23A-031 (5) BP-2023-1275
67 PARK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-031-001 CITY OF NORTHAMPTON
Permit: New Build
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1275 PERMISSION IS HEREBY GRANTED TO:
Project# RENO/NEW BUILD Contractor: License:
Est. Cost: 2650000 MAX HEBERT 110574
Const.Class: Exp.Date: 02/10/2024
Use Group: Owner: MAX HEBERT
Lot Size (sq.ft.)
Zoning: GB Applicant: DUFRAYNE BUILDERS LLC
Applicant Address Phone: Insurance:
46 ROUND HILL RD (413)896-3019
NORTHAMPTON, MA 01060
ISSUED ON: 09/21%2023
TO PERFORM THE FOLLOWING WORK:
GUT RENO, PARTIAL DEMO AND REPAIR OF EXISTING STRUCTURE INTO 1 LIVING UNIT. ADD SEPARATE LIVING
UNIT TO EXISTING STRUCTURE. ADD A NEW 2 FAMILY AND 1 FAMILY TO PARCEL.
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: 2,,,leff\i&
Fees Paid: $5,630.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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The Commonwealth of Ma sac net 14 2023$ vj
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Office of Public Safety and In pec= -
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Massachusetts State Building Cod C 11:�`Feui(D
Building Permit Application for any Building other than a On - r IN,� , . .-11in
• v1'4 or,s Q^'8
(This Section For Official Use Only)
Building Permit Number:013-/4 7S Date Applied: Building Official:
SECTION 1:LOCATION
67 Park Street ' Florence 01062
No.and Street City/Town Zip Code Name of Building(if applicable)
01062 01062
Assessors Map# 23A Block#and/or Lot # 031-001
SECTION 2:PROPOSED WORK
t
Edition of MA State Code used 9th If New Construction check here Cil or check all that apply in the two rows below
Existing Building 0 Repair 1E1 Alteration 0 Addition RI Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes II No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No Q
Brief Description of Proposed Work: Gut renovation,partial demolition,and repair of existing structure into 1 living unit Addition onto
existing structure as new,separate living unit.New construction of two 2-family structures,and one
single-family structure along north side of lot.
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): R2 Proposed Use Group(s): R2
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 2.5 621 3 675
Total Area(sq.ft.)and Total Height(ft.) 1,242 28'8" 1,350 28'8"
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile 0 R: Residential R-10 R-2 El R-3 0 R-4 0
S: Storage S-1❑ S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA D IB ❑ HA IIB ❑ MA IIIB 0 IV 0 VA IVA 13 VBD
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit Debris Removal:
A trench will not be Licensed Disposal SiteEl
Public l Check if outside Flood Zone® Indicate municipal Elrequired❑or trench or specify:
Private❑ or indentify Zone: or.on site system 0 permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable® Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No® Yes III No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: 9th MA& Use Group(s): R Type of Construction: VA
Does the buildinglMRr2 n Sprinkler System?: No Special Stipulations: N/A
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
4Max C Hebert v 63 Park St Florence 01062
Name(Print)1:.. No.and Street City/Town Zip
Property Owner Contact Information:
_ Project Manager/Owner 413_ 296 _1216 413_ 896 _ 3019 Project Manager/Owner
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
N/A
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here®.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals)
Dan Bonham(TDA) 617- 230 - 2367 dan@tdouglasarchitects.com 951433
Name(Registrant) Telephone No. e-mail address Registration Number
196 Pleasant St. Northampton MA 01060 Architect August 2024
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Dufrayne Builders,LLC
Company Name
Max Hebert CS-110574 Type U
Name of Person Responsible for Construction License No. and Type if Applicable
46 Round Hill Rd Northampton MA 01060
Street Address City/Town State Zip
413-296- 1216 413 -896 -3019 maxchebert@gmail.com
Telephone No.(business) Telephone No. (cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes® No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $2,056,000 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $188,000 appropriate mu real facto =$�
3.Plumbing $255,000
Note:Minimum fee=$" �" (contact municipality)
(HVAC) $151,000 p ty)
5.Mechanical (Other) $0 Enclose check payable to
6.Total Cost $2,650,000 (contact municipality)and write check number here f 0 7
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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.
Max C Hebert Project Manager/Owner 413_ 896 _ 3019 09.09.2023
Please print and sign name Title Telephone No. Date
46 Round Hill Rd,3rd Floor Northampton MA 01060 maxchebert@gmail.com
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: ,3-1 _3
Name Date
The Commonwealth of Massachusetts
Department of Industrial Accidents.
=:... 1—..
, 110111•0 , Miggiat , 1 Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.gor/dia
- -,-.t..-
II rakers'Compensation Insurance Affidas it:Builders:( iintractors/Electricians/Plumbers.
ID BE FILED liS 1111 1!IF.PEIEstirt IN(. A t I'HORITle.
:knolls-ant Information Please Print Lee.ildi
Nanw 1 Idusins.--ss th-gani4aucin ltuitsiduair Dufrayne Builders, LLC/Max C Hebert
Address: 46 Round Hill Rd,3rd Floor
City/State/Zip: Northampton/MA/01060 Phone#. 413.896.3019
.
1,1-r"con an employer?Cheek the appruprtete box: Type of project(required):
if]I ant a vmplovsz with errigskiyees(full arniOr part-tirtat• 7_ 0 New construction
2.173 I am a wk proptietut ur partnership and have ttu ernployni.working lee me in 8. Ej Remodeling
any capacity.[Nn%kw-kers comp,insurance itsguinaL)
9 0 30 lain a homeowner doing au l work iiiyielf.jNo workers'comp,insurance r .. Demolitionequiretil'
i 0 0 Building addition
50 larti a tionteowner mil win be hiring ourinackut to conduct all work un my property, I ks ill
ensure then all euntraciurs either have workers'conmemation owurunio or am sole 1,f ]Electrical repairs or additions
pruprickm with no Linployeaa.
12.0 Plumbing repairs or additions
I am a general euntractur and 1 but:hard the soh-contractors listed on the anoxia:4 sheet
13.1:1Roof repairs
These suh-einstracries lose cmployem and has e winters'comp.insurance;
14.0 Other
o.E3 WeInt a Corputatiun and ea(Aiken have cur.:ism]their right of e.tertiptsun per Mc a....
152,,toil.and we li.iroe nu anployces.[Nu stinkers•comp insurance requinail
Any appbcani that clunks box 41 must also fill uut the section halms shutting thee walkers'compensation policy"mforrnation
*Hoineownets who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a nest-affittav a ustficaang such.
leontracion.that cheek this Fox must attached un additional sheet showing the name of the sub-contracturs and state whether or not those entities have
employee, lids:sub-rorstrartrcm hale crnapicefces.the. Mint pru1 rile.thccr AOrk-ers"C4,111.5 p1.11k,!,
I am an employrr that is providing roosters'compensation insurance for my employees.. Below is the polity and job site
ittformation.
Insurance Company Nanic: _
Policy#or Self-ins. Lie. -4: Expiration Date:
Job Site Address: CityStaterZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requirexi unties MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500,00
ardor one-year imprisuninc:1 .as well as civil penalties in the form of a STOP WORK ORDER and a line of up to$250.00 a
day against die violator.A,:,,-iv of this statement may be forwarded to the Offirx et-Investigations of the DIA for insurance
coverage verification.
I do hereby c ilv un er tin pains d'ad penalties of perjury that the information pro third above is true and correct
Sloature: _
Date: 09.09.2023
Phone#: 413.896.3019
Official use only. Du not write in this area,to be completed by city or town official.('its or Town: Permit/License#
Issuing Authority (circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Elecnital Inspector 5. Plumbing Inspector
6.Other
Contact Person: Plume#:
, .
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 67 Park Street,Florence,MA 01062
The debris will be transported by: USA waste&Recycling
The debris will be received by: USA Waste&Recycling
Building permit number:
Name of Permit Applicant Dufrayne,LLC
09.05.2023 �.
Date Signature of Per it Applicant