36-064 (5) BP-2023-0015
11 OVERLOOK DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-064-001 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-2023-0015- PERMISSION IS HEREBY GRAN ED TO:
Project# REPAIRS 2022 Contractor: License:
Est. Cost: 5000 JAMES ROSS CS-07410
Const.Class: Exp.Date: 04/09/2024
Use Group: Owner: L MORIN JOHN A&MARTHA
Lot Size (sq.ft.)
Zoning: URA/WSP Applicant: JDR BUILDERS
Applicant Address Phone: Insurance:
PO BOX 66 (413)374-7983 WC9024479
WHATELY, MA 01093
ISSUED ON: 01/06/2023
TO PERFORM THE FOLLOWING WORK:
KITCHEN REPAIRS,HANDRAILS, SMOKES
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 VIILATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
! � 3-11 •
•Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
/ ANN
,,,/ / NN,\O
The Commonwealth of Massachusetts" NN.
. °
Board of Building Regulations and Sttnda0,. ,0
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Massachusetts State Building Code, 780 Cl q/.e� , , M 4IIUIP I Y
1,n ,ti
Building Permit Application To Construct,Repair,Renovate `'rl>�g ' h a evise Mar 2911
One-or Two-Family Dwelling 141 sc, k
This Section For Official Use Only S
Building Permit Number:1;5A- A 2 lJ Date Applied: `.,
4ii..J/Kass //Z I-L-ZOZ3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 11 Overlook Dr 1.2 Assessors Map& Parcel Numbers
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:
Publics Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: John A Morin Easthampton, MA 01027
Name(Print) City,State,Z1P
119 Oliver St 413 531 4296 jamorin1@charter.net
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s).1;7 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work': (l Ya i r5 4e IN se ; \C i.k GA, S vvi otc t bCTrc rvvi-Y
At..AD FMflnl
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ I. Building Permit Fee: $ Indicate how fee is determiiied:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ _ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire Off
$ Total All Fees:$
Check No.( )4-Check Amount: Cash Amount: 1 _
6.Total Project Cost: $ Sope" ❑Paid in Full 0 Outstanding Balance Due: 1
' SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Qn al Loos-- `/-9� y
� S 1 -0 5 5 License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) u
Tb.c3c))( 1-1
T II Description
No.and Street
eft Unrestricted(Buildings up to 35,000 cu.ft.)
01) , 144--ref��A / v^^,,A ' D/O 4 L Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(11? 7 Lt-7983 j ciLJei -b v i ' -Cuv, I Insulation
Telephone Email address D Demolition
5.2�Reegistered Home Improvement Contractor(HIC) , IS(f 7S 3—G�Zy
J
'J 1 � HIC Registration Number Expiration Date
HJ Company Name or HIC Registrant Name ,
t 'ibo+4- 4C. @jdrbdi /car-vi . Cow
No,and Street, -� — -�ei Q `) Email address
�k, v�,4. o, t43 3 Li / 3
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 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of th subject property,hereby authorize
to act on my lf, in all matters relative to work authorized by this building permit application.
a 04 Jan 2023
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By enteri g my name below,I hereby attest under the pains and penalties of perjury that all of the information
contai • in this ' ation is true and accurate to the best of my knowledge and understanding.
Print►' ner'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
'.- a 73r• Sys .sic
P•." Massachusetts ^w - -
,- z DEPARTMENT OF BUILDING INSPECTIONS 1. I�
;t. 212 Main Street • Municipal Building /- ,D
Northampton, MA 01060 sJ,tW I;D\��
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: V 6.,' I\f� c C3C11 ; 91
The debris will be transported by:
Name of Hauler: 1Z 7k.))L-t C- iw r •
Signature of Applicant: -Date: /_- —Z
The Commonwealth of Massachusetts
t-"r �, ,I Department of Industrial Accidents
ii �e�;_ ? I Congress Street,Suite 100
s1= ..� Boston,MA 02114-2017
' •�. www.mast`gov/din
)hurlers'('ompensatiun Insurance A%flidavit:Bulkkrs(ootracton LkctricianOrluinbrrs.
10 BE FILEI)N till 111E:PERMITTING Alrf1IO1tIT1'.
Applicant Information Please Print Legibly
Name l iiusines..th anvatwn lodir iduul): ab i� U 1�f /AX -
Address: �d 5- \-1
City/State/Zip: tx10, Ft' 1 t_b) i't'+4 . OIDLG Phone#: "1/3- 3 7 Y- 7 9 3--_3
Aae taw an employer,Cheek tie appropriate hos: Type a Pr'oied VellmiT*
1 1 am a employer with-, 4.•=zi_crape..}4v.18ut!and oe part thee')' 7, D New construction
amI a vase prupeirwrr or panenrrbga and barer,curio,w-+.wult.ing tar pre inLaRernadeltng
���--- any capacity.Pro waken comp.insurance reyutred.1
30I ant a homeowner doing all work rnyxlt.1xo workers' ip mimed". 9- Demolition
.or op.atasurrarc
1.0 1 tart a homeowner and w ell l,e hie nag contractors to coattail all wink on no property 1*ill
101:3 Building addition
ensure drat all lrratl:aaUrs elth"r have%twirl.'coomert,atmat raourana'e or are,ul" 11.Q Electrical repents or additions
prork:tors with no employrm.
120 Plumbing repairs or additions
5.0 I ant a g1.Ytcral c.,n1taatul:NJ I ha,c hard the wh-atnuriatun toted.sr elk stea.:fled shun.
13E3 Roof repairs
employees.thew mkt-contractors have employees.and Isaac worker, cunp umaran.e.;
14.0Othe r
bon We are a corporation and its officer.pus a crammed them right ut cu.-minim per''kIt.L e. ------
152.§It4L and we lime no enipk, i,. (No wtleirtl.'coup insuareereword I
*Any apphaant t!i che►ks bus$1 mum al,,,trill out the%carol)below Arming them rawLm. caterlpeaOhiM Miley idmmteior
r HometIw beet wits admit la affiah.x,Kt man mow Mel;are thorny all work and them hoc 1mn 1 e pBNSIBtaOfa emit rmR a claw afrad l,18 atedi like c soar
.1 untractun that check Ibis bus must attars,hod arm aah.htrorual de.s:a',bin*mg the nark utthe sah-a,neatarattaaad srate lerlledler a Hart 16142 ndlier'URIC
cItlf,lryce,. it ihk sins-ccnaraaturs have ettw,l,rya,c the.'mu-a pre=,hie their worker."marrow, p.•hi. number.
I am an employer that is providing wurAers'compensation insurance far my employees. Below is the policy and job site
information.
Insurance Company Name: Si f et.'ve )el S - Cv ' —
Policy it or Self-ins.Lie.d: WC_ 90L Lr-ri / Expiration Date: 1 ' 2 el- Z a :4 )-2 `) -Z y
Job Site Address: l 1 0 t/C/'I04L b tit tJ Z ("it), State Ztp:FW(I CC1 t Afft• 0/U6?
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under M(iL c. 152,*225:1 is a ct mural violation punishable l,r a line up to S 1.?tkh.00
and!or one-year imprisonment,as well as cis it penalties in the ttrini of a STOP WORK ORDI R and a tine of up to S2.)(Ml a
day against the violator.A copy of this statement may be for s ardcd to the Office of Invc-stigatralu.of the DIA tar insurance
coverage verilicati
I do hereby c • rider the ins and penalties of perjury that the in/ormation provided above is true and correct
Signalwe: `/ ))ate j" -73
Phone#: 13- 37 'l--i Y3
I Official use only. Do not write in this area.to be completed by city or town Oficial ;
City or Town: Permit/License It
Issuing Authority(circle one):
I.Board of health 2.Building Department 3.('ityifowa Clerk 4.Electrical Inspector 5. Plumbing Inspector
- 6.Other
Contact Person: Phony h: