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17C-201 (9) 5 BRATTON CT BP-2021-0017 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-201 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2021-0017 Proiect# JS-2021-000021 Est.Cost: $15000.00 Fee: $98.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: E STUART GILES III 101817 Lot Size(sa.ft.): 10367.28 Owner: PALUMBO LISA M&GREGORY ERAMO Zoning:GB(100)/ Applicant. E STUART GILES III. AT. 5 BRATTON CT Applicant Address: Phone: Insurance: P O BOX 1123 (413) 883-1523 () NORTHAMPTONMA01061 ISSUED ON.7/7/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT 1/2 BATH AND PANTRY TO FULL BATH & CONVERT PART OF GARAGE TO MUDROOM 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 Final: 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 Signature: FeeType: Date Paid: Amount: Building 7/7/2020 0:00:00 $98.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner J`V Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans hone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APP1 TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING c�— SECTIIIN i - RMATION 1.1 Property Address: This section to be completed by office 'F -Mj'j , /C��, Map 7� Lot ..�U Unit Zone Overlay District O\O�Z Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailin Address: ,� q ►� Telephone Signature 2.2 Authorized Agent: J J ON 'LT G t CCS .11— �� 117-S Name(Print i Current Mailing Address: O�� Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only cq=leted by permit applicant 1. Building Q, (a) Building Permit Fee 2. Electrical �J (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2+3+4+5) /S Check Number 5-2/cr/ This Section For Official Use Only Date Building Permit Number: 1 f 7 Issued: Signature: '7 Building Commissioner/Inspector of Buildings Date TU EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ® New Signs [Q] Decks [C] Siding [Q] Other[Q] Brief Description of Proposed \ Work: Ca /z/Z��3,ri �QJ"�7� �J(,L- i�T( coo Zt�� TO Alteration of existing bedroom Yes—4 No Adding new bedroom Yes No MJW Attached Narrative Renovating unfinished basement es No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorizeCl( to act on a f, in a atters relative to work authorized by this building permit application. VP Signature of Owner Date as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. C Print Na Z &7o Signature of Owner/Agent Date 4 i j{i;! LL'`.4:`fldu OL, pQ$ t(i: ,..t, .r"j+•.'li J'.F U., .. 20, gj!l')Sff Gk L.. -"1tt ., ,., x:. 4 ,_ ! a c� �i;, : LOU RM—r,�VIC t BE^.)ir FEIFC:1 C.v,I0LIT('r , Z ,il'"l oa's i i j r ,1,., Lr.. Y ........._...:..._.. __..._... , C:, _• �.+.,, ..L. t A' ^fJi_'e;r.t:'s±QiJ' 1 , }., t,4,l,1t_ J "z i`' �J •L I;)t...:a _ -1, 1`el" ! ©h ! `_Mjwt iii- Wi. :..x 1 w7(Fcplr Q4 ..re 7' t 1T tCa yl i t7yj�+�Ui1Le " ,. Ji-is L;. t>. _ .•7r l� �f.. :JS Q-T. A 1,10vi 11 _ o1,41 , .. 7-7 .. •C I t4C."; �I:•,... {. ti 1a ! I. :`: cfsu;x _. q -,.... 14'ar t._,R . ,.. `.�JS'` .....�i.0 i. .,1i�t' � .�`L.�!"�• .�?�i{.C:�� .'9..I�'��Sl.f1-��`�1�,::�� . ��+{J� 1 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: / �� (—'G - )Q t2) 1-7 License Number �J\�4 �to(ol Z�n�?D2o Addre�s� Expiration Date Signature Telephone 9. Reaistered Home Improvement Contractor: Not Applicable ❑ E- � - C I (12�t 7NT I (,Oz!jA Company Name Registration Number `2.3 o�oh� -71_�� 1202 Address ����f��` ,� � ` � O X35 Expiration Date Telephone:4,�j c' 4's ks SECTION 10-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....... 9 No...... ❑ City of Northampton Massachusetts N:. Y DEPARTMENT OF BUILDING INSPECTIONS y, , 212 Main Street • Municipal Building Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be d fe registere Type of Work: 7"'1��� Est. Cost: W /socn Address of Work:_ 5 7­12& T O(Zt—oa , IAA 1 O ka= Date of Permit Application: :7 —t— I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied _Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 7/7-/7,62o — F,-, '6TL)A2v C-7, (cc, 1=1 K2&Tspo Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature vp�,C i')�'L`�i241I `S C i rr w Rt- ?:T:•�.R.`83tJ. ��A! �; > • v C F! �an._. ii�rS .tsq}R : �:.t • .•1�,r.- p��M �tS '�. , .,.p.�r�^ > wyrx t .11 :'.� MTV, Np,r 'ti;i')!a'�l sl_� f7'J:i31'Ji�#C�tit! 9tYtU�'� b"s W: r",t. ,i. a) UCJP}E,.+t . .. C !C�i. K) f s ; r.,plrr ') i"j 'i..l}t�• 'li W! .punpid Y( 1Ti`JtSul 'rt Do, E::i`i::'::': f M1 r;t.t4iC'a'i(Jrl`i [ti tih'..(EE;3I')'["kIl1':I:il. f.rl7 jia' .'iI�+E`,. .'C 4419`/l31m. "Pay 11, `u r ra-1owbllno; !. . a:; d"J!t. "rt A `ri qE?.Vi+`'.` . '! 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'J ✓('j l 1(:'f' /151,041 A04 % e 4 `s . 1 AF ,�!!f',5 14 OTI M 11 IN 3W, t' W, i 1:MAT, ; . -rr'?• J� w , _, ;;�. I'Jttj °:ill•, tp•'i7 -UNIUK 0 0 Ann, v „i<. 6 . 1 :3E'? City of Northampton pMassachusetts 'r DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building 'M^*" Northampton, MA 01060 ;4 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 Permit 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: (Pie a print house number and street name) Is to be disposed of at: � N-(e-x/���c at��S"W (Please rint name dnd location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Z 202 Signature of Permi licant or Owner Date If, for any reason, the debris will 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. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass gov/dia IN orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AAAlicant Information Please Print Legibly Name (Business/Organization/Individual): I�� 1-- r Address: ll City/State/Zip: 0013hone#: -4�� �S �"S Are you an employer?Check the appropriate bo:: Type of project(required).- 1.[31 required):1.❑I am a employer with employees(full and/or part-time).' 7. New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 3.[:]l am a homeowner doing all work myself.[ o workers'comp.insurance required.] 9. Demolition 10 Building addition 4.[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the subcontractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am 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.Lic. #: 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 fine 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 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. I do hereby c rider the pains d penalties of perjury that the information provided ov is true and correct Si re: c� Date: z �2� Ph n # 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • i>.:, < fug b(t( ��: +` 1404 1,.,. :7' fL , f 1.. , LW!l (!cur i- f:OLD I•!•,t. . (,(M.(„” t> 7. t,iyt' fI1Y1 1.S�t:.tea 111�L It VA, de� t,h'•'S19 ',111. �.k ::ii 1 _ 1 1`• 51.'11 t!.•l1• ;lUl . vy; 1 . 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