32A-083 (12) BP-2024-0780
46 GRAVES AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-083-0O1 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-2024-0780 PERMISSION IS HEREBY GRANTED TO:
Project# DRYWALL REPAIRS 2024 Contractor: License:
Est. Cost: 9500 107699
Const.Class: Exp.Date:04/07/2025
Use Group: Owner: DOUAIHY CHRISTA&GRATIENNE G BASKIN
Lot Size (sq.ft.)
Zoning: URC Applicant: DOUAIHY CHRISTA&GRATIENNE G BASKIN
Applicant Address Phone: insurance:
46 GRAVES AVE UNIT 1
NORTHAMPTON, MA 01060
ISSUED ON:06/18/2024
TO PERFORM THE FOLLOWING WORK:
DRYWALL REPAIRS FROM PLUMBING ALTERATIONS
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/O
Fees Paid: S100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
/V �p � tt�-L
, Th Commonwealth of Massachusetts
J 2024 oard of Building Regulations and Standards FOR
/ ;4111N
f ass husetts State Building Code, 780 CMR MUNICIPALITY
I °`�r"Aorp� yy Ap lication To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
k01060
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 4/'9--A47- '71 Date Applied:
iEUUJ&5} 7/- Z l ,`172z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Asses ors Ma & Parcel Numbers
kf d -cur AP GGw�� I �a a Qa
Li 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:
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:
ka goi-frz ri A
Name(Print) I'Da a ( 0 k rislA
City,State,ZIPNa
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'- (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s)N Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
(Jyyiq I i2Qpa i t isvo ketA RIO*h,KJ ,¢/ic r J`$
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ ) S 06 ,— I. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ S-COO.. — 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fee
p� _ Check No. tt ,$6k heck Amount: k,6° Cash Amount:
6.Total Project Cost: $ ( S Q0. 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
7y= S
Massachusetts *
wI t
DEPARTMENT OF BUILDING INSPECTIONS �} 1/411:),
I
212 Main Street • Municipal Building
Northampton, MA 01060 �Npl
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND 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. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new / replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW/ private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor� ln� License(CSL) d 7 [ I
Ge (
IGt5 1 (v I v —7� q License Numberb Expiration ate
Name of CSlolder
PO
go)(
Qx (>!0 3420L List CSL Type(see below)
No.and Street 1' Description
F(� �� /7 U Unrestricted(Buildings up to 35,000 cu.ft.)
6 ✓ ( at°b Q( R Restricted 1&2 Family Dwelling
City/Town,State.ZIP M Masonry
RC Roofing Covering
WS Window and Siding
t-_ 3o_y7 b S SF Solid Fuel Burning Appliances
1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I.7 90 SS to/al
004143 HIC Registration Number Expiration Date
I I IC Company NairM or ��egistrillt ,
p ljj((��Nape, ( ibs iiace.@ ykat I. Coot
No.and Street d t �1(JG� U Eihail addre
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 0
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 ��( t S TAQvz.
to act on my behalf,in all matters relative to work authorized by this b lding permit application.
5iNer)ruk 6/17 st
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 ' plicatio ' e and accurate to the best of my knowledge and understanding. !7
6%
tint s or uthorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
The Commonwealth of Massachusetts
I! �t+E.MN et Department of Industrial Accidents
t __;:Bi- A 1 Congress Street,Suite 100
•
�;l:i - Boston,MA 02114-2017
�.,� 0www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/EkctriciansIPlumbers.
TO HE FILET)WITH THE PERMITTING AlTTIIORITV.
Applicant Information l t Please Print Legibly
Name(Business/Organization/Individual): l/O( ` 3 -h&)er
Address: e 6 (34i- 603 p2a .
City/State/Zip: ftavat,a'. /4 Phone #: (//3 — S 3o--Y7SS S
Are yea as employer?Cheek the appropriate boo: Type of project(required):
I( 1 atn a employer with employees(full aed+ot pattdiose)-' 7. Q New construction
2.0 I am a sole propriettn or pattnetnhip and have no employees working fur me in 8. (', Remodeling
any'rapacity.[No workers'comp.insurance moored] +--++
301 am a homeowner doing all wort myself.[No workers'comp.rosuranee required.]'
9. Demolition
10 Q Building addition
1.O l am a honsttrwner and will be hiring c ontractoaw csaiduct all wink on my pmpert'- I well
ensure that all contractors either have workers'corrrlre(uat,oa insurance or are sole 1112 Electrical repairs or additions
prupriewrs with no employers_ 12.0 Plumbing repairs or additions
50 1 am a general conaracwr and i have hired the tab-contractors listed on the attached sheet I .0 Roof repairs
These sub-contractors have employers and have workers'camp.insurance.:
6.❑we arc a corporation and its offteers have exercised their right of exemption per MCit_c. 14. Other
152.,¢1141,and we have no anploy+ees.[No workers'comp.insurance required]
`Any applicant that checks blest?I mtett also fill uut the section below showing their workers'compensation policy information.
1 l4omeowners who Whine this affidavit indicating they*redoing all work and then hire outside contractor must submit a new affidavit indicating such.
:Contractors that cheek this box inttst aitszliell an sddiliunal ghee(showing the name of the sub-wrttractoes and state whether or not those entities have.
employees. If the sub-contractors have encloyees.they must provide their workers'oontp.policy ntanbcr.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: T(/Dt(/q 16✓5 -
Policy#or Self-ins. Lic.#: GR )S o 6 2 4 Expiration Date: 10 If.25
AJob Site Address: 1 6 GYQv'9S k. C'ity/State%Zip: IV,Tii/ 6
Attach a copy of the workers'compensation police declaration page(showing the policy number and eijiiration date).
Failure to secure coverage as required under NIGL c. 152,§25A is a criminal violation punishabk by a fine up to S1,500.00
andlor 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 the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance
coverage verification.
I do hereby c l•under the paityt and penalties of perjury that the information provided above La true 7d co �/
Signature: . ijo ,� - Date: / a /( K
Phone#: I (3 - ' O _ y 7 i $
,
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.CitsiTown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
s,
Massachusetts 4,,
AY
DEPARTMENT OF BUILDING INSPECTIONS S C"
212 Main Street • Municipal Building
''•' Northampton, MA 01060 f O
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: Vet11-€1, 62,cc6ct�
The debris will be transported by:
Name of Hauler: DO Gr` 10
7)1 q Q
J
Signature of Applicant: Date: 6/1 770 Y