17C-095 (16) BP-2023-0630
136 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17C-095-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A)
BUILDING P1ERMIT
Permit# BP-2023-0630 PERMISSIO IS HEREBY GRANTED TO:
Project# BATH RENO 2023 Contractor: License:
INTEGRITY DEVELOPMENT &
Est. Cost: 30900 CONSTRUCTION I 090514
Const.Class: Exp.Date: 09/12/202
Use Group: Owner: YALE BALDI BRIAN& LESLEY
Lot Size (sq.ft.)
INTEGRITY DEVELOPMENT &CONSTRUCTION
Zoning: URB Applicant: INC
Applicant Address Phone: Insurance:
110 PULPIT HILL RD (413)549-7919 WMZ80080062242021
AMHERST,MA 01002
ISSUED ON: 05/16/2023
TO PERFORM THE FOL L O WING 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 i ,
1 . N,
Fees Paid: $201.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
1.0i.
iff4Y 1 f'
&pr �� ,The Commonwealth of Massachusetts
of FOR
ar eN,�o Ward of Building Regulations and Standards
H70/to N�r MUNICIPALITY
k.. Nsa --_ Massachusetts State Building Code, 780 CMR
. ._,� --- ti.41,,q Ecrio USE
Buildin'g'lmtsApplication To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Pit Number: 1 ,P-S.3- 6'.3a Date Applied:
il ..2 ''>> /7 5-I6,-202
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
j 3C9 6 ff&5'-oVar 1 C o 95-Co l
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: QO
KGS 1 Dx-aJj7.4, IE6/1) II)50 `2- C1
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-er Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public C� Private❑ Zone: Outside Flood Zone? Municipal Er On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP1
2.1 Ownerl of Record:
c1 SA L. hf 4 teSi/ )/4&fq 01 /c(' 2,,
Name(Print) City,State,ZIP
1 ci-t Ss\Jtri 5^2t,�r yi3-2ot/-36,5e 1320 1-.1)i e 4in . C®"4
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) 0 Alteration(s) EYlAddition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Q�--a.tott k TI O J 0 r (,_--)(15'T v41 .5, f 3jRGYJrV1
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ ZJ ZoZ� 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ -30 0 ❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ (p f 00 2. Other Fees: $
4. Mechanical (HVAC) $ ,vpt- List:
5. Mechanical (Fire Suppression) $ /' Total All Fees: $ it?
P�Check No. Check Amount:
6. Total Project Cost: $ 3 D f 9 0 a 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
G5 01 osiy o`j/i -/z q
4 N XA g . ewe License Number Expiration Date
Name of CSL Holder
i/3 /Att.1 N� ' f LL5 ed.- List CSL Type(see below) V 1
No.and Street / �/ Type Description
rtFns/ O/OO , U Unrestricted(Buildings up to 35,000 cu.ft.)
City State,ZIP ) /44 R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
�l3�511 f— I'? 4/,sj P/1E4p,U/W. 61m I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I/0O y/ O/ J/9/
cj � —►�V nl� 1 HIC Registration Number Expiration Date
HIC Corn y Name o -c 4egistranttme)
I/O I `/ 'LA, 4Ap.t/A @/N71 ('/4-D, deyv
No.AS,t)reef Email address
t-r -isr) ,IA d/' 2 05-5119- /9
City/Town, State,ZIP Telephone
SECTION 6:WORICERS' 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 I31/ No . 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1/)
I,as Owner of the subject property,hereby authorize )jj�[s1Q/j 1 r✓-LpPf l EN_ rl.4 U045 L/Gf
to act y behalf,in all matters relative to work authorized by this b lding permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
containe ' this application is true and accurate to the best of my knowledge and understanding.
1 i 0 \,(_
Print Own o Authorize 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
..,_,.._.
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'tr.::
Deportment of Industrial Accidents
I Congress Street,Suite 100
)
.41Etsi-•,.'-'19' Boston, MA 02114-2017
www.moss.govidio i
-- 11 0/kers Compensation Insurance Aflidas it:Builders/ContractorsfEkctricians.'Plumbers.
TO HE FILED% WI'111E PERMEITING AtfltIORITI.
Applicant information Plea e Print Lteihil,
Name(Business'Organizatiort'individualy JAI-I-t--641 ly 7,&-vt--IvPme /-; 4 ci 6 pi-tie 0 eh‘j
Address: lio 84437-- gd-L, 4A-p
. ..City/State/Zip: /4-y)141-p2-s3-17, B/A- ,a192- Phone#: 11V3 ---5(7/9— 99P/,
. —
Art you an employer?Cheek the appropriate box: 1- .pe of project(required)°,
I.211-arn a employer with j ,erriployees(full and,Or part-timel.• 7. 0 New construction
2.11 lam a sole proprietor in partnership and have no eats working (or me in 8. ( Remodeling
any capacity.[No workers'comp.insurance required]
9. El Demolition
1:1:1 I am a hunsrowner doing all work myself.[Nov/Aitken'curup.insurance required].
4.0 I am a huirwowner and will be hiring euntratiors to nduct 10 0 Building addition all work on my property. I will'
einem:that all Coniractur either have vomiters'compensation insurance or are WIC 1 I 10 Electrical repairs or additions
proprietors with no employes_ 12.0 Plumbing repairs or additions
.:;.00 I am a general contractor and I have hired the sub-contractors hated on the attached sheet_
i 3.0 Roof repairs
Mese sub-contractors base employee!'and have workers'comp.insurance.;
14_0 Other
h.E1 Vie are a corporation and ib officers have extnised their right of exemption per Wit.e.
152,*10).and we have no employees.[No workers'comp,insurance revered]
*Any applicant that checks box al mint also till out the section below showing their workers'compensation polky information.
*Homeowners who submit this affidavit indicaune they rue doing all wink and then hue outside contnieturs mini submit a new affidav it indicating st.s.-11
Contractors that check this box must anmehril an additional sheet showing the name of the suh-s:ontraeturs and state whether or nut those trunks have
employees.. If the sub.-contractor's!vise employees.they must pops ide their workers"comp_policy number
I am an employer that is providing workers'compensation insurance for my employees. Below Is the policy and job site
information.
Insurance Company Name: A . I. iv), 1114 bi114/Jo...,
Policy#or Self-ins,Lic.#: WiY1 -6o0 5 e'e,(e 2-2-q 2.4 2-3A : Expiration Date: 9/40/2-41
Job Site Address: /36, 0-fr-67)4 UT 5/, cityistatezip: „Op._.6-.---"le-E 1 tVIA1- 0/062_
Attack i copy of the workers'compensation policy declaration page(showing 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 fine of up to 5250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
..„
I do hereby certify under the pains ond penalties of perjury that the Information provided oho i'f'is true and correct
Signature: Date:
Phone e:
v Official use only. Do not Write iil thi,$gireit. to be completed by city or town official
iCity or Town: Permit/License
1 Issuing Authoriti (circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: , Phone#:
...c.,,„,..,...„
City of Northampton
0 „. s,
,., Massachusetts X. ' .C, F!
g
a iii, DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building ¢, >
Northampton, MA 01060 ^ 1'tia'
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 4 6 12F6yw,,.i. `'i St-i-oh14nia /20
G/ -57 (All n/. Sam G
The debris will be transported by:
Name of Hauler: TAWG (Al1C (,cc (2uC / o•I‘i
rL
Signature of Applicant: 020_(0Date: