31A-170 (2) BP-2023-1280
60 MAYNARD RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-170-001 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
\I I
Permit# BP-2023-1280 PERMISSION IS HEREBY GRANTED TO:
Project# FRONT STEPS 2023 Contractor: License:
Est. Cost: 300
Const.Class: Exp.Date:
Use Group: Owner: ROGERS MICHAEL&ALEXANDRA JESSE
Lot Size (sq.ft.)
Zoning: URB Applicant: ROGERS MICHAEL& ALEXANDRA JESSE
Applicant Address Phone: Insurance:
60 MAYNARD RD
NORTHAMPTON, MA 01060
ISSUED ON: 09/18/2023
TO PERFORM THE FOLLOWING WORK:
REPLACE FRONT STEPS
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 )2 . 'Pi •
• . , .
i
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
RECEIV .
gma i ( w it (cad
The I ommonwealth of Massachusetts FOR
., )1, SEP B•:rd o Building Regulations and Standards
MUNICIPALITY
4 3` 2O M.ssac� setts State Building Code, 780 CMR USE
,._..
PT of g; -..' 'ermit • pp!' ation To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
NoRTMA 'TpN IMA oEOHS One-or Two-Family Dwelling
This a tion For Official Use Only
Building ermitNumber: ,6 '..13- /2 Date Applied:
evrio (? - ,,e____/_,__.._._________
' Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
D /►1 ity Ina tet 116,...Z 3 t A 11- o
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
1 rGo 5--
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public® Private 0 Zone: Outside Flood Zone? Municipal I.On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: AA
MiC ka.4( ave��t.tS wi-.� �1
C 1teeKe (ee N k
ei , ,l 1wt MA- d l 06 a
Name(Print) 1e SL. City,State,ZIP
/)) (h4,vI Il o t A 4t3 sr.( 6.19 9 1 ,i-f+fik rottmic k&ti®9 vk,,,1 .r or,,
No.and Street 1 Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building El Owner-Occupied 0 Repairs(s) ter Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 12 eD(*it r-, i.4.y fro.a, + pore- it Svc/Sj
ado( A$ j irlii( . r J
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ )00 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ _ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: 5 Cash Amount:
6.Total Project Cost: $ 6 00 Paid in Full 0 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 Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted I&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
_Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email 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 Issuance of the building permit.
Signed Affidavit Attached? Yes 0 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 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.
(4 L64,( ant V/4/2oZZ
Print Owner's or Authorized Agents Name(Ele onic 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"
City of Northampton
Massachusetts . e
c,
DEPARTMENT OF BUILDING INSPECTIONS �- 1 '
212 Main Street • Municipal Building ph
Northampton, MA 01060 ry, $ ��'
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: 14 +41 p.ec 1[ t,i , ¢ L'o14 -�h,,,,,,6 . 12d, M 11... e;Tz v\
The debris will be transported by:
Name of Hauler: .M, kI,E ( ( G 1 tl
Signature of Applicant: Date: 9/19 t2 6L 3
City of Northampton
49a F.
des •,s,
; Massachusetts
ti
( � � DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building �,�
i)': • Northampton, MA 01060 "�'!%yy ,3Oy'l
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
AttI, t v�lat/( a 6 4.ri-c (insert full legal name), horn (insert month,
day, year),hereby depose and state the following:
1. I 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. If I engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this 11 day of `acp (t,« , 202.
(Signature)
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street.Suite 100
Boston,MA 02114-2017
wwmmass.goildia
1,s others'Compensation Insurance Affidat it: BuiSders1ContractorstElectriciansiPlumbers.
ID HE FILED wail in E. PERMITIING AUTHORITY.
Applicant Information Please Print Leeziblv
Name i BusiniessiOrginurationilndtvickial):JAI C(A rue ( 0
Address:_ _All/.44W6Vir 44 11—0. ort_
..._
City/StateiZip: 4.._,244_044,or Phone ti-.. q 0 5 e7 6-
Art yell AS employer?OKA(the appropriate bor. Ty pe of project(required):
1.0 1 nrn a employer 55ith .......employer:5(tail ant.14r part-time!+ I 7. c]New construction
20 i am a Wig 1Xupnet.or or panne/41T and IIIINt no cnsployec.5*ink tag for rea:In K. 0 Rcmudeiling
an)tLeapacity [Nlt We Tr.*',eromp,in:ammo: rcr4anW.1
; 9. 0 Demolition
IXII am a hum:owner doing all tkenie rnylel I.[No workt.75:eomp,wilorninev required.]'
1 100 Building addition
4.0 I am a isncowitcr and well 6.e itttutg tvilitlictari,to condua ad work on my property. I will I
enstere that all cent:rate liars cithci haYc Yvorters'compcmation attune:me or are viilk i I I.C3 Electrical repairs or additions
proprwlvra with ni)CittpluyevN
! 12.0 Plumbing repairs or additions
3.0.am a govrral contractor and 1 6104 c hued thc 51.111-cuntractor5 listed on the afttudial iher.A.,
Thes b ntra I 31:1 Roof repairs
e su -coctor s IvsYa empkiyem anti have wurkcm'comp.insurance.; -
: l 41q0t1tvl_fee _.4.t2L4,- __5:...6
6E3 Wc an a corporation anti 115 officers have exercised ascii right of c veroption per MU .
152.§1t41,and t;e haw on employee's.[No 1.4orkimi'comp.anacranee required.]
fr.--4- € P45 r i' ga
*Any applicant-that checks boa al most alau(di out the section below Alms ing their*misers'compensation policy information.
' tiornoovencrs A ho huinnil that.affidavit irtaicattny they are doing all wirti;and then hat outside contractors must 3,dbilEll 3 Usai...affidavit sadicatmg saa:h.
'4.2untracturs that check this box mina attached an adaitional Aver showing the name of the vo II-contractors atul AMC vilyether or nut dame entatim have
ce$ If the sul",cortr,c....o..la.'.'onriluvccs.thicy must provide their ''.t o;i.et, ..,:litr, pulley 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: • ______
Policy#or Self-ins.Lic.tP. Expiration Date:
lob Site Address: City,StateiZip:
Attach a copy of the workers`compensation;tube, 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 S250.00 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 and penoltieA at perjury that the information provided above A true and correct
SignJtup.:: --27 ..------ Dui,
phone 4: 4 (-1 cC( i-i. .
- - - -- --- - - -- - - - " -
tyficial use only. Do not write in this area,to be completed by city or town official
City or Toss n: Permit/License#,
issuing Authority(circle one):
I. Board of Health 2.Building Department 3.Cky/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
t).Other
Contact Person:
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