32C-077 8 CONZ sT BP-2021-1375
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-077 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Porch Repair BUILDING PERMIT
Permit# BP-2021-1375
Project# JS-2021-002293
Est. Cost: $5675.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: J STEPHENS CONSTRUCTION 189408
Lot Size(sq.ft.): 4443.12 Owner: TAYLOR JAMIE
Zoning: URC(100)/ Applicant: J STEPHENS CONSTRUCTION
AT: 8 CONZ ST_
Applicant Address: Phone: Insurance:
10 CRONIN HILL RD, APT B (413) 374-5012
HATFIELDMA01038 ISSUED ON:5/24/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:SUPPORT UPPER PORCH, REPAIR FRAME,
DECK & RAILINGS & REPLACE SUPPORT POSTS ON PORCH
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.
l T',. .• '
Certificate of Occupancy Signature' I 0
FeeTvpe: Date Paid: Amount:
Building 5/24/2021 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
11----l.1 m
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.moo s` The Commonwealth of Massachusetts
FOR
z Board of Building Regulations and Standards
,--; V r
.5 = Massachusetts State Building Code, 780 CMR MUNICIPALITY
c, USE
',.1.1) Q Bring Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
R One-or Two-Family Dwelling
;'1" This Section For Official Use Only
( —1 di +Penn'Number: 8 P 2) 137 S Date Applied: 05(211ZU2 i
l` }j t/ 5-Z� ZOZt
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ri.th 1—.) d 1C05. ,I'�
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 6166 a 1.2 Assessors Map&Parcel Numbers
$ Ca A Si-. Na 164 in 13 32C 0'7
1.la Is this an accepted street?yes k no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
URC6ob')
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:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Oivnerl of Record: l
Jamie TQYl r JjJ 1`ems4,`�6✓t A/ , 0(066
Name(Print) l City,State,ZIP
g cow 9-. J ar t o 1'0.-y(oc e ass.eI u
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s)it Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: Sc c+ t y W ?a,rc, . Re, ti
e Zv i'-ecS,1c1aradeA
6e.0 ( and ?oS�-S . vSolk& .vet ) c3-r y r ry 42 4- b e c k 10.'i 1;/S „vet,/
SvWo ri. .-- 0S-I-5. '2.a ZDI 575
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ s'6�s,a d 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) TTtal Allll Fps: $
Ch c c lo253 17BSCheck Amount: G,6 C Cash Amount:
6. Total Project Cost: $ 5-0s" 6 b 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C S — (e J 6 02 is— aZ.v 2,2
c PQ k S4te Pken S License Number Expiration D to
Name of CSI,Holder
List CSL Type(see below)
l 6 c(-On p ( 7 (. . 0. e: Type Description
No.and Street
L`T l�t 1't t F�rr�e 0 4 Unrestricted(Buildings up to 35,000 Cu.ft.)
1 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
qi3-3qq c ' t J ,4er046ans hntalll, Cain I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) f 8'a y 6'5 I�Q Jam'
'sep- S-I kes-S HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
[D C1on c• 4_/14
No.and Street Email address
-�;t n 103 37 � StePI4en5conS+0G7 M4/I Cdn�
City/Town,State,ZIP Telepphhoneone
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 .......... 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 J �--tY"tt►1.5 Cs) I Z--7 J cired\
to act on my behalf,in all matters relative to work authorized by this building permit application.
54 \,e Ta, /> D51249,�
Print Owner's Name Electronic Si Signature) e
( gan )
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.
3a4e 1 4//Or- t 9 /2.1
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
w w.mass.gov/oca Information on the Construction Supervisor License can be found at\}ww.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
°a r04 5�` ; Sic
' `�� Massachusetts �•c, ..- 'e
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i ( . # DEPARTMENT OF BUILDING INSPECTIONS
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1 4 212 Main Street • Municipal Building il` �b
'!, '...' Northampton, MA 01060 'Sfy 30%
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 BCC ZD2t-- 13-S 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.
'(5-
The debris will be disposed of in: Y ( eV P-RLYc 1 t
Location of Facility: y S /60/ -0 V C- c : A4CO d(-1 /1/1
01666
The debris will be transported by:
Name of Hauler: d).s.ey\,.. 0A_eli-S
Signature of Applicant: Date: 6 AO Z(
The Commonwealth of Massachusetts
►` ! _!i Department of Industrial Accidents
• sc?;�1 = 1 Congress Street,Suite 100
-tr_alai 4 Boston. MA 02114-2017
www mass.gov/dia
,.a�tss
Workers'('ompensation Insurance Affidavit Builders!Contractors/ElectriciansiPlumbers.
H)RE FILED WITH THE PERN1111'1,1t:.i,t t tittxl r�.
Applicant Information Please Print Leitihis
Name tliusineas Organization Individual): J 54-e7'e115 CO A_S C+ctd✓\
Address: 33 i-e rap l•e
City State/Zip: blyo ke ,q of oqo Phone#: q ( 3 - 41- 577 / �-
%re Sur an cmpkryte Cheek!tile appropriate hot:
Type of project(required):
1.0 I am aemptoyes with c lnFce, tall.i dlorpart-thee!-• 7. Q New construction
i am a iok proprieeor or purincr,htp anti ha:c no Q rr ployora working forme in S. Q Remodeling
song't`n say.[No worker,'comp.tnsuiantt rNutrod..1
1. I ant a ht .t ttc mrn r doing all..ork m4,ci1.;\ nes<t..uri 'comp_irotaraloe required.)• 9. Demolition
4.0 I ant a howt nnt ncr and x 311 he hinny;c a.ontrtur.3 Et,ttxtdu[t all*telt on my property. 1 will 10 Q Building addition
ctrtiurc that all..monitor,cith.t ha°.t 5,011..•1.'comp.n.atinu inaurance or are yule I(a Electrical repairs or additions
propnaoi�cots no cinpl.ncc,
12.0 Plumbing repairs or additions
50 I am a general contractor and I c hued the sub-contractors listed on the attathcd sheet l ❑Roof repairs
!hest•,uh-c nntractora Leis: ra employees and have worbera'comp.insunce.- t-�df
6.0 We are a torp rllbun anti its;tuners have exeniscd their nett of exemption per M(tt... 14. /her �trbn
132.f 10).and we have on employees.[No*cetera'comp.itaatoahcc reguired.I t .e?o(o t
•An} applicant that.h..cks box sl must et,o tilt out the secin)a below shoo mg then u urkcr,•.ont{icn.ation t+ol u.y rnlorrruitiiit0.
t 1lonterm,!WM,.hie,t.hrnti thns atfidasit inah.altng they art!going all work and titian hire oot,tdc conira..tor,into./subunit a new aftiidavit iYhltlWg steek
kunt::ctor:th.ii chink this het must att.s.lacd an oddrtion:3i sheet shins irta tote name of taz sub-contractor-,anJ,tans..hcthcr or not those entities have
€anplo.ec,. It the,uh-.on.rscttva has,:eniplu}cc,.the', n,u.t pros ids ih.is norkcr,'comp l,..lt.'runihcr.
I am an employer that is providing workers'compensation insurance for mt,employees. Below is the police•und job site
information. / \ (�
Insurance Company Name: �/4t cc" p�
PolicyT
#or Self-ins.Lic.#: 1 J� �% 9 Expiration Date: icX1/#(//A
Job Site Address: D C Q ri z S Cicy/StateiZip: /Uvc-(h 1IN►Q'bn /1/l✓� Gl G 6d
Attach a copy of the workers'compensation policy declaration page(showing the policy number sad expiration date).
Failure to secure coverage as required under MGL c. 152, ;25A is a criminal violation punishable by a fine up to S1,500.00
and:'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
cos crage verification.
I do hereby cer 'j nder the err# ' allies of perjun thus the information provided above is true and correct.
Signature: Date. 61/2,0/2-
Phone : LFl 3 - 3 - 5-6/oZ
t)/Jh iul rite only. Do not write in this area.to be completed by city or town official
(-its or Town: Permit/License# I
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3.('iii[I!win Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
('ontact Person: Phone#: