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30A-056 (7) 32 LIBERTY ST BP-2021-0058 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A-056 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit# BP-2021-0058 Proiect# JS-2021-000086 Est.Cost: $8500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PATRICK GALVIN 013977 Lot Size(s4.ft.): 11804.76 Owner: ZINK MICHAEL Zoning: URB(100)/ Applicant: PATRICK GALVIN AT. 32 LIBERTY ST Applicant Address: Phone: Inswance: 95 NORTH MAPLE ST (413) 253-6585 0 W_C' HADLEYMA01035 ISSUED ON.7/20/2020 0:00:00 TO PERFORM THE FOLLOWING WORK 16X16 DECK 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 Si<(nature: FeeTvpe: Date Paid: Amount: Building 7/20/2020 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner _ Z -o vZ m The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR 1: MUNICIPALITY Massachusetts State Building Code,780 CMR L a' B aikl mg Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar-2011 92 1 Otte-or Two-family Dwelling This Section For Official Use Only _Buildingpe_ mbrs: Date Applied: a —BuildingOfficial rine Name si nature l3� (P ) SECTION 1:SITE IINFORIVIATION 1.1 Property Address: 1.2. vessorss Map&Parcel Numbers 1.1a Is this an accepted street?yes no Map dumber Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Proided .Required Provided Required Provided 1.6 Water Supply:(M.G1,c.40,J54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Cl Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system O Check ifyes© SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: c l ip— Name(Print) City.State.ZIP �L( rn-�`/ ;;T— No.and Street Telephone Ismail Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building© Owner-Occupied d Repairs(s) © Alteration(s) O Addition Demolition 13 Accessory Bldg.0 Number of Units Other I Specify. Brief Description of Proposed Vtirorlt2: "r vJ -,v t o fv SECTION 4 ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1.Building $ ^., �S-uo 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical S 0 Standard City/Town Application Fee CI Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: S 4.Mechanical (HVAC) $ List: 5.Mechanical (fire $ Suppression) Total All Fer���� __ __ Check leo. C'h rnoun Cash Amount. 6.Total Project Cost: $ 0 Paid in Full13C3 Outstanding Balance Due: SEC"T"ION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS- Ul-2-3ri--� �I�fSLIL�L CI AL 01 /J License Number Expiration Date Name of CSL Holdery S N �Q L� ST List CSL Type(sec below) No.and Street Type Description L,E (Y�Pt' 0(03� Unrestricted(Buildingsu to 35,000 cu.ft.) R Restricted 182 Family Dwelling CityJTown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances "t1J t Insolation Te! hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Nl�tk� A (�AtJilJ E IRiu11�t .���2�"Ll HTC Rcgistratioa Number xpiratitsa bate HIC Company Na or HIC Reitistrant Name g.s N r0 . 0 Wvm t� No and Street Email address ikarou I m&, Dio-e,r- Cit /Town,State,ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSt;' 4,NCE 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. Signet!Affidavit Attach+cd7 Yes.......... k 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 1 to not on my behalf,in all matters relative to work authorized by this building permit application. / -0 uto Print er's Flame(Elec Signature) J Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,l hereby attest under the pains and penalties of perjury that all of the information contained in is application is true and accurate to the best of my knowledge and understanding. lu.k �Q —,�W 4� utb Print O 's or Authorized Agent's Name(Electronic Signature) to NOTES: T. An Owner who obtains a building permit to do his/her own work,or an ovkmer who hires an unregistered contractor (not registered in the Horne Improvement Contractor(MC)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.govioca Information on the Construction Supen�isor 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 lirdng area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of hal9baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage maybe substituted for"Total Project Cost" The Commonwealth o,f Massntrltusetts Department of.lndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 Wwww.mass gov/ilia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMIT"TI`NG AUTHORITY. Apykgvt Information Please.Print Legibly Name(Business/GrganizatiorAndividual): 1LALIQM10 JI R SUNS Address: Vii' T �)Dt:r4 S�­r City/State/Zip: 1- -k0\,C / MAV - Phone Are you an employer?Check the appropriate box: Type of project(required): 1.rI i am a employer with employees(fid)andlor part-time)." 7, ❑New construction 2.�1 am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.(No workers'comp.insurance required.) 3.[31 am a homeowner doing all work myself.(No workers'comp.insurance required.)t 1 ©Demolition 4,Q I am a homeowner and will be hiring contractors to conduct alt work on my property, I will 1 Buildittg addition ensure that all contractors either have workers'coition insurance or are sole 1 LE]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.rlRoof repairs 'these sub-contractors have employees and have workers'comp.insurance? 6.Q We are a corporation and its officers have exercised their right of exemption per ivIGL c. 14. Other ���L 152,§1(4),and we have no employees.(No workers'comp.insurance required.) Any applicant that checks box#I must aimfill out the section below showing their workers'compensation policy lafomnation, t Homeowners who submit this affidavit indicating they are doing all work and thein hire outside contractors must submit a new affidavit indicating such. tContractors that check this bone must attached an additional sheet showing the name of the sub•coatractors and state whether or not those entities have employees. If the sub-conbwors have employees,they must provide their workers'comp.policy manber. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site in,fornration. Insurance Company Name: L� Z IJS + Policy#or Self-ins.Lic.#: (AD- ZG 5����'�' I� - `lZ Expiration Date: 110 / U10 Job Site Address: __2z City/State/Zip:P)DON k(A On 0 N1� Attach,a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MCI,c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or ane-year imprisonment,as well as civil penalties in the form of a STOP'WORK ORDER and a fine of up to$230.00 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. Ido hereby certify tier thepains a p aloes ofper�jury that the information provided above is true and correct, � r, Signature. Date: L 0 Pone Official use only. Do not write its 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#: The City ofNotthampton. Building Department 212 Main Stred Northampton,Massachusetts 01060 Phone(413) 587-1240 Fax (413) 587-1272 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVAT ION PROJECTS) In accordance with the provisions of MGL c40, 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,sl 50A. The debris will be disposed of in: f L;i Q-i I to6, —1 FW Location of Facility The debris will be transported by: Name of Hauler Ss Lrn Signature of Applicant: &A Date: -7 ,9 S2�W iS .z �Z ,n'5 Llpi -LNIOC I ql I �q