29-233 (3) BP-2023-0332
126 SPRUCE HILL AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-233-001 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-2023-0332 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 BATH RENO Contractor: License:
Est. Cost: 9000 S-CEL-0 LLC 076237
Const.Class: Exp.Date: 04/24/2023
Use Group: Owner: KIMBERLY HARRINGTON RYAN &
Lot Size (sq.ft.)
Zoning: WSP Applicant: S-CEL-0 LLC
Applicant Address Phone: Insurance:
142 HANCOCK ST (413)273-1431 085BAIX9625
SPRINGFIELD, MA 01109
ISSUED ON: 03/15/2023
TO PERFORM THE FOLLOWING WORK:
BATH 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: I 511
le •
y/J I �
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
00- 1M Wt,C-ft-c i it--t-
r
I MAR 1 5 2023
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FO
!; I -,, l 'assachusetts State Building Code, 780 CMR MUNICIP ITY
US
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: Q P ) 3' .. Date Ap lied:
ua
4-2055 J 3 15 Z3
J��
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prgpertt Addrresss: i ii sNi_ 1.2 Assessors Map&Parcel Numbers
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: 11
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 CI Municipal Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY O�� HAP'
2.1 Owner'of Record: if I �` Q_JL 01
Name rint „/ City,SJtat@,ZIP
No. and Street L Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Workz: �f'91 gft ( q V t GI) ri'x1ce S` ,1_
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 3 S 00 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression)
Check No.�.1 Total All Fees:4(
6.Total Project Cost: $ �� �� heck Amount: j
0 Paid in Full ❑Outs 1 ce Due:
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4®fALA
City of Northampton
Massachusetts
i �-4 2) 1
n DEPARTMENT OF BUILDING INSPECTIONS
�
212 Main Street • Municipal Building
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.
4
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Spervisor icense(CSL) C�' 0 7 6 .C,37 Li—.2 - 3
` e'ii Sop- /(211 License Number <Expiration Date
Name of CSL older
Nr-Q s/ ,n S List CSL Type(see below)
No.an Street / (� Type Description
�/n S V r at 06 0 7 5" U Unrestricted(Buildings up to 35,000 cu. ft.)
vv��// !! R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
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 0 No . 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Pate
SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION
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 the best of my knowledge and understanding.
3 (j - <2.3
Print Owner'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"
ta.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.govidia
co-kers'Compensation Insurance Affidavit:Builders/Contracton/Electrie . Plumbers.
10 RE FILED WITH 111E PERMITTING AETHORIll .
Annlic I Information Please Print 1.egibls
Name filuamess;., arnizationiEndnichtal I: C e- " 0
c
Address: . C-0, K S
Sr (2-
CityiStateiZiv c76 /j0 Phone g: , / i
Are you an cumin?.tr.?I the appnipriatc box: / T,‘pe of prefect(rrquired):
ID I arn einpk.ler with emphay.ces(full iantor part-time I 7. etv construction
2.0 I am a sok propnetur or ine and b nu crradtry Wo toss rium for mc in K. RernOdefing
any capacity [Ni workers'comp. • mace required.]
9. El DernolittOrt
I arn a lionacovincr doing 411 wort:my3c !No worlitas'comp,immunize maim,
10El Building addition
1,E3 Arri a isaireov,ii and will ts:home cvlar wa tu conduct all work on my p .perty, 1 will
en-4;m that all contraciurs vither hate work.: corraismaation insurance or • sIIC] Electrical tepa3tS or additions
proprietors,v•ith no cumloycvs,
12. Plumbing repairs.or additions
sip I am a paterai contractor and I have hired tbc sub •untrta:tors Listed un . attached short
3.0 Roof repairs
These sub-writrackirs have employees and Its w •en'comp ins ance.:
14.0 Other
nO We arc a corporation and its offiern have exercised tba right of xerription xtWA,
1.51,§I(-I,and ti,,c halm no employcca.rsio worken' I. ants:mamma I
*Ay*applicant that checks box 411 rrau,t IL..041 tozetion bit hhow to their 9.uLx ollmemaii.!it policy information
Homeowners who!submit dos affidailt milicatina they arc:Juin. all rk and then hue outside ciintractors nuni submit a estw affidav it Milk-ming sta:h
:Contractors.that check this box must attached an additional sh stunk in the naarim.of the sub-contractors and ii:aEc fp:ther or not thum., liLiihave
ec-s. If the auh-curaracEors have employees,they must nwide their orkas comp.rulicl.numher
I urn an employer that is providing workers' nsation Ins unce for my employees. Below Iv the polity and job site
infarniation.
InsuraRce Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: c/ 6 ,Sprilce...j) S' CitylStateiZip: 41014- ( 4,1 cy)
Attach a copy of the workers' ompensation policy declaration page tshn Ang the policy number and expiryrpIraI1on date).
Failure to secure coverage as toured under MGL c. 152, §25A is a criminal is anon punishable by a fine up to 51.500.00
aridior one-year imprison t.as well as civil penalties in the form of a STOP IX *RK ORDER and a fine of up to S250.00 a
day against the violator. copy of this statement may be forwarded to the Office o nvestigatiop of the DIA for insurance
coverage verification.
I do hereby certify u er the ri hies of perittr the infitrmation provit d above is true and correct
SILI1j WIC 4:41K-- Date.
PE orl•
Weld/ se only. Do not write in this area,to be completed by city or town official
City i r Tow n: PermitiLicense
Issuing Authorit, icircle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6,Other
Conflict Person: Phone#:
..ik
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Smite 100
4 7:-..74ii:' ' Boston, MA 02114-2017
•'•,,..---. ;„•' www.neass.govidia
s‘41l kers' t oniptvisation Insurnause AIIIdatit: Buildersit'onlracturs/Electricians/Plumbers.
11.11111:Ell.ED WITH THle: PERMITTINt;AI IIH11111't.
Applicant Information Mose Print Leribli
Name I iiusines.s tXiI,Antr.ation.indisittitall): 5 - C el - 0 1... LC
Address: ili 2. ii ANI(...00K 5 T.
City/StateZip: 5Piti fJ&C;6 Lb tiA 0 ii 09 Phone#: '4/13 - 273 - /17131
/
Ate pm as alopiayar?Cheek she appropriate boo: Type of project(required):
I am a shotriloyer with cori,lo!,ees(halll asiakor Fart-taw)• 7. 0 New construction
2.012m a+lie iinviimior tn pesinershap and have% 04100)1.1.-%working kn me In 8. gkemodeling
any saillicity No workera.cam,.insuranix required I
, 9. D Demolition
LDI am a haisnouwner dating au wait thyself.IN°work Lu ers' mp inastrance resaturol.r
4 ]I ant a beaten%ncr and will be brans coalmines hi conduct all work on my property. I will lop Building addition
mum that all conk actors either have vinekera•cratipensatson insurance sw ate Ark i irj Electrical repairs or additions
propnctor.w Ith no employees,
1 an 4 11.1 ICI Al,Unilaiiiin.inal I hare hued the issb-corstraiktrt hated on the Abated&heel
A 12.0 Plumbing repairs or additions
I 3.0 Roof repairs
these nth..onus,.tor,ha%c cmpioyers and hasc worker, con, unurame
I4.00thet _
6.0 We area corporation and it.offieixa trait,e exercised thew night of ex.:moron pet Mt.1 ,
132.b1141.and we have no anpluyeea.rhio*token'client intuit:111,c rc,iineol I
*Amy yolimia that check,box nt mini alto till out the section below'hos.mg their workers ,t31111pell,di/a,l1 poi ii_s intorinattiat
t Homeowner.,.tilitt%tleltittl this alba-oil indwattratt they are doing all work.and then lure otitsuk,,,nira,has MU...!allillilli..nen allitholt tralicalsng such
:toot:a,tors that s.hicci this hot must egbdiCti an adational*hod shooing the name 4 the nib-eiVinkt.tt*a and slat,v.nether or nut those sattities ha...
etordostes It the sohurraLturs hate curio:we..ille must psos ode then workers. waif) puses l number
_....— ,. . • , _ „.
I dun an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site
information.
Insurance Company Name: AXiA INSU2ANC6 SERCC65 INC_
—
Pokey it or Self-ins.Lie.It 0 g S t5 A.1 X 9 62.5 Expiration Date: G9/09/23
kib Site Address: f() _6 .Spv-acei-u-i/ -7/— cityistat.,7.,,Nixtuts4-wroN, MA, 61.06Z
Attach a copy of the winters'compensation policy declaration page(showing the policy somber and explratioa date).
Failure to scieun:coverage as required under MCI_c. 152.*25A is a imamid violation punidiabk by a fine up to$1,500.00
and/or one-year impnsonment.as well as civil penalties in the form of a SfOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement nifty be forwuded to the Office of Investigations of the DIA for insurance
coverage verification
I do hereby certify under the pains and : ties of popery e information provided above is true and correct.
c__, ------,
Signaturc: -.=_) Date: ''' F-7------ ------
---
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----
Plioni
..---
Official last only. Do not write in this area.to be completed by tits-or town official
(:My or Tows: Permit/License
basing Ant horit. (circle one):
l.Boord of I lealth 2.Building Department 3.City/en:11i a Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Plume t$:—
I
City of Northampton
,,��jj4Y�TTfi
; ---'- ‘ Massachusetts � -'
t A' 'irit .,
DEPARTMENT OF BUILDING INSPECTIONS r,
212 Main Street • Municipal Building -+f -;b,,—" Northampton, MA 01060 �S �, �
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:
S A - S ,� S or C
I--
� I/`�
" t
The debris will be transported by:
,qs1
Name of Hauler: Q 54 E (,�
Signature of Appli : ,f --' -�2 DateY�
City of Northampton
Massachusetts
_ DEPARTMENT OF BUILDING INSPECTIONS ,.'
a 212 Main Street • Municipal Building ..� -
Northampton, MA 01060 �� tY t;_,t��
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
1, (insert full legal name), born_ (insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one-or two-family dwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in
a two-year period shall not be considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of , 20_.
(Signature)