36-275 (9) BP-2023-0188
88 MAPLE RIDGE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-275-001 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-2023-0188 PERMISSION IS HEREBY GRANTED TO:
Project# RENO 2023 Contractor: License:
Est. Cost: 97000 DALHAUS CARPENTRY INC 101628
Const.Class: Exp.Date: 11/17/2024
Use Group: Owner: JOHNSON JOHNSON CAROLINE C &SARAH E
Lot Size (sq.ft.)
Zoning: SR/WSP Applicant: DALHAUS CARPENTRY INC
Applicant Address Phone: Insurance:
11 CHERRY ST (413)977-6094 UB--5R908461
EASTHAMPTON, MA 01027
ISSUED ON: 02/16/2023
TO PERFORM THE FOLLOWING WORK:
RENO 3 BATHROOMS STAIRWELL RENO, ADD LAUNDRY
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: $630.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
4- RpL1.F� PLC .
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
EI°
.�I Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: ^A 3 f F8 Date Applied:
1, of-v, 0`2 UP 3
BuildingOfficial(Print Name) Signature Y U
gDa e
SECTION 1:SITE INFORMATION
treistlicer s : 1.2 Assessors Map&Parcel Numbers r
./ \-8•01:9- . 0 •?-. ."
1.1 a Is this an accepted street?yes o 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 Owner'of Rec l AA,0. ),_(\_ t
'klqame(Pent) City,State,ZIP
a
,ems C:K c� CS L\s \ tbD Cp,ra; CV 61(,�. c, no,I .Cd Street Telephone Email Address
SECTION 3:DESCRIPTIO 2/N OF PROPOSED WORKZ(chec that apply)
New Construction 0 ExistingEx Building Owner-Occupied2/ Repairs(s) Alteration(s) l�Addition 0
Demolition 1�Accessory Bldg. 0 Number of Units Other 0 Specify:
Briff DescriptionDescriptionWprk
v W i l q, 5� �/�C. v S S� e�:J`e�r-f;1it Y`QAD A ,')vim•
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ D) o1Th 1. Building Permit Fee: $ Indicate how fee is deter pined:
2.Electrical $ S 0 Standard City/Town Application Fee
0 Total Project Cost (Item 6)x multiplier x T
3.Plumbing $ , L 2. Other Fees: $
4.Mechanical (HVAC) $ 0,0 O O List:
I
5.Mechanical (Fire $
Suppression) Total All Fees: $ 630,..50
a Check No. ia,0Check Amount:
6.Total Project Cost: $ I It 00p , vo Paid in Full ❑Outstanding Balance Due:
City of Northampton
Massachusetts
f
DEPARTMENT OF BUILDING INSPECTIONS '
ay
212 Main Street • Municipal Building +g x*
.w^e" 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 City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES 45. Constru tion $ ervisor License(CSL)
S A r\ License Number E ira'on Date
Name o CSL older
\\ G S7 ` List CSL Type(see below)
N and t J I v pL. Description
n'� (l5 Unrestricted(Buildings up to 35,000 Cu. ft.)
�" JA. R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofmg Covering
WS Window and Siding
q(e SF Solid Fuel Burning Appliances i
DAYA1/41S
�,(l �► I Insulation
Telephone Emdil address V D Demolition
5j: Registe, ed e Improvement Contractor(HIC) 0 R l
'[1 G\fS D(n 1 �A'`' HIC -palgistra_tilon Number xpiration ate
HIC Company Name or HIC Registrant Name
us(Arypi-ilyti Peroi, -Cow\
No. Sk\9 E ail addres I
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 I. suance of the building permit.
Signed Affidavit Attached? Yes .......... No ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR PLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize 1
GI
to act on my behalf,in all matters relative to work au zed by this building pelicati .
çco\ w
nt Owner's Name(Electronic Signature) ,Date
S TION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my n below,I hereby attest under the pains and penalties of perjury that all of the information
con ' S pplication is true and urate to the best of my knowledge and understandi .
_ 2 iS— 3
ri er 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
--- ,..)1 Department of industrial Accidents
- ;74111=4,1„. 1 Congress Street,Smite 100
_
Boston, MA 02114-2017
... „ WWW.rmass.gerldia
Ns"(0 kers'Compensation Insurance Affidavit:Buildera,ContractoratEleetricians/Plumbers.
TO SE HIED WITH THE PERMITTI?it;AUTHORITY.
Applicant Information Please Print Legiblv
,,,,,
CitYrState:Zip: 0\7) ' • 1:1\ Phone 4: '. .. ..„.._11,717,_1_,- 6.57...i.,.-1,..--------111
aa employer,Clatrit the appropriate bail ' Type of project(required):
1., I am a employer with ....5_,..ertithes(fall anciae part•timel,. ' 7, [3 ew construction
10 I am a tole proprietor or pattnetaitip anti havu no easplava wining tor me in 8, : emodeling
ally capacity.[No wrirker*'camp,ietraninoc rottutre.i.)
9. Demolition
UI tun a kunTaaVa.lem3 doing an work myeelf.(No workart:comp.nouveaux retpumill
1 0 D U1dngadditiun
4.C3 t sot a buirstammet umd wan lio tom%tantraours it)vontioi.1 all watt.an my property. 1 We ill
elmou re that all oaturactoes eithet liaiie wodieb.'compen.tattini utwarentx or an:wile I I -1tctrial repairs or additions
praprictor$with no enaployeek.
i 1r Plumbing repairs or additiores
5C)i ant a getimai coma-ache and I ba vetisirdt be'A.1 b on LI az 4 v r s Voted tli the athwhiel%beet.
130 Roof repairs
Ihesc sati-cusafacion:have maployceo anti ter,t worker*"kaartp.inaurance.:
14.0 Other
n.D Wit are a wipacation anti th offteera have exert mod that:rigle of VACtIfiritl pet 1461..C.
152_,)Oat_and We'LUC roia ernpluyea...i.[Nu Vilarkern.ClAglp,Mamma:a-ivathatril
*Any anpticant that chazits boo*I mug atm ll tint the ireetitm below ithowino than welter 'cartiptm.wition;milky mformation.
*Plaititowractx olio submit the/allidillSlt Mahwah%they are doing all wadi and dim him 4)4JC.Silk caittleactvei ritual aabes141 a tht*aft:taboo inthi:ohnit siack
t..utiLtaLtors.that cheek ihra boo rinIM Attalaral an aidalithgla.,ilive%SOK Illg tilt:414.111C ol the 5a4b-vordractova 1d714.state,Atectiicr us WI dune oLialit.'s
,.rnri,,,:s•co. If tlw hol-..-.c,irairsri:ka,..-orri..P.ov.,.air;y stkiNi rc..,s),I,:lariciz A t,ii..cr.. oolcip r.....ii,-.,raurrilvi
+4.1.1,*"..M.P.IM mmeirom,n,r,,,,,n-A.I.M.a.,.."1,,..."M".1.6".•,,,.....11.,
I am an employer that is providing workers compensation insurance far my employees. Below is the polity and jab site
information.
in_surans.e Company Ntune:___C
Policy tt or Self ins Lk. #, , , 5 Kly:,.: .51-K106 -,k-t-1-Z Expizalturt Date:6/93
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date .
Failtue to stxure coverage as required under Mt.it. c. 152. §25A is a ernninai violation punishable by a tine up to S I.500.D0
andior une-year imprisonment,as well as civil penalties in the fortri of a 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 Investiganons of the DIA for insurance
coverage verification.
I do hereby rer lir n ns II d nalties o perjury that the information provided are is ur and correct.
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, ofrie.,use an! . Do not write in this izr,r 41,to he completed by city or town official.
f's City or'Fawn: Permit/License N ,
I ,
Issuing Autiturit!, (circle one): ,
:
i I. Board of Health 1.Budding Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
1 6.flther
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I Contact l'erson: Phone 4.:_______________
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City of Northampton
QCHgh4
Massachusetts 4$* I.-
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4,, DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building yJy Qb
\ . ' Northampton, MA 01060 ssl y 7<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:
Location of Facility:
The debris will be transported by:
Name of Hauler:
Signature of Applic Date: �I t c a5