17B-027 (7) BP-2022-1465
395 BRIDGE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17B-027-001 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-2022-1465 PERMISSION IS HEREBY GRANTED TO:
Project# STAIRS Contractor: License:
Est. Cost: 5750 ZACHARY JACOBSON 113486
Const.Class: Exp.Date: 06/29/2024
Use Group: Owner: WOLFF NOMFUNDO
Lot Size (sq.ft.)
Zoning: URB Applicant: MACHADO CONSTRUCTION LLC
Applicant Address Phone: Insurance:
200 MAPLE RD (413)214-4494 NXT9KX7X9-00-GL
LONGMEADOW, MA 01106
ISSUED ON: 11/10/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE FRONT STAIRS
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:
I • • •j -,
I '/ •
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts F6
R
Board of Building Regulations and Standards 1 0 ?WHOP ALITY
M Massachusetts State Building Code, 780 CR I NOV USE
Building Permit Application To Construct,Repair,Renovate Q1 olisl _ RevisedlMar 2011
r o run nwr,i - —,.,::
One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: og0 a,•J Date Applied:
as, ///7- 11-lv-Z62z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property sAddress/ qd 1.2 Asps Map&Parcel Numbers
1.1a Is this/jan 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 ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1, Own 'of Rec d:
u n 4J0 f- Nor- /v1Plor) / /14
l�-
Name(Print) ity,State,ZIP
315 Rot
No.and Street elephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building ) Owner-Occupied 0 Repairs(s)jit Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Pdroposed Work': R en-tier (On Cr i L� sffan f Ste,./�5
orc-h
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(La.or and Materials)
A Od 1. Building Permit Fee: $ Indicate how fee is determined:
1. Building $ 2sd
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: $
1)/6
Check No. 11r2' Check Amount:
6.Total Project Cost: 11 7 SO(CO ❑Paid in Full 0 Outstanding Balance Due:
City of Northampton
Qp,M _TO . _4 cI
✓� Massachusetts C,!cc
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1 DEPARTMENT OF BUILDING INSPECTIONS �.
212 Main Street I Municipal Building 1�D S'.1*
Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS, RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
1. Building Permit Application signed by legal owner and filled out
by owner or authorized agent.
2. One set of plans and specifications of proposed work (Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code —all new construction (Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The Cif
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL) /' I '3 La/av+ 6
c-1„6?- Jq,-.•s lat^ License Number Expiration Da e i
Name of CSL Flolder r �
�Q I� List CSL Type(see below) v l
O R No.and Street Type Description
r _ U Unrestricted(Buildings up to 35,000 Cu.ft.)
' �7 f a.. / Mil- d f Id( R Restricted 1&2 Family Dwelling
City/TcAdn,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
] 7 SF Solid Fuel Burning Appliances
�l3 ;)LL tfil/`I Z3 cad 1 i e I Insulation
Telephone Email address a� D Demolition
/
5.2 Registered Home Improvement Contractor(HI !' 41'41
l CIs E+a p�
Z' �' ✓tt.c..f - HIC Registration Number xpiration Date
HIC Company Naattfifiie or HIC R s ant Name
�rl,p3-Pry Z371c03 (16 aa.1-tf)-4_1_,4
No.apd Street Email address
L•r.2/".-1 /1/)/1—th'i Pric24 q/3 'Ice.ii-f fil
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:OWNE 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
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.
z # -i ' a c 35 I I/7/
Print Owner'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"
The Commonwealth of Massachusetts
••• •••=•••••• Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
WWW.mass.goWdia
Worters'Compensation Insurance Affidav it: Builders/ContractorslElectriciansiPlumbers.
10 HE FILED S%tin I la. PERM!F1'ING Al THOM
Applicant Information Please Print Leeibiv
Name iliusiness;Organiza' tiv16(-HA- Concter.41/61
Address: aChz. 14144e- (), L ,ivse‹.)04e 114/1
c7/./OC
City/State/Zip: Phone#.
• tip e)-(1? Lic-1:7`1
Are you an ersitskryell Check the appruprhili biz:
I)!Tr uf project(required):
1.0 lam a ncloser with employees(full asidior pun-tit' 7. jNow construction
271 I am a sole propnelor or partnership and have no employes workutE: for MC in K. Romodeling
capaei[y [Nu workers'comp.insurance required]
30 I ant a homeowner dirins all work myself.[No workers'inner.nuns-Arl 9. Demolition requar"
10 0 BuilIng addition
4.0 I sun a homeowner and will be hiring contras:tors to conduct ail week on my procrmni. I will
ensure that ill contractors either have workers' ison inNtinincr ii.0 Electrical repairs or additions
proprietors,with no employes:N.
1.2.0 Plumbing repairs or additions
I am Li general contractor and I have hired the sukr-contnictors listed on the attached street.
These aub-ountractors have employees and have workers'comp.insur.unee. 13E1 Root repairs
14.00ther
6.0 We are a corporation and its officers have exercised their right of exemption per hitri.
152.§1(41.and we Wise no errissloyees.[No workers'eon*.insusance requtreti.I
'Any applicant liras check%box 1 mast also till out the fiectiou below%how:us thirturar ornpermation policy inf.sinnitisar
who submit rho affistarit urstseatung they'redoing un work and then hue outside con-mu:tors mura submit a new afftdaaii Indic:Awls slick
tContractora that check thus bu must attached an adriational sheet showing the:tame of the aub-eoritswasys and irste whether or not thue enuuc have
eniplovets. If the 3 ub-curgy-acturs have employees.airy alma proaide their w..:ken' arap pubic?. number,
I am on employer that is providing woriers'compensation insurance,for my employees. Below is the policy and site
in/Or/notion.
Insurance Company Name: V rote‘Ct/ Dirt
Policy or Self-ins.Lic. ein wet 0-6txptration Date:S/ p3
Job Site Address: ' 395 R_(—) CityiState.2ip: Alb(44114,,,,/4-01
Attach a copy of the is orkers' compensation polic:, 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
andor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
co‘ Nerification.
/thi hereby cernfy on r the pains and penalties of perjury that the information provided are is true and correct.
Datilitcr
r
Phtlne 3
: ( (LC—L(
LfV
Official use only Do not write in this area., to be completed by city or town official
City or Tovvn: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3.tityrTown Clerk 4.Electrical Inspector 5. Plumbing Inspector
b.Other
Contact Person: Phone#:
City of Northampton
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'' Massachusetts '?�" - -.
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i - DEPARTMENT OF BUILDING INSPECTIONS �. "
..R 212 Main Street • Municipal Building * �~''
N , Northampton, MA 01060 "1'31, 0S"4
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:
- ff c
Location of Facility: C.7(1 tU� ►n►/ctl— \ E
The debris will be transported by:
Name of Hauler: ?Gl-c-c 3:7,,ey, 1
Signature of Applicant: Date: 4
City of Northampton
.1. s �. s
n Massachusetts
a ,. aas .
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building y,
Northampton, MA 01060 "^3,31'�Q'
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_ (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 requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project 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 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one-or two-family dwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in
a two-year period shall not be considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated 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 or 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 day of 20_.
(Signature)