32C-207 (6) BP-2024-0015
81 WILLIAMS ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32C-207-001 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-2024-0015 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 RENO Contractor: License:
Est. Cost: 16500
Const.Class: Exp.Date:
Use Group: Owner: RUTH FRANCIS,
Lot Size (sq.ft.)
Zoning: URC Applicant: RUTH FRANCIS,
Applicant Address Phone: Insurance:
P.O. BOX 1605
NORTHAMPTON, MA 01061
ISSUED ON: 01/04/2024
TO PERFORM THE FOLLOWING WORK:
KITCHEN AND BATH RENO
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 /
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•
Fees Paid: $107.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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The Commonwealth of MasstachuSette.. 204'94OR
Board of Building Regulations and Standat sr:0/1
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Massachusetts State Building Code, 780 CMf ?/ '�cbIJ4ALITY
USE
aJ N A
Building Permit Application To Construct,Repair,Renovate Or De d Mar 2011
One-or Two-Family Dwelling �,�
This Section For Official Use Only
Building Permit Number: 6 P- .19• /5 r Date Ap lied:
1 1 '
' f b . tr h% II
Building Official(Print Name) f Signature I i ate
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
t W .t a ills Sr.ee-f-
1.1a Is this an accepted street?yes 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 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private❑ Zone: Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 caner'of ord:
�v � ncis Nor1'harrtp -hog MA- 010(oa
Name(Print) City,State,ZIP
1t Ms L{t 31-Upti s-t13ti gvillitfoArhad. row/
No.and Street Telephone Email Addre
se
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s)1( Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Descri ti of Proposed Work': 1Qr� 0A '� �-1 ( ('1t fi 1 SO e,d�
1,�, .p 5 r110p ri i(�0./6(44011.
�''�Ol� Ck �I n��S � dpOr1 O�p a plus r-c t coteva p0U��q s•
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
_._._ 1.Building $ Ul C5) 1. Building Permit Fee: $ Indicate how fee is determined:
2 Electrical $ �� 0 Standard City/Town Application Fee
/ 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ ' J 2' 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fe
Check No.t 91 Check Amour f O' Cash Amount:
6.Total Project Cost: $ /1'1 57D VPaid 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 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 .❑
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
conta. in this appli ' n is true and accurate to the best of my knowledge and understanding.
O V01/21-1
rint Owner's or Authorized Agent's Name(Electronic 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 la ed,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/ ttics,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 C Number of decks/porches
Type of cooling system /j�' Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
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Massachusetts �a?. Ir. e,
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olliel ! DEPARTMENT OF BUILDING INSPECTIONS y, `
l- 212 Main Street • Municipal Building J�;. CD
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Northampton, MA 01060 J'J'Yh 3)%"‘
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: qa, ` I-c lec CIA 9
The debris will be transported by:
Name of Hauler:
J
Signature of Applicant: Date: 0 D L la. if
The Commonwealth of:►lassuchusetts
Department of Industrial Accidents
_ P"—41 1 Congress Street.Suite 100
I�;t : Boston. MA 02114-201
`�, wwwivass.igov/dia
11mkcrs' Compensation Insurance Affidavit:Builders,'('ontractor% Ekclricians'Plutubers.
10 HE:1-114.Il 11 fTH 11ii.l'F:K]tl l l[\(::A1'111OKI 1 I.
Applicant Information Please Print Letibil.
Name(business.OreantzationIindnviduall:
Address:
City/State/Zip: F'liaiic .
Art rim M etuiplu rr?Cheek an alrpuupriatc[was:
Type of project(required):
l.❑1 an a employer until employees[lull and or pan-tune t„' 7. 0 New construction
2C3 1 ant a sole peoprictur ur purtncrship and have our employer.%orkuir for nu in 8. 1:4 Remodeling
a w capacity..[Nu wur►cn'cuenp.uuurancc nywrj
am a hunsouv.n-r Join!all wort.myself.'lho wtmlacars'comp_insurance nvluircd.).
9. ❑ Demolition
10 a Building addition
415c11 ant a hornouwnet and u ill he hung cwidriclurstu conduct all work un my property.. I will
crouurc that all cwmractur,citlscr hake%wken'cvnnR-nsaiiun eruuranc ui arc code I I 0 Electrical repairs or additions
prupn+[on with no canpiuse e."...
12.0 Plumbing repairs or additions
501 ant a tcuc al cuntractur and I hawk hind the sob-euntractun tihted on the attached sheet. I3E1 Roof repairs
These+uh,euntraelun lose employee and Irate winters'comp.insurance.
6.0 We a a couapuratiun and its ut k r%Ira+.c exercised dhoti rigiit of excattptiwt per AKiL c.
14.D Other
n
132,f 1(41.and MIX lase in,unplu?sea.[Nu*LIA rs'cusp.matrancc rapine
'Any applicant that chocks ban Cl rain'ahra till our the iceboat barn shuwinn their uoilier.'compensation policy uttonnatura„
'Homeowners who submit this altwktt rI utdicatim;they an:doing all work and then hue outside contractors muss submit a nest alhdat is rritlieaiing such.
(ontraetors that check this bos anus[ana:hcd an additional sheet showing she name ut the soh-c:.nttractor.s and state whether to not those wttatics leas.
Ini+luvcrs_ ll Ili.hub-eulnraetors line cisipkiyoes.they must prusidc their worker.':+ramp.p uIae' auunbel.
1 um an employer that is providing workers.'compensation insurance fur my employees. Below is the policy and job site
tit/arnintinn.
lsmuiance Company Nam(,:_
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City?Statc'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 tine up to S I.500.00
and'or 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 copy of this statement nay be tor►varded to the Office of Investigations of the DIA for insurance
co+,e r age'verification.
do hereby-c 't i'urx frthe its and�/penalties of perjury that the information provider'( ores rue and correct.
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t r ( V 1 i}ate_ 9-
A
Official use only. Do not write in this area.to he completed by city or town official.
(il% or.Town: Permit,[License
Issuing.tuthoriti, (circle one):
I. Board of Health 2. Building Department 3.City[Town Clerk 4.Electrical Inspector 5. Plumbing,Inspector
G.Other
('Itntact Person: Phone#:
City of Northampton
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f • Massachusetts ^:< 4�
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6 ;i- 71 , DEPARTMENT OF BUILDING INSPECTIONS j,°,
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,�� `,� , 212 Main Street • Municipal Building ��, cs
_�.,.-a� Northampton, MA 01060 Jyln ��,1J
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
1UC4f\ GARuS
1, (insert 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' 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.
Si d under the pains and penalties of perjury on this day of lic/a 20
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Signature)