28-008 336 SYLVESTER RD BP-2021-1150
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:28-008 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:replacement windows/siding BUILDING PERMIT
Permit# BP-2021-1150
Project# JS-2021-001934
Est.Cost: $50000.00
Fee: $325.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(so.ft.): 1361250.00 Owner: VANASSE STEPHEN F&JEAN
Zoning: Applicant: VANASSE STEPHEN F & BETTY JEAN
AT: 336 SYLVESTER RD
Applicant Address: Phone: Insurance:
336 SYLVESTER RD
FLORENCEMA01062 ISSUED ON:4/9/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIRS TO WALLS, REPLACE SIDING,
WINDOWS, DOORS
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 NORTHAMPT N ON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
• t • ..4a)931
Certificate of Occupancy Signatu
FeeType: Date Paid: Amount:
Building 4/9/20210:00:00 $325.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
/`,/1 l'''.44::CI''6'.1
The Commonwealth of Massachusetts OR � �,,
W
Board of Building Regulations and Standards FOR
M ICIPALITY
Massachusetts State Building Code, 'IOrZ 1 USE
Building Permit Application To Construct, Repair, Reno t0/r/
ptPetg9lish a Re4/ised Mar 2011
One- or Two-Family Dwelling ''�'f;'"F� r
q Tj
This Section For Official Use Only °'Oso s ,
Building Permit Numbera6049-'4/1' I 60 Date Applied: -_J1
0 ii-.) (/ 55 14-q-ZZ)
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Ass.ws Map& Parcel Number
g3C0 SyLiF 2 iZer
1.1a Is this an accepted street?yes gp no Map Number 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 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:
Zone: _ Outside Flood Zone?
Public 0 Privatek Check if yew Municipal 0 On site disposal system 1'
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: ,/
SEPbvf�a- VfI�.ass- /1-2oizr`�Cc ,- i9 e'/06 a
Name(Print) City,State,ZIP
336 .5YLvi s7 z Az4rgo 4/i3-67-6-9-53-7/ syymnsse 37-fe 4n*i.'/, Cat
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building® Owner-Occupied ® Repairs(s) 8 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units / Other 0 Specify:
Brief Description of Proposed Work': -z,rot aqc. or 1.wc ,.s Gu9GL �r�zf 5 ...suc..97 -
"Aq 7 cLc'C iZ2cA4 .S/eer. c/c — . - .1uzs ,9s .A/ lJ / �t-�2'ACe.1,14K,r-
7.�7 1za't Samy, '1/l. 2a'15 z' l c A1c 4/ ��
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 2 S O 0 0 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ l 0 Standard City/Town Application Fee
l'�, 0 0 0 ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ S., e o cp 2. Other Fees: $
4. Mechanical (HVAC) $ tea, o 0 o List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
coo Check No,i56 ' Check Amount: Cash Amount:
6. Total Project Cost: $ mar 0 0 0 0 Paid in Full 0 Outstanding Balance Due:
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 Masonr
y
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 .2E'
to act on my behalf,in all matters relative to work authorized by this building permit application.
cam. - i _
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.
Si EPtf Es N V'm1 rSE "F. 20 z
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"
City of Northampton
Cp'tH MPT\
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Massachusetts �' "° �
VA scy
E 4.011 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 9O .
Northampton, MA 01060 44 V%$
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: /a ,9,-,j,r ; /72/ — 46/any cyc
The debris will be transported by:
Name of Hauler: p‘v�-v Z-'avvRcc )
Signature of Applicant: A-.- Date: ,4 ZlL ,-
The Commonwealth of Massachusetts
Department of Industrial Accidents
xv=
1 Congress Street,Suite 100
. ;
=MO•N.
Boston, MA 02114-2017
www.mass.gov/dia
11 Inters'Compensation Insurance Affidavit: BuildersfContractors/Electriciins/Plumbers.
10 ni:FILED 14 Ili!Till.PERNIfITING AI 91.110R1TY.
Applicant Information Please Print I.egi
Name(Business/Organization/Individual): VaN/1-55-;:-2.-
Address:
City/State/Zip: 1Ze).20:-X/cE" /17, Phone Fir: Llq 3- - 35 /
Are we an caught!,re Check the appropriate,hot! Type of project(required):
L[] 211111i ainiplui,ir with 4:111plOpeCh(ftill aridiorpanktime)_• 7. New construction
,.n I am a sole praprietur or partnership and hate no employers working fur Inc in $. Remodeling
any caaieity.[Nu waters'comp.ignorance n.spuircd.1
9. LI Demolition
.1 : I am a humarwrier doing all wank myself.(No workers"comp.iroorance ropinall'
10 El Building addition
.1.50I am a hinnouviner and will be hiring comractors to conduct all w on my pruperni_ I will
anon:that all ountracuars either lose workers'campornation insurance or are IL i,J Electrical repairs or additions
proprietors with no employees.
12.E Plumbing repairs or additions
5C3 I am a gum-rat contractor and I have hired the sub-contractors Fisted on the attached sheet_
130 Roof repairs
These sub-contractors have anp/oyees and have*Driers'count,.insurance.;
14. Other
is.E]We an a consolation and its officers have exercised their right ot exemption per MirL L..
132.§10).,and we lase no employees.No wearers'camp,instrianee required.)
•Any applicant thai checks box#1 must also fill out the section below showing their workers'compensation policy information_
$I lannoow tiers who submit this affirinit indicating they arc doing all ore and then hire outside contractors mart submit a new affidas it indicating tack
:Contractors that check this bus must attached an additional shod show log the name of the sub-controetars and state whethes or not those unities hose
einployces. lithe sub-contraetms 61W employees,they must pros ide their wort:era'cornp.policy number.
I um an employer that is providing workers'compensation insurance for my employees. Below is the policy and ph site
information.
lil,,urarice Company Name:
Pulley#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/Stale/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and espiratims date).
Failure in secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
andfor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
col,(*rage verification.
I do hereby err*?under the pains and penalties of pezjun that the information provided above is true and correct
Siimature: • — Date: /",•:-.3/2.2"G" /
Phone#: -4//3 - 2 -
Official use only. Do not write in:hi area.to be completed by city or town official
City or Town: Permit/license#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3. Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Plume#:
City of Northampton
paT HMPTO _._
.
,. Si s-1w1.1 "' t\ S(
Massachusetts 4., fe
w *.v `r
4 ^E ,t, DEPARTMENT OF BUILDING INSPECTIONS ?S. i
212 Main Street • Municipal Building Jti a
, #tFV*(7?- Northampton, MA 01060 ssd$ '�"�
BiON
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, j'i-tent_ 1= k 'V.4►s5z —, &-'-- ai- /969) (insert full legal name), born (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 �77 day of /-�JJ2J'L , 202/.
_ Z /seam- -_
(Signature)