18C-141 680 BRIDGE RD-29 CRABAPPLE BP-2021-0959
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C- 141 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2021-0959
Project# JS-2021-001641
Est.Cost: $36000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MARK JODOIN 49918
Lot Size(sq. ft.): 1497897.72 Owner: LATHROP COMMUNITY INC
Zoning: Applicant: MARK JODOIN
AT: 680 BRIDGE RD - 29 CRABAPPLE
Applicant Address: Phone: Insurance:
15 JONES DR (413) 885-7361 WC
EASTHAM PTO N MA01027 ISSUED ON:3/2/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD WINDOWS, KITCH CABINETS, VANITIES,
PKT DOOR
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.
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Certificate of Occupancy Signa , re: `,
FeeType: Date Paid: Amount:
Building 3/2/20210:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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' • The Commonwealth of Massachusetts
r\' . .)-1., Board of Building Regulations and Standards FOR
ru t MUNICIPALITY
m rw i Massachusetts State Building Code,780 CMR
t•f. USE
f• Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
m —_� _J One-or Two-Family Dwelling =,
n n This S ion For_ Official Use Only
�-- _"`' -Building emit Number: -o?/ — �i , Date Applied:
eviN (2.55 / �`— 3-2-2021 ii
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION I
1.1 Property Address: 1.2 Asse rs &Parcel Numbers) i
ee, 011tdbc-ao, - 1-1 C / i2G Map um )(.4
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1.1a Is this an accepted street?yes no Map Number Parcel Number 9
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(R)
1.5 Building Setbacks(ft) I
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 0 Private El _- Outside Flood Zone? Municipal Cl On site disposal system 0 t
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
L-4TW0049 aaj Us. iT 174,e. LI4JT71-IQ'eIp t C- I /114 , ID ot'7
Name(Pru City,State,ZIP
t ap 0,446C7- >. Pi4 vE-- L(13.432-5-99 V Cfijeolke (arr+,ego.keN4L.1"-‘9►n
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building Cl Owner-Occupied 0 Repairs(s) ❑ Alteration(s) kt Addition 0
Demolition O Accessory Bldg.0 , Number of Units JOther Specify:
Brief Description of Pippposed Work2: n yl/t,, 9ocdj(e-f lAil Ant) � 1&) C I
144")l 1-7(J1 /"eeegi—
SECTION 4:ESTIMATED CONSTRUCTION COSTS
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Estimated Costs:
Item Official Use Only ,
(Labor and Materials)
1.Building $ ? l 1. Building Permit Fee:$ Indicate.how fee is determined:
0 Standard City/Town Application Fee .
2.Electrical $
-> 019O • ()p 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing S 3 00D •CO 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire T
Suppression) $ Total.All Fees:$ r
.h
Check,No.)13 Check Amount: LQ I
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: d
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The Commonwealth of Massachusetts
tit= Department of Industrial Accidents
;i c 1 Congress Street,Suite 100
ati Boston, MA 02114-2017 .
'°r www.mass.gorldia
Workers' Compensation Insurance AIRdavitt Builders!Contractors/ElectriciansfPturnbers. `
TO HE FILED WITH THE I'ERMIrI.1N(:Atl'1'IIOkITY. ,
Applicant Information Please Print Legibly
Name(1lusinesslOrganization 1ndividuati: L�tt�}r(1� V £J T .tol.(ry '/.
Address: [ DO 6� rr A 04l v& !�
City/State/Zip:_t r1i tvVgro-d /1OA OIO7:7_ Phone #: cir.
.,'4 3 7 c p -- -
Are you an employer?Check the appropriate here: Type of project(required):
1.0 I am n employer with`�_employees(full andVor part-tinie).* 7. 0 New construction
20 I am a sole proprietor or partnership and hare no employees working (or me in H.•y� Remodeling ,
any capacity_(No war'er 'comp.imunince reeauircrl.) tYh�rr
y_ ID
I 30 I alp a omoownet doing all work myself.INo wort:ins m comp.insurance •quirt:J.j
10 0 Building addition
•t.Q I am a homeowner runt will he hiring contractors to conduct all work on my property. I will n
ettkure that all contractors sits,hake wirkeR'compensation insurance or arc sole 1 I'LJ Electrical repairs or additions
proprietors with no employees.
I 2.0 Plumbing repairs or additions
t I am u general contractor and I have hired the sub-contructots listed on the attached sheet_ i
L� 13.Q Roof repairs
These sub-cirutractors have employees and have walkers'comp.insurance.• _ I
6.�Yr c are a corporation and its officers cers have eacii iced their righl of exentpliotl p.'r MOI.C. 1�I•a�tt1t`t
152 i It•tl,and we Moos:no einpluy'ecs.(No workers'comp.insurance required.)
.Any applicant that checks two al must also lilt out the section below shun log theirwutkers'compensation policy information,
t Iloma,wlsen who submit this affidavit indicating they ate doing all woe(:and dxro hire outside cwttracturs mint submit a new allidalot indicating such.
lCuntrtletant that check this trot mutt uttxhcd un additional sheet show ing the name oldie sub-cantrwtiurs arld state whether ar not those entities have ..
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employees. If the Yob-colrtraetara have employees.they must provide their walkers'comp.policy number. l
I am on employer that is providing workers'compensation insurance for my employees. Below is the policy and fob site
information. •
��,, _ �,
Insurance Company Name: A-65/¢C/k1��)&r � ' >6 -lr'L''cii �' er'-a �vti(
Policy#or Srlt=ins.Lie.;1: We D Z--I 0i3 3-7 3 Expiration Daft: tom( Ok ?�02'� i
Job Site Address: IC? L It iStatc.Zi
Attach a copy of the workers'compensation policy declaration ge(showing the policy number and expiration date).
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Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to S1,500.00
andr'or one-year imprisonment,as well as civil penalties in the refill of a STOP WORK ORDER anti a tine of up to S25D.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. - it
1 do hereby certi y un r the pains and penalties of perjury that the information provided above is true and correct. s
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Sign re: -� <e-4 e• Dale: l f 74� 1
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PhoneLe: � 7. p
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Official use only. Do not write in this area,to be completed by city or town official.
' City or Town: Permit/License if
issuing Authority(circle one):
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I. Board of health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector .
- 6.Other
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Contact Person: - Phone 0:
SECTION 5: CONSTRUCTION SERVICES
5,1 Construction Supervisor License(CSL) CfJ.. 04(ict (CTO i Z(2,l iv:tz__.
Mt&v_ io?chid License Number Expiration Date
Name of CSL Holder
f 5— 5 o 5 . v� List CSL Type(see below)
No.and Street Xl1 Type Description
�� / U Unrestricted(Buildings up to 35,000 cu.ft.)
CAsn�,/144A6 r-D.O 4 I`� A, 0 t07; R Restricted I&2 Family Dwelling
City/Town,State,DP M Masonry
RC Roofing Covering
WS Window and Siding
3 SF Solid Fuel Burning Appliances
Li(S 5.7.3411 I Insulation
Telephone Email address D Demolition
i 5.2 Registered Home Improv meat Contractor(HIC) 15-1 C 3?
M t7es�f - D/iB4 .Tope,c l- x}' e
L 111C Registration Number Expire i
HIC Company Name r HIC Registrant Name
1c 30,4A l(JLty4-
NJ). Street Email address
,i 01e.a *A n07.:1 r
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE APNIDAVIT(M.G.L.c,152.§25C(6)) •
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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 _ z
I,as Owner of the subject property,hereby authorize____A4 .. IrOboslry
to act on my behalf,in all matters relative to work authorized by this building permit application.
/- 1i - (4- �'�` s �, rya l/2.4(4011
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION 4.
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.
a-6445 4-1404.— l(Z.o Zioz
Print Owner's or Authorized Agent'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 f
(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
1.
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) l
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halflbaths i
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"
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City of Northampton
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` DEPARTMENT OF BUILDING INSPECTIONS aI � '
} '� 212 Main Street • Municipal Building 5J'•., I' ' r
Northampton, MA 01060 `2rN•,,.. .•'����c
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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:
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Location of Facility:
The debris will be transported by:
Name of Hauler: Gdie-riV eKl y 4.,)C:
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Signature of Applica� Date: l 3-1
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City of Northampton
PYH�M ,
`' ' rz ti4 5�5..�• S��
f { Massachusetts RQ}'
e iI DEPARTMENT OF BUILDING INSPECTIONS x.
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212 Main Street • Municipal Building I. 'a
Northampton, MA 01060 `s94... ;�.�5�
HOMEOWNERS'EXEMPTION ELIGIBILITYAFFILIAVIT
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
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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. I 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. I uali under the State BuildingCode's definition
q f}/ fi n 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 t
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
qualifij 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.
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Signed under the pains and penalties of perjury on this % day of ,64 v*ir-�f , 20 ti.
( .— I
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Signature)
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