23A-108 (3) BP-2024-0817
133 SOUTH MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-108-001 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-2024-0817 PERMISSION IS HEREBY GRANTED TO:
Project# PORCH REPAIRS 2024 Contractor: License:
Est. Cost: 20000
Const.Class: Exp.Date:
Use Group: Owner: M.FITZGERALD, THOMAS
Lot Size(sq.ft.)
Zoning: URB Applicant: M. FITZGERALD, THOMAS
Applicant Address Phone: Insurance:
133 SOUTH MAIN ST
FLORENCE, MA 01062
ISSUED ON: 07/09/2024
TO PERFORM THE FOLLOWING WORK:
REPLACE PORCH FLOORING AND CEILING
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: 7'2
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Buildins Commissioner
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The Commonwealth of Mjet
us OR
Board of Building RegulationStardjim
Massachusetts State Building 78MR c 7 2 CIPALITY
r, �Q USE
Building Permit Application To Construct,RItn Demolish a Rev' ed Mar 2011
One-or Two-Family Dwe N°RT 4�l(mp/NG rNsa
��..LL gs Section For Official Use Only Tory'MA oio�Building Permit Number: il�d7' i7 Date Applied:
71 q 2`1
Building Official(Print Name) Signa re Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
133 Sow mAI1- 2-3A -in- oo I 23A -1 03'001
1.la Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
SING-LS 2FSIF 1MAI_ I`f O 2- 152-1(0
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.Lc.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Q Private❑ Zone: — Outside Flood_,Zone? Municipal liOn site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
THOW1k S K 1TLG E,2,A 1> ►'h A 0106Z
Name(Print) ity,State,ZIP
133 SMITH MAW 13.5434 y70L —rmarrFITZ_@aoI•(O,,•
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PR (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) i Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work': R C RL j4C£ W E THE R S,V FV12C N F Lha121 ocr A1"
C.rALINCs AS A/CGESSAP
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 24 pip 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $ Total All Fees: $
Suppression) L�
Check No. Check Amount:al,..,
6.Total Project Cost: $ 2c)c)0 0 ❑Paid in Full 0 Outstanding Balance Due:
r
City of Northampton
Massachusetts
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DEPARTMENT OF BUILDING INSPECTIONS w:
�. 212 Main Street • Municipal Building ZJ` \ate
Northampton, MA 01060 f ),10
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 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 ❑
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 ' true and c ate to the best of my knowledge and understanding.
• \&53 , i (";14 (a .d•7 • Ill
Print 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,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"
". The Commonwealth of Massachusetts
t
... 'lei Department of Industrial Accidents
"' =;:r�-= I Congress Street,Suite 100
, Boston,MA 02114-2017
'.>.,.. www;mass.got/dia
11'ur-kers'Compensation Insurance Afftdas it:Builders/Contractors/ lectricianstPlutnbcrs.
'1•D BE:FliED W1111 1-11H:PER.SIlT1'INC Al THORll•1.
Applicant Information Please Print l.eeibh
Name i13usines o tzutian:Individual►: 1140166iS*S ilk r L` ctFAALD
Address: l 33 5D UTI-4 /n A(0 Fl.-Di2E,N C6 4'u Ci ic'
City/State/Zip:_ Phone#: N t 5/f Li g7o'L
Aire you as employee('hick lire appropriate box: Type of project(required):
1.0 I am a employer with _ _ employees(full jna!'ut pat-tiered.• 7. Q New constetrctton
1t t'1 am a sole proprietor or partnership and have no employers working' forme in }l 0 Remodeling
� y apecrty.(No workers'comp.ntauninor required.]
9. 0 Demolition
.l am a homeowner doing all work myself.(No workers'comp.Insurance required]'
10 Q Building addition
•t_a 1 am a homeowner and will be luring contractors to imeiduct all work on my prolx-rty. I w ell
ensure that all contractors either have.rakers'c0crap..-nsatnat insurance or are sole 11 a Electrical repairs or additions
proprietors v.ith no employees.
12.0 Plumbing repairs or additions
S0lain a gcnerul contractor and I have hind the sub-contractors listed on the attachtad sheet.
These sub-imam-tors have employees and has a workers'comp_insurance 13 not repairs
6.0We are a carpi-ration and its officers have view-vied then nght of exemption per MGI.. I Other POY N R$4"A 1 I:\
152, 1(41.and we have nu employees.(No workers'eurnp.Insurance required.'
*Any applicant that chocks box it 1 must also till out the section below showing tl:e:r.,Utters.compensation policy mfunnatawm
r t tomeuwners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affi lav it indicating such.
:Contractors that cheek this box must ansched an additional sheet show Itrg the name of the yob-etmtractun and state whether or not those a attics&axe
employees_ if the sub-contractors base employees.the, nuist pro+ide Mien titorket."coati i policy number
I um an employer that Is providing workers'compensation insurance for my employees. Below is the policy and job site
Information.
Insurance Company Name: _
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a tine up to$1.500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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
to+ct we verification.
I do hereby • rift'and rlt sins a • pr a Its of perjury that the inforntat on provided above is true and correct.
/'wnarure: l 4'� , �-1"1 Date: '4)‘1 a
` Chone#:
Official use only. Do not write in this area.to be completed by city or town official
('itv or Town: PermiVLicense#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
G.Other
('ontact Person: Phone#:
City of Northampton
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Massachusetts ?
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� t, DEPARTMENT OF BUILDING INSPECTIONS
40'1Anr't.a, 212 Main Street • Municipal Building
Northampton, MA 01060 fs-n. 1,,N•�
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: SA.S-tHAMr'TOPJ1 /11 A G►O 27
The debris will be transported by:
Name of Hauler: S L'F
/`
Signature of Applicant: 4,3 /1,47-k)-C7e1A Date: (9 • k7 '
y
City of Northampton
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�- � R Massachusetts ^e+ k. ';,
. 1 DEPARTMENT OF BUILDING INSPECTIONS z
212 Main Street • Municipal Building
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, 'HcmAS AlF tl2GDRAL (insert full legal name), born a' (insert
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 ri day of 31.2NC-- ,20 a`(
7\k, ittjk:177-&-E-N,ti
(Signature)