25C-251-002 BP-2022-0932
54 FAIR ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-251-002 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-2022-0932 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est.Cost: 1000 JOESEPH JASINSKI CSL05702'5
Const.Class: Exp.Date:06/05/2023
Use Group: Owner: HAMPDEN HAMPSHIRE FRANKLIN &
Lot Size (sq.ft.)
Zoning: URB Applicant: J&B CONSTRUCTION
Applicant Address Phone:, Insurance:
54 FAIR ST (413)584-0307 AWC-400-703 5 3 1 7
NORTHAMPTON, MA 01060
ISSUED ON:08/08/2022
TO PERFORM THE FOLLOWING WORK:
NEW ROOFING ON 4-H BUILDING
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: el • ".9 • cPata
I r
Fees Paid: $100.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massac se s AUG 2C�2
"� 1 Office of Public Safety and Inspectio s
t�.�I�l f r Massachusetts State Building Code(780 ) DFPT of
Building Permit Application for any Building other than a One= T#oi44 wig i11.
_
(This Section For Official Use Only) Mq 01 t)ti
Building Permit Number: C/ ate Applied: Building Official:
SECTION 1:LOCATION
S Li Fair S4- A/vr-4-17ams+ O/a(ncU -fl f-x=.41 f -�
No.and Street City/Town Zip Code Name of Building(if app'cable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building'§. Repair, Alteration 0 Addition 0 Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No
Brief Description of Pro sed Work Q-e,T" OY1 4—H Fc4:4 13..c+1, but L
Aa�-c Ci. <GCZ,rs,Lrt ' As(-e L- er bf
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) D
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
N p ^ 6, 161_ Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA CI IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV El VA VB
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public 0 Check if outside Flood Zone 0 Indicate municipal ElA trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system❑ required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes 0 or No 0 Yes❑ No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner f i.w140S6<<C, Fretn iOn*AA((l.0.441 t':4t ',s r;<<.l t,r 5,--x-.€I j
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information
eetnerft( mx-vceiler 413 V - 37 Cr(3-S _) 7s i n F�e.g C. +1.7 (.CA)._
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
J co., eCZI.(&a.(L - Feirr c . A.3"4-t,.a.„0-e.A N.U4 AP t a(oO,
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
J 3 C,>vv {r.ac-fla„N
I
Company Name
Name of Person Responsible for Construction License No. and Type if Applicable
Ltv? 6al,r Gk. /lJ vc _w•10.6,,, Yu Pr D ( ak0-b
Street Address City/Town State Zip
4/3-5( 03047 t-(3 sag-tr-P)3 +ceic-401-3cest/$06@aA(.cu-
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the is uance of the building permit.
Is a signed Affidavit submitted with this application? Yes No Cl
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ /i .
1.Building $ // 7 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)_$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$i CO (contact municipality)
5.Mechanical (Other) $ / Enclose check payable to C�' 0f- /
6.Total Cost $ /� ��a (contact municipality)and write check number here ,,7 9
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this jy
application is true and accurate to the best knowledge� and understanding. 1�/
Jc 1 g( LaCi tcQ (. U(; - SY_ �c�3'1 Cb N
e
Please r' t and sign name Title Tele hone No. Date
Li ir'�� S�" sf3eK4 lctilwt All - Z'(17(cr7 j a-c 3c-u-nktfat2r.c.A.s.u-
Street Address City/Town State Zip Email U Address
Municipal Inspector to fill out this section upon application approval: ��� -?"ZDZZ-
Name Date
Re-roof with architectural asphalt shingles over existing single
layer of 3 tab asphalt shingles on front and back of 4-H Food
Booth building
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The Commonwealth of Massachusetts
Department of Industrial Accidents
r = 1! Fi 1 Congress Street,Suite 100
Boston, tl:t 02114-2017
' ac' r- oos..ntass.gov/ilia
1l to kern' Compensation Insurance Af idas it: Buildersf('ontrat(ors:Lice(ricia us•I'luntberlt.
I BE 1-11_t_U 1%1111 111E PERM'FILM;Al I IIORI I 1.
Applicant Inforinalion I'irast Print I_ee.ibly
Name(Business Orramzationllndividtml):"µme I^y►:fc,f c' `L-l.•-1 d '4Cie. CQr-, (ie-.v(4 cS - ,e2).e.kui
Address: ib —c 3(75- S 1-( Fee c .
City/State/Zip: No-C44.4.10k4, tow f)1t c7 Phone#: 1-( t 3 - S C`( - ,, S'i
Are you as employee Check the appropriate bus: Type of project(required):
I. I am a employer with 1 _ r pioytes(hilt anikoe part-time)_' 7. a New construction
2 l am a wale pmprie' or pnttemhip and have no empkw.Ys working for me>n $. Q Remodeling
any capacity_[No workers'comp,iasuran.x rrquin:4A
30 t am a homeowner cluing all work myself.[No winters'corral.itsiurmcc moire&I.
9. 0 Demolition
4.0 1 am a lwrnrowner and will be h ew contractors to conduct all awl on my pro party. 1 a ill 10 CI Building addition
ensure that all contractors either have worker,'compensation insurance on are sale 11.a Electrical repairs ur additions
proprietors with no terrtptovert.
12.0 Plumbing repairs or additions
q:3 1 am a teneral contractor and 1 have hired the sob.cuntracturs timed on the attached.heel 13 Wf aim
These w m b-contracu base employees and bate workers camp.insurance.^
613 We are a corporation and its officers haveesen-ised their right of etc Iron pet Skit c. 14.❑
1$2,.§I(4).and we have no anployecs.[No workers'comp.insurance requited]
1
'Any appbearrt that decks Tart al must also fill out the set-tide below showing their workers'comminution policy information_
t Homeowners who submit this ar1:'rdavrt indicating they are.tang all work and then hue outside contractors mint submit a new affidac it indicting su:h.
teneatae ars that cheek this hot moo attached an additional sheet showing the name of the sub-cuacut.rs and stale whether or nut those cithties have
employ ccs. It tie sub-contractors base employ cos.t1n-s most pnMdcrtheir workers'ecnnp.policy numler.
I am an employer that is providing wurbers'compensation Insurance for my employees. Below is the policy and job site
information.
lmurtn,:e Company Nanft:: A. 1.M. VkcceQ k n.S�c4-v‹.4. C.4-,tn4...fc.xu t —
Policy#or Self-ins.Lic.#: PrIk)C k1 a>-1 C23s3 I'l-::,a 7 A Expiration Date: v'7 14 I tf P �
Job Site Address: 54 Ec City/State/Zip: /1/4.575� r t 4 FF Dl Olc_t.
Attach a copy of the workers'compensation polity�page(showing the police number and ettp Lion date).
Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to S I,500.00
:uul+or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may he luryrarded to the Office of Investiguttom of the DIA for irsurance
coverage verification.
I do hereby c t under the penalties of perfroy that the information provided abase it true and t urre'ct.
S:LttJ t llttf d, //IL—_. Date: g/516: 4;
Official Else ondr. no not write in this orevt.to be completed by city or town official.
('its or-I ow n: Permit/License#
Issuing authority (circle one):
I. Boa al of health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
It.Oilier
('stance Portion: Phone#: __
City of Northampton
y Massachusetts fit
16 _ DEPARTMENT OF BUILDING INSPECTIONS
0: 4"
: 212 Main Street • Municipal Building Jb.
\. r4` Northampton, MA 01060 ss
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: L( ` OLd S'z', I3Z7 "1 4c>1/ OAA tO(QD
The debris will be transported by:
Name of Hauler: U 5-' R uoa-Sie -t-
Signature of Applican : b"2"-. Date:
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