25C-064 (5) BP-2023-0718
274 BRIDGE ST COMMONWEALTH OF ASSACHUSETTS
Map:Block:Lot:
25C-064-001 CITY OF NORTH MPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREG STERED CONTRACTORS
• DO NOT HAVE ACCESS TO THE GUA NTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0718 PERMISSION IS HEREBY GRANTED TO:
Project# PORCH REPAIRS 2023 Contractor: License:
Est. Cost: 5100 JONATHAN TOSCH 116108
Const.Class: Exp.Date: 10/08/2024
Use Group: Owner: PRYOR, RYAN E. &WEIDMAN, LAILYE M.
Lot Size (sq.ft.)
Zoning: URB Applicant: JONA HAN TOSCH
Applicant Address Phone: Insurance:
312 AMHERST RD (630)902-1627 WC5-33S-B22DGV-012
PELHAM, MA 01002
ISSUED ON: 06/06/2023
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO FRONT PORCH
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 bepartment Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NO' THAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: j >2 3-1 •
Fees Paid: S65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
•
The Commonwealth of Massachusett ����/r1
Board of Building Regulations andSta •arch -1 l?OR
V • Massachusetts State Building Code, 7: I CMR�N 7vIUN/IPALITY
4.7m5 USE
Building Permit Application To Construct, Repair,,Rt'tty. •r Demon [a Rev sed Mar 2011
One- or Two-Family Dwelling "N444 ,1n/N,,
This Section For Official Use Only
'— zogp /VS
Building Permit Number:pP_D, .. 712 Date Applied:
i<eJ 25-) // 7 - t 12023
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
2,7 it Moat- Slag-ET 25 C 25G-144
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
976-0 60
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
�V A//j�.�
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 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
PR.YO#Q 444411: W 1 mAly,• Ga/GYP'Nl. Nvnzf�AMP1fl4/, Mq 0/06t-
Name(Print)' City,State,ZIP
171- R&D OE' £7'
No. and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Ll' Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: -_
Brief Description of Proposed Work2: tv w t eeJVivi 04/ FiLI'VT /F02[4,-; 4-04/IV!
/{-b011i,Nd l0/L?L flNd/01�L fat v�- JO/t-7L /r IvGELai'c fA
t✓ ?2.f✓
Mgbirytivykv/Goilu i w cw,t t 4-r ILe/4-4, xycn_ SL.
/ SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ U p 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ - 0 Standard City/Town Application Fee
0 Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ -- --
Suppression) Total All Fees: 4;1
6.Total Project Cost: $ Check No.108 I Check Amount: Li Cash Amount:
0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) GS.- /l4 0 7 tfI/O 10-ot.f-
J LA/A7/FAA/ 7)S �1----- License Num r Expiration Date
Name of CSL Holder
3/Z AA ri t f 7 2 List CSL T (see below) �/
No.and Street Type Description
0 ElAbi
4 /1f4. 0 (DO I_ U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
6 3o ?&Z. /6 27 dal 0,71 -4 f 4/L- (M' _ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expir ion Date
HIC Company Name or HIC Registrant Name
VI_ 4 j{-612£7 /Last,rL dt741/0.70 SC/-&aniAit .CD/►ti,-
No.and Street Ol C/0 2._ �03Q 2Otj/t 7_7 Email address
City/Town,Mate,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 Issua of the building permit.
Signed Affidavit Attached? Yes f 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 p rmit 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 pe 'ury that all of the information
contained in this appli;/. is true and accurate to the best of my knowledge d understanding.
66/a
Print Owner's or Aut :rized Agent's Name(Electronic Signature) Date
NOTES:
I. 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"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: 'C.5C - LOT: Q5CrO
LOT SIZE: 57C 0 -
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
1*' " �tWI
F6tit njd r
c(elveA-
(fiir
I
Ottit/t A-
O
147-1
FRONT SETBACK
FRONTAGE
A
City of Northampton
1 Massachusetts .��` ... -!c�,
at
't DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building J�%
Northampton, MA 01060 j'y--11 0:‘
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: 1/4t -cY f(! L-, t4V71e-4 v• tf---
The debris will be transported by:
Name of Hauler: TO CL-U4- W� f '4 (j'C GO'1
Signature of Applicant: Date: 0c/I 23
The Commonwealth of Massachusetts
Department of Industrial Accidents
1- iir r= I Congress Street,Suite 100
Boston, MA 02114-2017
....,Lkir
www.mass.govidia
‘1 or kers' ( onipensation Insurance Affidavit:Buliders/ContractortifElectrichint/Plumbers.
TO BE FILED WITH'THE PERMITTING AlITHORITV.
Applicant 1 info r mit(ion Please Print Legibly
NatriCilittStrx-5%,Otganizationintireidual): TO$C-#— C.-45 tvglrivexte-Irlkr id- 1.--e's
Address: ?fg.,_ A.Alifrericr fr2.—
City/State/Zip: P6744/40( 'fit-- 0/OD 2 Phone #: 0•rOs e02_. i‘4..7
An"a employer!Cheek the Appropriate hat: Type of project(required):
i. I ant a employer with 6 employees(NIL arieVor part-timel,* 7, (J New construction
21:3 I am a lute pruprietex in partnerstup and he no envloyees working fur me m 8. 13 Remodeling
any iArpacity (No workers'cuinp.'insurance required)
9, 0 Demolition
ICJ 1 an,a honsisiwner doing ali work march[No workers'comp,IltAlratti:4:requireill"
i a El Building addition
40 i am a homoowner and will be knring contraeturs to eorntact all*ink on my property. I will
ensure that all contrawlors either have A'oric "compensation insurance or are%4310 i 1 a Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
..5C3 I am a general contracttn and I have hired the sub-contractors hind on the attached"beet
131:319iof repairs
These sub-contractor%brie employees and have workers'emir.insuranee:
h.C1 Vie are a corporation and its officer*NiVC vAixtasord their nsin of exemption per liKil,c, 14.ItWOthei p Opyai. 17,274/4___
152, 114j,and we have no employees.[No*calm'comp.insurance required.]
*An"applicant that cheeks bin"1 mint 4644 till out the whoa below show ing their workers'eintqwersation policy informatuni.
t Ihrinetissners who submit this affidavit indicating they are doing all weft and then hire ouislik contractors snug salmi!‘1 new A Itiri4V IE indicating sueb.
Contractors that cheek this boa must attached an additional sheet*hoe,in g the amine of the subcontractors and state whether or riot those entitioi haw
employee, II ti,,,,mih-i:ornractors lsi*e eiriployees„tfie,v mini provide their worker*"arum,policy riumkaa
1 am an employer that is providing.workers compensation insurance for my employer.,. Below Ls the policy and job she
infOrmation.
InNarart,ce Company Name: aeeiryi 444/7(/41.--.
wiwi47.
Policy g or Self-ins. Lie. 4: We4-73.1 ezz.116V- 012 _ Expiration Date:1(4424,212.L.AWE
Job Site Address:2_rfit&La e- g2.7 City(StateiZipP06,#44414at 414- Otain___
. , •
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGI.c. 152.*25A is a criminal violation punishable by a fine up to SI.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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verifica
I do hereby cer nder the pains and nalties of perjury that the information provided above is true OA correct.
Signature: . .
r...............................fe
Phone 14: 6° 0 tol A a..7 Date: 05-7/3# A-1--
Official use only. Do not write in this area,to be completed by city or town official I
:
City or Town: PermitiLicense it
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Cit /Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
t
Contact Person: _ Phone t4:
AI
City of Northampton
Massachusetts
{ y
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building ie;
� Northampton, MA 01060 Ats
0;4
HOMEOWNERS'EXEMPTION ELIGIBI ITY AFFIDAVIT
I, (i sert 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' •xemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.i.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 seeki 'g the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings cons cted in accordance with 780 CMR 110.R3.
3. I qualifij under the State Building Code's definition of"homeowne "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 o i 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 require 'nts for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in 'onnection with any project or work involving
construction, reconstruction, alteration, repair, removal or demo ition 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 ith the aforementioned project or work on my
parcel,I acknowledge that I am required to and will act as the sup', isor for said project or work.
Signed under the pains and penalties of perjury on this day of 20_.
(Signature)