17C-322 (4) BP-2024-1046
58 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17C-322-001 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-2024-1046 PERMISSION IS HEREBY GRANTED TO:
Project# ADD BATH 2024 Contractor: License:
Est.Cost: 72500 DANIEL DACRI 105989
Const.Class: Exp.Date: 05/07/2025
Use Group: Owner: TR MUNSON ANDREW T& KRISTIN W
Lot Size (sq.ft.)
Zoning: URB ,applicant: DANIEL DACRI
Applicant Address Phone: Insurance:
247 RIVERSIDE DR (617)543-2843 R2WC357035
FLORENCE, MA 01062
ISSUED ON: 08/20/2024
TO PERFORM THE FOLLOWING WORK:
ADD BATH IN BASEMENT, REPLACEMENT INTERIOR AND EXTERIOR DOORS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring U.P.% . Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House # Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Drivewa 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. j
Signature: r��R—.—»
Fees Paid: $544.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
RECEIVED
\--- P.>'tk J V lc�aC t-ler tip 1. cam-r.-,
I,UG 6 2024 The Commonwealth of Massachusetts J
,, n Board of Building Regulations and Standards FOR
•k VP ie. Massachusetts State Building Code, 780 CMR MUNICIPALITY
[�r�T Or- ;w /lc 1NSPFc.TIONS USE
NO tTFIA',/T"ON ',` ' ' mit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building P
ermitNumber:� G ���c,(.../0 c�`f Date Applied:
! ,umtoss 8-I9 zozq
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Propertty Adn$ esy: s L p/ cL
1 1 1.2 Assessors Map& Parcel Numbers
a Is this anacceepptedd streeet?yess v no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use I,ot 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
9j posal System:
Zone: _ Outside Flood;one?
Public V Private 0 Municipal E On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2fb��drt, ' f/ SO►\ ii j')bEtwt- 614 0I06:4
Name(Print City,State,ZIP
'
c
c sAM' s-i" yy0 —9S—Fd(P.
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 12/ Owner-Occupied'❑ Repairs(s) 01 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:"Add cut LA fob", pi 5"0+_
741 Hor►s 41r mac/ ex1's 1 j
h Ot t 'h
— ASP a e i ,,\ n. c r o
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building 50 L 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ �� 0 Standard City/Town Application Fee
C � 0 Total Project Costa (Item 6)x multiplier x
3. Plumbing $ a 0) 000 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ / Total All Fees: $
Suppression)
Check No. heck Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
1 Construe • upervisor License(CSL)cSao
I 0 5-7 M 1�
Q� C r License Number Ex iratiSt_7o Date
Name of CSL Bolder
t7"t T R)v4i51 /_ List CSL Type(see below) (JNo.and Street (�•(,' DrType Description
/OrC.Y1(L) ! 1 A o/O(� U Unrestricted(Buildings up to 35,000 cu. ft.)
1 ' R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
61 _ - !2 SF Solid Fuel Burning Appliances
I/ Q9(��3 I Insulation
Telephone Email address D Demolition
5.2�.�egistered Home Improvement Contractor(HIC) / ..qa1 A'(A� C Y) HIC Registration Number Expi ion 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 Issuan of the building permit.
Signed Affidavit Attached? Yes No .❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
T
I,as Owner of the subject property,hereby authorize Y\ GIG f)
to act on m behalf,in all matters relative to work authorized by this building permit application.
All i'L`Ni Alv5n5or-N Sr /0(4
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
D4',/\ Doc r 8" /‘ )-
Print Owner's or Authorized Agent's Name(Electronic Signature) e
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
Sys:.... .s�c�
Massachusetts z? - <<
. DEPARTMENT OF BUILDING INSPECTIONS ytt
212 Main Street • Municipal Building
J O
- ' Northampton, MA 01060 4 1PS‘'�
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 :Facilit %! 7u TeC7())
y
The debris will be transported by:
Name of Hauler:
Signature of Applicant: f Date: r//)--C/
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
e, i Department of Industrial Accidents
I= 1 Congress Street,Suite 100
`Ij,="' Boston, MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/ContractorsIEkctricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORIT''.
Applicant Information Please Print Lecibly
Name(}lusincss organiuitioivindividual):
Address: )&)\ DC--
City/Sane/Zip: F102htg1 IY O)06)- Phone#: C�� `"���3 J 2.8'93
Are you an employer?Cheek the appropriate tot:
Type of project(required):
LID I an+a employer with _employees(full and/or part-time)_• 7. ie construction
201 am a sole proprietor or partnership and have no employers working for me in S. emodeling
any capacity.[No workers'comp.insurance required.]
30 lam a homeowner doing all work myself.[No workers'comp.in e�e ruran required.] 9. ❑Demolition
4.0 lam a homeowner r and will be luring contractors to conduct all work on my property_ I will 10 Q Building addition
ensure that all contractors either have workers'cornpe:Esation imsuran a or are sole 11 a Electrical repairs or additions
tors with no employees.
12.0 Plumbing repairs or additions
5 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 Q Roof repairs
These sub-contractors have employees and have workers'comp.insurance.;
6.0 We are a corporation and its offsets have exercised their right of exemption per MGL c. 14.0 Other
152,*1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box*l must al o fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mint submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees_ If the sub-contractors have employees,they must provide their wrorkers'comp.policy number.
I ana an employer that is presiding workers'compensation insurance for my employees. Below is the policy and Job site
information.
Insurance Company Name: 6'() Cof /Y1 t5 Co
Policy#or Self-ins.Lic.#: ��" ".. C.L/31 6 66 Expiration Date: /0/ a-L
Job Site Address: 57 d► ...t&bY7J1 CityiStatelZip: fJvr1ia) /04o1 2
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 fine up to S 1,500.00
and/'or one-year imprisonment,as well ,civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of. is :tement may be forwarded to the Office of investigations of the DIA for insurance
coverage verificati r'.
I do hereby • rtlfy u •er t pal and penalties of pedury that the information provided a re s true and correct.
Signal ef/ Date:
Phone#: 61-1- -5(-13 m3 /3
Official use only. Do not write In this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
5-F. ci,¢, h 0 5+ l evy ct_ am J c n,
617- -$y3---c,v(i3
4 _
LGtv
44,i, Al A Al
kid 6 ,� 36 Sl3 r
- ILId t c C\
0 /)
tsw, o
1)-,q.,e A.01)- .gq-i-ii(corn
----)
0,As;i/L,
E-....5;._, Dc,)(
N -. )%\
r ________________._ ' i ' ___ \
.,
-