Loading...
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