18C-178 (2) 705 BRIDGE RD BP-2021-1371
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C- 178 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2021-1371
Project# JS-2021-002289
Est.Cost: $12000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAY WATSON 177571
Lot Size(sq. ft.): 19253.52 Owner: BERKOWITZ-GOSSELIN
Zoning:URB(100)/ Applicant: JAY WATSON
AT: 705 BRIDGE RD
Applicant Address: Phone: Insurance:
50 MAPLEWOOD DR (413) 522-7769 O WC
AMHERSTMA01002 ISSUED ON:
TO PERFORM THE FOLLOWING WORK:REPLACE ROOF, INSTALL ICE/WATER &
ROOFTOP GUARD
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.
art .
Certificate of Occupancy Signature: ' ' ;n„ ,� ; I
FeeType: Date Paid: Amount:
s/2y)2421
Building $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
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IS- The Commonwealth of Massachusetts
C_:7 rj= 17 ' Board of Building Regulations and Standards FOR
t- •,ti' ; Massachusetts State Building Code,780 CMR MUNICIPALITY
v�i USE
_r` 11 ing Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
_
L..- -(-__ r This Section For Official Use Only
L__.t:_$uildtn P it umber: �� d
_g__ __ 1055
P—202,1-l '1 1Dat Aplied: �/ Z Z/
�l�irJ % 5 04-09Z)
Build' Official(Print Name) / Signature Date
Building
SECTION 1:SITE INFORMATION
1.1 Properly Address: 'RD- 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
ORB(10 0)
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 0 Private 0 Zone: _ Outside Flood Zone? 0 On site disposal system 0
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
DAv,0 /i_CArt 13612.( )( No^-TiiRhPT Aniz
Name(Print) G-OSS 04-1^' City.State,ZIP AL:veNs"...or. C?dr,n L
1-05 gr1: DbR 4t3 A2-\0 S645 a.,.,rc u...,-K ea.T AIN1sTnr•tor..
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) I Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: R C it i,q c Z n-I- i2-o o F ,/ 5 t.<u i
S t•.:.•.14 i I (5-/L Arc Q Ica ., w A)e n - 2 O u F --1-L A" t 74vi-1�� 6. rt R.0-
SECTION 4:ESTLMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 12.1 p U ,, 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ a
2. Other Fees: S O ++
4.Mechanical (HVAC) $ List:__
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No.1 y(,L Check Amount: Cash Amount:
6.Total Project Cost: S 121 o 0 0 Paid in Full 0 Outstanding Balance Due:
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) S ct 0 5
J^y w ITS ; - License Number I Apiration Date
Name of CSL!folder
So M A P ea-w-e u v a� .- ' List CSL Type(see belou1
No.and Street -- T> Description
)'J1 M,A- O t 0 V Unrestricted(Buildings up to 35.000 cu.ft.)
City/Town.State.ZIP R Restricted I&2 Family.Dwelling
M Masonry
RC Rooting Covering
WS Window and Siding
?1 — S 2 i —4 �; Ct h o\ ^�'' SF Solid Fuel Burning Appliances
3 ISI t✓.cE a 9 11 —. I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I 1-4 (
3 6w 1 S /` G 0.ti s H a T i ) HIC Registration Number Expi ion Date
III('Company Name or 1 tIC Registrant Name
S 14'ILRWJaI\? l)v • (3icC-<g,a:9 6le MOiMA.
No.and Street
,n„� .a t 3'j /V'A 0l t)G '9 t 3 S Z 2 '}}{ 't 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 lssuanc 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
—r
I,as Owner of the subject property.hereby authorize _J 1A16I450y�
to act cm my behalf,in all atters relay e to work authorized by tes building it application.
egt
Print Owner's N ectronic 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.
J l,.iP S3 -51)I1
Print Owner's or Authorized 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
++ n„i.,"+s,_ Information on the Construction Supervisor License can be found at++++ +.i is .,20\_.li
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"
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( Ae(Gneneamiseaa 61P, 4 ae/Fiaelj
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR •
TYPE:Corporation
Registration Expiration
177571 04/11/2(-Z2
JB WATSON CONSTRUCTION,INC.
JAY WATSON
50 MAPLEWOOD DRIVE
AMHERST,MA 01002
Undersecretary
Commonwealth of Massachusetts
Division of Professional Licensure
III/. Board of Building Regulations and Standards
ConsitwtthStYttlpervisor
CS-079105 Expires: 10/09/2022
JAY BICKFORD WATSON
50 MAPLEWOOD DR
AMHERST MA 01002
)/Sti•I.l���o
""
Commissioner daSet,,
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City of Northampton
• M�>p: ,AS
r�- • ' Massachusetts
I 0 Li' U DEPARTA�NT OF BUILDING INSPECTIONS i ,x
w `r 212 Win Stra.t • Municipal Building `*
•�''yr Northampton, MA 01060 3'1'4 ;,10‘\
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 B 9_2021 -)37 I 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: t Ad A S L O ^'C i2
The debris will be transported by:
Name of Hauler: Gr t )
` �" '" S L� ire , ^� 2
Signature of Applicant: Date: I /)-J
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The Commonwealth of Massachusetts
I' =!I Department of Industrial Accidents
— _ ii, 1 Congress Street,Suite 100
_ y` Boston,A1.4 02114-2017
www mass.gov/dim
1$utlters'('unspensat' Insurance iffids.it:BuilderslConlractorsiIlcctriciym:Plumbcr..
It)It) I II:VD tt I I II I Ilk,PHt%II 1.i1M:Al}HIOR111.
Annlicant Information L+ Please Print Ixiibls
Narne l oust thy-int/Anon Ludt,ideal, J 1J t� \S L p ti S 7 A H t- I Cti
Address: S k) ,M A e L 4.. `"'' -' J A
City/Stale lip: fl:M\,• tr.e.)1 CDC Phone#: — >t c
t -i Li
Me yea era 11111111111,111114 hark the appropriate hut: Type of project(required):
I.Q I am a etttploy t otth . employee's I4u11 and tot part-time 1• 7. 0 Ness construction
2.10 I am a milt proprietor riero r or worm r cup and have no employ is nudist cur me in $.o Remodeling
any capaatty $so%taker,'comp rn,uram Ineywr.l l
9_ a Demolition
1.E1 I am a Ihrnaora net Jenny all Nana myself.l\u .fI st,'.ou>r ttrsarus. mytmro.1"
4.0 I am a onatnt nee and will Ise hump contractor,to conduct all Va p,m on my ptupetty. 1 will
10 El Building addition
h
ensue dial all e„tanaata.r,either Lute voodoos'eaaatptnvuan nuuta®ce so vie ink 11.a Electrical repairs or additions
ptagsreton w lib rn'cttyloytts
12. Plumbing repairs or additions
S.Cl I am a Item-rat contractor and I hate hired the suh-t.attractors lured.en the attached sheet 13 oofn p.airs
(lieu:suh-..ntiactuts hate employee,and hate notkers'caanp rn,a,raac
b.. We an a culmination and at aftictn has c eetreised then right of a temptiam per Wit.c.
ds i1441.and re hate noemployec>.ISM so ter,'comp mun r sameegi ued.I 14. Other
*Any applicant that shirks So♦ttI muss alto till out the statist helot,shots Ing their tt makers toneprnsatt.m policy infomutnrt.
s Ihsnteeatuten t Mho submit this atTdus tt miheatinp that arc doing all stork and then hie awtsuk contractor,mutt sterna a nee,attolat ti indenting such.
4.rmtr:ctors that check this hot must attached an adsnionai sheet span,mp Inc name of the sub-ct tractor,and state„tartar so not thane entities has:
.ctpl•rest It the mils-aant1raatots ler.e cteq*6..sc...the must pro,:de their workers'esrtnp polio!.mottoes
I urn an employer that is providing worLers'compensation insurance for my employees. Below is the policy and job%de
information.
Insurance Company Name.
Policy#or Self-ems.Lie.Si: — . Expiration Date
lob Site Address:_ City/State'Zip.
Attach a copy of the workers'compensation policy declaration page(showing the policy number and es piration date).
Failure to secure coscrage as required under SM(il.c 152. ::.,25A is a crtntuwl siolation punishable by a tine up to SI..SOO lio
and or one-year imprisonment,as well as cast!penalties in the form of a STOP WORK ORDER and a tine of up to S250.0KI a
day against the violator.A copy of this statement may be forwarded to the Office of Ins cstigations of the DIA for insurance
tits erat:e t eriticatltrt.
I do hereby certify under penalties of perjure that the information provided above Is true and correct.
Signature_ V... > Date: 5 J i 9h J Z I
Pharne::: 4/1 3 S 2 Z '. --}i
Official use only. Do not write in this area,to he completed by city or town official
( its or loan: Perntit+t.iceme a
Issuing Authority(circle emith:
I.Board of Health 2.Building Uepartrnent 3.City/Iowa Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
('outset Person: Phone#:
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