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25C-242 (9)
BP-2024-0559 239 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-242-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2024-0559 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: Est. Cost: 2875 RICHARD PALMISANO CS089485 Const.Class: Exp.Date:03/05/2026 Use Group: Owner: DEBORAH KEISCH Lot Size(sq.ft.) BAYSTATE RESTORATION/BAYSTATE WINDOW & Zoning: SC/URB Applicant: DOORS Applicant Address Phone: Insurance: 87 SHATTUCK RD (413)549-6824 6HUB-6B21339 HADLEY, MA 01035 ISSUED ON: 05/08/2024 TO PERFORM THE FOLLOWING WORK: REPLACE PORCH ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Sere ice: 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: 1/2 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 1 MAY - 6 2024 S , The Commonwealth of Massachusetts Board of Building Regulations and Standards „�,T pF ntatsmir+114SP'FOR'''y 1 Massachusetts State Building Code,780 CMR� w--__-" -'��LIT'Y USE Building Permit 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: �)' '`) `Jfa' Date Applied: ii nev .) lOss //4 5-8-702y Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property QAddrew �� - 1.2 Assessors Map& Parcel Numbers l rt O 1.la 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 0 Zone: Outside Flood Zone? '? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' . O� ner'of Record: /iLisCi44/4C1‘t-iN(t• IAA. . D ( 0(�(;) , Name(Print) t( City,State,ZIP 2--Bq 6 rt.dge S4- . (q,7)cm,-slr 1 ,bol .tndKa-I5 mut.omk- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-OccupiedUUR4 epairs(s) Altera 'on(s) 0 Addition 0 Demolition 0 Accessory Bldg Number of Units Other =Specify: ex[& saTtrg- Brie scriptio of Pr osed Work'-: C� '��[(J—-- 7 k To{ sa zH►� R C/�V�J�'f{JI cams ''r .Lmt, It c ik'Qc.1�- 3'. " t 1.?NI SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materia s) 1.Building $ Cn r7C 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 $ Total All Fees:61 Suppression) 86 Check No. 94 'Check Amount'` 0 Cash Amount: 6.Total Project Cost: $ A7S 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES Construction up rvisor License(CSL) Y( '-- Jc/a r0 License Number Expiration Date 7me of CSL eI er01/4 2 kse.,n-unie_ VEL . List CSL Type(see below) ` Type Description Net ©h3 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,Stat ZIP M Masonry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances l 3 37y(r/ I Insulation Telephone Email address D Demolition .2 Registe ed Home Improvme ontractor(HIC) \ 90 a./ 3/a , Learnt* . LN� HIC Registrati n Number Expiration Date HIC pang ame or HIC Registrant ame C No.and Street �ail address City/Town,State,zi Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitteed 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 0 SECTION 7a:O ER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRA R APPLI S BUILDING PERMIT I,as Owner of the subject property,hereby authorize i#k to act on my behalf,in all matters relative to work authorized by this building permit application. s / 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 n ined in th. lication is true and accurate to the best of my knowledge and understanding. S int Owner's or Authorize 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" City of Northampton i•:; ez-44)., y'•r" Massachusetts , ..:4 „,,. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ,:, ri Northampton, MA 01060 sre ••a;�(\`� 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: 2Q il Location of Facility: kfatj .‘ The debris will be transported by: (ItnnName of Hauler: ,t� Signature of Applicant: Date: 64162/ . ' \ , The Commonwealth of alassachuseus ) L=CI Department of lndustrialAccidents 4 = 111�_ 0 1 Congress Street,Suite 100 rili` Boston, MA 02114-2017 •;b, - ." 1vwwmass.gsov/dlu 11 urkers' Compensation Insurance Affidavit:Buiiders.ContrattorslEkctricians/Plumbers. "It)BE FILEll WITH THE PERMITTING AUTHORITY. Applicant Information Please Print I.t ibly Name(Husiness.Urganization lndtvidual): ,tt () MA,S,01.--t7 Address: S L rru e-1k- ?el' City/State/Zip: Phone#: (4 d3 �72/—-off 7/y Are you an employer?Chalk the app abate box: Type of project(required): err a employer with employees(full and,Or paut•tin e).• ']. 0 New construction 20 I sm a sole proprietor or purtncrship and have no employes-.working for mein 8. Q Remodeling any capacity.[Nu workers'comp.insurance required.) 9. 0 Demolition 30 I am a hunnvwner doing all work myself_[No workers comp_insurance requineL)' 4.0 lam a one ow nor and w ill be hiring contractors to conduct all work on my property_ 1 will 10 0 Building addition h ensure that all contractors either have workers'eurngensation insurance o are sole 1143 Electrical repairs or additions proprietors with nu employees. 12.0 Plumbing repairs or additions 50 I am a general conuaetor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers comp.insurance.: 13 twf repairs 6.0 'e are a corporation and its officers have exercised their right of exemption per MGL e. 14. Other N 152,§1(4),and we have no employees.[No workers'comp.insurance required.) •Any applicant that checks box sal must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this atl'sdavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. (Contractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or nut those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is providing markers'compensation insurance for my employees. Below is the policy and Job site Information. Insurance Company Name: F ( Y .�),??..S �j Policy#or Self-ins.Lic.#: �(,(_' _L.( �.t-531 `-L` - Expiration Date: �S (3( `c:7 Job Site Address: (3' (3( t e1L c)4. City/State/Zip: V t 06-0 Attach a copy of the workers compensation*Icy declaration page(showing the policy number and e piration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine 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 i " ' s lator.A op f this statement may be forwwarded to the Office of Investigations of the DIA for insurance coverage ve ion. I do hereby •. laund. e s d penalties ofperJury that the Informutiurz provided above Is rue d e erect. Signature: , . i a Date: S l Phone> : 13 3i1_ 7/ Official use only. Do not write in this area,to be completed by city or town official City or To►t n: Perntit'l.icense 4 Issuing Authority (circle one): I.Board of Health 2. Building Department 3.CitylTossu Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: