mounted brushed nickel faucet and actuator/
T- mixing valve.
777 0
( 10. "What We Make"white concrete countertop with
Kohler white undermount Verticyl 19"sink(17.25"x
r Or
n 13"bowl).
OO 11. LED Bathroom Mirror 55"x 28",backlit+front lit,
dimmable/color selectable.
BATH 12. Recessed outlet behind mirror,coordinate location
with power location on mirror.
29' 6' perim. i I. 13. GFCI duplex centered on vanity,centered 6"above
119 ,� countertop.53.6 sqft 0
14. Runtal 60"high 3-tube(approx.8 g"wide)model
UHX-3 vertical panel radiator,white. Re-use valves
from existing Runtal radiator to be re-moved.
\� ci
_/ 15. Extend k copper tube supply and return lines to new
1 location of radiator.
t a 16. Previous location of 4"copper tube supply and return
I 2" _ lines for former radiator.
17. Oasis Shower Door,Exterior Satin Etch(low iron
It . glass), "thick.30"x 80".Brushed Nickel hardware
f ® (hinges plus double sided door pulls).Includes
� O7(� _ x ` install and clear plastic sweeps.Provide solid1
1�r �i blocking as required by Oasis Shower to support
,. \ 4' W.� door installation.
ii
�� \ 6 ��� 18. Towel hooks(2),Brushed Nickel finish.Provide
t \ blocking in wall.
(� �`.� 19. Schluter nom.12"high x 20"wide shower niche,fully
tiled.Provide blocking in wall to support niche.
Iv 20. Schluter Linear Drain,nom 70",tiled cover.
e.I' 21. Switch(es)for:Ceiling downlights(2),mirror,shower
tl 0 downlight,strip lights at closet,ventilation fan.
///1 = Op ��r 1 t 1 22. Cut back existing heartwood pine threshold
t I _ (hatched area)to align with the centerline of the
• door when closed.
1)I I SHOWER 23. Remove and replace jamb and header casing with
j , j; 1x6 painted poplar flat stock.Paint all sides.Paint
j 19-10 perim. color=Benjamin Moore Regal Select Satin N550
i''� / . 21.6 sqft / (untinted).
`/ 24. Moen 3669EP handshower on slide bar with drop
,111�1 \:eB:•.'==:'se::al: :�_ ; Illnlunnui\'tnn�\ ell.Wall mounted.Transfer valve at side wall near
w �� shower door.
/ : :e.. x' . ... // //
25. Location above of recessed ceiling LED downlight.
26. Location above of ventilation grille(or combo
ventilation grille plus LED downlight at shower)
connected to above ceiling in-line fan.
5'-11 1/4" 27. Wall mounted thermostat,to power and control
4f / under floor electric radiant heat.
The Commonwealth ofMassdchusetts
a WI
,—� 1. Department of Industrial Accidents
_q��! 1 Congress Street, Suite 100
}
����= Boston, MA 02114-2017
,G�t. ' 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): Jacqueline L. Scott
Address: 65 Henshaw Avenue
City/State/Zip: Northampton MA 01060 Phone#: 413-585-8709
Are you an employer?Check the appropriate box: Type of project(required):
1.IZI I am a employer with employees(full and/or part-time).* 7. ❑New construction
2.1:1 I am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling
any capacity.[No workers'comp.insurance required.]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. El Demolition
10❑Building addition
4.®1 am a homeowner and will be hiring contractors to conduct all work on my property. I ill
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5 El 1 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.t
l,.❑We ate a corporation and its officers have exercised their right of exemption per MGL c.
14.El Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 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:
Policy#or Self-ins.Lic.#: 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 under MGL c. 152, §25A is a criminal iolation 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 and penalties of perjury that the information provided above is true and correct.
Signature: ' >,a u/ jilft— Date: April 27, 2023
v
Phone#: 413-348-0011 L.
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.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: