25C-221 (5) BP-2022-0926
50 WALNUT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-221-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0926 PERMISSION IS HEREBY GRANTED TO:
Project# Contractor: License:
Est. Cost: JDR BUILDERS 104530
Const.Class: Exp.Date:01/21/2024
Use Group: Owner: GOHR GOHR FRED W JR&JAI MARLA
Lot Size (sq.ft.)
Zoning: URC Applicant: JDR BUILDERS
Applicant Address Phone: Insurance:
PO BOX 66 (413)665-7587 WC9024479
WHATELY, MA 01093
ISSUED ON:08/05/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE EXTERIOR DOOR
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:
1 r • )42 - 51—°1 ' f
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
/J .The Commonwealth of Massachusetts
4o � oard.ofBuilding Regulations and Standards FOR
G aSsachus s State BuildingCode, 780 CMR MUNICIPALITY
, i USE
do 0,F uilding 159 it A lication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
9Ttiqit;,�,,,n,� ne-or Two-Family Dwelling
�''�•4�1pFr This Section For Official Use Only
Building Permit N U' �oNs eta A)- — 924 Date Applied:
1 UR)42s5 /Z' Z 8.5-26zz
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
S L/ lnu - Sire.f a,6'C.. .. •D-!
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 �f ��ord: Co014K. W0 ('t� A'�1 / 1/1�/� 0/6 GO
Name 'rint) City,State,ZIP
;-O � (),L��� Si C11) (Dq./. )1
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0° Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': RR p 4 a X I... 0 r r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ I rota 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 $
-11 if
Suppression) Total All Fm$
Check No.M) Check Amount Cash Amount:
6.Total Project Cost: $ lyoa 0 Paid in Full 0 Outstanding Balance Due: ,
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
71 YX a n Rs,rr License Number Expiration Date
Name of CSL Holder ' )
I'o a2 Lit-It r f) List CSL Type(see below) V
No.and Street Type Description
n^ U Unrestricted(Buildings up to 35,000 Cu.ft.)
�� ly 1"1u `��� R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
Gig
37ti S t' c-ley
Qs
s 0n a lek c SF Solid Fuel Burning Appliances
_/ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) l J/7 c c 3 _9—2 4(
I 0(a � , lc/s- c 1 "C HIC Registration` Number Expiration Date
HIC CompanyNaa or HIC Registr t Name
? t -y 4^ ti/ic fa sj—D C 50 Ra ..0_,,-s ,,„,
No.And,Str et Email address
W 'frr/,y 0lu93
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 P No 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FORBUILDING PERMIT
•
I,as Owner of the subject property,hereby authorize 3 D i 12„;/dcS i 1 C 7 4/-44. /,,-- laic(
to act on my behalf,in all matters relative to work authorized by this building permit application.
rfi 6oirn
Print Owner's Name(Electronic Signature) Date
4-•-, 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 is 'on is e and accurate to the best of my knowledge and understanding.
i,
HZ/
�,Print Owner's or uthori edgent's Name Electro i nature
( g )
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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
b*,t:1 P/r(.-,.i1 mrr� aw�~,' , • StCff
/ Massachusetts
c
,)
l_ l DEPARTMENT OF BUILDING INSPECTIONS ' : 'je°
\,. 212 Main Street • Municipal Building , A 1�
� Northampton, MA 01060 fr.
.'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 Facility: i i-ey Re cy chi)
The debris will be transported by:
Name of Hauler: JD /2 /deJ'
(,
Signature of Applicant: L /1-. ._____ Date: / ' Z
"� The ('rtntntuntvealth of Massachusetts
Deportment of Industrial Accidents
_~ c Congress'�' CongressStrcet.Suite fftl'?
:h Bruton, M-1 (1211.$-2llf'
WW tlnnas.c. or/dur
11 s,rkers'Compensation Insurance Affldar it: Builder tuntractorsiElrctriciantlplumbers.
It)HE FILE)4A 110 THE PERMUTING At"100I0 tit.
Applicant Information Please Print Ix+iihlr
Name ustrieis.Cri ;antzau lndtwdual l:__ 3 D irk- 1)L I ,14'^S In C._
Address: Po 4
City/State/Zip: yt'i` ` 6, fn'w' 01091 Phone#: (//3 7 I - so q
Are yam rrrt mptoyer'!Cheek die appropriate box:
Type of project(required):
3.1-1 ant a employer with a_.__ employees Bull ardor part-tinrtcl-` 7. 0 New construction
20 I ant a stile prupnctor or purtacrshrp and has a no cmp1rvcta workumg air mc m 8. Q Remodeling
any capacity.[Nu wuriert cianp.insurance requircd.l
30 I ant a hum eovun r doing all work myself.(No workers'cunnp.insurance nquintl.l`
9. ❑Demolition
4.0 I ant a homeowner and will be hiring cunuw trrs to t-anduet all wink on my property. I will 10 Cl Building addition
eo
ensure that all cmuraciurs either have workers'runrperuation insurance or an:sole 11.0 Electrical repairs or additions
pruprictu+s with no employees.
12.1:1 Plumbing nrepptirs or:additions
SO I ant a general contractor and I have hind the sub-contractors listed un the attached skeet
Them:sub-cuntractors have enpluvcc-s and have corners'comp.insurance:: 1 Roof repairs
•
6.0 We a a corporation and its officers have cx. iised their right of cacrnpu .un per MGL c 1 0 '
are
er
152.;,)1(4),and we have nu urprluyccs.[No workers'comp.insurance required.]
`Ann applicant that decks but al must also fill out the suction beluu showing their workers'compensation policy information.
+(tin ..,wnr%who suttrnti this atlidat it indicating tluy are doing all work and then hie outside contractors must submit a nett aftida%it iodic ling such.
Ituntractura that cheek this box must attached an additional sheet showing the name of the suprctattracturs and mac whether or not those entities have
employees. if the sub-contractors have crnpluyces.they uwse provide their workers'cutup.policy number-
m
I am an employer that is providing workers'compensation insurance for my employees. Below is the poliry and job site
information.
Insurance Company dame: t (
St le Ck`t e 1 ACA)P
Policy#or Self-ins.Lic.#:— 1U C I Oa _f y 74 Expiration Date: d I/2 9
Job Site Address: S e) We4 I t r 5/Tee f- City/State/Zip: WAX¢L
Attach a copy of the workers'compensation policy declaration page(showing the policy amber and e n date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to 1,500.00
andior one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement nray be forwarded to the Office of Investigations of the DNA for insurance
coverage.verification.
I do hereby cer y ut der the pains and penalties of perjure`that the information provided
iabove is true and correct.
Signature: Date: O/it 2 1,--..
Phone?:: CI13 3-y 'roc/
Ofcial use only. Do not write in this area.to be completed by city or town official
('its or Town: PermitiLicense
Issuing Authorils (circle one):
I. Board of Ilealth 2.Building Department 3.('it}:r loan Clerk 4.Electrical Inspector 5. Plumbing Inspector
hi.Other
Contact Person: Phone#: