07-019 (9) BP-2024-081_5
326 NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
07-019-001 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-2024-0815 PERMISSION IS HEREBY GRANTED TO:
Project# ADD 1/2 BATH Contractor: License:
Est. Cost: 8000
Const.Class: Exp.Date:
Use Group: Owner: KREPEL, PAUL &KREPEL, CANDACE
Lot Size(sq.ft.)
Zoning: WSP Applicant: KREPEL, PAUL &KREPEL, CANDACE
Applicant Address Phone: Insurance:
326 NORTH FARMS RD
FLORENCE, MA 01062
ISSUED ON: 07/08/2024
TO PERFORM THE FOLLOWING WORK:
ADD 1/2 BATI-1 TO BEDROOM
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Lnderground: Service: Meter: Footings:
Rough: Rough: House # Foundation:
l 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: 7
2.
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
T. ' _ ._,EIVED
JUN 2 7 2024 r« fr
The Commonwealth of Massachusetts FOR
INSPECTIONS Board of Building Regulations and Standards MUNICIPALITY
li 'N.MA010g0 Massachusetts State Building Code, 780 CMR
USE
Building Permit 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: �j�J,�'' /�Z Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property ddr 1.2 Assessors Map& Parcel Numbers
.3,z 4 l ortk �ct f l'Y15 �d. O-7 0 19
1.la Is this an accepted street?yes A no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(It)
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�. Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system
Check if yesjEl
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
1 k'r epe-� /o e.1 - MA- 0 1 d (, .2
Name(Print) City,State,ZIP
3 6 NOff), er04s g/Y g37 a.28a e 3a975oceiteN 32./tx—
No.and Street Telephone •1
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building El. Owner-Occupied 11. Repairs(s) 0 Alteration(s) 121 Addition 0
Demolition 0 Accessory Bldg.❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work': /t d d //.2 0a f-1L to Fro K f- bed iPoniae
h /iytiI&d ctrem ou hard a, 30r/-P..c_ 5Ke ><cGt
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ /, 0 6 U 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
3� v O G ❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ L/' 60 v 2. Other Fees: $
4.Mechanical (HVAC) $ _0 _ List:
5.Mechanical (Fire $ b
Suppression) Total All Fee I9
Check No. I Check Amount: V
6.Total Project Cost: $ Pj C)O O 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
A) A- 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 1&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 0 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.
PCUA.-1re / 6 �
Print Owner's or Authort Agent's Name(Electronic Signature) D e -e
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.inass.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
(7----
• Massachusetts ,� ',
�� DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building T
Northampton, MA 01060 J'}' .�1 ,%``
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
o iW.-00'er°
I, /7G�-i- ��'
c / .e -e 7 (insert full legal name), bo
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, 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 ..9 6 day of - 4 f , 20�y
.7/'...1
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The Commonwealth of.11ussuchusetts
T
it. Deportment of Industrial.•lccidents
I Congress Street. Suite 100
Boston. .11.4 02114-2017
Is•ls.sr.mass.goddiu
11 otkers' Compensation insurance.1,ffcda%it: Builder.`( ontractor\ I lcctricians.Plumbers,.
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/am an employer that is providing n'orAers'compensation insurance.for my employees. Below is the police and job site
information.
In.urJll:C(\imparts \ante
Poll,\ ::or Sell-ins. 1.1:. I.\piratlot; 1)at:
Job Site :address: t its State Lip
attach a copy of the ssorkers'compensation pudic) declaration page(shim ing the Indies number and expiration date).
Failure to .e.uue .o\era_e as required under \It& c. 152. :25 1 I.a criminal s ii Lit;on punr.hable in J :il;e up It/S 1.`Lni Ili'
and or rrtc-‘cat imprisonment. a. ++ell as .is it penalties in the torni ot.a SI()P Wt.)Rh(.)RI)LR and a :ire of up to S250 IN)a
.lax a_anr>t the \iolatir.:\:op\ k.,1 this NUICIICtlt II;..\ Ili :c•r'a.lrbrit ii.' Ihi: ()111ce of Ins C.tl.!at.lons n: t!.. 1)1A for 111.1.1r:Uli.d'
i.o erjge\eiitkitot,n.
/do hereby certi/i•u the Iuu '(wpeenaallttiies of p ,-urr that the in/urination provided above'ii.sr truer and t orrt'c t. /
1gn.itul. /� / Date 6 /46)7. -.
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Official use only. Do not write in this area,to he completed 1;y city or town official
f
(•its or loss II: Permit 1 icense A
Issuing.►uthurit} tcircle ones:
i. Board of Health 2. Building Dtparhnt•nt 3.(•ity-'Ius+n( Ier1. 4. Eirctrlcal Inspector 5. I'Iutnbint: Inspector
6.Other
('ontact Person: Phone a:
City of Northampton
Crt.
Massachusetts
/ DEPARTMENT OF WILDING INSPECTIONS 212 Main Street • Municipal Building
-�� Northampton, MA 01060
%f-
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 lice ..zed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility:
The debris will be transported by:
Name of Hauler: A-,5 0G/a7 c/ c I cf lrici CO Fe c c
s rro/7 ; d
/3 -73 .2 3/79
Signature of Applicant: /24". Date:
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