25C-173 (10) 125 NORTH ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1903
Map:Block:Lot:25C-173-
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-2021-1903 PERMISSIONISHEREBYGRANTED TO:
Project# 2021 BATH RENO Contractor: License:
Est. Cost: 31000 DEVINE CONSTRUCTION INC 095779U
Const.Class: Exp.Date:07/07/2024
Use Group: Owner: KATES, DAVID &KATIE TEMES
Lot Size (sq.ft.)
Zoning: URC Applicant: DEVINE CONSTRUCTION INC
,applicant Address Phone: Insurance:
129 LOVERS LANE (413)478-9691 2001 W89165
GRANVILLE, MA 01034
ISSUED ON:09/20/2021
TO PERFORM THE FOLLOWING WORK:
DEMO BATH, INSULATE, DRYWALL, INSTALL ELECTRIC&PLUMBING
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:
. TIT
Fees Paid: $202.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
CV 9_
‹
U I_
:g �1, The Commonwealth of Massachusetts
'1ltt '
Board of Building Regulations and Standards FOR
Massachusetts State Building Code,780 CMR
MUNICIPALITY
r USE
(WI puilding Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
I w One-or Two Family Dwelling
(1-:: (-- _i This Section For Official Use Only '
Building rmit Number:(8P-2021 - I q 0 3 Date Applied: et/zc C2o Z-I .
Kr ;4 < ____, / 9 20-2OZ1
Building I fficial(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prope Address: 1.2 Assessors Map&Parcel Numbers
i2‘ g.lo(i-k S4' 2SC-173-00 i
1.1a Is this n accepted street?yes h no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
tAltot: y!! - IyAz1'-
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1,5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Require o Provided Required Provided Required Provided
f
1.6 Water '•upply:(M.G.L c.40,§54)• 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public q-- Private 0 Zone: OutsideC rf yes Zone? Municipal )n site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owne of Record: ,``
legfrc 14- t 11-.J t y7 t"��// S N o(Aka I.... IJ p-P
Name(Print)r City,State,ZIP
125 Nr rti SA- C7/7 Is 'C 65-67
No.and S I: Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORD(check all that apply)
New Con• ction 0 Existing Building 0 Owner-Occupied&rRep a i rs(s) ❑ Alteration(s) 9iii Addition 0
Demolition j 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Desc 1•tion of Proposed Work2: -.Ci kn '3A404 r-s a M ei U wi,j `k-O S't•lc(S
14,,E 1+.-M 6 I Ave dl``1 t.,,-q. ,I ctyt 'ZP A ‘ 1 vr,A.bi "-"-A
5I e.('4ta 'i' 'IPA- 1-6 S'fc 4f P-eA.e}(IV S AlA4
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 2_SD 0 t.) 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electri . ;j $ Z U 0 ❑Standard City/Town Application Fee ,�
0 Total Project Cosh ((Item 6)x multiplier ' x
3.Plumbing $ . a t9 0 _ 2. Other Fees: $
4.Mechanical (HVAC) $ --------- List
5.Mechanicgal (Fire o
Suppressiot $ Total All Fees:$ 20 2-- eL
Check No.191' Check Amount:ZOZ: Cash Amount:
6.Total Pioject Cost: $ .3\I 0 ) 0 Paid in Full ❑Outstanding Balance Due:
,
1
1 SECTION 5: CONSTRUCTION SERVICES
5.1 Const action Supervisor License(CSL) 75-- 7
e.3 k -De o Ld\Q License Number E it on Date
Name of CS, Holder
List CSL Type(see below) U
12-
No.and tre t Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted i&2 Family Dwelling
City/Town, ate,ZIP M Masonry,
RC Roofing Covering
WS Window and Siding
i SF Solid Fuel Burning Appliances
( / OCfe4 d `eey () askime I/,COi,„t I Insulation
Telephone Email D Demolition
5.2 Regist ed Home Improvement Contractor(HIC)
4 _OS i7s
,A Lem S v<v c i--t 0 tJ i'V C HIC Registration Number Expiration Date
HIC Com Name or HIC Registrant Name
\Z-"t a Jer5tct`t .fie- ad r �•a�t� r�. IDNo.and Stye Email d'ess 41
a rc o yi3 1..(7Fs "16c (
City/Town, tate,ZIP Telephone
SE ION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers C penation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affida will result in the denial of the Issuance of the building permit.
Signed Affi vit Attached? Yes ' l3 No .Cl
Fi SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
f
I,as Owner f the subject property,hereby authorize C .A.A.N.t -r1�4c Pv to,Nito act on m behalf,in all matters relative to work authorized by this building permit application.
Of1/41-3\--C) V-kk-C--(Th I -0"S' i-2, k
Print Owner'4 Name(Electronic Signature) Date
SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering ray name below,I hereby attest under the pains and penalties of perjury that all of the information
contained it n is true and accurate to the best of my knowledge and understanding.
� 12�IZI
Print Owner's or Autho Agent's Name(Electronic Signature) Date
I 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.nlass.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 itrea(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross livin area(sq.ft.) Habitable room count
Number of places Number of bedrooms
Number of 'athrooms Number of half/baths
Type of he ing system Number of decks/porches
Type of c ' g system Enclosed Open
3. "Total 'roject Square Footage"may be substituted for"Total Project Cost"
I
i
• s ; . City of Westfield, Massachusetts
�'yry Building Department
_, i 59 Court Street
l%)-1.:il 1 '' Westfield, Massachusetts 01085
I',�)c1 Tel: (413)572-6251 Fax: (413)572-6389
Carissa M. Lisee
Superintendent of Bull logs
LOCATION OF DEMOLITION DEBRIS
1 ►2s 1\644,,Sf- 1'vv Aarn p�09
In accordance wit the provisions of MGL c 40,S 54,a condition of Building Permit Number 13 P 2 z 1 "II 0 3
is that the debri• resulting from this work shall be disposed of in a properly licensed solid waste disposal
facility as defined by MGL c xxi,S iSoA.
The debris will be disposed of in:
.
I U 41Le y Pecyr rt A 9)
( cation o Facility)
{
..--
SignaMiXiiiit Applicant
4ZT/2,(
Date
II
I
The Commonwealth of Massachusetts
'eZiel, '
„ i ori
,, Department of Industrial Accidents
1=1 1 Congress Street,Suite 100
t�?= f Boston,MA 02114-2017
11.1117)
www mass govidia
`0 ;Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Annlit nt Information Please Print Legibly
Name (Businass/Organization/lndividual): ."'--Op_,..),.. (2,2)--).,_ t ,,v r 1.,j
Address: Cli,2 to u e_r \c .vvo
City/State/Z ip: G c ct Au k. Ol.o 3 cJ Phone#: '//3 'Y 7 .7.6 GJ
I
Are you an employer?Check theem appropriatej box: Type of project(required):
43'1 am a empl f cr with G._. employees(full and/or part-time).* 7. ❑New construction
2.1::I am a sole proprietor or partnership and have no employees working for me in 8. `i/'emodeling
any capacity.[No workers'comp.insurance required.]
3.0I am a homeiwner doing all work myself.[No workers'comp.insurance required.]t g Demolition
4.0I am a home owner and will be hiring contractors to conduct all work on my property. I will
10[]Building addition
ensure that contractors either have workers'compensation insurance or are sole ILO Electrical repairs or additions
proprietors •th no employees. 12.0 Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.1
a
6.0 We are a corlioration and its officers have exercised their right of exemption per MQL c. 14. Other
I52,§1(4),aad we have no employees.[No workers'comp.insurance required.]
*Any applicant that creeks box#1 must also fill outthe section below showing theirworkers'compensation policy information.
t Homeowners who aidunit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Contractors that cheU this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the su -contractors have employees,they must provide their workers'comp.policy number.
lain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. .�--
Insurance Comp y Name: ;4-- \--E t`-�L k.t-�
Policy#or Self-- Lie.#: 2 e 0 S Expiration Date: '7 1 i`t 12 z_
Job Site Address', \`7 T J`o C 01 4JLc-- City/State/Zip: P of *0., P i-oJki !t&/-
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure*overage as required under MGL c. 152, §25A is a criminal violation pmishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the vioblator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby ce ' un :d penalties of perjury that the information provided above is true and correct.
Signature: Date: � Z&---/7_I
Phone#: 4(e 3 `/7' 9&' (
Official use orry. Do not write in this area,to be completed by city or town official
City or Town Permit/License#
Issuing Autho (circle one):
1.Board of H lth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other