Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
23A-011 (9)
301/2 PARK ST BP-2021-1474 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-011 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-2021-1474 Project# JS-2021-002450 Est.Cost: $18000.00 Fee: $117.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): 1 1020.68 Owner: GUEST CORINNE Zoning: URB(100)/ Applicant: GUEST CORINNE AT: 30 1/2 PARK ST Applicant Address: Phone: Insurance: 30 PARK ST (518) 596-0580 () FLORENCE ,MA01062 ISSUED ON:6/11/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATION 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�?naturo � • • FeeType: Date Paid: Amount: Building 6/11/2021 0:00:00 $117.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner fI,- % % o `io, ') . The Commonwealth of Massachusetts-, NT o,� 9 1 Board of Building Regulations and Standards 9'tiq,�y'�o, ! FOR 4 '' ' _ . Massachusetts State Building Code, 780 CMR pT ti,'Msos U E 011 q 0�CpiO Building Permit Application To Construct,Repair,Renovate Or Demoli 60 N;ev se Mar 2011 One-or Two-Family Dwelling /�� This Section For Official Use Only Building Permit Number: t'/,"4 I'My Date Applied: 4.-1./i4.>Z5 -----,--- 10-11-76Z( Building Official(Print Name) Signature Date SE TION 1:SITE INFORMATION 1.1 Property Address: VOW" ' ) 1.2 Assessors Map&Parcel Number 3O`/ S 4 19 orevic t, µA /l 1.1 a Is this an accepted street?yes i no Map Number ' r 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: Public v Private❑ Zone: Outside Floodyone? Municipal L/On site disposal system 0 Check if yeslr SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: (panne 6uect ...10r--el 1 GC , MR Olob2 Name(Print) City,State,ZIP 30 'Fb rl�W64 ( . '/z tine tut co t+)(511)914-ono r'i nne est�qw4 I•corn No.and Street Telephone I it AddresV SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building re Owner-Occupied I Repairs(s) " I Alteration(s) l Addition Demolition Id Accessory Bldg. 0 Number of Units I Other 0 Specify: Brief Description of Proposed Work2: .—dw�b k f 161rt ,ad d ,S �11�_ LAN*,r 1W 1 1e w• s. Pd newl�ib liViaN ♦. 1��:L -_i.•IV .. '1 `I' ./_.Li - ifeci- • SECTION 4:ESTIMATED CONSTRUCTION COSTS � W 11 Item Estimated Costs: Official Use Only(Labor and Materials) 1.Building $ 81000 1. Building Permit Fee: $ Indicate how fee is determined 2.Electrical $ 0 Standard City/Town Application Fee 1 00 0 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ (Q , OM 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:[ Check No. i t 55 Check Amount: 61,11 Cash Amount: 6.Total Project Cost: $ ( IS,1 000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) W/A, 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 Masonry _ 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) N/A 1 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 /1 I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. 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. C o( r_At &ut s Print Owner's or Authorized Agent's e ectro 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/dns 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" • . • 00'3 , L.....„.......) I i _ __ _ . . ) I" i i 1 Hi ' , X 0 0 1 ,c I - — 1 — i I I . ..... . . . fra \ . _ , ... %..Ark.t.'"r"_,,4,,•!!, 0 [. 1 I L . , 4, --..." ,.._.. 5 i44.7V - MM (94 y‘i1.411Jvliiryfi) ) - 45 iproa -z-A oe I -301/, ? 1Vc1 1---,t,wryt(t , OA 6V0(9'1.- t • PaVO5.6) alli1\4:6 f i y S �� (7,-,J 1 t o 0 Kcc. .4(1 )......_ ....., 1 1 T 1 . . _____, , Olt) 1 . _ 1- I 4 -.: 1;�.;. I i (4.. (C.... .... L a r __._. i • . 1 E._71- 0 —At-v.-or-q.t. .2QJ,,9 r '"l(l 4 , c00..4 vr,h04 19 Eke rawly f Y�+�tit r c-Ni- v' �" The Commonwealth of Massachusetts t Department of Industrial Accidents i 0,_- s I Congress Street,Suite 100 „1��-- Boston, MA 02114-2017 `?;,.��,� www.mass.govldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMI11INC AllTHOltlTV., Applicant Information Please Print Legibly Name{ilusinessrorgamtationllndividual):C' .orinn ., (QSk Address: ) 9G�4'-St-. �� ' - ria,u.i Cityf StatefZip:'fl4?ACQ_ ,M Pr a 0(o el". Phone#:(5.117)11Mii' b _ Art yaw an employer:'Cheek the appropriate hot: Type of project(required): I.©I am a employer with_____..__._. Li ea tfelt andVur part-time)_• 7. [ ,New ct n£•truction 211 I am a sate proprietor or partnership and have no employees working for tat in g. Remodeling y capacity_[No workers'comp-insurance required"31am a homeowner doing all ttiurk myself.[No workers'comp_insurance am/tired"♦ 9_ Dtyrnolition 4.0 I am a homeowner and will he hiring coturacaury to conduct all work on my property_ 1 will 10 Building addition elhsnm:that all Ctlalineturti either have workers"compe-matrcm iri surancr er are sole 1 la Electrical repairs or additions proprietors with no employees_ 12.0 Plumbing,repairs or additions 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet_ These sub-contractors hawemployees and have workers"cutup.insurance.: 13❑Roof repairs 14_Q Other 6.�we are a corporation and its officers have exercised their right tit-exemption per h4GL c. —• 1 S2.*1(4 and we have no employees.[No workers'comp.insurance required.] 'Any applicaM that chocks box al must also fill out the section below showing their workers'conhpeaswiva policy information_ t Homeowners who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new affi4 tit imiimuing suck IContractors that check this box must attached an additional sheet showing the name of the sub-ccauracturs anti state whether or not those entities have employees. If the sub-contractors have empluy'cts.they mrrsl provide their workers`wrap.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: CitytState'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 S I.500.00 an&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 coverage verification. I do hereby ify ern the pa and antes ofperjrrry that the information provided above is true and correct Signatu e: Date: (9)21'2 Phone#: 5.11, 'Ft�' Y0 iOfficial 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): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector (t.Other Contact Person: Phone#: City of Northampton aY14tf, -+M• -✓ Massachusetts 4r L 'ee It! DEPARTMENT OF BUILDING INSPECTIONS vE x /:. 212 Main Street • Municipal Building 0\ ODD` �,, .• Northampton, MA 01060 yj�•• j�� GO HOLMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT ^!•L1%3 I, ✓11 31W�7 (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 ains and penalties of perjury on this lay of AUX , 204. ature) City of Northampton id?",HAMP,oti AS.........sic Massachusetts ��?.' S,_ '<< •i t 's'4* DEPARTMENT OF BUILDING INSPECTIONS �`. 4#�` 212 Main Street • Municipal Building yvy,, ` Northampton, MA 01060 ss .• ;`00 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. r The debris will be disposed of in: \/ iJk RaJ d li,vpLocation of Facility: ' The debris will be transported by: Name of Hauler: A64)7AkkeVi I ( 1YUC t'--" Signature of Applicant: Date: 2