25C-110 (5) BP-2022-1439
38 GRANT AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-110-001 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-2022-1439 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 SHOWER Contractor: License:
Est. Cost: 15500 RICHARD PALMISANO CSL89485
Const.Class: Exp.Date: 03/05/2024
Use Group: Owner: SUZANNE DANTONET
Lot Size (sq.ft.)
Zoning: URB Applicant: BAYSTATE EXTERIOR RESTORATION INC
Applicant Address Phone: Insurance:
87 SHATTUCK RD (413)374-2719 6HUB-6B21339-4
HADLEY, MA 01035
ISSUED ON:11/03/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE SHOWER ON 1ST FLOOR AND MAKE ALTERATIONS TO ENTRY WAY
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: r
I� . �' + �
• •
I
Fees Paid: $101.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of MassaEhuse F//°'.
Board of Building Regulations and Sty rds*op
: Massachusetts State Building Code„7$P. c, I2IN� IU P,EAI ITY
%�c� 0
Building Permit Application To Construct,Repair,Reno9, emolis a Revis Mar 2011
One-or Two-Family Dwelling \nn,/4,,
This Section For Official Use Only 4o,`�CT,
Building Permit Number: ,,- a-�'-l q 39 Date Applied: TO,2
€mot /155 l/2 11-3-70z-�
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
T &RA-ate (\- _f .5C. I/O
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 Ow erg of R cord:
Namrint) City,State,ZIP ,_
St-, 53-0557 , d�, KaAu,its lesiattk, < easy..,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building.? Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other)21pecify:
Brief Description of Proposed
op°�osed Wor 2: '
c�Q pM�` -1(k C cL Hl.o e�ae�� mc�. jI S boe�� s
{- Q(Yrk.)skao S it
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 5 OU0 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ TbC30 0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ d-SOU 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $ I CI =Check Not'11?.Check Amount 4/0(.c:—Cash Amount:
6.Total Project Cost: $ l ✓t � ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES 1
5. nstruction S p ' or License(CSL) --.3Ci, 1�-c 3 s-' yie
li Q\w's'o't c License Number Expiration Date
Name of CSL Hold r ��
l 5La k J . List CSL Type(see below)
No. d(Stregt Type Description
�J _I Fes, t �y 3- U Unrestricted(Buildings up to 35,000 Cu.ft.)
�l ��� 4 ID V J R Restricted 1&2 Family Dwelling
City/Town,State, IP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
13 a 1��9 [�0e t2 - I Insulation
Telephone Email address D Demolition
.2 Registered Home IIoomprovee�mer Contractor(HIC) t 9 0 )_59
S l))�C,t etx.�C., 5 �- �1 C� HIC Registration Number Expiration Date
IC C mpany 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 . 0 No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN s
OWNER'S AGENT OR CONTRACTZk
PPLIES B DING PERMIT
1,as Owner of the subject property,hereby authorize r lkiSe.,r-y)
to act on my behalf,in all matters relative to work authorized by this building permit application.
?A-7- U CI 3i /a
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
con i d in this a pl a'on is true and accurate to the best of my knowledge and understanding.
Print wner's or Authorized Agent's Name(Electronic 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"
City of Northampton
� n ` ' s s
�� Massachusetts 44 * ... ....„ .
tG
,�' wi ,Y
.- �- � DEPARTMENT OF BUILDING INSPECTIONS y. 4 t
212 Main Street • Municipal Building 0.k. .�'e�
Northampton, MA 01060 J's:b ..... `;;O
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:
I tr
Location of Facility: V,,, (2eC10_,A-E-70)
The debris will be transported by:
r_1
WName of Hauler: S 6 k--e2� Z, �'rZl6-kd
Signature of Applicant: Date:
The Commonwealth of Massachusetts
--�1,,,.. ,.„.... Department of Industrial Accidents
=itot� I Congress Street,Suite 100
Boston, MA 02114-2017
www.mo.ss.gov/dia
11 urkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
1'O BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information f Please Print Let<ibiv
Name(Busin Organization/Individual): C'i 4A, ,I Cn.o
Address: ( ,tr. "-- �
City/State/Zip: Phone#:
Are you au vaiptoyrr?Chcrk the Appropriate tors:
Type of project(required):
tatn a emgrloyer with : _ _employees(full trnd'or pan•tirnel.•
7. 0 New construction
2 I am a sole peoprietar or partnership and hare nu employees w'urkutg for me in K. odeltng
any capacity.[No workers'comp.insurance regains!"
9. Demolition
31:j lam a homeowner doing all work my-self.[No work as"comp.imaurnu:e required]'
i 0❑ Building addition
i.❑I am a homeowner and will be huutg contractors to conduct all work on my property. I will
ensure that all contractors either hale workers"compensation insurance or are sole I I Electrical repairs or additions
proprietors with no employees_
12.0 Plumbing repairs or additions
S17j lam a general contractor and 1 have hired the sub-contraeton listed on the attached sheet.
13.a Roof repairs
These sub-contractors have einpluyeea and have workers'rump.insurance)
14.QOther
,1:3 WC area corporation and its officers have exercised their right of exemption per MGL e.
1t'_,§1(a),and we have no employees.[No workers'comp.insurance requircd.1
'Any applicant that checks box al mart also fill out Utz section)claw slurs ing theca workers'compensation pulley information.
f Homeowners who stthrnii this affidn it iidacaung they are daring all work arid iliac true outside contractors mitt subnot a new affrdas it indicating such.
'•C.untrrxton that check this box must attached an additional shout shothing the name of the sub-contractors and state w hether or not those m iitics base
employees. If the sub-contractors bass employees.they must provide their workers'comp.ps licy number.
1 ant an employer that is prodding workers'coati vlsation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: tea? S
Policy#or Self-ins.Lie.#: V Ct'l.l5 Lob -3(-3C1 q Expiration Date: `1 (3( (a-5
Job Site Address: 5 Y1 b4 -0- I t l)'E_ Cityi State Zip: /30V- ) )-Carl f r\J 4_ O (O toO
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,§25A is a criminal violation punishable by a fine up to$1,500.00
andior one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a tine of up to$250.00 a
day against i ,violator. • cop a this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage ritic.,ion.
I do hereby cer ify , „e t �^-e s�nnd penalties ofperjury that the information provided abut, is tru and correct.
Signature: k IimA)4,4_____ Date: ib 131
Phone 4: C51 3 2 `T ( il 1
1 Official use only. Do not write In this area,to be completed by city or town official
City or Town: PermitiLicense#
Issuing Authority(circle one):
1. Board of)Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
C'utitact Person: Phone#: