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25C-051 (15) BP-2023-0807 59 LINCOLN AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-051-001 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-2023-0807 PERMISSION IS HEREBY GRANTED TO: Project# ADD BATH 2023 Contractor: License: Est. Cost: 30000 SCOTT NICKERSON 053156 Const.Class: Exp.Date: 01/10/2024 Use Group: Owner: SWEET GINTIS VALERIE &WILLIAM Lot Size (sq.ft.) Zoning: URB Applicant: SCOTT NICKERSON Applicant Address Phone: Insurance: PO BOX M (413)896-3347 0 LAKE PLEASANT, MA 01347 ISSUED ON: 07/07/2023 TO PERFORM THE FOLLOWING WORK: ADD BATH AND BAR TO GARAGE 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 etfit Fees Paid: $195.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECFIT-;7) AmrAL 0 ,i; ,MLf 17/03 , 11AR272U23 The Commonwealth of Massachusetts 1' 16 j Board of Building Regulations and Standards FOR DEPT O:Zr ING INSPECTIONS Massachusetts State Building Code, 780 CMR MUNICIPALITY wv�s_NOR ,:,,f TON,MA 01060 _. USE Building ifermit 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: Bl'-..t,3— gtt 7 Date Applied: I ai I 1 12 • % 7 7 3 Building Official(Print Name) I Signature i ate SECTION 1:SITE INFORMATION 1.1 Prperry).ddresy �� 1.2 Assessors Mapi &Parcel Numbers �f be 6, n J 1.1 a Is this an accepted streetilcr no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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 Wate ply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Dis al System: Public Private❑ Zone: Outside Flood Zone? Municipal PE15n site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 A-te 'of Record , ,/ fit 4 O / / Q Name(Print City,State,ZIP r , treat I e, ft S 5 7 L,h e-,/ g---e- cif 1 - 2 V y-S yes'' P- iatil/t �« No.and Street Telephone Em.' Address V SECTION 3:DESCRI/I<OF PROPOSED}�ORK2(check all that apply) New Construction 0 Existing Building ner-Occupied © Repairs(s) 0 Alteration(s) EKdition 0 Demolition 0 Accessory Bldg. C� Number of Units f Other 0 Specify: Brief Descrip i of Pro osed Workz: / / Sri r;/ ?� n4 0.44/ &e he / n .4„tiv✓ y A r is-� V Aa fir.. 14,41 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ /1 C c a 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 4 06ir 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ /0 00 a 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No,K9 Check<Amount://5= 6.Total Project Cost: $ 3 � ,O Z 0 Paid in Full 0 Outstanding Balance Due: City of Northampton t. . Massachusetts r,, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Buildings -- Northampton, MA 01060 ,,N 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. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor Lice se(CSL) ^-� 53/S'G /io �. y S&7f io1 License T umber Exp' ation Date Name of CSL Holder fi b List CSL Type(see below) No.and Street Description /"` n r Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP [e f /K Q��1� Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding yl3 S i6 - 3 30 Swit ec/ :rcc4 SF Solid Fuel Burning Appliances `/ ��,.,.` I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Fontractor(HIC) /Sa 3 /y ,Z_ sA w+2 ! HIC Registration Number pirat on Date HIC Company Name or C Registrant Name ` / rsc No.and Street Ematf 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 Issuanc the building permit. Signed Affidavit Attached? Yes 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 authorizes' #0ezbiezt to act on my behalf,in all matters relative to work authorized by this building permit application. 3/ y/2 Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my nam w, I hereby attest under the pains and penalties of perjury that all of the information contained in this ation is tru t of my knowledge and understanding. 711-1 /f 0." /1 3 Print Owne or Authorized Agent's Name(Electronic Signature) ate 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 Comnsonwealth of Massachusetts 1 i Vil= i Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.govidia '''''-'-• 't.: 2'7' ‘S'orkers't'ompettsation Insurance Affidavit:Builders/ContractorstE1ectricians1Plumbers. ID HE FILED WITH THE PEICSIITTING ACITIORIII. .tonlica tit Information Please Print Legiblr Name i Liminess. ;Organinitionlndiviciusil):_c(ci lie. /1)1(.1e1VGLA Address: , 6. --72.-A,- fri d/7Y7 e - 7Y City/StatelZip: Z, /A4.444, Phone#: 11/ _ //14'A . . — Are ytan me employer?Cheek the appropriate box: Type of project',required): I 0 I am a nployer with etriptis,,eta(full azutor part-tr Iry 1,* 7. 0 New construction 2 am a sok propnctor or partnership and base no employee.No Prising tor me in etre.........er 8. 0 Remodeling any capacity (Nu worker.'comp,insurance required] 9.. 0 Demolition 3.0 I Ara u hunseowner doing all work spelt.(No worisis°comp,insurance required]" 10 0 Building addition 4,0 I am a hurnouvitt7 and will he turn comractors to evriduct all%ink on nry property, 1 will aL%1Lre that ali ci,mtraeturs tither have worker.'eoropettsation Maur al111X or are sole I i a Electrical repairs or additions proprietor%vs ith no employees.. i 2.E]Plumbing repot or additions I am a 100.71erai contractor and I hese hired the.1.th-contractor%hated on the anached sheet 130 Roof repairs nese sub-corarsetuis Isi,,,,i employees arid has e workers'*Amp.,insurance:, I 4_00thet ha We are a corporation and its officers ha v e exercised their right of exerrmtion per MC&, §I(1),tiivi We hive no employees.[No work rat'comp..insurance requircrif that eibeeLs box al most aho fill out the aection bekne show mg their workers'einnpensation policy intermateuet ' 11.;ineoss nem who sistmit this affidavit indicating they are doing all work and then hire outside.contractors nand suhrnst a new artist:In ii Had 11:Alliail MA.il 'Contractor%dust cbsi:k this box must attached an adristiona1 Shtce tio.0,iny the name of the sub-eormaetots and state*shelter ix riot diva ertiitios have empluyet... If the aub-consiractor%1241.4:tiriplo,era,they moat pri,N.1de!heir Autk4.1,"';:otrir.r.,ii,-;numbs./ I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site Information_ Insurance Company Name: — Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City'State:Zip: Attach a 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 line up to SI.5()0.00 an&or one-year inimsoninent,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 cop - - is statement may be forwarded to the Office of Investigations of the DIA for insurance verification. /dr)hcrt.kr certifj ant e poi n penalties of perjury that the information'provided above iN eerie and eorreet„ Sienature- Date. l',:==r'_ W'3' fi n •-'; 3 V-1- [ Official use only. Do not swite in this area,to he completed by eity or town official ('its or Town: Permit/License# Issuing Authority (circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector = 6.Other , t:ontact Person: Phone#: ter, City of Northampton Massachusetts * DEPARTMENT OF BUILDING INSPECTIONS III ,a 212 Main Street • Municipal Building ?' Northampton, MA 01060s tib ` 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: VA-14 /4 , /'� The debris will be transported by: Name of Hauler: �� # lerd� _ Signature of Applicant: Date: /rA� City of Northampton /?° 'K"Jf 3 n Massachusetts ] DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 ss7� s ,itit HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born_(insert month, day, year), hereby depose and state the following: 1. 1 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. 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