30A-026 (2) 34 LEXINGTON AVE BP-2022-0029
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-026 'CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: KITCHEN RENO BUILDING PERMIT
Permit# BP-2022-0029
Project# JS-2022-000048
Est.Cost: $29000.00
Fee: $188.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 26136.00 Owner: PAVLOVICH JOSEPH M&BARBARA T •
Zoning: URB(100)/ Applicant: PAVLOVICH JOSEPH M & BARBARA T
AT: 34 LEXINGTON AVE
Applicant Address: Phone: Insurance:
34 LEXINGTON AVE
FLORENCEMA01062 ISSUED ON::7/12/20210:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN RENO
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 Signature: `
FeeType: Date Paid: Amount:
Building 7/12/2021 0:00:00 $188.50
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
The Commonwealth of Massachusetts\ , ,jam
Board of Building Regulations and Standards\ ,,,,^� 8 TOR
.a c�
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Massachusetts State Building Code, 780 CMR `' n��? �`�'
^,1 USE
Building Permit Application To Construct,Repair,Renovate Or De `ct ised ar 2011
One-or Two Family Dwelling (i706,,0
This Section For Official Use Only
IS 'meik, ... .,
Building Permit Number: ".?-al.. al Date Applied:
Building Official(Print Name) I Signature 1 i
SECTION 1:SITE INFORMATION
1.1 P e Address: 4 1.2 Alms Map&Parcel Number
1.la Is this an acceted street?yes 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:
Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
ECTIO. 2: PROIY —'ll' OWNNERS''HIP
2.1 Owned of Recor • J
4 I`/, —f Ftr`b n /4r/`/11, 4 E4ri r ,1/7 D/$0
Name(P ) City, State,ZiP
3V eA4-'A �vr 4lig 6 -�7(/.6e&ki,ra . -U/O 'cA �' '
No.and Street Telephone Enikil Address
E:C+'1810143.7:1l1ESCRIPMOINIOFIP t+D I SEDIW..0 ch k' all[that a 1
New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ , Alteration(s)Al Addition 0
Demolition ❑ Accessory Bldg. ❑, Number of Units * Other E Specify:
Brief Description o Propos Work': M�Gh9h ,.(2.,1ev0eje/ oleic/i C/f LL?M /� cej%
fe'f,L,1 C b(-z geee, v�1 ) 6-'/ooi; '/ze 0 t v e,r • WIL(�, 1--
/ $�,��c r0 ' %i r r s, 4 pc17 X /o r o'w C dig/ 5ie/ t5/ , 'T/u )200
r ,x,4--c�u Spa
S1 1IIQN!I.ESII MEDZCONSITREABON1:(OS1'TS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ q eve.0-0 I. Building Permit Fee:$ Indicate how fee is determined:
ii3O Standard City/Town Application Fee
2.Electrical $ • o'''vo ❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ €94fl 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No/041Check Amount:10 6°Cash Amount:
6.Total Project Cost: 0' cl DDO 0 Paid in Full 0 Outstanding Balance Due:
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City of Northampton
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A v1DEPARTMENT OF BUILDING INSPECTIONS ?s� 1 0
'F, ''� >` 212 Main Street • Municipal Building as,.. ,oc,
•.'"• Northampton, MA 01060 sN,y,^•i �..
OONSTRUATIONIC EBRISIAFF _A�VIT
(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: Ag 1dU) + Li / CtJcl .,i
The debris will be transported by:
Name of Hauler: ( I_jv ut f rock , r) Do—f ef��
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pp
Signature of A licant: —'� 9J20�9Qf � Date: ' 5 Id 1
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E: `r • The Coma onir'aalt a of3laassac nsa'tts
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f 'l'curkers"Compensation Insurance davit:BuildersfeontractorffiectriciansiTlumbers
Applicant Information JPlea.eprint Legibly
Name f'A siness'OrprintioniTudirdcfi : 4.?"3- fq al ._. 09 v to 0.'4,4. I
Ci1ty/Staiear :i. 0(6i!c - I-ai&i,„-'2_ one -_ 977-- 6--a T7
AMC you 22 reLmployer?Check ilteNspropriatr lb=
Type ofproject reatuiseal,.
R.0I=.71amplapraztat =plo =(ii li=leesput-ti=c). s'. ❑NevrcouLtuction
.01=2 Gasp-run/atm=w=vr..12ipaaellhatanoamplaysinlrci ia3 fan=La a . EAMOCTigli4E
as+eap eetycplbricciar. carp.ia:usanca saetnirad_]
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aa.s r ibta thata= r�+itis= r to o stact Au Ar3, r= ,grg?{,'^Z ir`it
7a: o mat all '*a-ar, rs oxt�sa� i a �arics� c soon sciswasa ua 7aa 1 1_ Flecfirical repay or a dilionr
g a4r,�At,.�.?<,. ,.,n; 12_D Phanibing s gai ,or additions
ID I.a Fanaral cant artan:ad:awl r'adt 2 man-cratar.tors lima en tEs atractcd thaat. l _❑ fn'
airs
Mums Bulb-carcractDri bare captayaa:andIravo aim:'camp.farsaaace 1 ---- 7
&D lro ara a ceiperatdca audit:efacasslhat2 asasasad thikris t cfazaapfcaparMGL c. =. 11eY i
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'Hai+m}agpp7icani that char&ab Iffi¢s5also lilt cruf le sac€oa'Ezlour.hatiria, chairtiresikar cccepamatErmpolicyiinfarazatias
Eicancumnraso mdtazit dam afiids.3t 3icatrnr ecy ara&iagall cork aadi thaa tin cratida sauracterraa.t.r3m't an=afftearitia^�irs!.in a mII .
+tca r.tar:tb2chart chi:Arcs saa:t at a]hcd an aadiiiozli thaai.ls ciar ea saa_,agile ulb-ccair*_rar aai:m:a vehataar Ernaitlaw prido I lara
a tc3aa,.Mae aall-scat zetarsha:a ompinyam,r3aymu tprovid:tthair vsailiare cow.palicyranati.
lrartl one employer that spnnfding workers'ea3nl peli3afietl snsaaaaanraja+r nut errlp.dan'ees_ &faaroc as zhe policy cradjob Ski!
atloraraataatc i :_ ____ ___.-_�___ _____.._.
Iaamceaxnpany ma s----- -_- l 11
Policy or Self ins.Lie.i'i 1 Emoi ationDate_ !
rob Site �� f my*�� fates ' 1
Attack a copy of the workers'conepensatiarn policy declaration page(showing the policy number and expiration slate).
Failure to secure co,rea, a as requiredmaderlAGL c_152„.§213A is a thmkal liolationpiroishableby a fine cep tag.S1,50 .00
anrli°orone-gear imprisa to as in-ell a civil romailties lathe form ofa STOP WORK ORDERanda fire ofaga to S2511110 a
day against the liolator_A copy ofthis statement may be forwarded to the Office of Inve-Aigations of die DL .forin in e
coverage velification.
I.do hereby cerri r underthepa inns ind penalties ofpetizarr&Mlle information praa tided above ispue and canrecL
-
Official me only. Do zotnaalie it thisarea,to be congaed by city or man official
City or Toren: - ___-
City Peiinit,{Ficense i
Issuing Authority(circle one):
1.Board of Health Z.Buil Departinent 3 CityJTou Clerk 4.Electrical Inspector Pivanhimg1nspector
h.Other!_ '1
onit:�ctFer-son:r' i
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Phone :
City of Northampton
r:_ Massachusetts S = c'�c
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' i; °" �. Er DEPARTMENT OF BUILDING INSPECTIONS 6 i `�,)"
"- ' � 212 Main Street • Municipal Building \1- 4C•
r'
;, Northampton, MA 01060 -st%k,�3;j11i
WYPEOWSPRSIEWEIMMOVIEOLOWSWAREPEAVIA
I, ./<5)rKbl /47 L-14 1/i G (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 6day of \Ai .20.i
AIcM&\
(Signature)