02-028 (9) BP-2024-0510
642 NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
02-028-001 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-2024-0510 PERMISSION IS HEREBY GRANTED TO:
Project# GARAGE RENO 2024 Contractor: License:
Est.Cost: 15000 KUEL MCQUAID 051394
Const.Class: Exp.Date: 12/11/2024
SCOTT, TIMOTHY D&DEBORAH &MARION
Use Group: Owner: KEISCH
Lot Size (sq.ft.)
Zoning: WP/WSP Applicant: KUEL MCQUAID
Applicant Address Phone: Insurance:
131 FERRY ST 413-537-5063 SOLE PROPRIETOR
EASTHAMPTON, MA 01027
ISSUED ON: 04/26/2024
TO PERFORM THE FOLLOWING WORK:
FINISH ROOM OVER 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: 14/2...
Fees Paid: $98.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts f
T ? Board of Building Regulations and Standardises 2 5 2024 I FOR
ICIPALITY
(: �� Massachusetts State Building Code, 780 CM�1
USE
Building Permit Application To Construct, Repair,'RenQv_ate Or Demolish a.____JRevi4d Mar 2011
One-or Two-Family Dwelling h7TOTBU1tDINr INSPECTICNSI j
'v� I Mn 01060
This Section For Official Use Only _, '---�"
Building Permit Na
mber: 13} ,2 ti..6'/Q Date Applied:
`WEviNs /lam I+Zb-ZZ2
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
W Cowl 2._ I.) Fvwlt RA_c r.' v AAA-
` 1.1a Is this an accepted street?yes X 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 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: JVtrfi'lAa
J - 4' itAi /ILIA- OiAv 4—
i
Name(Print) City, State,ZIP
c_li N Fluwvs R G51- 2.4(.1-5-2.1 Krisk. k;nnil sel.4-wl,Cain_
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) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Kr`k ���k e-K l c k� •c O m tn� m U'f'
c -C6— ( 17�K I IT ) a t Am In�`L VI%+ ILA S t�+,-:u Wc.\l4,
1-4-o e- it_ oux.4 c_e_VA 7.___ 4.--in 3 0-k-- 0 ti tA.2_44.--1,-,,y1A4s.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 7 Cam b 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ El Standard City/Town Application Fee
20 G 0 0 Total Project Cost3 (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ t,0(0b List:
5.Mechanical (Fire $ Total All Fees: $ °c6
Suppression) Check Noheck Amount.
6.Total Project Cost: $ j�Q 0(7 D Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts ,_..
j
DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building
n
* Northampton, MA 01060
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.
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-o6 t 394- aZik
U , C- Q tJ C .N.k License Number Expirhtion1Date
Name of CSL Holder
/ 3 . List CSL Type(see below) (J
No.and Street 1' Type Description
i f-W 47:91A_ L/ 0 to Z 7 U Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,State,ZIP /"1(� R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
1 `J ry� SF Solid Fuel Burning Appliances
9'(3-C37-�Ch63 1�c Qu0.l/l. tL✓e- lS'C411���kJ)tat I Insulation
Telephone Email address.- D Demolition
5.2 Registered Home Improvement Contractor(HIC)
_p 10(7m6 / 30
VP 1 / c Qv4 �C HIC Registration Number E pirat on Date
I �Compa y Name or HIC Registrant Name
/5l r�� Ntc_ (tvet � �co
No and Street S Email address
Eq.s-k ec,ti MA to 1027 13-
3 7 r i
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 /<V.
,as Owner of the subject property,hereby authorize 1 � (��!0.�L \
to act on my behalf,in all matters relative to work authorized by this building permit application.
•
Print ame(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.
A/,,a /25�2oz�-
Print 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 planned,provide the information below:
Total floor area(sq.ft.) Zoo (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"
q.
The Commonwealth of Alassachu.setts
izni==0 Department of Industrial Accidents
/ congress Street,Suite 100
,,..., .,....., Boston,MA 0114-2017
.k.,..... ... www.ntass.govidia
11 inters'Compensation Insurance A flidas it:Builders/ContractorstEkctriciansiPlumbers.
lc) HI% t 11.1%111%11111 I Ili: rt:Rmi-t-fmc Ai'THOM%.
Applicant Information Please Print Legibls
Name illusurcssiOrganizatiowleulnichiaK kiE-( At C cz,)
Address: /31 e_.(cy_ --4---•%-- -,e.---1K--
City/State/Zip: 0.6`k--\/1/46w.1/4,.4-oLk, )4it- 0(027 Phone #:
Are yaw au employer?Cheek the a pprropriute hot: Ft peel project(required):
la lam a tinploy tx with sinployees owl anti or part-nine 1• 7. 0 New cOnStrUi.liOn
lgrarn a auk proprietor or paromershm and have nu ianpioyem working form:in . emodeling g ['OK
any capacity..[No wortera'comp.nisurionv requanadl
9. El Demolition
.30 I am a hurneowner doing all work myself No workers einrci.insurance requattlA
i o 0 Building addition
4.0 I.am a homeowner and'will be luring youth-actors to cundbct ail 9weak on my prroix-rty. I Will
ensure that all L.-warm:tors either!we Wottcra'coenp.tnsanun insurance or inc sole i ifj Electrical repairs or additions
propmetors with no ploy,e ,
11E1 Numbing repairs or additions
5c],.m a general contractur and I have hired the sub-contraetors listed on the attached sheet
I 3.1: :1R00f repairs
[hest:sub-contractors hate employees and have workers'eivrip,LIBUMICC'
I 4-0 Othei
6.0 We are a corporation and its officers hate eaereiscd their nest of emanation per MCA.e.
152,§1441.and we hate no ang,loyees,[No workeni'comp.insurance requortif
'Any applicant that...11-.A.I,box al must also fill out the seetnni beloa.show in-2.then-A kers'compensation potiey.mformation
itomeow nem vitt,submit this affidavit LThthextang they ate acting all work and then hue outside itractors must submit a nei..atiida..,it indicating such.
kinlia.:tors that check this bus must attached art additional sheet show mg the mar of the suh-cmaractues and suit whether or not tlii.ise tninties haw
lithe Ni,1,-,onLictors have employees.Mel.-must provide their A miters'comp policy number.
1 ant an employer that is providing ovorAers'compensation in,terarice for my employees. Below i8 the policy and joh Aire
information.
Insurance Company Name: —
Policy;g or Self-ins, Lie.#: Expiration Date:
Job Site Address: City/Stater/4:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MCiL c. 152. §25A is a criminal violation punishable by a tine up to$1,500.00
antlfor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violator_A copy of ibis statement may be forwarded to the Office or inves-tigations of the DIA for insurance
coverage verification.
I do hereby certif.under the pa s and penalties of perjury that Ike information presided above is true turd correct
S,2liature: (.14.?./
Date: 917-,612-0 ZS&
Phone :
official use nab. Dr 0 not write in this area.to be completed hi ekr or 10411 officiat
City or Town: Permit/License
Issuing Authority (circle one):
I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing lusioctitir
6.Other
Contact Person: Phone#:
City of Northampton
f• Massachusetts
, DEPARTMENT OF BUILDING INSPECTIONS
z 0-a _
212 Main Street • Municipal Building
---°"-- Northampton, MA 01060
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: V b...q re--v c cse_ /v o c -' AAA( &v. MA
The debris will be transported by:
Name of Hauler: koe-1 c- Qc a_\,.GC
Signature of Applicant: "68/
Date: Ct(7.4 ZoZ
City of Northampton
c r'„- F�*, SAS.., '�' i
Massachusetts �� 1 ''t.
* -c
Y DEPARTMENT OF BUILDING INSPECTIONS v; r x-
212 Main Street • Municipal Building .'�
\\`,,,,•�t"'.." Northampton, MA 01060 '�3'1, \1\
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (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.
Signed under the pains and penalties of perjury on this day of , 20 .
•
(Signature)
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