25C-047 (3) BP-2021-2109
218 NORTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-047-001 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-2021-2109 PERMISSIONISHEREBYGRANTED TO:
Project# REPAIR LANDING Contractor: License:
Est. Cost: 4800
Const.Class: Exp.Date:
MENDELOWITZ EITAN GILAD & ELANIT
Use Group: Owner: WEISBAUM
Lot Size (sq.ft.)
MENDELOWITZ EITAN GILAD& ELANIT
Zoning: URB Applicant: WEISBAUM
Applicant Address Phone: Insurance:
218 NORTH ST
NORTHAMPTON, MA 01060
ISSUED ON:11/01/2021
TO PERFORM THE FOLLOWING WORK:
REAPAIRS TO LANDING
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:
Fees Paid: 565.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts; 1
w Board of Building Regulations and Standards OCT R
Massachusetts State Building Code,780 FMR 2 8 �427 IPALITY
SE
Building Permit Application To Construct, Repair',Reriiivate,, coolish a evis dMar 2011
One-or Two-Family Dwelling' - A'^`2F r,',i:rq ,�'nr^r,insb-
N.l7q 07Cr0O
This Section For Official Use Only -�`o
Building Permit Number: - Date Applied:
Building Official(Print Name) Signature
---��
SECTION 1: SITE INFORMATION
1.1 Pro a Address: dJ i 1.2 Assessors Map&Parcel Numbers
1.la Is this an accepted 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 0
Check if yes❑
2.1 Owner'of Record: ��� �� �/
k t iie1, �.((w +z_ I�lo(414.,,,�, 060
Name(Print) �� k City, State,ZIP
249 A/0rit, S4. (32.3)gY-YYs7 e WA,L,M®q Me,/l• com
No.and Street Telephone Emdfr Address
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s)A( Alteration(s)A( Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other,/❑ Specify:
Brief Description of Proposed Work': ,s i,1) f-4( rim_ U Z-('P Reiff "400 -
(�vt61ru /- SI New Cp1stire i�'P (/ ��C/iK, , /a sfrio5
rip D , 6 , p 1 th'' if' led c ; ;.. i, ,2 y pos/4 a-1 cU vreideo
i;01.0 c Y6' s<f
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ // f p 0 p 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
�( 1 Check No10'5g Check Amount:06.
Cash Amount:
6. Total Project Cost: $ ! ?a, v U 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofmg Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,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 .......... ❑ No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
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 true and accurate to the best of my knowledge and understanding.
Ert„ M��„ lolar/Zr
Print Owner's or Authorized Agent's Name(Electronic Signature) 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
•' Massachusetts mow? k- '<<
if Lo
+ ' . i' DEPARTMENT OF BUILDING INSPECTIONS
v. rl ' 1.
212 Main Street • Municipal Building ' OD
Northampton, MA 01060 PsHh, WO%�'
(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: VA fie/ ReC/21-‘\k.5
The debris will be transported by:
Name of Hauler: �/I
Signature of Applicant: Date: Alzr/u
The Commonwealth of Massachusetts
a1' Dipardnent of Industrial Accidents
k v_» _ 1 Congress Street, Suite 100
—"' —,�� Boston.►1I 0211�f 201"
. � `� ,r $1,..iwas s.go,:fdia
_ Wut.•kers'Compensation In:iu-auce Affidavit:Builders Contractor:Electricians Plumber:..
TO BE FILED WITH THE PERMITEL ( AUTHORITY.
Applicant Information 1 Attu Please Print Legibly
Name(BininessOrpmn iouludisidua:+ Fi f-t � I ./0A 3Attu 12-
Address. 1IV. N it-
C'ity?Sta> Zip_ X oriLI c.M10401 MN Phone:: 32- MCP WS/
Are you au employer'Check the appropriate box: Type of project(required):
I r_a rasp ryer with omplo twat iftt and or part-time I.• 7_ DNew.con:trncctton
❑I am a:ale propriamracp reatchip and l:m a no amploy oo:working for ma:a & D Reluodelrna
any capacity.[Notteriaaa cautp sasuranco ragauoi]
DI s 3os' „s 9_ 0 Demolition
•
10®Building addition
_ • amnia that 11.❑Elechzcal repau:a addmons
�sst • 1?.�Plurubing repair or additrai:
' El I ant a grams::onttactcratstIimaakiasdtba tub-contactor.L•:tad ea tha ara._had=rat flat❑I'IUOf repair:
Theta ratio actor.hoc maplarta and Imo masks='comp_im:uraaca
b D'li'e aro a casporaticn and ineffrcat:Imo aanrcisad that right of axomption par 11'L c 14.❑O
212. ;441.animators so employ a:.No warhar:'comp.;w:wean.ragairod.,?
•Auy applicant that chock%hoz al mutt alto fill ant the:action bolox tb.w inz ihair•xcrkort'comport:anon policy information
°.icmaowaor:xbo submit this affidr-it:sdicatii=they an dainz aJ work and than hiro vanilla contractor.mu:tsbmit a nom afida'.�:is9i.cauaz Itch.
cat-a:ton that chock du;box mutt attr:acd as adiitiona::hoot.amine the nano of iha:uhrcomuartor:and itata whether cc not t ie ant:tio:hoe
anaplo7;aat If the tub-contractors haca amplccee:.they mtr:t pro•:.9a that -archon'comp polio aambcr
I am an employer that is providing workers'compensation insurance for rnr mildorees. Belot is the policy and job sire
information
in:iva :e C onipanv Name: _
Policy=or Set#ms.Lie. _: E,umatron Date•
Job Site Address:_. _ Cm'State Z rp:
Attach a copy of the worker compensation policy declaration page(:honing the policy number and expiration date).
Failure to secure coverage a:required under MCA_ 152. `2,.A is a crmzinal violation punishable by a fine up to SI 500.00
and or one-year rnlpn:onment. a:well a:civil penalties in the foam of a STOP WORK ORDER and a fine of up to S2S0.00 a
day agaimt the violator.A copy of this statement may be forwarded to the Office of Inv a:tteatrons of the DL.for m..ucance
coveiaee verification.
I do hereby'certify'under the pains enables ofperjun'that the information provided above is one and correct
Si!iature:/ - 1 IMUSAV2j.
Phone=: 2 23 ,S01—(yf'
Official use oflt. Do root+071e in this area, to be completed by city or tome Off
Oita-or Town: Permit License
I::uing Authority(circle one):
1.Board of Health Z.Building Department ?.City Iown Clerk 4,Electrical Inspector Plumbing Inspector
6.Other 1
Contact Person: Phone=:
City of Northampton
`.
VF/f F� O
L^. Massachusetts e�
*
11 :( ,• 4 4 DEPART1 'NT OF BUILDING INSPECTIONS y m
-. '0.; 212 Main Street • Municipal Building 43,
Cs
N Y, Northampton, MA 01060 �s'N�y -�,D''
I, )� H►, e ()C1 O(,il r"f l_ (insert full legal name), born L/27/7 1— (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 Zr day of 00 , 20111 .
(Signature)
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