17C-019 (6) 96 NORTH MAPLE ST BP-2022-0015
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-019 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-2022-0015
Project# JS-2022-000022
Est.Cost:$15000.00
Fee:$98.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SCOTT CALLAHAN 97309
Lot Size(sq. ft.): 18556.56 Owner: HILL KAREN
Zoning: URB(100)/ Applicant: SCOTT CALLAHAN
AT: 96 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
33 WESTVIEW TERR (413) 320-6269
EASTHAM PTO N MA01027 ISSUED ON:7/7/20210:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR/REBUILD 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.
2 . Tot .
Certificate of Occupancy Sit;nature:l ' I
FeeType: Date Paid: Amount:
Building 7/7/2021 0:00:00 $98.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
i isr�,C `;
/ / -
The Commonwealth of Massachusetts o,� `6' OR
Board of BuildingRegulations and Stan+, o,�
k``` ' Massachusetts State Butilding Code, 780 C '.7,(74/o/n ���7 CIPALITY
Building Permit Application To Construct, Repair, Renovate Or IP a evised ar 2011
One-or Two-Family Dwelling �1°7 EG%, 1
J This Section For Official Use Only
Building Permit Number: a '/A'/5- pate Applied: `,
1/L:•=0/..) /Zs //�� 16-7-7-202j
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: u A ! 1.2 Assessors Map&Parcel Numbers
Ct it) N -� Q
1.1 a Is this accepted street?yes no Map Number Parcel lumber
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 0 Private❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
p L e'IL.A-c.n t-k-1 L ¢-lexit ,ce v.i1 A- to I Oto 4-
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction' ? Existing Building 0 Owner-Occupied lit Repairs(s) I Alteration(s) 0 Addition 0
Demolition tic Accessory Bldg. 0 Number of Units Other Specify: 1 ,6)+ \a
Brief Description of Proposed Work2: ` "h7^ r
( .Q.V)t). 1d C(a)r 4645 L lou+ 2c.J ft.A, u S ,'bvvt SI-PS
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ l S '0 00 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: /X
Check No.1551 Check Amount: !/I Cash Amount:
6.Total Project Cost: $ 1‘4 I 0 CO ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction SupeCtOJJLJ.-
'sor License(CSL) "l 75 c7 a�
S�� License Number Expiration D
Name of CSL Holder
33ZList CSL Type(see below) v
t V t W` l r
No.and Street Type Description
- r,_ [ �01 �,„ D I ,D�� U Unrestricted(Buildings up to 35,000 cu.ft.)
� `'��'� �'CJ`" ` 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 istered Home Improvement Contractor(HIC) 1c�c)-7
LHIC Registration Number Exp. ation to
HIC
(C?r ny Name or R gi t 11[am
No. S reef T� Email address
Ci own,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 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
'4..ei
I,as Owner of the subject property,hereby authorize IE )CT C_i 4C(pt- kiN" �J
to act on my behalf,in all matters relative to work authorized by this building permit application.
7 /c 46 i e Ma q/Z-/zo?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 and accurate to t of edge and understanding.
Print Owner's or Autho - Agent's Name le onic Ignature) 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
O:SHAM-P 10,.. SAS Si
p�� ( Massachusetts �� -
01 g k DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
` Y. . Northampton, NA 01060
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: Vi 1 �.,Q_ C(r N 0(-aka we l
The debris will be transported by:
Name of Hauler: q.fL \O
Date:
Signature of Applicant: �" '��
The Commonwealth of.tlassachusetts
l.n Department of Industrial Accidents
i .' I Congress Street,Suite 100
4 Boston. .t1A 02114-2017
_ www mass.gov/dia
flusters'Compensation Insurance A(Iidas it: BuilderslContractorsfEkctririaits Plumbers.
10 HE FILED WITH I Ill.PE1011T1 11G At!-MORI 1'l.
ADDIkant Iafarmation Please Print t.et:ibls
(11 ! �
Name tl3ustricss.,'(h�ga:,ixstino.lndts,dual►: ` ('_U� CLL_._(,0 .L¢v'1--.____
c
Address: 0,,.Q, I L _.__._.._..,_.__.____._._._. ____.__ w_.__ _
City/State/Zip:_ 'ti - i..)-f'014 `1 ! 3 320 .265
•
Are yea MI wimplaiyeef l lock the appropriate tat: Tv pe of project(required):
1.0 I am a employer with employees*lull anther pan-umet.' 7. [3 New construction
2' I am a iok pruprretes er partnership and hate no employee's%orkutg for me sea g. 0 Remodeling
t' capacity. No workers'comp.rnsuruax roimired
9. 0 Demolition
30 I am a hutncsrwnet Joint all wort myself.[So notions'cun>E, nburamx required]'
4.0 lam a twrn n ruwrr and will be hiring min raetors to conduct all work on my property- I will
100 Building addition ensure that all corm:sours either hail"warken. compensation insurance or arc Yule 1 i a Electrical repairs or additions
c rataith no employees
p` n w 12.0 Plumbing repair,or additions
SO I am a general contractor and I hat a hued the sub-contractors listed on the attadrea*IWO-
130 Root repairs
These sub-contractors fuse empk,yees and has r*when'comp.assurance
6.0 We area corporation and as officers have exemiaed their right ofexeraptaan per NCI_4..
I 14.0 Othei
152.Q 114 t.and we lust no ere/ploys-vs.(No workers'comp.msurar►ce teyuued.j
(
*Any apptiiamt that cheeks box aI mint also till out the%ration halo*showing then ounces'compensation poesy information
'tir►nerownen who submit this officttsrt uadaeatmg they are doing an work and then here outside contractors must submit a new atfwitsit unlis long such.
!Contactors that cheek ides box min$attached an a:Id u,mat sheet showing the name of the soh-contractor,and l i t c a hether is not those.aruUes lugs
ersrploycs-s It the aub-cuntracWn have...ma tw ces,thes must mot ode their worker.'comp policy slumber
I am an employer that is providing wvorAers'compensation insurance for my employees. Below-is the policy and job site
information.
Insurance Company Name:__ —
Policy a or Self-ins.Lk.#: Expiration Date: -------.
Job Site Address: CityrStatc.'Zip:
Attach a copy of the workers'compensation policy declaration page(shooing the policy, number and expiration date).
Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishabk by a tine up to S I,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
Ct?verage scnlicatiun.
I do hereby certif ' puler the c• ; s nd:- Ities of perjury that the information provided above is true and correct_
l -
S'i+t_tare: /J,I Al / d' Dal,. J
Phone a:
Official use rink Do not write in this area,It)he completed by cili'or town of/iciul
( it or lossn: Permit License a
Issuing.%uthorits Irirrle one):
I. Board of Health 2. Building Department 3.( it, I ossn( Ierk 4. Flertriral Inspector 5. Plumbing Inspector
6.Other
( untact Person: Phone#:
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