24D-239 (7) BP-2022-1642
176 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-239-001 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-2022-1642 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS Contractor: License:
Est. Cost: 10600 BARCELOS AND SONS LLC 103710
Const.Class: Exp.Date: 08/02/2023
Use Group: Owner: SULLIVAN REAL ESTATE LLC
Lot Size (sq.ft.)
Zoning: URC Applicant: SULLIVAN REAL ESTATE LLC
Applicant Address Phone: Insurance:
54 LADYSLIPPER LN
FLORENCE, MA 01062
ISSUED ON: 12/22/2022
TO PERFORM THE FOLLOWING WORK:
DECK, WALL & WINDOW REPAIRS
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:
Fees Paid: $200.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts
Office of Public Safety and Inspections �c 2 1 20a
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only) -- -
Building Permit Number:0V /t"2- Date Applied: Building Official:
SECTION 1:LOCATION
11A pr rncr s NeeMireni q/oCO
N d Strest1,.G�00I City/Town Zip Code Name of Building(if applicable)
Assessors Maap#! Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building O Repair Alteration D Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as-�part of this permit application? Yes 0 No
Is an Independent Structural Engineering Peer view requ �c -c•X- S� P e 0 No
�riof�p •ripaon of Prap�+Wor JC citaa tinnivii Ado-DV pli itrnvcd
i3 P v/'P,r cc.
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.) 3
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 U Nightclub 0 A-3 0 A-4 G A-5 O B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 U H-3 0 H-4 U H-5
I: Institutional I-1 0 I-2 0 I-3 0 I-4 0 M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 U U: Utility 0 Special Use U and please describe below:
Special Use Description:
SECTION&CONSTRUCTION TYPE(Check as applicable)
IA ® IBU IIAC IIBU ILIA ® IIIB0 IV 0 VA 0 VB 0
SECTION 7:SITE INFORMATION(refer to 980 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 0 or indentify Zone: or on site system 0 required® trench or specify:
permit is enccll osed
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable U Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed O Yes U or No U Yes 0 No 0
SECTION&CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: !VC) Special Stipulations:
Design Occupant Load per Floor and Assembly space:
I SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Svtw4' (OIL E 04rf,ccC Sy L .r f/i L� Ffcrgi@ /r9- OA
I Name(Print) No.and Street City/Town Zip
i
Proper Owner Contact Information: SQ41 9 SQ..G1 rSUf f/.1/01/[l! C„M
I Title rei hone No.(business) Telephone No. (cell) e-u1,iii address
I If appli e,the •r a , owner herebyauthorizes:
1 f 11 y [mil//if iv e F612- Q,, /1'''4 cY0P
1.ICL1lC Jl1CC11»lU1CJJ `.ilyi Iv." JUNK fill!
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 D.
Otherwise provide construction control form(see section 107 in the code)as required.
10.1 R 'stered Professional�Responsible for Construction Control(the professional coordinating document submittals)
Y/3-3yL-yWV/ dirx470,:sv -, pe f CS/° /o
I Name(Registrant) Tel h e No. e-mail addre fm'4J.eel Registration Number
I6-GP/Vead
Street Address " City/Town State Zip I Discipline Expiration Date
1 �
10.2 General Contractor
/ /0 i
Company e
ad es/037/0 (�., .Aia9df I
Name of�Pelson Responsible for Construction License No. and Type if Applicable
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Street Address City/Town State Zip I
Iy/3JYe Yi / - - chg,r,me w 4.7-74,-,/. —7 I
l elepnone No.(business) l elepnone No.(cell) a-marl aao ress
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 Cl No 0
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor I
""1t and Materials) Total Construction Cost(from Item 6)=$
I.Building $ 10 to O. 0 0 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ an»rn»riate mnrvirinal farinrl=
3.Plumbing $ p.oal31
$ Nut l e: vliiiunuiii fee
4.Mechanical (HVAC) _$ * (wntcia municipality)
c Ist/le.l,a.v;..a1 (Other) S
`' ", r` Enclose check payable to
16.Total Cost $ ,03 1 Uv , Dv I (contact municipality)and write check number here 49$‘
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the ains and penalties of perjury that all of the information contained in this
urrlacau--v��iiAA1S uud c Mal ui�utalc ;LC ucJl hit my l�1lV v cu6c allu u1luClJuu luulb.
(I 7/2o4 - O i� /3 - Y / 4a/0 17
IPleasgprint and sign name Title Telephone No. Date I
(Ai ez3i/7 fir- / i4-v'4 - ,(o.�.2
Street Address City/Town State Zip Email Address
Municipal Inspector to fill a fill out this section uponapproval: i�-- /2-21 �u
application ppro
Name Date
The Commonwealth of Massachusetts
Department of Industrial Accidents
' � ,
AIM 6
ic
k'° 1 Congress Street,Suite 100
Boston,MA 02114-2017
w.
s WW1Kmass.gov/dia
r� % token'Compensation Insurance Af idanit:BulWersl(ontractors/Ekctrklans/Plumbers.
TO RE FILED S1T11I1 1•HE PERMITTING.%t THORIT1.
Applicant Information _ Please Print liegiblv
Name 4ausincsi(hganszatwa'lndrvtduaI): 3-.b6 c- ' McjGcee,\ds
Address: r 7 Lc k2 Or
city/state/zip: 3 t'1(le,r VO wY1 MA n I°°17hone#: I—i I3--e1_Cl2 10 k 7
Are y.e as rttapbyer?cheek the appropriate boa: Type of project(required):
1.0 lam a employer with employees(tall andur part.tiawL• 7. 0 New construction
2E1 I am a sok proprietor or partnership and hate nu employers working for me to H. IN Remodeling
any capacity.(No workers'comp.insurance regturall
9. ❑Demolition
ICI 1 am a homeowner doing all work myself.[Nu workers'comp insurance regmred.l'
i.❑I am a homeowner and w ill be hiring,untraetun to conduct sill w irk on my property. 1 will 10 O Building addition
ensure that all contractors either bate%otters'compensation insurance or are sole 11 a Electrical repairs or additions
pnpneton w ith no employees.
12.0 Plumbing repairs or additions
:SO I am a general contractor and I have hired the sub-contractors listed on the attached sheen.
These sub-euntracwn base etnpluvees and b w Ilan Mien,'co u comp..uuranec. I 3.E:i Roof repairs
6.0 We are a esrpuntiun and its officer have exercised then nghl of exempbnm per M(iL c. 14.a Other
IS.2.fi Ili).and we base no ertgloyees,No worker'comp.insurance recoil/ed.!
*Any applicant thai checks boa a I must also fill out the stetson below show mg then workers'compensation policy information.
'Homeowners a ho submit this allsdas it indicating they are doing all sunk and then hue outside contractors must subnut a new affidas it mdsaiing such.
•(unuaetor.that check this ts,s must atta.hwd an additional sheet shins mg the name of the sub-contractors and sate whether or nut those entities base
employees. If the sub-contractors have employees.they mug pros ide their worker'camp.pulse)number
l am an employer that A providing woriers'compensation insurance for my employees. Below Is the policy and job.site
information. /�/�
Insurance Company Manic: ` L 1s bed] y , " .5\Ucl 1 n.5V 1c,f t:C
Policy#or Self ins.Lie.#:w a733 5—via.36\ �-C\. - Expiration Date:0 C.L„, ii$ O 3
Job Site Address: .-!k-1$ Y`04 JC Ck Cj � .MACity'State:Zip:NOt� int\C .MA0 0( ' a
Attach a copy of the workers'cothpensation policy-declaration page tshowing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152. *25A is a criminal violation punishable by a tine up to S1.500.00
and or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 for insurance
coverage ventication.
I do hereby certlfy�and they' and 2 allies of perjury that the information provided above Is true and correct
• . Signature:it.' / Dine- / ///r/2
-2-
Phone sir: /3 9 7 2" 70/
Official use only. Do not write In this area,le be completed by city or town official
City or Town: Permit/Lkense k
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.('ky/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('ontact Person: Phone a:
Appendix 1
A.-VA LOLL A.A..-Lttl l Al\A.LA1.1 IL11LO ALL 1. 1LL.tLL11 Ll/1V1 JLLL LLLLI L.J ILA LLLL 11 CLUE LV1.1LVIV II LL1l I...IV S..1Vlll 1V✓ . 11LL
checklist below is a compilation of the documents that may be required. The applicant shall fill out
LL LL Ll ittSVAJL Ll1 ALA Ill V V/LLL. LA It LVA L IAA LL 11 Lk All 11 ILA U V1 l li1 LL LL A LLIJLLA LU V1 VALlJAL11 LLLSJ A L.JVVA P1V1t 1V1 AA LL
documents. This appendix is to be submitted with the building permit application.
Checklist for Construction Documents*
Marx-x.where applicable
No. I Item I Submitted Incomplete Not equired
1 Architectural
2 Enunciation
I3 I Structural I I
$ rue Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
I 8 Plumbing(include local connections) I r
I
I 9 Gas ti3aiurai,Propane,ivieuicai in uiherl
10 I Surveyed Site Plan(Utilities,Wetland,etc.)
11 Specifications
12 Structural Peer Review
13 I Structural Tests&Inspections Program I I
I 14 File rro.l ecu•vn 1ia.rralive Repot.
i
15 Existing Building Survey/Investigation I I
16 Energy Conservation Report
17 Architectural Access Review(521 CMR)
I18 I Workers Compensation InsuranceI
1., dtdl UUUO 1V1dLel AM1VliU)'dUlllI.LJUIUUlClll LW
l l -Al I
20 I Other(Specify)
21 Other(Specify)
22 _ Other(Specify)
must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the
authority havine jurisdiction.
Registered Professional Contact Information
101,e0N AA ,arcetC 1t?)-9ci._7ot7 7e ,r'r1,,,,.04,thy_n \I3 Uln 7
Name(Registrant) Telephone No. e-mail address VVL&t Registration Number
L
c..._..L -1....— r41..Pr---.... c._1 Discipline EXp.ration Date
JUCCI A\.&U1 COD ....lL''/ IUAVIL JWLV z_ap
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip .r--•� r
* ^ �D^ ^ ^�l` T^,^��^�^T7^ ,address
Registration Number
i vu,L IL(Reg,istrant� Telephone 1VU. e-mail Lail address
Street Address City/Town State Zip Discipline Expiration Date
Please follow this link for construction control forms to be used by Registered Design Professionals.
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Conslrxtt t t$rvisor
f
CS-103710 spires:08/02/2023
CHAD MICHAEL O'ROURKE
6 UNIVERSITY DRIVE
SUITE 206-215 +4-
AMHERST MA 01002 • yC
"WOO
1:t i
Commissioner eywe. 1;. nacen m...
Construction Supervisor
Unrestricted -Buildings of any use group which contain
less than 35,000 cubic feet(991 cubic meters) of enclosed
space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call(617)727-3200 or visit www.mass.gov/dpl •