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16B-048 (4) BP-2023-1742 221 NORTH MAIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16B-048-001 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-2023-1742 PERMISSION IS HEREBY GRANTED TO: Project# GARAGE ALTERATIONS 2023 Contractor: License: Est. Cost: 15500 Const.Class: Exp.Date: Use Group: Owner: FISHER,TIMOTHY J. & VERSACE, AUTUMN Lot Size (sq.ft.) Zoning: ' URB Applicant: FISHER, TIMOTHY J. &VERSACE, AUTUMN Applicant Address Phone: Insurance: 221 NORTH MAIN ST FLORENCE, MA 01062 ISSUED ON: 12/13/2023 TO PERFORM THE FOLLOWING WORK: REFRAME AND INSULATE GARAGE WALLS, ADD CLOSET SPACE 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 . TO 11 • I � Fees Paid: $101.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Buildinc Commissioner 4 (a vd in Mad &` . The Commonwealth of Massachus tts j l' ' Board of Building Regulations and S dat is>r 'OR j! ' Massachusetts State Building Code, 780 CMS°`��(, nit' • CTPAY ITS' n a..i USE' r Building Permit Application To Construct,Repair,Renovate Or DetftPisk Revised Afar 2011 One-or Two-Family Dwelling �\,,o,;�3,,,„ /. This Section For Official Use Only / Building Permit Number:BID i.3- 1 742 Date Applied: e__,,,a,s l2-/ -2A-3 Building Official(Print Name) ignature Date SECTION 1:SITE INFORMATION 1.1 Pro er Address: 1.2 Asses ors Map&Parcel Numbers 6 �1 �rft, JL'kt 'S—r- rib r /U -ol ,, D16 5 S rol 1.1 a Is this an accepted street?yes c no Map Number Parcel Number 1.3 Zoning Information:n 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 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? Municipaltn site disposal system 0 Check if yes❑ )) SECTION 2: PROPERTY OWNERSHIP' 2.1_9.wnerlofR r 1 tn4o',tli 41-tir R v'e,it< MA- 0106- - Name(Print) !V1 City,State,ZIP tm Sf 6d3-gq-a�3.7 fi0-F6 4-< &(/ xii cony 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(s) 0 Alteration(s),Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units I Other ❑ Specify: 1 ' Brief Description of Proposed Work2: R�-Ycl,,�� >' fn5 Ogle- I`ett-eri1 a- V J e:Li-4q.v walk cuid add r 109 jr 4/0are i i au &r rVi 1-44.3+dty v-0o01. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 6(90 D 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 6---0ElStandard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: S Check No.p0 I I Check Amount\O\ Cash Amount: 6.Total Project Cost: $ I 6-- 7 500 0 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.) 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 address D Demolition 5.2��Re ster/ed Home Improvement Contractor(HIC) I� ��,g -5/ ��— v V�( vti V�C a p5 II- I HIC Registration Number Expiration Date HI omanyet or HJC Rnistrwit Name 6 C. © Pv✓ 5 to 1'1neki)1 rl k`� jfii'1?C6) c owl N n4e. uet iNYI �0i007 /'3' 3��t�� 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 No .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize ‘4 >R to act on my behalf,in all tters e work authorized by this building permit application. Pri NI-ek . ))7/V)-3 nt Owr)r's Name(Electronic Si ) Date SECTION 7b: WNER'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 e to the best of my knowledge and understanding. /11\ DA 3 - ( IV�- I 113/9-3 Print Owner's or Authorized Agent's ame ctronic Signature) Date NOTES: 1. An Owner who obtains a building per it 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 MC 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 ••" Massachusettse • L" '! DEPARTMENT OF BUILDING INSPECTIONS ti T �r 212 Main Street • Municipal Building Jti Northampton, MA 01060 ssHW 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: The debris will be transported by: Name of Hauler: jI 3 1)115+-0( Signature of Applicant: Date: 1)/ 3 City of Northampton #ai�^MP>o SS` ':• SC ' Massachusetts ( ? DEPARTMENT OF BUILDING INSPECTIONS «'` 212 Main Street • Municipal Building 01160,* Northampton, MA 01060 �sbh waCN HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, Ir 1 1 t t (insert full legal name), born _ (insert month, day, year), hby 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 ant 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 1 day of De('t '111,PeY , 2023. (Signature) The Commonwealth of Massachusetts r Department of Industrial.4ccidents 1 Congress Street,Suite 10i .- ,PT Boston. .11.4 0 2114-201 www.mass.govIdu: It or kers' < rntrpensat In,uraurr:%Rdarit:BuikIert/C'ontractora lectricianslPIumbers. I() hit h n t u ss I III I Iik PI:k%1l11I%(:At 1110141.11. .%oolicant InfurniAUun Please Print Leeibly Name(Humors..chl aturauon Indic'dual►: Address: ?--,?- 4p r Ma City!State'Zip: Fmr~ /1A4— /OEM. Phone#: D?j- - O 1- L3 3� Are tau an employ re('heck the trppr•priale bet: i� pr of project(required) I.o I airs a tngskn ca with cmp1utrrs(full and ur part-time t• 7- [3 New construction 20 1 urn a sole proprietor or partnership yeal lute no employe t workelrg for me rn 8-7 Remo deito any capac:ty INu Nuticn'cwnp.unuranu resound; j��� 10 i am a homeowner doing all wok mk-lell.iNo Ntnkall'corm insurance nt�ntrul�,' 9- ❑ Demolition 0 El;3 1 am a homeowner and sod uu)be ha3 contractor.to conduct all....irk on ma pauperty. I will Building addition ,asure that all oonttactun either hate workers-compensation insurance ie arc sole 11 O Electrical repairs or additions peopnelul9 with no employee, 12.0 Plumbing repairs or additions 50 lam a general contractor and 1 hate hard the sob-cunua fur►listed on the mtnfietl sheet 13.C1 Roof((pair Thew sob-euntrxtort late employee.and late workers'ctanp insurance We an a corporation and its officers hat e exen oed then nghi ut exemption I4.0Other per 5ktL t 15...i itaL and we hate no anpluyces,(No Nutken comp tnairance reyutted. 'Any applicant that chocks bus al mutt also till out the wetwa below show mg their Nurkci compensation policy udoemattun • Homeowners who iak,nit this atlidusat indicting they are dwng all Wink and then hue outside contractors aura subnnt a new affidat it miIicaung stab :Contractor that check this box mist attached an additional elect Aiming the name of the sub-contractors and state whether or not those eanities have t-tn(dotces If the sub-iuntroetiaa hate c-itelo,ees.the'.mils(pntstile then Mockers'comp poltt:t nwnb t I am an employer that is providing a•or!ers'compensation insurance for my employees. Beloit is the policy and job sue information. Insurance Company Name: ?oiicv#or Self ins.be.#: Expiration Date: Job Site Address: CityState'Zip: Attach a copy of tbe 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 fine up to SI.500.(k= andi:or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.0U t .lay against the violator-A copy of this statement msty be turwarded to the Office of Investigations of the DIA for insurance a+,cr.iec vcrtfuation. I do herein certi • er a pain,and penalties 01 perjury that the information provided above is true and correct. Sumature. i at. / 1Z/d` Phone#: Official use only. Do not write in this area,to be completed by city or town official ( its or I own: Permit l.icensr to Issuing Authority (circle one): I. Board of Health 2. Building Department 3.t its,I o„n Clerk 4. Electrical Inspector 5. Plumbing Inspector Ii.Other Conine, Person: Phone#: CITY OF NORTHAMPTON SETBACKAp PLAN $ �D MAP:D/(, LOT: ()OO I LOT SIZE: iO, r_ft REAR LOT DIMENSION: REAR YARD M SIDE YARD SIDE YARD `s` i 9f- =1 FRONT SETBACK FRONTAGE