25C-252 BPi202 2-1096
37 FAIR ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-252-001 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-2022-1096 PERMISSIONISHEREBYGRANT I TO:
Project# PIERS Contractor: License:
Est. Cost: 2000
Const.Class: Exp.Date:
Use Group: Owner: CAROL KARNEY STEPHEN &
Lot Size (sq.ft.)
Zoning: SC Applicant: CAROL KARNEY STEPHEN &
Applicant Address Phone: Insurance:
37 FAIR ST
NORTHAMPTON, MA 01060
ISSUED ON:10/12/2022
TO PERFORM THE FOLLOWING WORK:
PIERS FOR FUTURE STRUCTURE ATTATCHED TO GARAGE
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 VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 3)971
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
yy,c/1-(4,r0 (A—
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The Commonwealth of Massa uset )'
� Board of Building Regulations an Sta '. d�EP I OR
, VYr • Massachusetts State Building Co e, 78 i CMR 1 20 UNI(CIPALITY
_ OFa 22 USE
Building Permit Application To Construct,Repair,.)Ze* tee* II-molish a Revied Mar 2011
One-or Two-Family Dwelling -Pri,i 'o\4 1nfSPrrio f
This Section For Official Use Only titH°'°os:s !
Building Permit Number: g,' a ''/d q Date App ied:
I '!
.
. , a 10,/.R/a.a
Building Official(Print Name) Signature Ddte
SECTION 1:SITE INFORMATION
1.1 Address: 1.2 Assessor%Map&Parcel Numbers
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(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
t
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 Rood Zone? Municipal 0 On site disposal system 0
Check if yes❑
2.1 Owner'of Record:
Ste tit tv kst. t •1 Mov2-1-134-w•PToN1 tin A- D\00
Name(Print) City,State,ZIP
Si F4.\2 ST Lai W06 3R\ Li S'i'EvEt-.4V_ ►E\ 64.0...Comm
No.and Street Telephone Email Address
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': t t rs 1w r -vt`E-N Yam, -Co r 6-t r Gt L(-C t✓-Q.. LA...),' 1'-t,
A 51' S — (247)f
Item Estimated Costs:
(Labor and Materials) Official Use Only
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
$
Suppression) Total All F
Check No V Check Amount`' Cash Amount:
��
6.Total Project Cost: $4j ❑Paid in Full 0 Outstanding 13,4..lce Due:
an.
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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
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this applicati n is true and accurate to the best of my knowledge and understanding.
Print Owne s or Authorized Agent's a Iectronic 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.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"
-r�-.
City of Northampton
Massachusetts
R ' DEPARTMENT OF BUILDING INSPECTIONS ti
212 Main Street • Municipal Building
Northampton, MA 01060 JJf.Jti, ,4,.-' '
(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 A4,4
The debris will be disposed of in:
Location of Facility:
The debris will be transported by:
Name of Hauler:
' �22
Signature of Applicant: Date: 7
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37 Fair St Plot Plan apx 10 foot GRID
C:\Users\steve\Desktop\8 GARDEN\37 PLOT GRID 10 FT SCALE
City of Northampton
` Massachusetts ��+ �1t
P; DEPARTMENT OF BUILDING INSPECTIONS s
+_► 212 Main Street ill Municipal Building 3 a
Northampton, MA 01060 sSilW 1,004.
I, S TF E ' \< Vi / (insert full legal name), born 1 t— "41 (insert
month,day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requi ements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a proje t 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 C R 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R'.1.2:
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on whi h there is,or
is intended to be, a one-or two-family dwelling, attached or detached structures accesso , to such use
and/or farm structures. A person who constructs more than one home in a two-year perio• shall not be
considered a home owner.
4. 1 do not hold a valid Massachusetts construction supervision license and, except to the extent t ,t I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the roject or work
on my parcel, I am not engaged in construction supervision in connection with any project or ork involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity re: lated 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 •r 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 pains and penalties of perjury on this 2 day of Sp'km ' , 20 20.
5 „/,,,,, 90(4p,
(Signature)
The Commonwealth of llassacltusetts
Department of Industrial Accidents
-iii_ 1 Congress Street,Suite 100
-i =cif,; Boston,l 02114-201"
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srrrn:niass.govilia
"..�cher.•Compensation Insurance Affidavit:Builders Contractor::Electricians:Plumber .
TO BE MED WITH THE PER ff1TNG.AtTIHORIIy
Applicant Information Please Print Legi ilv
Name 0$u iron L.Or inrnaoaInddili(htnl): 1 f.'P 4.G N <-‘,\tV4.0-N
Add et..s: 31 c-1. -\ ' 1
City;State/Zip: IV c!siL.T'kbvNA?TO(\; . Flip e =': LA 0 ‘— la S_3‘1 1
Are woe an employee Check the appropriate hex: Type of project(required):
1.0 I an a ttrplayer with employee:(fa!:and cr part-dine).' �Ti. DNew con;trucction
2.0 I am a sob reptietorar parmarYp and hare no employee:working for ma Ls 8_ pRemode➢an a
whip!-IXow.r>brrs'came.imasace x. ] -
❑w 9. ❑Demolition
t. 10 Q Building addition
tlillIllpIIIIIIIIIIIIIrllIll
11.❑Electzical repass or , .on
12.❑Plumbing iepans or . . ,
5.❑I an:a parietal coatacmraad Ihave hosed the:ok-cantra:tor.h;ted on du attached-jaw.
These cub-coactracmxi:hava amptoveet and hare workers'corm iattrrance: 13.❑ltaof entrant';
Daher ,
6.❑A'or ate a coeponoon.andin officer:hate starched their rapt of examptioa par 3SlrL c 14.
152.144).and wo bars ao employee:.[No workers•comp.tnoinane regm red.l
':bat,'applicant that check:boat a1 mutt alto Ell out the:noon betow:ho inst thair weaken'compeasa ke.pohcp infarm.ao on.
:loareouuerswho:nbmit this affida.it indicating they are tieing a:]work and than hire outside contractors mutt:mbmtt anew affida'.La indicating.loch.
eattr_mr:that check tin:bon malt attached an additional..heat:bowing the namia of the cub-contra sort and aria whether or rat than aunties Iiii is
acaploteet If the:ubtastracsm:have.mpio.;ao:,shay mutt pro'ida their worker.'camp.policy tmmbar.
I am an employer that is providing workers'compensation insurance for my employees_ Below is the policy arrdiob site
information.
Insurance Company Name:
Policy 4 or Self-ins.Lic._: Expiration Date:
Job Site Address: C itv'State Zip:
Attach a copy of the workers'compensation policy declaration page f:ho'i'ting the policy number and expiration date F,
Failure to secure coverage as required under MGL c. 15 , .A is a aiming violationpurriliable by a fine up to Si.5CO.I'i0
andL'or one-year inrpri:anment.a:well as civil penahie:in the form of a STOP WORK ORDER and a fine of up to S 50.00 a
day age:n-,t the violator.A copy of this statement may be forstaid.ed to the Office of Intiestigations of the DIA far insurance
coverage verification.
I do hereby c ertifr under the pains realties of perjar'that the ntfawation provided chow is t and correct
S,iimille /FW ��fDate ` '2b22MOM �(o1-a9i6
Official use only. Do not write in this area,to be completed by city or roam official
City or Town: Permit.License=
Issuing Authority(circle one):
1.Board of Health 1 Building Department 3.C ty limit Clerk 4.Electrical bespatter S.Plumbing In-. ,,
6.Other
Contact Perms: Phone Oh
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