32A-239-005 (Incorrect parcel on permit) BP-' 022-1533
2 POMEROY TERR UNIT COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot: CITY OF NORTHAMPTON
32A-239-011
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-1533 PERMISSION IS HEREBY GRANT, D TO:
Project# KITCH RENO 2022 Contractor: License:
Est. Cost: 16700 BEAUDRY HOME IMPROVEMENT CSL108605
Const.Class: Exp.Date: 03/20/2023
ONEILL, WILLIAM CHARLES &FO'MANT,
Use Group: Owner: PATRICIA TRUSTEES
Lot Size (sq.ft.)
Zoning: URC Applicant: BEAUDRY HOME IMPROVEMENT
Applicant Address Phone: Insurance:
117 FERRY ST (413)320-1348 6S6OUB2E863000
EASTAMPTON, MA 01027
ISSUED ON:12/05/2022
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
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:
• laa 9T. '1 •
Fees Paid: $117.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
F12E8
C V )The Commonwealth of Massa hu.eftsNOV'7 `I�" �` Office of Public Safety and Inspec� ons
11i1 3v Massachusetts State Building Code(780 • R 2022
Building Permit Application for any Building other than a t ne o. ' amil Dwelli
(This Section For Official Use Only) NORTEe HAMPinht,I s 0 0
Building Permit Number. —16 ' Date Applied: Building Official: --
SECTION 1:LOCATION
2 �omQ my itoCQ At�AwpA oit1,6
No.and treet City/Town Zip Code Name of Building(if ap.licable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify: .171,1,1 y\ 114.1
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 0
Brief Description of Proposed Work OW a bI NN), Cow A1rt 1\1 VAAL
sot\ ym d e,vki',t0.\ up VnTe,
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) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
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 0 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❑ 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 0 IB ❑ HA IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA 0 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 0 A trench will not be Licensed Disposal Site 0
Private CIor indentify Zone: or on site system Elrequired 0 or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 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 Ploor and Assembly space:
City of Northampton —
. < ° • Massachusettsw? t
I ? flit
DEPARTMENT OF BUILDING INSPECTIONS ; It ( ;
\'"' . . 4, r e 212 Main Street Municipal Building w
4.',
Northampton, MA 01060 � •}�
i
i:
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL &
MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS
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 & Hard copy).
3. Site Plan with location of proposed structure(s) and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CSL and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (if applicable).
8. Note any Conservation and/or Special Permit requirements (if applicable).
9. Driveway Permit (if applicable).
10. Proof of Water and Sewer entry fees paid (if applicable).
11.Trench Permit (if applicable).
12. Initial Construction Control Documents filled out and signed by the Registered Design
Professional in responsible charge.
13. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton
SECTION 9: PROPERTY OWNER AUTHORIZATION
N e and Address of Property Own
Vo)1-it �oy1iy 0-�
q o rOt +er t0 Una} J o 610 for r lob o
Name(Print) No.and Stjreet City/Town ' Zip
Property Owner Contact Information: L
c)vir r u13-go- I '( =SA'"`- t _ 1_Yman
Title Telephone No.(business) Telephone No. (cell) e-mail add ss
If applicable,the property owner hereby authorizes:
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
eavkAvi t-VAII Lt,,,pnVv -6,—
Company Name
'l ail-�4 j (3e n a l a(t) ‘ T. �'
Name of Person Responsible for Cons ction License No. and Type if A ph :.le
in 1 sfi roi nyp/1" d IV -7
Street Address City/To*n StateZip
- - ' 3 3�-o- 13c(? rnclo ►sue( yishco- w/
Telephone No. (business) Telephone No.(cell) e-mai ad 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 issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 0 No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building - $ 11 f 'Q(u Building Permit Fee=Total Construction Cost (Insert here
2.Electrical $ 1 0 appropriate municipal factor)=$ I
3.Plumbing $ (N
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ I Ltf -1 a V (contact municipality)and write check number here_1 7 3 )
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
application is true and accurate to est8fMy knowl dge and understanding.
Corr /Ado)- 4(3 -3?-0-1 y i ii)-XI,-g
Please print nd si name c }y^ To Telep one N Date
I I� H,m/ SI- k.. 4i c pA \ U l()a-`7 - ) ,
Street Address I City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: __,,Z1 / -Z 11.30 ZOZ z
Name Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
The Commonwealth of Massachusetts
h.
t___FVa= Department of Industrial Accidents
S":Fin= 1 Congress Street,Suite 100
Boston.MA 02114-2017
.�-t,a wwi .ntass.gov/dia
11 udders'Compensation Insurance Af iidas it:Buihlers,CuntracturiaElectriciattsl'Plumbers.
'1'4)BE FILED,11T11 THE PERMtl'1'1M: tiriiioitl'rl.
Applicant Information Please Print Leeilthr
Name lBtuirtc r(1t anvaau+n ItetltairJttal): l3e1I�Ad1 -) om pro
Address: _ 11 F'1?, y S1 `AS1 I 0 Vh '" '4 01-0 P.-7
CityiStalcr+Zip: Phone#: �I I�- 3O i 3 Li $_.
Are sun ar rattphtt er?tleek the appropriate liar_
Type of project(required):
116 I ant a curioyclr with ` enaplu�ccs I;tull and ry part-tow s.• 7. 0 New construction
I ant a s1k pcopricdut or purtncr hip and hate no employcti-e.aaotkuig lur roc in K. Remodeling
any cap taty. [No rc orkcrs.cvnnp.ttuurancr nyurc�l.I
9. Demolition
ant a homeowner doing all tut rnysel1. No v.otikos`comp lnsnrancc rcgiur .
I0 Building addition
�.❑1 am a IN1111tW ii.-t and%ill lac haring contractors to caulduct all MARL ten any raw t4. I Wall
arson ihal all coma-actors ciaber hat.-woukcrs"compor satin n ntsurancc ow arc stele Ha Metrical repairs or additions
pttpnctun with rn1 attpintrtcs.. 12.0 Plumbing rd4wtn or additions
-0 1 am a C- ralearatrack.r and I has,:hart al talc sub-c nit,acius bated on the attachtal sheet
thew sub-onnt ad ur m es Icnc eploye and ha%e voila. moor.insurance. 13D RIJt)fK repairs
th
14.ElOther
6.0 We are aawporauan and au Whoa..has c exenisc d their nght ut exscne tion per Moil-c.152.IMK).sad we have nu agtloyccs.[Nu wailers'comp.aasnrancc utyutrcvl.[
•Any applicant ion cheeks box RI mud mho fill out taw srectiwt Iwlo w showing their workers'cotnpcn.Lion!policy mfrwtnatiun.
t Iknruana rerra who submit this affidavit indicating ti ng day me doing all wtntt and is hire uiut.ltll'crlataraeturs Must stdnnit a new:initial,at un i aims such.
';Cunttactorr.thickck this boa trust an dedasadtiliaaelteeshowtagtieaatrrutthevul.-coniractorsLaudstatevrta::hcrcenottluuscuaniticthate
employees lithe auh-crnaracwrs laneenpkgaes.they sit Ctuvidc their amino'uotip.1sdre.+number.
I um an employer that is providing workers'compensation insurance jar my employees. Beiow is the policy and job site
in/irrntatiun. � � ���
(n�turanc�(unipan Name:y
Policy#or Self-ins.Lie.#: C 9S( V U(5)Ecg V W Expiration Date:
lob Site Address: 9- POMP 1 1� VII)\' 5 City Starr Zip: r 1II 0 i 0 b O
Attach a copy of the workers'camp amnion policy declaration page(sho►sing the policy number and date).
Failure to recur coverage as required under M(iL c. 152.*25A is a criminal violation punishable by a tine up to S 1,500.00
and''or one-year imprisonment.as well as civil penalties in the form ufat STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA tar imurance
coverage verification.
I do hereby certify under the pains and iienalties of per try that the in formation provided a re is t• e and carrot t.
Signature: ij,�,s.. / J Datc:
Phone#:
y 13- 1)-0- 13Yg
.�. 1 -ate
Official use only. Du not write in this area,to he completed kr city or town uc-ial
('its or Tussn: Permit license#r
issuing Authority(circle one):
I.Board of Ilealth 2.Building Department 3.City Flown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
�� '''t �, Massachusetts if!'`'' — 'C'
It
{ t DEPARTMENT OF BUILDING INSPECTIONS h hi
�+' . '� 6 212 Main Street • Municipal Building vti ,-�
� ' Northampton, MA 01060 '1'sN,y ar''‘,'`
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: IA I Is-el Qe(Ai cl 1� -0. '1Grr, �� `� uJ
y � ,
.tiqt
The debris will be transported by:
Name of Hauler: VA)
ui�,r
Signature of Applicant: Date: l J -*AA
CONSTRUCTION CONTROL WAIVER
From: Kati-Wki 6eCk kid
hi
6011/10Irly !—)Y
To:
Jonathan Flagg
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10, I request that you
grant a modification to waive the requirement for construction control of the project at
z
02-2At� I)N,f 5
because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire
safety, and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,