23D-126 BP-2024-0756
2 WINSLOW AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-126-001 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-2024-0756 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS TO PORCHES 2024 Contractor: License:
Est.Cost: 10000
Const.Class: Exp.Date:
BOUCHER DONALD J JR&CATHERINE M
Use Group: Owner: BOUCHER
Lot Size(sq.ft.)
BOUCHER DONALD J JR&CATHERINE M
Zoning: URB Applicant: BOUCHER
Applicant Address Phone: Insurance:
2 WINSLOW AVE
FLORENCE, MA 01062
ISSUED ON: 06/11/2024
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO FRONT AND BACK PORCHES
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of\1 icing D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame:
(:as: 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: 72.
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVED
ala WON fia4
JUN 1 1 024
ss The Commonwealth of MassachusettsW ,a R
Board of Building Regulations and Standards , ,R I Y
Massachusetts State Building Code, 780 CMR°F ORTHAfMPTON! not,so i�,�t USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
A . / This ection For Official Use Only
Building P rmit Number: $ '/�`�' 71.1,r Date Applied:
r-u1N 72..., .__1/_ 6"I/-2oZL(
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
e t Address: 1.2 Assessors Map&Parcel Numbers
ins `-/A '0't�.r►!,{ Dia7S1
1.1a Is this an accepted street?yes 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)
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 0 Zone: Outside Flood Zone?
— Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
22at w Oner'of R eco
Co N,i�z` O.5"a er— Ftertr efli# OIY-
Name(Print) City,State,ZIP
.2 I)in$1o1.414lot, ga,-g04-8.047 eGF1 w•G6C► ,a,:QCr.d
No.and Street Telephone Email Ad ss
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Fief Description of Proposed Work`: *a... -/ CTpo�i.c. r.Jt"n� , � e� .!/�
AI,n 0 W rr.pi .Gl krti at- — I(J t7 Ow i-:( -1`C) ft -Pea n I-
.3 0 55
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
',Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
24lectrical $ CI Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ �j
Suppression) Total All F N�
Check No.001 Check Amount: ��
!Total Project Cost: S 1 01 0) 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Qt Ham\
[� � a Massachusetts S,c't�
DEPARTMENT OF BUILDING INSPECTIONS
{ ff 4 212 Main Street • Municipal Building � :Cam
Northampton, MA 01060 ssN VD%'%4'
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
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 and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate(new/replacement windows).
7. Home owner's License Exemption Form(if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction (Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
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 I&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 ❑ 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) 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.
mil✓ 6/lciaoa41
rmt 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,fmished 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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
M ==` 1 Congress Street,Suite 100
-- 'J Boston,MA 02114-2017
wwis:ntass.gov/dia
11 inkers'Compensation Insurance Ardas it:BuilderslContractorsiElectricians!PIumbers.
1'O 11E FILED W1'1'11'1'ItE PERAII 1'1'1\4:Atri'HORIT%'.
Applicant Information )� Plens Print t_ittiltts
aerie 113usczcss•'Clrganttation Individual►: �',t'lGrl h li aj + p/`
Addres y. t✓LS/k2 AVG-
C stag Zip: Fare'/tLti)ict 0 2 4Rone Go- 8a%-S�Yo9
Arc you au employer?Check the appropriate box:
Type of project(required):
l.❑1 am a cmpkcr with..___......_.-.employees(bill and'eu part-time).' 7- 0 New construction
-L_t 1 am a vole proprietor or partnership and hate no ernployeus working fur me zn fit. O Remodeling
'my capacity.(No workers'comp.insurance required.]
VS: •ant a homeowner tunny All work myself.(No mottos'comp.insurance requiroxl.j'
9. El Demolition
11/4,,s4. am a homeowner and will be hung contractors to conduct all week on tiny property.. I will 10❑building addition
cnaure that all contrastors either haste wwrkers'cwnprnaatr+m insurance ot an sole 11. Fie.trical repairs or additions
proprietors with no cmpleuu
12.0 Plumbing repairs or additions
5.0 lam a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-eon!aaora base employees and Isave winters'comp.insurance.; 13 Root repairs
6.0 We are a corporation and as officers have exermsed then right of exemption per MGL c. 14.D Other
152.y 1(41.and we lose no employees.IAlo w.xkers•comp.insurance require!.,
'Any applicant that yhncka boat i 1 must also fill out the section below shim my their wurl a s•contpena:Mon policy tnt`vnrtattc.•t_
r!Ions:owners who submit this dlidisit outwitting they arc doing all wank and then hoc outside eontractor;mini submit a new ifiisLn it maicslaw arch
:contractors that cheek this boa muse attached an additional sheet show ine the name of the sub-contracture and state whether or nut those en11tit•.+have
emplu lithe sub-contractors have employees.they moat pros ide their .a uikcrs-a>mp.policy nuinlir.
I UM on employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
in f uvnalion.
Insurance Company Name: _
Policy#or Self-ins.Lie.#: Expiration Date:
dress: a LJtn 1J vti cily/'state zip: Ft or6/,0_4. /17n O
Attach a to workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152.125A is a criminal violation punishable by a fine up to S1.500.00
andor one-year imprisonment.as well as civil penalties in the fomi ofa STOP WORK ORDER and a tine of up to 5250.00 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 ofperJury that the information provided above is true and correct.
' attrrhr It Date. 4/iaJ.yf
Phone
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.CihfTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
b.Other
Contact Person: Phone#:
City of Northampton
� HAM•
Massachusetts
(# tt 1-
1•( DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 'PSI*
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: Vaile VeG1(1?4,4
The debris will be transported by:
Name of Hauler:
Signature of Applicant: ,4, z, �37,�,�,� Date: L` LC'a
City of Northampton
0 `S- «:• __S�.
Massachusettsc-
* ' �6
.N DEPARTMENT OF BUILDING INSPECTIONS
�av 212 Main Street • Municipal Building
Northampton, MA 01060 rj1 <�0
�1
.3116
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I leti'Ivu ie ,p Ito - ��to�1 j66
, j .,�- � ,C .tE' (insert full legal name), born_(insert
month, day, year), hereby depose and state the following:
1. 1 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, I 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_112y of 94,4",_ ,20 •
aQ `it
„hiaracilex
(Signature)