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31B-234 (4) BP-2023-0716 74 KING ST UNIT 1 COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-234-001 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-2023-0716 PERMISSION IS HEREBY GRANTED TO: Project# RENO 2023 Contractor: License: Est. Cost: 30000 JAMES MAILLOUX CS-081694 Const.Class: Exp.Date: 10/16/2023 Use Group: Owner: PHYLLIS WILHELM JOSEPH A III& Lot Size (sq.ft.) Zoning: CB Applicant: JAMES MAILLOUX Applicant Address Phone: Insurance: 221 PINE ST SUITE 160 (413)585-1592 WCT0721Q FLORENCE, MA 01062 ISSUED ON: 06/06/2023 TO PERFORM THE FOLLOWING WORK: 2ND AND 1ST FLOOR BATH RENO, ADD KITCHENETTE TO 2ND FLOOR 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 sClj Fees Paid: $210.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massac set - S j c, Office of Public Safety and Inspect' 2023 / �r Massachusetts State Building Code(780-C, APQV/ Building Permit Application for any Building other than a One-oa? a wel ing (This Section For Official Use Only) ` rf�criONs Building Permit Number:o?3- '7/6, Date Applied: Building Official: ��J SECTION 1:LOCATION 4/ 16 ks w - IT I TO 0 106 L No.a d Street City/Town Zip Code Name of Building(if applicable) Assessors Map# 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 eir Repair 0 Alteration ' 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 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No Br Brief Description of Proposed Work 2 MD 1 wort RE A o o n 3.4 11 rogor►1 /6 MI r#etrc, /sr pz ir&i,o 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) ❑ 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.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 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 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA ❑ IIB 0 IIIA ❑ IIIB ❑ IV CI VA CI VB SECTION 7:SITE INFORMATION(refer to 780 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❑ A trench will not be Licensed Disposal Site 0 required 0 or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner H/t1heM Sy pc 0 1.`rfl' N r%n Name(Print) No.and Street City/Town Zip Property Owner Contact Information: t A JL 0 wN4n- _SA- 3q 80 3?-o f; St Iv./he/"pc & A+ •CO Title Telephone No.(business) Telephone No. (ce ) e-mail address If applicable,the property owner hereby authorizes: Name Street Address ity/Town State Zip 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 O. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor J JM /1?,,2L(64'1,X Company Name €r /sir(•"-.� 8'16 9 1/- Name of Person Responsible for Construction License No. and Type if Applicable 22A p,/l c PT O n‘n•Ct i 44 0 i 116'2— Street Address City/Town State clrZip /fy� _S�3_y6sy niA,/l4•�31CleC sC tn«, /.cam} Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAV ter(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 c enial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes CI No El SECTION 12:CONSTRUCTION COSTS AND PiRMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 16/< Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ /0 i appropriate municipal factor)=$ . 3.Plumbing $ lb x ce 4.Mechanical (HVAC) $ Note:Minimum fee=Sal (contact municipality) 5.Mechanical (Other) $ Enclose check payable to COlt 6.Total Cost $ e � � (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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. / .�•, A'l/liI/- aw. ' _jiff K11 4/i 2.' Pleas; tan• sign name Title le Telephone No Date Street Address City/Town State ip Email Address Municipal Inspector to fill out this section upon application approval: L. 5-zoo Name Date City of Northampton Jcr _ r F ,5 S,6 f 66 Massachusetts ��S k_• 'e`,, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �+� O� Northampton, MA 01060 ss� •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: ,7 Location of Facility: VI! &y K `L (e I' The debris will be transported by: Name of Hauler: Up .5 /1'1 Signature of Applicant: Date: 4/2- The Connnorrrt'ealth Of Massachusetts T'� J" Department of Industrial Accidents I. rv'` I Congress Street, Suite 100 Boston. MA 0211 4-2017 r lov.ntass.gov/dia 11orkers'Compensation Insurance:lftitla%it: RRuilderu('ontractnrsiElr.tt iii.ui' Plumbers. 1'0 Hi:FILED tt l I It'IIIE PERstrrrl ,t:At'flt(ORl I . ltrt>lk iiii information Please Print I.tiihta Nanie 1tiustst,.,-.I 1 antzattont Inds.'duut): s1/41�/i4, it a --x Address:.____ZZ I 7►He 57 �/�.1�.^-(i:• /''1Ot c)/Uc 2__ - City/State/Zip: I'}icat1e -.: --//? S /5.-72 Are employer?('leek the appropriate boyI..h pe of project(required): 1. 1 ant a employer with j employees(full and ur part-tiiney" 7. DNew construction 2.1:I m I am a auk ppneten ur partnership and have nu engrkryets working for ere in ft. 0/Remodeling any eapaeity.[Nu worker.'comp.insurance moved.) t=9 30 I ant ahunieorwrter doing all wtirk myself.[No w`aktas`Lump.iusurutce ret4tureell 9. ❑ Demolition Ia0 Building addition 4.0 I ant a homeowner and vittl Is;hiring o ururacaora to conduct all pork on my p up rty_ I will ensure that all aoiura:turs either hake verniers'compensation newuranet or are sule I I 0 Electrical repairs or additions proprietor,with nu employers. 12.0 Plumbing repairs or additions 5.0 1 ant a gimeral contractor and I have hired thesub-cuntracton.listed on the attached:,beet. 13.0Roof`repairs These tb-euntra cturs base employees and have a^writers'comp.Insunince.= 14.0 Other N.:1 We are a cxnpuraliun and its officers have exen.ised their tight of exemption per Mt,L c. - 152,tli41.and we litre nu cmpluycers.[No workers'comp.insurance required.] •Amji applicant that checks bus t:1 must also fill out the section below aho ing their_ worker'compensation pedity information. r Itoinxtw'ners who submit this atlidat It i diating they are doing all work and then hire outside emir-actor.mist tutting a new affidavit indicating suck lContractors that cheek this but must attached an additional sheet shots trig die name of the sub-,onrrn.tuts and state whether I not those amities have employees. If the sub-contraetras haw employees.they must pros,idc their 'sulkers'.v�mr r..,ire'.ntanher. Iaman employer that is providing nvorkers'compensation insurance for rut'evnpta+s.'d‘.. 1;r1.,11 rs hitt.Ittfli.•u and lob site information. Insurance Company Name: /I n I A, cf.- /w At c e►C..% _ Policy#or Self-ins.Lic.#: 1.A/C r 07 S 1 a Expiration Date: /O/f/23 �/ CT ' y 00 a Job Site Address: ��116 /�aM6} Cat, 1 Y1. (�i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under b1GL c. 152. ;25A is a criminal violation punishable by a fine up to$1,500.00 andlor 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 co y of this. ,tt,:1:.rat may be forwarded to the Office of Ins...-:,..rations of the DIA for insurance coverage v'eri'' t'on. I do hereb certi an It e pains and penalties 0/perjury that the inlOrnantion provided allio 't.'is true and correct. Signature: I; t: b 2IZi Phone 4: I/i CV /f Official case'au/r. I)o not writs'in this area.to be t orrapleted by city or town ojfit'ial ('ity or Town: Permit/License 0 Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.CO:Town Clerk 4.Electrical Inspector 5. Plumbing Inspector Pi. Other ( (intact Person: Phone#: