38B-277 (9) 27 REVELL AVE BP-2019-1076
GIs#: COMMONWEALTH OF MASSACHUSETTS
M0-Block:38B-277 CITY OF NORTHAMPTON
Loth:- _01 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category,Bath reno BUILDING PERMIT
rVIBId# BP-2019-1076
Proiect# JS-2019-001746
Est.Cost:$32029.00
Fee:5208.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: KIM RESCIA 022464
Lot Sire(sp.h.): 7167.40 Owner: WERTH BARRY A&KATHY I GODS
zoning:URB(100y Applicant: KIM RESCIA
AT. 27 REVELL AVE
Applicant Address: Phone: Insurance:
311 Locust St (413) 320-18310
FLORENCEMA01062 ISSUED ON:3/29/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENO BATH WITHIN IN EXISTING FOOT PRINT
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:
Driveway Find:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke, Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Sienature:
FeeTvpe: Date Paid: Amount:
Building 329/2019 0:00:00 $208.00
212 Main Sheet,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED ga+k4a
19 Department use only
Nep� City of Ntxtha pion Stews Pe M1
Building Depa en wd ,ray Parma
212 Main Sir det F , jAptic vailabNl
y
Room 100 a e vaie1hKty
f Northampton, MA 01060 Tiro Sets of Structural Plans
phone 413.587-1240 Fax 413-587-1272 Ploi Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR RENOVATE OR DEMOLISH
A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION 6r_ 107
G
1.1 Property Addreu: This sssdon to be eomplsfed by ogles
ReotJAy"uL Map &Fs Lot a7 7 unit
/ f
Zone Overlay District
0IO60 6m at District Cit Distdq
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT // sp
11
w v curw+�,3� SliB 10197
iahpsae
Sgmwr
JES-�-LATE'I)
311 Loc y+ $ rd'
t iCu s.Wig AdM1.sc
x N11 3-).0- H31
Blgnewre Teieplxxie
SECTIOCONSTRUCTION COM
Item Estimated Cost(Dollars)to be Official Use Only
com leted b permitappficaunt
1. Budding 2-3.13 S-I.d a (a)Building Permit Fee
2. Electrical J (b)Estimated Total Cost of
1 7 $S•JO Cons=lon from 6
3. Plumbing 0 dO Building Permit Fes *1
4. Mechanical(HVAC)
5.Fire Protection
S. Total= 1 +2+3+4+5) as Check Number
This Section For Official Use Only
Building PermitNumbe Date
Issued:
If
Signature', 3"27p
-7M
Building CommissioneHlmpectoroleuildings Det.
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
, . .
; .
s,
SECTION 5-DESCPJPTION OF PROPOSED WORK ck all applicable
New Here" ❑ Addition ❑ Replacement Windows AlmratbMs) Rooting 0
or Doom 0
Accessory Bldg. ❑ Dernoi1 I❑'"1� New Signs [O] (Decks [0 Siding[0] Other(CQ
Brief Description ofPro'
llChdYSK �Aar+Cdb`t G i ih P#i Ski aD1+
Work: �<
Alteration of wasting bedroom Yes 'x No Adding new bedroom yes NO
Attached Narrative Reorambag unfinished basemen) _ No
Plans Attached Roll -Sheet
an.if New house and or addition to existina housina. complete the following:
a. Use of building ;One Family Two Family Other
b. Number of rooms in earl family unit: Number of Bathrooms
c. Is there a garage attached4
d. Proposed Square footage of new construction. Dimensions
e. Number at stones?
I. Method of heating? Fire s o Woodstoves Number of each
g. Energy Conservation Compliance. s-
ad
Energy Compliance form attached?
It. Type of construction
1. Is construction wigin 100 a.of welands? es _No. Is �struaion within 100 yr. floodplain_Yes_Na
J. Depth d Oeaement or celar door bekry d Bede
k. Will building conform to the Building and Zoning regulations? Yes_No.
I. Septic Tank_ CitySerer_ lomm(ewel_ Cdywatw Supply
SECTION 7a-OWNER ALI THOROJITION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, l'Y as Owner of the subject
grape '✓
17
by Guth aniM 0% c;4
ad on behad,in d to work arslrodzed by this building penind application.
7Alt 5
gn ar Gate
I, Kr vh �QS L n/i as Orewr/Aulhonzed
Agent hereby declare that the statement and irbmiatlon on the foregoing application are true and acaaals,b.ere best Of my Imo Wedge
and belief.
Signed under the pains add penalties of perjury.
Q$C'
Print Name L
p
Sign ure Dale
Section 4. ZONING Au Information Mat Be Co npleteE.Puma Can Be Denied one TO Incmnplete Infomution
Existing Proposed Required by Zoning
'lis. 1.m b<Bum m by
Buildmr Dt unman
Lot Sim
Frontage
Setbacks Front
skis L: L' R.
Bear
Building Height
Bldg.Square Footage
Open Space Footage %
flat Oma minae bWBa qrm
M ofParking Spaces
Fill:
wlame
At Loranon
A. Has a Special Permit/Vanance/Ftnding ee r been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit rec ed a oetry fDeeds?
NO O WYES O
IF YES: enter Book Page and/or Document i
B. Does the site contain a brook, of water or wetlands? NO Q DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
The Commonwealth of Massachusetts
-"- Department oflndustrfatAccidewts
I Congress Street,Suite 100
Boston,MA O2114-2017
w Rsmass.govldia
Workers'Compensation Insurance Affidavit:BuBders/Contractots/Ele ricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicator Infearminkne Please Prier 1 ibl
Name(Businas✓org,aauodlmividmD:' l'r's Address:-311 40Lvft �iWeY
City/State/Zip: A- fit, MA Phone N: lJO -3 - 10 1
Are yas...rnpl.rwr chess the.ppa,H.h Type of project(required):
LE]I mn..ffv. a wth .ngrkyoo 1w anNor panumcl' 7. ❑New consNrction
2m1 am.sok pa viewrev pmmaship and m.e oo snaloym wating r nr m 8. ❑Remodeling
.try c.p.ck,IN.wakescamp.insomnce regaij
9. ❑Demolition
l.❑l am a hateowvm dams al wa4 myself INo aroAen'rmp.imwma ayuireJ.l'
a.❑I.m a h„nwnwncrana w;n b Kirin
win 10❑Building addition
g.nnlr m co Wl all wale my propelry. I
emsu.IMI.n-n-ion tither nmr wnrte—'�rampmaaia�ia.,.sw�ce a a arc salt 1 1.❑Electrical repairs or additions
propriemu with vis emplaycca.
12.[]Plumbing repairs m additions
sCTe,w garalmnlrxar aWlM..mind ft ba
o cr% ha.Jonmeamde 13. Roof irs
llas.mb�onuactas bare amwk,ysa anJ M1avc wakai cury.iuw.urv.t ❑ rape
fi.❑We.a.wgiorniou-d.,.unci—hart ca.aciad Ilan richt ofann n on pa son. 14.❑Other
152,§1141,aMwe.havewcnwiey a.INowoh 'telco.irtw regi J
'My applicant Ilial checks bra 01 nwst elm fill an as nxliva blow stowing their wakm'anrw'awriaa pdiry infonlalion.
f Hom-.wlw submit This amJrvil iaaesam race arc devng all wok and then him aunide awmrlaa mut submit.new amdarit inJiautinp cosh.
�Conatrtoa this check this Ms must anabd in additional she Y shnwi,the Isar ofde wbGTnaclgs apd stlle w11eIM a not lhosf Lntilia's h—
employees. line suh-conlmctom havicemployees,day=9 P ,&their wohers'comppolity rni a
1 am an employer char is providing workers.s'compensadoo insurance for my ernployeec Below is the policy andloh Bile
informadoa.
Insurance Company Name:
Policy g or Self-ins.Lic.m: Expiration Data
Job Site Address: City/SuEv7ip:
Attach a copy of the workers'compensation potiry declaration page(ahowiag the peticy somber and eapira lou date).
Failure to secure coverage as required under MGL c. 152,g25A is a criminal violation punishable by a fire up to S 1,500.00
and/or one-year impisorunett,as well as civil Penalties in the forte of 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
coverage verification.
1 do hereby ceertift u the pain vanities of perjury that the information provided a"iis�a neefsodtcoJncert.
Si trace,= X / �/ .-'7��// Date: 5A/ d / / /
Phone s 113 vi 0 13
Official use only. Do not write in this area,to be completed by cicy or town ofjseiaL
CRY or Torn: Permit/License a
Issuing Authority(circle one):
1.Board of Health 2.Budding Department 3.City?owo Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone M
City of Northampton
w Massachusetts
V r DBPaa2TffiNT or BUILDING INSPNCPIONS
212 Ilan Street •NunioiPal Building
y xoiUupton xw 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Peri[shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
X 1 PQVW I Ae"t-�—'
(Please print house number and street name)
Is to be disposed of at:
L/j&y I«CVC/lh
(Poeta' print name an . bon of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Sign re o er it AlSokant or Owner Date
If, for any reason,the debris volt not be disposed of as indicated,the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
SECTION 8.CONSTRUCTION SERVICES
8.1 Umnced ConsVucflon SSuom.f�ye/IoI.. Not Applic" ❑
Name oft."HelderKH, r'(eSL/yi cs-oaay6v
Liceme Number
311 1-o,,A 9y— . F(om1w- d hA oijs� P20
AWmaa
1413 -316 - 1131
Signature Tdspl
9.Reaistered Home Improvement Contractor: Not pplm bi
Company Name Re9isbaim/! mbar
A W1 e c/
Address EWWabon 96W
Telephone
SECTION tb WORKERS'COMPENSATION INSURANCE AFFIDAVIT)M.G.L c. 152,1 2SC)8))
Workers Compensation Inwrance affidavit must be completed and submitted with this appYcatim.Fall re w provide this aeWevtt vaN result
in dw denial of the isvranw of Fe
Signed ARidavit Attached Ves....... Na..... U
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