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23A-251 19 MANN TER BP-2021-0812 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-251 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN&BATH RENO BUILDING PERMIT Permit# BP-2021-0812 Project# JS-2021-001388 Est.Cost: $26300.00 Fee: $175.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: C & T CONSTRUCTION 062884 Lot Size(sq. ft.): 7579.44 Owner: BISSIAS GEORGE Zoning: URB(100)/ Applicant: C & T CONSTRUCTION AT: 19 MANN TER Applicant Address: Phone: Insurance: 15 Fairway Drive 1413) 586-4965 SOLE PROPRIETOR FLORENCEMA01062 ISSUED ON:2/26/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:RENO KITCHEN AND 2 BATHS 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department 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. �9'TA�I yQ . Tie • Certificate of Occupancy Signature: ( FeeType: Date Paid: Amount: Building 2/26/2021 0:00:00 $175.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusetts' JAN 2 0 2021 I ;FOR W Board of Building Regulations and Standards MUNICIPALITY Massachusetts State Building Code, 780 CM& R ova t of B m 1 3 TI•NBeviscd Mar 2011 i USE Building Permit Application To Construct, Repair, enovat��OrAL •rfig �`oso ! One-or Two-Family Dwelling - - This Section For Official Use Only Buildin Permit Number: I .4Y' �/)- Date pplied: t 1/ �an /z 2•Z5-20z.1 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pr�o'perty Address: 1.2 Assessors Map& Parcel Num e,� 19 V�la,nrl. Terre . --.-4 c, i 1.1 a Is this an accepted street?yes L- 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 lid Private 0 Zone: _ Outside Flood Zone? Municipal A-On site disposal system 0 Check if yesla- SECTION 2: PROPERTY OWNERSHIP' 2 1 Owner'of Rec d: (erne • ,j5A S f/artn,A r M 1q l ©!o ` I Naame(Print} City, State,ZIP �f /5 Mctiin if, f (4 13 ) eV 2- i(d/ 4..ss;AS 0 IA411, "411 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) 0 Alteration(s) 0/Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work':_ ep c t'ci , , 3cLe �.l liter fled r'"'UDNLS /te Atectd S-ISi-eGl1 • SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 5 000 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ 0 Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ d List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ WI L Check No,�i'14,�Check Amount: i 7 J Cash Amount: 6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �^y2 9 Q 30 Zpz / %r"� / /7 LLi-ceense Number Ex rati Date Name of CSL Holder List CSL Type(see below) l (toy No.and Street Type Description Fl_ c6 a z a Q/06� U Unrestricted(Buildings up to 35,000 cu.ft.) 60 l R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances /3)Ji%4' 6S 07(76/N Sr ,kd-coo I Insulation Teleplone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /6/ 76( r72-3/�1 HIC Registration Number E piirratiio Date 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 Issuance 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 I,as Owne f the subject property,hereby authorize ,U 1/15 /NC ((a17 to act on behalf,i ers relative to work authorized by this building permit'application. 1 / � / 20 Print Owner's N e(Elect • Signature) ! Aate 2-( 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. //6/Z-04:( P int ier's or Authori d Agent s Name(El ctromc 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" ,� City of Northampton r �' Massachusetts r .. t ;, w; it s DEPARTMENT OF BUILDING INSPECTIONS �t i x �/ " 212 Main Street • Municipal Building �J'4. ��` " � Northampton, MA 01060 ss�W... ��� 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: IA// / ( C 7G 7 The debris will be transported by: Name of Hauler: /4c1. 71/' AP N. Signature of Applicant: /� /� i Date: e z� � G The Commonwealth of:Massachusetts 11, ot Department of Industrial Accidents t 1 Congress Street,Suite 100 • d Boston, MA 02114-2017 -,,, wwx:ntass.got�tdia %Porkers'Compensation Insurance Affidavit:Builders/ContractorstElectriciansiPIumbers. '1'0 BE FILED WITH THE PERMITTING AUTH0RIT1 Applicant Information Please Print Legibly Name t hlusincss,'Organtzationtlndtvidual): Address: 1 sY'-( P . City/State/Zip: )7c iette7ec `4/14. /ao Phone #: Are you as employer?Cheek the appropriate box: Type of project(required): I.❑I am a employer with employees(lull and,or part-time 1,* '. 0 N sv construction 2/i"`+ i a sole proprietor or pertnerahup and have nu employees working for me in 8- { .{�'t„modehng any capacity.[Nu workers'camp.insurance required.] to .30 I am a homeowner doing all work myself.[No workers'comp.Insurance required-)" 9. ® Demolition 4.0 I am a homeowner and will he hiring v_nnttartorsto conduct all work on my property. I will 10:pudding additionme ensure that all contractors either have workers'compensation insurance ea are sole I -Electrical repairs or additions proprietors with no employees. 11 tubing repairs or additions 5 I am a general contractor and I have hired the sub-contractors Listed on the attached sheet. 13 II Roof repairs These sub-contractors have employees and have workers'comp.insurance.; 6.0 We are a corporation and its officers have exereiscd their right of exemption per MGL c. 14.0 Other 152.§1141.and we have no employees.[No workers'comp.insurance required.) 'Any applicant that clucks K.A.sal must also fill out the section below showing then workers'compensation pokey unfurnatiown. Homeowners who submit thus affutavit indicating they are doing all work and then hire outside contractors must subnut a new affidavit indicating stab. :Contractors that check this.box must attached an additional sheet showing the mune of the sub-contractors and state whether or nut those%slides have cmplovetti. If t)x sub-contractor%)tave employees.they must provide their workers*vtmnp.policy number 1 ant an employer that is providing►corkers"compensation insurance for my employees. Below is the police'and job site information. Insurance Company Name: Policy#1 or Self=ins.Lie.4: Expiration Date: Job Site Address: City.SfateiZip:__ Attach a copy of the worker's`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 tine up to S1,500.00 andkor ose-y risonment,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 copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. f do hereby cer 'j,under the pr and penalties of pe rwrr that the information provided above is true and correct. Signature: ! / Date: 7(IO7Zeor Phone#: / O{Jicio/use will. Do not no`rite in this urea. to be completed by city or town officiaL ('its or Town: PermWLicense#r Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Cityfl'own Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 4: oi•JI /Zr7(0 Covs-/i/ut-X ‘ 40 - . . r,q—si4;-7,7cgrc.;-;--L- (,„s Kellpy µia -sue- 701-2,r �1p Pot'"�w' , -. I 1-ill a , { fili -______> - $ 03 1 , ,:iisai . t. 0_ _ r7.. _ WOO 6iainh \!iipi , t ' , awl 1 1 , ',, t 7,:-• c lW �95-2 k II,11