Loading...
24D-162 BP-2023-0687 9 MYRTLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-162-001 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-2023-0687 PERMISSION IS HEREBY GRANTED TO: Project# REPAIR ROOF 2023 Contractor: License: Est. Cost: 9300 Const.Class: Exp.Date: Use Group: Owner: BHATT RAJESH Lot Size (sq.ft.) Zoning: URC Applicant: BHATT RAJESH Applicant Address Phone: Insurance: 9 MYRTLE ST NORTHAMPTON, MA 01062 ISSUED ON: 05/24/2023 TO PERFORM THE FOLLOWING WORK: FIX LEAK IN SUNROOM 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 NO HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: $ ( • ja Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVED �' .. 0 Grn aV ruAyyvt. MAY 023 3 The Commonwealth of Massachusetts Boar' of Building Regulations and Standards FOR Boar State Building Code, 780 CMR MUNICIPALITY PFPT.OF BUILDING INSP USE " 'a` g of oivpp}icattbn To Construct, Repair, Renovate Dr Demolish a Revised Mar 20I 1 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 4 l0- 3- Log 7 Date Applied: ,�►�i`o� /ff/ 5.23-zoz3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers q M1 TLf Si• :vcrt1 4M PDo,.J 24-b- 162 - oo I 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 0.oc1 4ciecs 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 Waterat Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 8 Sewage Disposal System: Public kV Private 0 Zone: _ Outside Flood Zone? unicipal I9 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: R.Al-6sl1 Gil A T T N o r�11-i j v+�` M A C) I o 6 0 Name(Print) City,State,ZIP q I''v`lA1%.E S 1. 512- 660- 225 1 81-1,RT► e L&MA S S. 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( ) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: T 0 F-1 % LEA K i N --Su R QOM - REP LAC ON 41 RcOF CAQ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ , 3 n 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees: $ ,y� Check No.Jo Check Amount' V Cash Amount: 6.Total Project Cost: $ 9) So 0 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U L'nrestricted(Buildings up to 35,000 cu.ft.) 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 ad.' - s D Demolition 5.2 Registered Home Improvement Contracto (HIC) S 6 03/t a- 25 �U N 1 02, MA► N r£N A N C& HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name . F S112 E r DAR`, P ci l e elmAIL , City No.and Street Email address 9-4ST N A M P T of M 4 413 — 236 City/Town,State,ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE • FIDAVIT(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 1ilr No ❑ 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) 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 contained in this application is true and accurate to the best of my knowledge and understanding. Si') 13►-1 ( MAC 23) Z 02 S Print Owner's or Authorized Agent's Name(Electronic Sign ) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owtter who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will orS 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.govroca 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 Cart,041, ��s arc'•..r Massachusetts �w� �� �r DEPARTMENT OF BUILDING INSPECTIONS ��, ,' £ 212 Main Street Municipal Building of O° Northampton, MA 01060 '�s ,y T,)�'N 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: C AST il A-M►,ro NJ 12t_cy c L ► N C. The debris will be transported by: Name of Hauler: Sz' `''�' DO ALvA 9- E— Signature of Applicant: T Sh �`H `\ Date: a\ `"' �--3i 1 ° 23 1 h 4,- The Commonwealth of Massachusetts Department of industrial Accidents 1 Congress Street,Suite 100 • ", Boston, MA 02114-2017 www.mass.gov/dia n takers l'ompensation Insurance Affidavit: BuildersiContractors/Ekctricians.'Plu whets. TO HI rttio 1•11i THE PLICHITIT'sf;AtTHORl1 . Applicant Information Please Print Letilth Name liiusInvs.s—OrgantzationlIndividual): R :I- --S}-1 2 I-1A YI Address: 9 M'1Q1L , City/State Zip: N0g-T1144No1 19-M NI MA 0\ 660 Phone#: .S 1.2.— Cz>C) — . . Are)uu at.employ er?check the appropriate bus: Type of project(required): • LEI I an a employer with _employees(full and or part-tiinct.• 7. a New construction 213 I am a..ole gruprietor or Ilannership and have nu employers worting forme sn S. Remodeling any capacity,[No workers'comp.insurance requiredA 9. Ei Demolition 30 aill hUlaILVW/itT 4.10111S all Wuric myself.No workers'tunilt.irtiorance mellowed] 10 0 Building addition 4. ant a ittillteNnkilc1 and*ill be hoists.r.-ontractors to conduct all work on my property. I*ill alzlift:that all contractors either have markers"compensation insurance in ITC MAC I lip Electrical repairs or additions prupncturs with no employees. 12.0 Plumbing repaus or additions .5E1 I arc a general contractor and I have hired the sub-contracturs listed on the attached sheet I 319-friCof repairs These sub-contracturN have memloyees and have workers'comp.oisurartee;, 60'We are a curTsoradaun and its officeni have exercised then right of exemption per MCIL c. 14. Other 1 . 1.and sve have no employees.[Nu wuri.ers'comp.insurance required] *An.? applicant that checks box ci must also fill uut the section bcluss show int;their nurkcr, compensation policy information. *&immix^sera wipe submit due aftidak it indicating they are doing all w urk and dam hire(MAW&.•urttruclur.must>almi a new affidavit uaitieanng such. :Conuactors that check this Isos must attached an additional sheet shins ing the name oldie suir,:untractur.and',raw,A!tether or nut those artistica have empluvce, It th..:NUb-iuntrAauts ki employocs.they must pny,ide their u,orker.: INJIrcy number lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job she information. Insurance Company Name: Policy#or Self-ins. L lc.#: Expiration Date: Job Site Address: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dates. Failure to secure coverage as required under NIGI. c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 anitor 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 cover,p2_ I do hereby certify under the pains and at:hies of perjury that the inhIrrnalion provided above is true and corrci r. Signature: s Date: 144 e 23) 2":)2"---3 Pho : I 2- - 6so Official use onl). Dr)not write in this area,to be completed by city or town official. City or Town; Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: