32C-155 (9) BP-2022-0697
39 KINGSLEY AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32C-155-001 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-2022-0697 PERMISSION IS HEREBY GRANTED TO:
Project# Contractor: License:
Est. Cost: 11570 BENJAMIN JOHN imyt0
Const.Class: Exp. Date:
Use Group: Owner: B MORRIS MARYANNE
Lot Size (sq.ft.)
Zoning: URC/WP Applicant: BRJ BUILDERS LLC
Applicant Address Phone: Insurance:
PO BOX 505 (413)800-4253 WCV0148400
BERNARDSTON, MA 01337
ISSUED ON:06/13/2022
TO PERFORM THE FOL LO WING WORK:
DECK REPLACEMENT
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: Q
• 3-1•1 •1
Fees Paid: $78.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
eTrna l fl-I , t
RECEIVE T e ommonwealth of Massachusetts
and . Building Regulations and Standards FOR
ssac usetts State Building Code,780 CMR MUNICIPALITYUSE
)JuN13rrm Appl cation To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
U_ '' This Section For Official Use Only
Buildifl P ?ffti @6O 4N.r a A'`! 91 Date Appli-d:
- I I - Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numje�rx.
39 I - s(,� A�A- 3.ac_. 15 5
1.1 a 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❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Md.r IAI�r% r' r ori9 _h r
011.. 4.M fi-OrT 1 ✓V\14 O t C too
Name(Prit) City,State,ZIP
34 t.i r6g 1.t-4j ► Zv;- 41 3 33O a.)-la-rrQ.-.3 anr,... w'o.-rc Q e.o1%.C444-.k.�-}
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ii Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work': Dp.&x rci lC•CLM-c.&r t S II i.r cl d o r ir-ceto.K".c.&r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $, 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $ 78.QO
Check Noa x3 Check Amount: Cash Amount:
6.Total Project Cost: $ 1 \ S Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
1
5.1 Construction Supervisor License(CSL)
C'5,- tI2qJ4 I /9/ t�L �`f
a'' ..m 1r•1 Ill . John License Number Expiration dilate
Name oT'C'SL Holder r ,
P.O . i3O List CSL Type(see below) C.C.•
No, and Street Type Description
ta-trn Qke+or , N A' CI 3'7 U Unrestricted(Buildings up to 35,040 cu.ft.)
R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
•
RC Roofing Covering
WS Window and Siding
eel
SF Solid Fuel Burning Appliances
q13-600-IIZS3 Del ED ezci bun 3dn.(_c !'NI t Insulation
Telephone Emai address 1 D Demolition
5.2 Registtenered Home Improvement Contractor(H IC) } 7g 4 0a/ t i 1 ,.,.h - 1
1 -+�-1. HIC Registration Number Expiration Date
III Company Name or IlIC Registrant Name
Po• Qo x ,57t S riler,& .br\ bc�i I dills..
No.and Street tail address
fin) Mfic O I�37 313fSDD-425
City/Town. State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT (M.G.L.c. 152.a 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 Il 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 1:3u.30 ,M i (—.$ 1-• .,„),ehn
to act on my behalf,in all matters relative to work authorized by this building permit application,
12/1
mint Own 5Fe Kronie 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.
1 13.c..n:a.rH r% GZ, -Sokn L,/13J76z2.
Print Owners or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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 rj have access to the arbitration
program or guaranty fund under M.G.L.c. I42A. Other important information on the HIC Program can be found at
www.m:tss.govioca Information on the Construction Supervisor License can he found at www.mass,gov/dpi
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
SETBACK PLAN
MAP: LOT:
LOT SIZE: • I 1.1
REAR LOT DIMENSION:
REAR YARD 3 Z
t�t A,cc,k
OLT GC5
SIDE YARD 1/0. /r/ J�^^ �� SIDE YARD
ll/ L
�L
ko0tdc9c
17. S
`2-e VGIOrG7
FRONT SETBACK 1-1
FRONTAGE
Massachusetts Interactive Property Map
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City of Northampton
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j✓'•"' Massachusetts tee,
JAI VA
DEPARTMENT OF BUILDING INSPECTIONS S'•
212 Main Street • Municipal Building
\ = Northampton, MA 01060 '''s h. . D%10
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: n c:{q 3+ . a,F-Jr e,(dL i rti-I I- 616-18
The debris will be transported by:
Name of Hauler: o sTut -k.irn •
Signature of Applicant: Date: (2 -/37 -7,6'Z Z
'1 1he commonwealth of Massachusetts
Department of Industrial Accidents
Mit t,- Office of Investigations
sat=j Lafayette City Center
�,s � "" 1 2 Avenue de Lafayette, Boston, MA 02111-1750
. r ,� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le>:ibly
Name (Business/Organization/Individual): Bu`-Th- R C.t i t a e FS
Address: f- 0 . L ax' St' S
City/State/Zip: -P.r-n -...:_________________0— z4l_..Zj 01337 Phone#: 4f 3 - 3 cis—— 967/,.S"
—
Are you an employer?Check the appropriate box: Type of project(required):
1.V 1 am a employer with 1.1 4. ❑ I am a general contractor and 1
6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. Remodeling
2.❑ i am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in anycapacity. employees and have workers'
P ty'. 9. ❑Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ i am a homeowner doing all work officers have exercised their i I.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] + c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information.
I Iomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
:mployees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. n insurance Company Name: /r' 1 a f1'H C Chcx
` r-4-e-r ' -c-)Spa-.CCc -- ra-r 1/
Policy#or Self-ins. Lic. #: W C- VC) 1 1-18 a1a.) Expiration Date: a /i (zoz_3
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of the DiA for insurance coverage verification.
i do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
-
Signature: 71,,(,.<:.e..../..---. Date: to _1 3-to Z Z
Phone#: q[ 3 Li S - q 0
Ofcial use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
I❑Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5alumbing
Inspector 6.0Other
Contact Person: Phone#:
_ - . . _. - _- __
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