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30A-078 (4) BP-2024-0738 4 HIGH MEADOW RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30A-078-001 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-2024-0738 PERMISSION IS HEREBY GRANTED TO: Project# BATH RENO 2024 Contractor: License: DOUGLAS B THAYER DBA DOUGLAS THAYER Est.Cost: 13000 WOODWORKING 107699 Const.Class: Exp.Date: 04/07/2025 Use Group: Owner: E MURNANE JAMES A&ARLEEN Lot Size(sq.ft.) DOUGLAS B THAYER DBA DOUGLAS THAYER Zoning: WSP Applicant: WOODWORKING Applicant Address Phone:, Insurance: P O BOX 60322 (413)530-4785 6HUBGR15002 FLORENCE, MA 01062 ISSUED ON: 06/11/2024 TO PERFORM THE FOLLOWING WORK: RENO BATH 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 Drnenay 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.Si nature: 172- Fees Paid: $85.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 1peh The Commonwealth of Massach etts `/�1 1W" Board of Building Regulations and Land rds ✓ 41 ICF� '' Massachusetts State Building Cod , 789w R 8 �Q�Q 4SEALITY aT Building Permit Application To Construct, Repair,f �k) .1"-molish a Revis-d Mar 2011 One-or Two-Family Dwelling A�"'ro2iNp This Section For Official Use Only �'L'q 0;0ioys Building P it Number: ea �CI_ 73� Date Applied: �. evio 6I<o�, ��/2 -// ZOZ11 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property dress: M 1.2 Assessor Map& Parcel Numbers tt 1 `0 J toadnv Re, Ito A- d? - cv i 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 II) 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: Zone: _ Outside Flood Zone? Public'§ Private 0 Check if yes Municipal On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Aflepl £ Acrant f V Ildh ifedot., Name(Print) City,State,ZIP 4- IMi /14410t__ I 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 Other 0 Specify: ` Brief Description of Proposed Work': Pet ov&4-ioh aI" EX,' -:tj Ft}rf" Fitiry 54 fl SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) Official Use Only 1. Building $ Cr coo I. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical i $ ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ $G oQ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Fees: $Total All $ Suppression) 1f �J Check No.jG 0 Check Amount: 6.Total Project Cost: S 1771 00 0 0 Paid in Full 0 Outstanding Balance Due: City of Northampton Massachusetts • S ,. DEPARTMENT OF BUILDING INSPECTIONS **7.. 'x' 212 Main Street • Municipal Building Northampton, MA 01060• PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR, ETC. I. 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) 1 v 7/Q q 10/2 6 ijoKiCt4 "tituv ( License Number Expiration Date Name of CSL FftlIder List CSL Type(see below) 'PO geg (O39i.a No.and Street Type Description (( /� U Unrestricted(Buildings up to 35,000 Cu.ft.) I I&'e(K�t. / R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry (O RC Roofing Covering 6 WS Window and Siding SF Solid Fuel Burning Appliances • I Insulation Telephone Email address D Demolition / 5.2 Registered Home Improvement Contractor(HIC) 17g0 SS 1 d/2 p 7 / N S S C)O c,h1 U S ( n li c 1('v HIC Registration Number Expiration Date Co mp omp y N a or HIC Registrant Na e A"uS sd— No.and Street Email address Flartrtc4 i ' 7 - S3o - X716 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 .n.. No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTORR APPLIES FOR BUILDING) PERMIT J�I,as Owner of the subject property,hereby authorize otAGA'&3 Ploy /l oy r to act on my behalf,in all matters relative to work authorized by this`building permit appkcation. A \ee ' /1� n4 e ‘/7/12cL 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. o/7 02 V Print Owner's or Authorized Agent's Nam 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.) (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" A a3av:v The Commonwealth of Massachusetts Department of lntlustrial Accidents I =• I` - 1 Congress Street,Suite 100 ,.sees _:, Boston,MA 02114-2017 wwwJnass.gov/die 11 hikers'Compensation Insurance A(lidos it: BuildersiContractorslElectrieians/Pluntbers. TO 1W FILED vi I t ti THE PER:sifT1`1Nt;At 1'HOR17.1. Applicant Information Please Print Legibly Name(Huseness&U nuzatianllndividuai} DO(tg'I .� -O'L4��y -- Address: Po 1lo� 603a� U Flv ei,e0 if OIoG ' City/State/Zip: Phone#: Are you au employer?Cheek the appropriate box: Type or project(required): 1 employer with. . ...........employees 41141 asaalor part-nine t-• 7. D New construction 20 1 am a auk etas or rah: and have no loves workin• for ox in proprietor t� pt; K. 0 Remodeling any capacity.[No workers'comp.insurance required] 9. ❑Demolition 0 I am a Iutmrww Iter doing all work myself.iNo work,:rs'cun{r_trnuratax rettttired.}" 11.0 lam a trunxwwu.-tr and will be hiring cuntraaanrs to cvtrduct all work on my .}r nrlretty. 1 will I Q CI Building addition rtc;ure that all contractors either have winters'compensation Mtn-aril-1;or are:Pole Ha Electrical repairs or additions proprietors wish nu empluycasc. 12.0 Plumbing repairs or additions 4c3 I am a general contractor atul I have hin'cl the suls-contractors listed on the attached sheet. 13 ri Roof repairs These soh-contractors have employees and have workers`comp..insurance.; 6.0 We are a corporaanon and its off►ceis have exercised duo right of exemption per MUc. I .❑other 152 'l{4)..and we hose no anployees.[No workers'comp.insurance n quireil.} `Any applicant that cketkx box al mesa also fill out the section below showing their workers compensation policy information. r iterneowners who submit this affii avit indicating they are doing all work and then bee cwtaide contractors smut submit a new afftdas it indicating such. *Contractors that check this box must atrarbral an additional sheet showing the name of the sulrcuntracwcs and state whether or not those entitles have employees.. if the sub-cuntraetors have esmplovees.they'must provide Pair worker,'comp.policy number_ l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: It Ave(ieV5 - _. Policy#or Self-ins.Lie.#: (IR IS 0027 Expiration Date: 1O/13 Job Site Address: t1 h jl oph n 624 City/State/Zip: 010. Attach a copy of the worriers*compensation policy declaration page(showing the policy number and expiration date). failure to secure cov'erdge as required under MG,c. 152,.$25A is a criminal violation punishable by a tine up to S I,50(LOO 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 site violator.A copy oft is statement may be forwarded to the Office of Investigations of the DIA for insurance coverage tic c n t ic ation. 1 d'hereby ccrti f i•under the pcutt,s uarid penalties ofpea jury that the information provided oho 'e is true and correct. Signature: 4------ te S a ,�`� Da Phone#: V(1 5 3o / 73-5 offiicial me only. Do not write in this area.to be completed by cite or town official 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 Inspector 6.Other Contact Person: Phone#: City of Northampton ,,_ Massachusetts �4r ! * � A. ( )J DEPARTMENT OF BUILDING INSPECTIONS Northampton, MA 01060 i 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 G(l`.Q �N 1> _G The debris will be transported by: Name of Hauler: DO `u-S 1-1,cte. pp Signature of Applicant: j\-(\—) 44--.\ Date: ‘77 �S g City of Northampton ,0 M.. � �,y,f•\'�'� Massachusetts •' _ t� • ,` DEPARTMENT OF BUILDING INSPECTIONS `u-'n 212 Main Street • Municipal Building `3;:\ Northampton, MA 01060 W~3� Y HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1, (insert full legal name), born_ (insert month, day, year), hereby depo and state the following: 1. I am seeking uilding permit pursuant to the homeowners'exemption to the permit requirements of the Massachu tts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work o parcel of land to which I hold legal title. 2. 1 not engaged in, and the project or work for which I am seeking the aforementioned homeowners' xemption, 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 1 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) C " (0 ,4 r a- wt le -)- 1 h ____________ i/rivd ( -17(,14 ,01.3 u zes In /1 i:Z CD IT ,--o Zn v 1 � � n it N [Li - pi: ZO t \,_ ___ ) 0 1 • • 0I ,-- -, V 0 lb , CuoiQx3 ! ram' )9"1/1 l'6)-1-i li • Hi 1/1 P e a66(4 Po(. ?vop0 5 0 oi\ i } r O I 1 ON ,1 L 4 [1-1 r . J V W N \ V 'c- (C) iods P J ip( Gt vi 11 i-F(' 17 vti oa_ icia) kR Dci 6,0)