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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 w 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: