38B-117 (9) BP-2024-0557
17 EAST ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-117-001 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-2024-0557 PERMISSION IS HEREBY GRANTED TO:
Project# new chimney 2024 Contractor: License:
Est. Cost: 5500 PETER SHEPERD 077611
Const.Class: Exp.Date: 05/23/2024
Use Group: Owner: CASE MICHAEL A
Lot Size (sq.ft.)
Zoning: URB Applicant: SHEPERD MASONRY &SLATE ROOFING
Applicant Address Phone: Insurance:
32 FOREST AVE 413-658-5935
GREENFIELD, MA 01301
ISSUED ON: 05/07/2024
TO PERFORM THE FOLLOWING WORK:
REBUILD NEW CHIMNEY
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: t":47
ID
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVe
The Commonwealth of Massac usettsUAY - 6 2024
Office of Public Safety and Inspections
Massachusetts State Building Code(780 CMR) DEN OF nun.nrNc------._-
PAWS
— Building Permit Application for any Building other than a One-o`rrFwoORr� 1 I�w pg 8
(This Section For Official Use Only)
Building Permit Numbers 7 Date Applied: Building Official:
SECTION 1:LOCATION
f-7 t loilhrrp>J fie.
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used ' If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair( Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other Er Specify: Q))WY)At" /
Are building plans and/or construction documents being supplied as part of this permit application? Yes `EJ No 0
Is an Independent Structural Engineering P r Review requ. ed? Yes 0 No 0
Brief escription of Proposed Work: r C O D-_
�e U S 1 Ltd v i C m �-), gi� `c e
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) CI
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 ❑ 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 0 M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA CI IBC IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV CI VA CI VB
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:
Public 0 Check if outside Flood Zone 0 Indicate municipal 0
A trench will not be Licensed Disposal Site CI
Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
_awl L re kr.sheperdft e jtA,i1 . C'w-r,
City of Northampton
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DEPARTMENT OF BUILDING INSPECTIONS ;
rr
212 Main Street • Municipal Building vy r'�
Northampton, MA 01060 PPS.—16,7‘`a.
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL &
MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS
1. 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 & Hard copy).
3. Site Plan with location of proposed structure(s) and setbacks.
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 CSL and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (if applicable).
8. Note any Conservation and/or Special Permit requirements (if applicable).
9. Driveway Permit (if applicable).
10. Proof of Water and Sewer entry fees paid (if applicable).
11. Trench Permit (if applicable).
12. Initial Construction Control Documents filled out and signed by the Registered Design
Professional in responsible charge.
13. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton
A
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Addre s of Property Owner
147i�1 C6604 rl . r .ifisk 1 . 11)oe444 Ap J ivirt
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
.S 112e5t'll 7 37 fl eitoe- --e-k cr3e/
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 O.
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)
4k- �, S AP -_ �- iki& /7g �tf
N e(R ant) ephone e-mail addressg� Registration Numbe
�5� C ())30/ 21�a�
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
E h-e p-e1 o Mti-solo-O
Company Name
frJ/L E o2 0776/f
Name of Person Responsible for Construction Lic a No. and Type if Applicable
3Z. f es4- 2 V L ex P D/3b
Street Address City/Town State Zip_
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 ' ance of the building permit.
Is a signed Affidavit submitted with this application? Yes No 13
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$� (contact municipality)
5.Mechanical (Other) Enclose check payable to
6.Total Cost $ (contact municipality)and write check number here
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 t of my knowledge d understanding.
—P(E - 54i Cifj19 6(k) — 1413-6cr—Sf3.3 51b/Z°zy
Pitse prod sign me �1 Title Telephone No. Date f' f
37- t-ov i Av - C'/�'�i�r-rGlc� Apt. a/30 l /6 E/ s)- o2 f-J ',
Street Address City/Town State Zip Email Address COO
Municipal Inspector to fill out this section upon application approval: 5-7-zoz y
Name Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
'</--'—':' : -,t,‘
Massachusetts
01 1 , '�. a DEPARTMENT OF BUILDING INSPECTIONS
,- 212 Main Street • Municipal Building
Northampton, MA 01060 ��s ,j}.
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: �0��5t-(14--_
Location of Facility: � w?�z /c/ Al. _
The debris will be transported by:
/-1/fit)_S 4//' O ri- 77g-ieZ9
Name of Hauler:
Signature of Applicant: A'' Date: S Xj
.. ,,.
Ls%- The Commonwealth of Massachusetts
Department of Industrial Accidents
. T-':',1 . 1,&--• -6; 1 Congress Street,Suite 100
zrz. zca Boston, AL-10114-2017
, ....... , www.nta.ss.govidia
l'ibaters'Compensation Insurance Affidas it:Builders/('ontractorslEirctriciansiPlumbers.
TO SE I:ILED WITH THE 1,1:101111 IN ti AtITHont IA.
Applicant Information Please Print Letibts
Name(itosancss-Orga nitration:Individual): 5ht FLer 4 IP ic
______.
i.----s
Address: --3,, to((.5+ tivc_ G ree_v3 te OM .
t
City/Statoli p: Phone#: if/3 KSS —5- 3_5r----
, —
Are y MI an employer?it'heck the appropriate hot: Type or project(required):
101 pi a employer with ariplOycts(fa i mam purt-tinic 1..* 7_ CI New construction
le
2 I am a so p or ropriet or partnerthip and h IT ave no employets working fur IPC trt
8 0 Remodeling
any capacity,(No v.orkers'comp,insurance required.]
9. Ei Demolition
3.0 I MT a homeowner doing all work myself.[No worktrs.comp,iniglrAllit,e miaowed 1*
10 0 Building addition
4.0 1 ant a lugneowner and will he hootg oonrracturs to conduct all work on my prtiaerty„ 1 will
ensure that all contra:tun either haw workers'coniperliairsOn in6t,trani-V or arc sole 1 1 a Electrical repairs or additions
proprietors with nu employeci.
I 2.0 Plumbing repairs or additions
I ant a general oath actor and 1 have hired the sials-cuntraeturs Ihte4.1 tin the attached Axel.
13.0 Ryof repairs
These itth-contractoni haw onpluyecti and laaVe.V.I.nien.cuinp.intitnani:c!.
*, 14-Pr'Othel' ChfAtatied
60 We an.a corporation and itt offieras have exercised their right of et.a-min:en per hdtTit c,
1'52.1.11 41...and we have no employees.[No*utters'cutup.insurance reuutrettj
'Any applicant that checks hot 41 mint Abu fill uut the stxtion below showing their woriers'eurnpestsation ja.ilicy. inlormation
1.Hoincowners who submit this at:GALAN it indicatinit they art-doing all work and then hire otitsitk etviirecwri mint submit a nu*a Mho,it tuilicaus mk.11.
t'untracturs that cheek nib Kix emit attached an additional sheet showing the name of the suheuntractors and state whether or not those,ntirtie›have
einployees.. tf the sub-contracturs feat Vitip1.11!•1-%!%.they must pros ide their v.bikers'annp.pAtt l,number.
lam an employer that Is proriding Pr,orkers'camper:1101°n insurance for my employees. Below is the polity and job Ain'
informant's.
Insurance Company Nam :
Policy#or Self-Ms. Lie.4: Expiration Date:
Job Site Address: /7 ..;15"..- _ /-- cityiState,7ip: A,,,44 42i4,4J 40.
Attach a copy of the workers'compensation polic:s declaration page(shossing the polic:k number and elpiration date).
Failure to secure coverage as required under N1GL c_ 152. *25A is a criminal s iolation punishable by a line up to S1,500.(0
and/or one-year imprisonment,as well as civil penalties in the(ban of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
...--.)\erage verification.
I do hereby certify der the pains and pr. ties of per-us,'Oar flu information provided above is true and corset%
nature: l) i,.. 5 A/962 L.(
"//Prime 52 ..i15____
.... .
Official use onl). Do not write in this area to be completed by cat) or town official.
City or Town: Permit/License 4
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Cit;k1Tov$n(7Ierk 4.Electrical Inspector 5.Plumbing Inspector
b.Other _
Contact Person: Phone#:
......._—
•
i
(------- Initial Construction Control Document
To be submitted with the building permit application by a
1
'it
Registered Design Professional
for work per the ninth edition of the
s..... ,.,,, Massachusetts State Building Coder 780 C. Section 107
Project Title: Date: 516./20 e 47
Property Address: 17
Project: Check(x)one or both as applicable: New construction Existing Construction
Project description: Chi,1414.2.4 epVi IA--
I MA Registration Number: Expiration date: .am a registered design professional, and I have
prepared or directly supervised the preparation of all design plans,computations and specifications concerning::
Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information; and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780
CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my
designee)shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1 Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents_
2. Perform the duties for registered design professionals in 750 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibilit regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent
comments,in a form acceptable to the building official.
upon completion of the work,I shall submit to the building official a 'Final Construction Control Document'.
Enter in the space to the right a"wet" or
electronic signature and seal:
Phone number: , _5-731 Email: pr,vi,sii_Ep,5„.0,a Gni I , CO Al
Building Official Use Only
Building Offidal Narne: Permit No.: Date:
Note 1.Indicate with an'x.'project design plans,computations and specifications that you prepared or directly supervise&If'other'is
chosen,provide a descriphon.
Version 01_01_201S
Y
Appendix 1
Construction Documents are required for structures that must comply with 780 CMR 107. The
checklist below is a compilation of the documents that may be required. The applicant shall fill out
the checklist and provide the contact information of the registered professionals responsible for the
documents. This appendix is to be submitted with the building permit application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
1 Architectural
2 Foundation
3 Structural
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing(include local connections)
9 Gas(Natural,Propane,Medical or other)
10 Surveyed Site Plan(Utilities,Wetland,etc.)
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Access Review(521 CMR)
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified
must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the
authority having jurisdiction.
Registered Professional Contact Information
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address
Registration Number
Street Address City/Town State Zip
Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address
Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Please follow this link for construction control forms to be used by Registered Design Professionals.
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From: ti•ieftIL" 12-, 5 069E01/ She J2✓ J A-136t).)1(j
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To:
Jonathan Flagg
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts.Building Code, section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10, I request that you
grant a modification to waive the requirement for construction control of the project at
/ r4_5 0611-4 eL) (MO
because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire
safety, and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration. •
Respectfully,