23B-010 (5) BP-2024-0740
209 LOCUST ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23B-010-001 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-2024-0740 PERMISSION IS HEREBY GRANTED TO:
Project# SHED 48X28 Contractor: License:
DOUGLAS B THAYER DBA
DOUGLAS THAYER
Est.Cost: 60000 WOODWORKING 107699
Const.Class: Exp.Date:04/07/2025
Use Group: Owner: LATTES THAYER DOUGLAS B&JAIN
Lot Size (sq.ft.)
DOUGLAS B THAYER DBA DOUGLAS THAYER
Zoning: OI Applicant: WOODWORKING
Applicant Address Phone: Insurance:
P O BOX 60322 (413)530-4785 6HUBGR15002
FLORENCE, MA 01062
ISSUED ON: 06/14/2024
TO PERFORM THE FOLLOWING WORK:
48X28 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 NORTHANIPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 1/� �
Fees Paid: $269.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
z . oe
File #BP-2024-0740
APPLICANT/CONTACT PERSON:DOUGLAS B THAYER DBA DOUGLAS THAYER WOODWORKING
P O BOX 60322 FLORENCE, MA 01062(413)530-4785
PROPERTY LOCATION 209 LOCUST ST
MAP:LOT 23B-010-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $269.00
Type of Construction: 48X28 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) For all projects that need additional reviews p1!_ r,12
as checked below,please see the Office of Planning& Sustainability Permit page or scan here -L
PLANNING BOARD PERMIT REQUIRED UNDER:§ .:
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
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
Signature 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.
I
_ RECEIVED
The Commonwealth of Massac lusetis �y - 8 2Q24 FOR
*4ly Board of Building Regulations and StanOard "
0) Massachusetts State Building Code, 780 OMR MUTy USE ICIPALITY
Building Permit Application To Construct, Repair, Reti2RM A °4?evised Mar 2011
One-or Two-Family Dwellm
!, This Section For Official Use Only
Building
Permit NNuuJmber: 6P .2 S// 7 cite, Date Applied:
elf
r>s .7/ 6 14? Zozy
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
a49 Goot}&- s4- 235 v10
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
01 Shed 10G t
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Pros ided Required Provided
26I 1a0 I 1S`6" 20 2.06
1.6 Water Supply: (M.G.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Publioo$C Private❑ °°e Outside Flood Zone?Check ifyes❑ C Municipal'p� On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Recor 1�, /� /� /,
Ooaq�o� Mar RIMkcl ,i it V06
Name(Print) U 1 City,State,ZIP
tS Spv:K( S�- V(3-c3047s$
No.and Street J Telephone Email Address
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 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
y9r,�at ' 'Timber c)i.4/ 54QP shed(
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 60 040 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $ _ ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ — 2. Other Fees: $
4. Mechanical (HVAC) $ — List:
5. Mechanical (Fire $
Suppression) Total All Fees:$
Check Nog) Check Amount:" Cash Amount:
6.Total Project Cost: $ C 0 0 00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) l 0
.7 q 2
0OO�\ s -May f License Number Expiratio Date(?
Name of CSL Ho er
�1 List CSL Type(see below)
eo 136X 60 3;a[ Type Description
No.and Street p
FI ovet1ct l (.(j.
A- Unrestricted(Buildings up to 35.000 cu. II.)
Restricted 1&2 Family Dwelling
City/Town,State.ZIP M Masonry
RC Roofing Covering
WS Window and Siding
( `7✓S 3O ` c'78, SF Solid Fuel Burning Appliances
f( I I Insulation _
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Qu lad —aka tI /'IO$S 4ZI_
1-IIC Registration Number n Date
HIC mpaWy Name or HI gistrant Name ^ 1
Q ROC 60 2 2 ia5ICS T1ale. 1 qyt�:I. COv*
No.and Street A.A. �`�6� g Email a dress
Hato tic, J
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 .❑
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 !✓Qu -MR
to act on mybehalf,in all matters relative to work authorized by is buildingpermit application.
0-1,---- Pp
6/ dy
Print Owners Electronic Signature) ate
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.
f)0t \ Thacte sr 6 6 V
Print Owner s or Aut drized Agent's Name(Elditronic Signature) Date
NOTES:
I. 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 H1C 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
SETBACK PLAN `,
MAP: 21) I/ LOT: 010
LOT SIZE: ) a a U S
REAR LOT DIMENSION:
REAR YARD °2v4
cv 1)1° 4-
V)601
6 '
GO
SIDE YARD SIDE YARD
PO
FRONT SETBACK
FRONTAGE
City of Northampton
~"`�.." - Massachusetts � S`~ 'c!
O
3` wi ‘itDEPARTMENT OF BUILDING INSPECTIONS D, is
r
212 Main Street • Municipal Building �Jp .'C`
Northampton, MA 01060 f�•`-^ ''�°�0
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: Va
il-r- ROCI)C\C
The debris will be transported by:
arasiCL,
Name of Hauler: —Alo (
Signature of Applicant: Date: 6A4 9-
The Commonwealth of Massachusetts
t} = .I Department of Industrial Accidents
=r111 b 1 Congress Street,Suite 100
_tNsi= • Boston, MA 02114-2017
.;,:,,�`� ' www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/ContractortttElectrkians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Annlicont Information } Tk Please Print Lettibly
Name($usiness.'Organization Individual): Po uc14 S �u(vesr
Address: QC 61io 7, 603,2.2.
City/State/Zip: F604tck A A Phone#: 0 ((3 - S 3 0- Y 7 S
Are you an employer?Check the appropriate bat:
Type of project(required):
I.01 am a employer with mm.V.-__employees(full and/or part•tinte)_' 7. D New construction
2.1:1 I am a..ik proprietor or partnership and have no employees workinn for me in g. ,g,al
any capacity.[No workers'comp.insurance required.] Jul
i0 I am a homeowner doing all wotit myself.[No workers'
comp.insurance required] 9. Demolition
eo workers'
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
I 0 0 Building addition
ensure that all contractors either hare sorter`cimivensation insurance or are sole 11.D Electrical repairs or additions
proprietors Meth no empluyeca.
12.D Plumbing repairs or additions
tin I am a general contractor and 1 have hired the sub-contractors listed on the attached,suet I 3CI ROOFTepa-
rs
Thee sub-contnitors have employee%and have workers'comp.insurance.:
60 We are a corporation and its officers have cxen Wit.ised their right of exemption per Wit. . 14.0 Other
152,f 1(4),and we base no.zreployeen.[No workers'camp.insurance required.]
`Any applicant that checks box a1 must also all out the section below showing their worker'compen+.:rtion policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mew subnut a new afTidav it indicating such.
i iicutactor that check this box must attached an additional sheet showing the name of the sulrvtuivactors and state w hethet or not those entities have
employees. If the sub-cuntractrs have cmployeea,they must proti idc their worl.ers'comp.paolr:y number
l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site
information.
Insurance Company Name: 1 viavet (Qv) —
Policy#or Self--its. Lic.#: G g I Soo c27 1-vpiratton Date: )U/.
Job Site Address: )CI 1-1-16e4 L- 5* CitylState''Zip: WO
Attach a copy of the workers'compensation polky declaration page(showing the policy number and expiration date).
Failure to secure coverage as requited under MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00
andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 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 verification.
I do hereby certify an e s and penalties of perjury that the information providedaba''e is rue and correct`
Signature: Date: V J 51
»Phone : 11 Z 1-5o `-- / 7i 5
Official use only. Do not write in this area,to be completed by city or town official
(City or Town: PermitlLirense AtIssuing 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#:
City of Northampton
Massachusetts b rC i 1 N !i
( " DEPARTMENT OF BUILDING INSPECTIONS i
212 Main Street • Municipal Building •
Northampton, MA 01060 r 4. - %'�0
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
1, (insert full legal name), born _ (insert month,
day, year),hereb 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 qualifij 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 day of , 20 .
(Signature)
CA u
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