31B-117 (4) •
BP-2024-1424
19 EDWARDS SQ COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31B-117-001 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-2024-1424 PERMISSION IS HEREBY GRANTED TO:
Project# SIDING/WINDOWS 2024 Contractor: License:
Est.Cost: 10000 SAMUEL TAYLOR 118933
Const.Class: Exp.Date: 02/21/2027
Use Group: Owner: LLC TAYLOR NORTHAMPTON RE II HOLDINGS
Lot Size(sq.ft.)
Zoning: URC Applicant: SAMUEL TAYLOR
Applicant Address Phone: Insurance:
245 NORTH ST (413)588-7421 WC5-33S-B24Q42-013
NORTHAMPTON, MA 01060
ISSUED ON: 10/28/2024
TO PERFORM THE FOLLOWING WORK:
REPLACE SIDING AND 2 WINDOWS
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:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 172.
Fees Paid: $75.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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,OCT 28 e Co onwealth of Massachusetts
c'-'O24Boa d of uilding Regulations and Standards FOR
op Ma sach etts State Building Code, 780 CMR MUNICIPALITY
qrH14if?/I USE
't ppli ation To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
Oioff°Ns One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:84>I- /"-/Z 1 Date Applied:
967. -''if—r 54' �, A-49-2y
-Building Official(Print Name) dgt Date
SECTION 1:SITE INFORMATION
1 1 Prop rtyAddress: 1.2 Assessors Map&Parcel Numbers
evi
l.la Is this an accepte street?yes 7 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 upply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private 0 Zone: — Outside Flood Zone? Municipal❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: � �/U�
Nat�1 lam l/
(Print � City,State,ZIP
is .c 7 rei6— Z1
No.and Street �` Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(checky►Il that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) itrAlteration(s) 0 Addition 0
Demolition Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': if . a'e t ( � t-4.0 reelr,r i
Zwjiti C44 �- ic Ulea1.. i- .
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $/d 00 a 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ — ❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All F
Check NoPJICheck Amoun# t4 Cash Amount:
6.Total Project Cost: $ /0 /AO 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
us:..r-...sic
Massachusetts +0.
ti• DEPARTMENT OF BUILDING INSPECTIONS
� 212 Main Street • Municipal Building
, Northampton, MA 01060 3y:'^„ `as+
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.
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) it PY.73
T_J License Number Expi tion ate
Name of CSL Holder
2-ItT k) ?f . t. List CSL Type(see below)
No.and Street J Tie Description
Mr �^A D/O6 0 Unrestricted I 2 l upel 35,000 Cu.ft.)
City/Town,Ste,Z1P ,,�T C� R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
�l 8$r� � WS Window and Siding
�,,�}. �/ SF Solid Fuel Burning Appliances
CH; 56 ``10 3 �., � (A'r�+ #,(ca J Insulation
Telephone Email addrEss Demolition
5.2 Registered Home Improvement Contractor(HIC) 21 O Z!1g
/I Ol Zo2.4
1(iC{ HIC Registration Number xpir Lion Date
HIC Company Name or HIC egistrant Name
s;ce ul Ca
No.an Street Erna] address
City/Town, ate,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 f 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
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 applicatio ue and accurate to the best of my knowledge and understanding.
I072—C`ZO? -
Print O s or thoriz A '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.) (including garage,fmished 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
City of Northampton
Massachusetts ?
t DEPARTMENT OF BUILDING INSPECTIONS i r
y ' 212 Main Strout • Municipal Building
Northampton, MA 01060 ss
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: Va-(j
The debris will be transported by:
Name of Hauler: ka4-5)—
Signature of Applicant: Date: / Z Vail
k
The Conunonwealth of afassachasetts
ay Department of Industrial Accidents
"» 1- = I Congress Street.Suite 100
tin..'-- .........
Bosron,MA 02114-2017
Safi' www.mass.gorldia
11 urkers'Compensation Insurance Affidavit:BuildersfContractorslElectriclans/Plumbers.
10 BE FILED WII II THE PERSII I"I INGAil'I'NORITY.
Applicant Information Please Print Lceibh
Name tBusinessOrgani»tiom'IndividualI:
Address:
City/State/Zip: _ Phone r-:
Are v an employer?Cheek the appropriate tat:
Type of project(required)..
i. I am a employer with•._.. _cndoyeea(full aniline pact-time►•
7. 0 N construction
20 i am a wit:proprietor or partnership and have nu employees working fur rue in 8_ Remodeling
any 4.apaiity- No worker's'comp.insurance retiuind_)
9. ❑Demolition
t.0 I am a hunxvwnet doing Ill midi myself.ps:o workos'cony.wourame requited_]"
I0 0 Building addition
2.❑I ate a humcvw 21,7 and will be hiring cortra...ion to conduct all work on my property_ I will
ensure that all contractors either hale workers'compensation insurance or are sole l la Electrical repairs or additions
prvpnetors w ith no employees_
12.0 Plumbing repairs or additions
50 I am a general contractor and I have hired the sub-contractors hated on the attached sheet
These sub-cuntnctun have employe and have war►er>'comp.insurance.: I 30 Roof repairs
t,.0 We are a corpaxat:un and its officers have exasciscd their nght of exemption per.ttii 14.u Other
12 ;114).and we have no mnployeea.(No workers'comp.insurance required.)
'Any applicant that chocks box al mast also Ills out the section below showing their workers,'compensation policy oaformation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mast suhnut a new affidavit indicating such.
:Contractors that check this but moat attached an additional sheet slowing the name of the sub-contractors and state w hcther or nut those entities have
employees_ If the auh-contractor,ha'et employees.they must pro+ids--their Aorkers'eomr.rubes numb.''r.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. f //�
insurance Company Name: ti 1 t e/17 ii _
Policy#or Self-ins.Lie.#: Lt.,9C..S^ 3 3S' -6> z.}.4. -3 0 l3 Expiration Date: I(/?( ? :)
Job Site Address: ji S,,h/� City/StaleiZip: per > A 6(61
Attach a copy of the workers'compei tion polies declaration page(showing the policy number and elpiration date).
Failure to secure coverage as required under MGL c. 152, *25A is a criminal violation punishable by a time 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 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 certify under the pains and penalties of perjar)'that the information provided abo.e is true and correct.
Signature: Date: 7.—f! -O ZT
Phone#: L113--.�g 8Z-i
Official use only. Do not write in this area.to be completed by city or town official
t'ih or Town: Permit/License#
Issuing Authorit% (circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
(a.Other _____._
('onttact Person: Phone#:
City of Northampton
(
S.s s,C
Massachusetts .4Y,' '._ '.1.
." I..i * c
1 DEPARTMENT OF BUILDING INSPECTIONS pk ,r,-
?� 212 Main Street • Municipal Building 1 r�C��
\.F Northampton, MA 01060 wo'
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. 1 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. 1 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)