43-156 30 HAWTHORNE TER BP-2021-1381
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:43- 156 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-2021-1381
Project# JS-2021-002304
Est.Cost: $70000.00
Fee: $455.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: TEAGNO CONSTRUCTION INC 034716
Lot Size(sq.ft.): 45302.40 Owner: FIERST DANIEL
Zoning: Applicant: TEAGNO CONSTRUCTION INC
AT: 30 HAWTHORNE TER
Applicant Address: Phone: Insurance:
228 TRIANGLE ST (413) 549-0803 Workers Compensation
AM H E RSTMA01002 ISSUED ON:5/26/20210:00:00
TO PERFORM THE FOLLOWING WORK:RENO BATH AND 2 BEDROOMS
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. '
• fir . � . 11-°• •
Certificate of Occupancy Signature j i
FeeTvpe: Date Paid: Amount:
Building 5/26/2021 0:00:00 $455.00
•
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
1, / I
rfii - Ye &I
CI
14 o =' The Commonwealth of Massachusetts
14 \' Board of Building Regulations and Standards FOR
r� 'tl Massachusetts State Building Code, 780 CMR MUNICIPALITY
l': USE
(?_-'5) Q B -°'1a. g Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One- or Two-Family Dwelling
n uz
This Section For Official Use Only
L_, BuildiniPern4N ber: a0—...2j /3 f I Date Applied:
v .;t• Njf„,,L 0 r .,,,,isalipAL,
Building Official(Print Name) '; Signature $ 0 Data 1
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
30 Hawthorne Terrace 43-156
1.1a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
No Change 1.04 AC 100
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
NO CHANGE NO CHANGE NO CHANGE
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 OWNERSHIP1
2.1 Owner'of Record:
Daniel Fierst and Naomi Clay Northampton MA 01062..
Name(Print) City,State,ZIP
30 Hawthorne Terrace danfierst(a.gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) XI Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2:
Renovate bathroom and two bedrooms
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
I.Building $ 47,000 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 5,000 ❑ Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 15,000 2. Other Fees: $
4.Mechanical (HVAC) $ 3,000 List:
5.Mechanical (Fire $
Suppression) Total All Fees: iii /j
Check No.A, i Xi$ Check Amount " Cash Amount:
6. Total Project Cost: $ 70,000 0 Paid in Full 0 Outstanding Balance Due:
Renovation/Alteration Fee: 6.50/1000 = 6.50*70 = $455.00
d
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-034716 1/10/22
Donald Teagno License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
PO BOX 2298
No.and Street Type ` Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Amherst MA 01004 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-549-0803 contact(a7teagnoconstruction.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
108109 8/17/22
Teagno Construction Inc. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
228 Triangle Street contactOteagnoconstruction.com
No.and Street Email address
Amherst MA 01002 413-549-0803
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 IX No 0
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 authorizeDonald Tea no I Teagno Construction Inc.
to act on my behalf,in all matte 've to workfu ed by this building permit application.
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'btl,- �,\ fQ4 \ c/ lei 12o2A
Print Owner's Name(Electronic Sign 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
c tamed in thiplication is true and accurate to the best of my knowledge and understanding.
�s ap 5/19/2021
Print Oer'aer Aut d 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
NO CHANGES
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
( " Massachusetts tea' ,' `,'�:..
JF 6'1 ati
c 4 ` DEPARTM 'M ENT OF BUILDING INSPECTIONS ,. I .
�k 212 Main Street • Municipal Building v b
y.,
\,� " t Northampton, MA 01060 s� W
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: USA Hauling and Recycling Inc.
The debris will be transported by:
Name of Hauler: USA Hauling and Recycling Inc.
Signature of Applicant: Date: 5/19/21
A
4 \ The Commantveaft1t of Alassachnsetts
Department of InilustrialAccidents
1 Congress Street,Suite 100
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. =LI t. Boston,NIA 02114-2017
'''c '", • wtookmoss.gor/dia
Ilrot kers'Compensation Insurance Affidavit:BuildersiContractorsiEleetricians/Plumbers.
TO trE RILED wrrir'IllE PERAIttl'ING ALIT1101t111i'.
Applicant Information Please Print Leniblv
Narne(13usineas- lOrganizationIndividual):Terignci Construction Inc::::Inc.:::':'
. . ............_.__...._.... ... ... .. ... .... ........
Address::228 Triangle Street.,'::'.....' ...-..."...:'"'';'..:--::;'...':.:.'..-',. ::'...!.., .'' ':!..:.:!:'...:.....•;:"...-.....: :::.:*.''
_ _ ... .... . ... ' .
-- ';'".:::. - '•' :'::'". • '.;-::: !"::::'''''' : :::: : ::::'"::'',":'' ':. ' ' . : :::.::',.....1'.
City/State/Zi*.Amherst MA 01i)02 : . Phone#:..413.549-0803 . . . . ...-.Tx
.. .... _
Axe rill an employe?Catticclaa apprioriatt Inn! Type of project(required):
...:-•,-- ,-: .
1.2I I ant a employer with 17 - . egnoloyoN Milt atnikw-pan.tinat-1.. 7. 0 New construction
21:I I tat a iolt pcnoticou or partnership and haee no eumtoyeex wealth* for tise its g. El Remodeling
any c-apacity.[No workers'imam.imamate required.]
9.. C=1 Demolition
SO I arn a tii 'owilcx dung;all nork nrocif.IN-0 workers eonm.irouranee rev: are/I*
10 El Building addition
..n I...homeowner and will be hiring uusm-amoes to i•onduet all work bit I'M?gatireity.I will
maitre that all oontracints either haVe Mtlittrt.LVii4S-Itilliedi imustaneeist axe sole 1 I II Elettrimi repairs or additions
inoptietors with ni,eirmloyeet.. .. 12...0 Plumbing repairs or additions.
sin 1 ani.a gimmid tontratitor mid 1 haute hired die sub-contractors littolti un die ettadied sheet
These sub.einstraetots lmw.,itesplia,!,,cm and have workers*oomp.iittilitleitt.; I 3,1::Roof repairs
61:3 We ate a eimgrration and impair:Is have exist their night of exemption per 1401.c.
152,i 1(4),and we luiverio employees.[No workers'oump.insuratiee sequin:LI
*Any applies:tit that eitiszks box lt1 mist also fill out the se i:thiet latlow showing_their Worlatrs't onmerwation putty Enfoentation.
t Hostanswelimi who tibblilit alit affidavit indicating they are doing all vets&and tlx hire outside sandbanks must submit a um affidavit indimaing such.
.4tuntreeturs that itheell this box must attaf:bed an additional shosel shoviing dm noun of the sub-tontractoes and state witedser or nut those entitim,have
employees_ If'the stib-eontenerms have erriployisk.they alma nnsvitie their workers'twins.polity*rarebit.
I am an_employer that is providing workers'compensation insurance for my employees Below is the policy and job site
infortmatiort.
Insurance Company NatnetAIM Mutual Insurance Co. : :::: ....: ..:..,. ,:,..H:... .. .:..,..:: .... :. ..... .... .. - ....: ,....„::,.....: ...
.__ , • .. :' - • 72' - '';''''- ';'-;' '':;:: :...-':';;:l.;;::,'".:i::!:t.;.:j. ::;.;:;:::',:;:i;::,t.; ' ' :::':1:::';!:..::'!';:;:',.
Policy#or Self-lits.Lie.#:WMZ8006223012021A..,..';:,:„ . ::.-:!.. : : --:'..,..•!....:"'•i7r, Expiration Date:4/1/22
Job Site Addreas:30 Hawthorne Terrace::: :-: --: ! . ."..:. '.:.- .- •-::- :::.City/Stare:lip;Northampton MA 01060
Attach a copy of the workers*compensation policy declaration page(showing the policy number and expiration date).
Failure to seimre coverage as required under Mal.c, 152,*25A is a criminal violation punishable by a fine up to$1,5001)0
and/or one-year imptisonnumt,,as well as civil penalties in the form of a STOP WORK ORDER and a Ent of up to S250.00 a
day ageMst the violator.A copy of this statement may be forwarded to the Office ofinvestigations of the DIA for insurance
coverage verific;Xion.
I do here - 'lily andephe pains and penalties of perjury that the information provided above is trite and Asirrect.
Sionanate: Date: 5/19/21
phone t 413-549-0803
._ ,. _ ... .. . . .. .. __ .. ... „. ..... ... ...... .-- .. -. —
Official use only. Do not write in this area,to he completed kr city or town official
City or Town: ';. - : .... : PermitiLicee# :!';..-.-::::.;;•...'-s'i
Issuing Authority(circle one);
1.Board of Health 2.Building Department 3,Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
• 6,Other
., •!i:!'.'..::'-:i';:.'.:'.......: ::;'....::',';..:.'....!:::'....:.'.'.ii; . •
C.ontact Person: