25C-058 (5) 25 LINCOLN AVE COMMONWEALTH OF MASSACHUSETTS BP-2021-1874
Map:Block:Lot:25C-058-
001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1874 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION Contractor: License:
Est. Cost: 4900 SDL HOME IMPROVEMENT 103635
Const.Class: Exp.Date:05/20/2023
Use Group: Owner: LAWLOR, ANDREA &MELLIS BERNARDINE A
Lot Size (sq.ft.)
Zoning: URB Applicant: SDL HOME IMPROVEMENT
Applicant Address Phone: Insurance:
24 CHESTNUT ST (413)247-5739 WC9024456
HATFIELD, MA 01038
ISSUED ON:09/14/2021
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ER I ZATI ON
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.
Signature: T
• it , -
IT
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
City of
Building De0artm nt
212 Main Str t
LATION
Room 10
Northampton. 1060
.._- - t ,-9/, // / "Li g
.
... phone 413-587-124 ..? 7-127 -( i
i ONL
441 N
•n, $-•••-• :
APPLICATION FOR INSULATION FOR A ONE OR MiL 1, WING ONLY
SECTION 1 -SITE INFORMATION INSULATION PERMIT
This section to be completed by office
1.1 Property Address
7,25— /A ri d_e)C-0-1 l' /V—C--' Map Lot Unit
'AIZ. 1--P1 a ) rri v9 t()Ca 0
( 1 f-r),0+0(--J (... Zone _Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1
I
2.1 Owner of Record:
14-7-1.04_e_CL
Narne(Print) Current Mailing Address:,
./,(3
,I. 923--. 8—g---S—Ca7
Telephone
Si nature
2.2 Authorized/!,17: 7L,s,,,,,,L,,„,..,_
i i ,, _L,,,,..10„,v,,,yv hi-
iN .,rne Current Mailing Address. L.t._i ,4-2( ( ci ryl
/G-c4./7-S7a13
Si nature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
-
Item Estimated Cost(Dollars)to be 1 Official Use Only
completed by permit applicant ''I. Building 44"(.1 9 00 ---- (a) Building Permit Fee
2 Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
I ,—
4 Mechanical(HVAC) 05
5. Fire Protection
6, Total =(1 + 2 + 3 +4 +5) nO Check Number
This Section For Official Use Only
Building Permit Number be-4i//g97Y 1
1 Date
Issued
Signature - )9-20z,
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Constructipp-{IQ�ryisor: j 4_
Not Applicable 0
Name of License Holder f d 41 c"�r"�i -t C1 I -" C. - 1 0,:.G 3`.
License Nu ber
i�f L n c 1 - -5- ", "i'ac f- e 1 Qt./ ril /4 o o?)�Y' --- :� I a 3
4ss Expiratio Date
„di
iiii,,,...d.m/1.5....____________
Ce
gnature Telephone
9.Re istsred Holsolivoprovemsnt Contractbf Not Applicable 0
/ VV i
Compan Name t �,� l ^1nQ-. ,L ..4 -t — (f � )Registration Number
A 1e1 .Sa-- -,— 5�-- r � 3
Address Expiration �ate
-- �" ,c l e._, rl"'�" UI U`lj Telephone/Li I3-:.)U0-S?1„ )
1
SECTION 5-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affida t must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the build g permit.
Signed Affidavit Attached Yes.. .. No 0
Brief Description of Proposed Work NOTE: INSULATION ONLY
/,oav &) -�-/- / -I-/9 ua d be 3Iasi 79c cc_I ---
1.411 N el- -+'1-Z-)0 le__ , --i4-1 1--- .S.- .Gc_,LI f-)i a4r_____, ri.„,t_.-L c_te--d____ _
i l
I (\)Q 4 1 i '\ \ V • as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Prikkt LDL... ,i (N;:',--- k-D ---- AL:_c)\k., .1-rof ave.,rn ,r)A--- (oak(cide_S, 17,,c,
Print Name -.%'
� - q_ y_ .o a. 1
Signatur of Own r Agen� Date
f cian C`�A_1 L2.1,,L%Ci-_I' as Owner of the subiect
property <I\
hereby authorize <� '� __
o ct on my behalf, in all matters relat e to work authorized by this building permit application.
Signature of Owner Date
DocuSign Envelope ID:FE5778FC-653E-49CC-986E-13357ED84E34
RISES
ENGINEERING
OWNER AUTHORIZATION FORM
Andrea Lawlor
(Owner's Name)
owner of the property located at:
25 Lincoln Avenue
(Property Address)
Northampton, MA 01060
(Property Address)
hereby authorize
Subcontractor(to be filled in by office)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
The permit will be secured by the subcontractor, at no additional cost.
It is the homeowner's responsibility to close out this permit by contacting their municipality at
the completion of this work.
—DocuSgned by.
PtI/L.
Oi 'rd S f1atute
8/29/2021 I 3:09 PM EDT
Date
RISE Engineering,a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335
www.RlSEengineering.com
......... City of Northampton
.....= s.,,,
;'/.# ' ' . , ,,,...
i-, Massachusetts ,,.,/ .2...
DEPARTMENT OF BUILDING INSPECTIONS 5 )
212 Man Street i'Munlcipal Bu.11dIng ;'_ ‘4,,,.0*'' ,
Northampton, MA 01060 ----,"-'t'1/4
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40. S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A,
The debris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
----V, , ,,,, __, ;\_, (A c ,.. ' .,-'e.,r,;, -i f... --k-Ver(v.c.-e...v c\,.. , /IAA
(Please print name and locah of facility)
, )
Or will be disposed of in a dumps r onsite rented or leased from.
.
C;) t•-_, \\c-r NA... - „,/rL....),,0 tr)j-k,-t rL,Ls\A-- Lcf'
c .--
1
--\- co y-e_ \ 1 ; C-1-)1C-) -
- ' (Company Name and Address)
__ 9- 9- .=, )
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
City of Northampton
,.,,s.
Massachusetts
l":• elif,fir 1415 t'
DEPARTMENT OF BUILDING INSPECTIONS S )4 . -
212 Matn Street e Munictpal Bualding , .,'
Northampton, Mh 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation i"OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units. or to structures which are adjacent to such residence or building" he
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC, that entity must he registered.
Type of Work: exiGt_17 )b A
.. -.' Est. Cost: '9 9 .)/_.) —
_
.
Address of Work: (:).2,5 Li ele_d/
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
Job under S1,000,00
Owner obtaining own permit (explain):
Building not owner-occupied
Other(specify):
_.....
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDLNG PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building peraiit as the gent of the owner:
114u.\
i I 9 Li / ' --
Date Contractor Name FlIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts
DEPARTXENT 01 BUILDING INSPECTIONS
VY
,12 MA:,. Street • MunacIpal Building
Northampton, MA OliW *-
MANDATORY FOR HOUSES BUIL r BEFORE 1945
Property Address ...„,aLif
Contractor
Name: SN-,1----, j-t---vLy\-4-
%
Address ,,..)L4 ( k6
City, State; AA-MA , -k_.t (,),. V-Y\Or CA U 3
,
Phone: )-4 t . -- 3 Li-1 - .).. 1,,
- 1 ).) 5
Property Owner nckeot,
Name, k,ert,t)t-in r
Address
City, State. -Al‘r)-4.4- -P-v-)/0/C1 ) r`rNi Ol OU 0
1. 9
4it 1 ,-)0,rV,_1 "Y-'- (contractor) attest and affirm that the building I intend to
insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit,
4
,q6;
ontractor
Date
The Commonwealth of Massachusetts
sea= Ammon=
r, = Department of Industrial Accidents
•••••• Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
NV4whers' ompensation 'Insurance A friday& BuildersiContractors/ElectriciunsiPlumbers.
/RE I,11.1,1)Nt I III I PERNII I I INC ‘I THORITI.
Npplic o t o formation Please Print Leijbh
Name
SOL Home improvement Contractors, Inc
iitusin,,, nigan mils actual
Address: 24 Chestnut Street
Staterh p: Hatfield, MA 01038 Phone 0: 413-247-5739
Art,x on an employer?Cheek the appropriate box: Type of project (required):
8
t emplo>cr•.*rth rondo;res mit anchor tune) 7, 0 New construction
2 I ant sole proprietor or crannessh in and have no employees wiwk mg for me m K. Remodeling
tits ettpaerty INo workers'comp insurance recanted
Ej Demolition
101 am a Immeowner donig all work myself No workers'cilium insurance regimes! '
o 0 Building addition
4 DI am a hoover..tier and will he hiring contractors to conduct an wort on my prorem I will
ensure that all contractors either have workers'compensation otsurance or are sole I 1.0 Electrical repairs or additions
pruprictmn with no employees
12. Plumbing repairs or additions
50 I am a terns ectraratitor and I have hired the solv-sivvetrairors listed on the attached sheet
13.0 Roof remiirs
These stav-ctsntrAtitint have CinpkrVet'S and hake workers"comp insuratice
1 .12 e are 4 4:44 4m 4'441 and its oft icers nave ecitex ivied their nen rxtnwton per 4 001er niselaijit.r4
c
152., 1(4),,and we have no employees (No workers.comp insurance matured
'Air%applicant that cheeks hos must also lilt out the section hetow sherwing they worterv.it'amperisation policy ri .nnain
tomeowurtv who submit this affidavit indicating they are doing all work arid then hire outside cottractors most vutorn a new affidavit enthusing such
tour:trims that cheek Oita hos must attached an.iutstmonal sheet showing the name vsf the tub-contrisoors and state v,hk.Ther or l4 thone:mimes have
r moldy refs Ii the!lib-contractors have pia%idc the it workets ,itrup polteit nuoditet
I
am on employer thrills providing worAer%'compensation insurance for my employes. Below sr the polity and job site
information.
Selective Insurance Co
Insurance Company Name:
Policy o or Self-ins 1 h.: WC9024456 Expiration Date, 02/23/2022.
Job Site Address: ez423 ner.,7 in Ar—e— City'SI:11C•zip Ala-)44-ick rir),p1-Qr\J
Attach a copy of the workers'compensation policy declaration page(showing the policy number stud expiration date).
Failure to secure coverage as required under 1140.„c. 152.§25A is a criminal violation punishable try a tine up to S1.300,00
and/or one-year imprisonment.as well as civil penalties in the linen of a STOP OR is,ORDER and a line of up to$250.1X)a
day against the violator. \copy of this statement may he forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cer nder mires nod penalties of perjury that the information provided above is true and correct.
Si flaw Date:
Phone 413-24 - 739
,
.1 Official use only. Do not write in this area.to be completed by city or town official
i5
51
t sits or Town: Perm itiLicense
I issuing Authority (circle one):
I. Boaill of health Z. Building Department 3.Cityrtowa Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
onue: Vermin: Phone