24D-059 (8) BP-2022-0451
177 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-059-001 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-2022-0451 PERMISSIONIS HEREBY GRANTED TO:
Project# PORCH REPAIR Contractor: License:
Est. Cost: 500 NEIL MENDELSOHN 112441
Const.Class: Exp. Date:07/24/2022
Use Group: Owner: LLC PIONEER ENTERPRISES,
Lot Size (sq.ft.)
Zoning: URB Applicant: PIONEER PROPERTY SERVICES
Applicant Address Phone: Insurance:
125 GRAY ST (413)218-4733
AMHERST, MA 01002
ISSUED ON:04/28/2022
TO PERFORM THE FOLLOWING WORK:
PORCH REPAIR
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: i �( 9-0,l •
I
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
I
The Commonwealth of Massachusetts APR 2 7 2022 FOR
W
Board of Building Regulations and Standards MUNCIl'ALITY
Massachusetts State Building Code,780/CMR USE
Building Permit Application To Construct,Repair,Re>iovate Or 4NSRF1 y edMar 2011
One-or Two-Family Dwelling -- kin
This Section For Official Use Only
Buildin Permit Number: �—K2-. 4S'/ Date Applied:
Cu i�J Koss �� y•ZS ZOZZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Addr 1.2 Assessors Map&Parcel Numbers
I 7 17 01 rD.rP r c s--. 7 os� - oca 1
1.1a 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(It)
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.40,154) 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❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record;
rt Onee1 Cn{erpiiSef APIA et! 1 , (1 0/O o 2
Name(Print) City,State,ZIP
I zs 6 re)y c4. y,3.2/e, 'z pioneerpsiicefrlaiicosi
No.and Street Telephone i Email Addrehf
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) 1137rAlteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units `2— Other ❑ Specify:
Brief Description of oposed Work': J 1p(1V v/0/ ez coo r A el 6 ra( ,,. /
PPM o oh orCh vJ r �jnII( inJ/// Peg.) ov A',„ Q,, r�
I'Uh`Cik QL pal r'
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 5 0 0 1. Building Permit Fee: $ 6 S Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:if ittc
Check No. `(1 Check Amount: Cash Amount:
6.Total Project Cost: $ SO 0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisoif License
(CSL) ) I 7-1-1—i I -7�2L/f ZZ
1 - /Ale; I en�L o 1 n License Number Expiration Date
Name of CSL Holder
1^e, List CSL Type(see below)
No.and Street Y T Description
A milL p r f F., /1 woo?. U) Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,State,ZIP 1R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ) ! 7 9 2- S _ 2
p
I►onee( 1 orv/0 P9'y V M'(ef
HIC Registration Number Expiration to
HIC Company Name&MC Registrant Name
IZs' rgs y f pi°ntPc�l�G ej► A' Cow,
No and,Street
Am/erg r, M/4 ot007- tiazie.v733 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
property,hereby a tr4# fP✓✓► C to./
I,as Owner of the subject ro authorize / i bit Cl°� �rn
to act on my behalf,in all matters relative to work authorized by this buildinjermit application.
Ne, I MI 6le/1o%n y
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
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.
Ne,•I1/1, / h1 //7-1
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.massgov/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
oa M. • C . . iI
*.'''' Massachusetts - - �'i
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` `! �, ' DEPARTMENT OF BUILDING INSPECTIONS a
O' .
�, y �@ 212 Main Street • Municipal Building Jti. •
�� Northampton, MA 01060 rr ; ',��C
CONSTRUCTION DEBRIS AFFIDAVIT
(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 (4141%Facilit :ytlf ./..' /0 e'710047 / -1--r< i k)
The debris will be transported by:
Name of Hauler: ' " 4
Signature of Applicant: Date: ` /4
The Commonwealth of Massachusetts
;mt •
W` Department of Industrial Accidents
=:�h 1 Congress Street,Suite 100
:= — Boston, MA 02114-2017
.:, wwwntass.got�/din
1l i,e kers'Compensation Insurance Alridas it:Builders!ContractorslElectricians1Pluinbers.
1)BE FILED WITH TIIE PERMITTING AUTHORITY.
\pplicant Information Please Print I.ei ihh
c Name 1liusin -s l.)rtaniirnon►mit%'dual I: Pi tO n e r r /(Q t} r',)/ sJ Pi�t•[(i
Address: / Z r 6 rei / aft. r
City/State/Zip: t)Mbtti1 j (V14 01o0Z- Phone#: V/ 7, 2 /s, t,'777
Arr yuu an rmplrrel'?('heck the appropriate hot:
"C)prof project(required):
1.0 I am a employ es with employees(full and or part-tune t• 7. D New construction
_' nt a sole proprietor or partnership and hate nu employees working fur m:in1 Xa S. Q Remodeling
y capacity_[No workers'comp.insurance required)
9. ❑ Demolition
30 I ant a homeowner doing all work myself[Nu workers'ions insurance required.)'
4.0 I am a humw nt-r and w ill he hiring
mtrutura Cuconduct all w i k on my property. 1 will
1 0 Q Building addition
sv
ensure that all contractors either have workers'compensation insurance or an sole 1 I.a Electrical repairs or additions
propnetun with no employers_
12.0 Plumbing repairs or additions
50 I am a eemeral contractor and I has a hired the sub-contractors listed on the attached sheet.
13 Roof repairs
These soh-contractors base employees and hr..:%%token'coop.insurance.-
14. Otl 'i �C�c',/ /Oo/c`j
6.0 We are a corporation and its officers lose exercised their nght of exemption per A1GL e. /
I 52.j 1111.and we base no employees.[No wutkers'comp.insurance required.[
•Any applicant that chocks box a must also till out the section below showing their workers'corrtpensaliun policy infunnattun.
+Itonieuwriers who submit this attidatit ind,cahne they are doing all work and then hoc outside contractors mist submmt a new affida%it indicating such
:Contractor that cheek this box must arts hod an additional sheet showing;the name of the sutrcoatracturs and gate whether or nut flux cnhtics base
.-mplotces. It the sub-contractors lessc enirknas.they must pits ode their worker"ss'rip policy number_
/ant an employer that is providing worbers'compensation insurance for my emptorees. Below is the policy and job sue
information.
Insurance Company Name:
Policy#or Self-ins. Lis. -`: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to S1,500.00
and or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S25O.00 a
day against the violator.A copy of this statement ntay be forwarded to the Office of Investigations of the DR fur insurance
coy erage verification.
I du hereby tertifj.under the pain.,at penalties of perjury that the info rotation provided a re is true and correct.
Signature �7 Date: /1 Z 7--
Phone:: Li )7 e 2 I p, 7 7rs
Official use only. Do not write in this area.to he completed by city or town official
City or Town: I'ermitiLicrnse#
Issuing Authority (circle one):
I. Board of health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: