24D-007 (2) BP-2022-0589
24 HAYES AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-007-001 CITY OF NORTHAMPTON
Permit: A1ts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0589 PERMISSIONIS HEREBY GRANTED TO:
Project# DECK Contractor: License:
Est.Cost: 18000
Const.Class: Exp.Date:
Use Group: Owner: MECHEM JOSEPH W JR&JENNY B BENDER
Lot Size (sq.ft.)
Zoning: URB Applicant: MECHEM JOSEPH W JR&JENNY B BENDER
Applicant Address Phone: Insurance:
24 HAYES AVE
NORTHAMPTON, MA 01060
ISSUED ON:05/31/2022
TO PERFORM THE FOLLOWING WORK:
14X16 DECK
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: (Y1
I • a' , yl1 . ''1 ♦
I I ,
Fees Paid: $117.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildinc Commissioner
7 -CK File #BP-2022-0589
APPLICANT/CONTACT PERSON:MECHEM JOSEPH W JR&JENNY B BENDER
24 HAYES AVE NORTHAMPTON, MA 01060
PROPERTY LOCATION 24 HAYES AVE
MAP:LOT 24D-007-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT •
Building Permit Filled out
Fee Paid $737.00
Type of Construction: 14X16 DECK
New Construction � ��
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan iTH FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ORMATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Perm it With Site Plan
Major Project: Site Plan AND/OR SpecialPermit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Perm its Required:
Curb Cut from DPW Wa ter Ava ilability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission ' Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
a as
Si ature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
n -...-.. 1 - - 1 - ^ ..
Zii
a v;� = y u y The Commonwealth of Massachusetts/ M
• -n< Board of BuildingRegulations and Stan' ds �� 4 4 FOR
ii*c74r4 ry E Massachusetts State Building Code.780,0 20�2 IPALITY
- . , w USE
n�
c' Buil i� 'ermit Application To Construct,Repair,Renova t rt evised Mar 2011
o� rNw r5' One-or Two-Family Dwelling °N �'`�nro600Ns
a ry
rQ This Section For Official Use Only
Ba 4.1 1 �GiUl�l�\1 III ,� : 0?- aoew'l- 6S 5 1 Date Applied:
P C ___Via f ' 1 ,' I
_,S-4.2a
Building Official(Print Name) I Signature
SECTION 1:SITE INFORMATION
1.1 Prope Address: 1.2 Assessors Map&Parcel Numbers
L‘A IaaLr$ iv c &\of\- ,-1146-. Off. 02 1/4-1 a ►o\ 007 i i 1
1.la Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zcining Information: 1.4 Proper�y Dimensions:
Qe;iaew1-4� ' -esJ�,vr-\ .54 A / 2_4( 53290F,) 1.001-
Zoning District Proposed Use Lot Area(sq ) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
10 IS IS 2.0 Zo 10t4
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public J. Private 0 Zone: Outside Flood Zone? Municipal 9. On site disposal system ❑
Check ifyesq,
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owne f r Recor scili : Pl �h /vi 7,i„1 AAA 0 O O
Name(Print) - -r Ciittyy,,State,ZIP /
7---1 It'y s e 9/77I i/ / jos►lmockewle j ‘l.(Di's/
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other IfSpecify: Dee.
Brief Description of Proposed Work': i o bu‘a p. L LI y-1 b Csec,V, 0 Ff - vLi,
ccu( ocF — 'ha'S-e
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1(8\ aa) 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $ ii
Check No. Check • flint: i''ll ►�sh Amount:
6.Total Project Cost: $ l�} DOO 0 Paid in Full ❑ utst:i .. :"..lance Due:
1- /t/ 4�
�� i g
i gig - U1
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)
City/Town,State,ZIP R 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)
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...........❑
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
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 ap ication is e accurate to the best of my knowledge and understanding.
2-yZz
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"
•
•
1 •
•
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CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE: • 5 1 AC-(CS
REAR LOT DIMENSION:
REAR YARD 100 ;"
peo,oS:r) ()Eck<
SIDE YARD 9 o c b SIDE YARD__ "°
MI=
FRONT SETBACK
FRONTAGE 100 k
2N-2]7M1
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21D-1117.001
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2Oi14111
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".. The Commonwealth of Massachusetts
. Department of Industrial Accidents
1,,
� �,.. a 1 Congress Street,Suite 100
_Isar Boston, MA 02114-2017
r
'49
www.mass.gov/dia
11 orkers' Compensation insurance Affidavit:BuildersiContractorslEketrieiansfPluitilwrs.
Cl) HI_ I ILL.)N 1•111 THE:PERMITitNC AUTHORITY.
Applicant Information Please Print Leribls
r----_.
Name(Busincxs Organization Individual): JV5C1 A itigaltec41
Address: Z y Harr e-
City/State/Zip: /Vic' -0p tan / a�b Phone#: q l' - 711- °-1( 3 j
Are you an employer?Cheek the appropriate hos: Type of project(required):
I.Q 1 am a ernpl yer with...mm_..,_....___,employ (full mutest part-time).* 7. Q New construction
2J 1 am a sole proprietor or partnership and have no etrrptoyeea working for me in g_ Remodeling
any capaerty.[Nu*micro'comp.uwutauct required.)
30 I am a homeowner doing all work myself:[No%makers'comp_intun'nee itquirerij' 9. 0 Demolition
4ia1 am a honsaawner and will be hiring omtracinra to conduct all work on my property_ 1 will 100 Building addition
ensure that all contractor either have wsnkct compensation imuraoce or are role 1 10 Electrical repairs or additions
propticWrs w aft no employers.
12.0 Plumbing repairs or addition,
3r3 I am a general contractor and I hate hired the sub-contractors listed on the attached sheet. 13❑Roof repairs
Them sub-cantracu,r%have empluvice,and have waxier,'carry.iseminrnr. �/�
6.0 We are a corporation and ib officers have exercised their rrgtrt of exemption let Ma_c. 14. Other �e� -`
132,¢i(4),and we hate no employees.[No workers'comp.anomraoce required.)
'Any applicant that checks box=1 must also till out the seetwn below shwa ingt their workers'compensation policy information.
f Fknneown'ns who submit this affidavit indicating they arc doing ail work and then hire outside contractors mist submit a new affrdarsit indicating inch.
:C'untracturs that check thin box must attached an additional sheet show nue the name of the sub-ccartr etors and saute whether in not those entntie,have
employees It the sub-cuniractcvs I.ie crreptoyccs.they must pro%idc ihrcmr workers'pomp.puhcw number
am an employer that is providing workers'compensation insurance for my employees. Beloit-is the policy and job sift
information.
Insurance Company Name:
—
Policy#or Self-ins.Lic.#: 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. USA is a criminal violation punishable by a tine up to$i.500 00
ani 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 violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
co%crier crntication.
I do hereby certify and the pain d nalties of perjury that the information provided about is dews and correct.
�icnatuic: I J /
i'i:r.rt:c 'l 17 -7/'r-1 l 3)
Official use only. Do not ',rite in Nri.area.to in completed by city or fawn official
City or Town: Permit/License x
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3.('ityr?own Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: I
City of Northampton
rr ,,,,, Massachusetts ���,,,,, : s
c
,„
( y, { DEPARTMENT OF BUILDING INSPECTIONS z
',"� 212 Main Street • Munici1140Wpal Building v� .D'
'--'1'' Northampton, MA 01060 sSJ', 1 e'
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 Facility: \\z,i\\1
(ZC,LIA,1:1\ Z3L1 gvaL n A (3 , N 4,,, ;kin t o11
The debris will be transported by:
Name of Hauler: iasol, 1L^Vc;IL
Si nature of A licant: jilt . 71Date: `S / / Z
g pp
City of Northampton
01110°N ‘S . Si
<4 Massachusetts �t25 .x-_ �'c�.
gu
1'l DEPARTMENT OF BUILDING INSPECTIONS t• z
\' 212 Main Street • Municipal Building Jti c.
LLD`� Northampton, MA 01060 �SNly '''
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
/ 111 ilI� l
I, oX f/1 / l /1'1 (insert full legal name), born _ (insert month,
day, r),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 ins and penalties of rjury on this /1 day of At/`` , 20
V r
(Signatu
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