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38B-050 (7) 27A LYMAN RD BP-2022-0060 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-050 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2022-0060 Project# JS-2022-000110 Est.Cost: $10000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): Owner: SECHLER JENNIFER MILLER Zoning: URB(100)/ Applicant: SECHLER JENNIFER MILLER AT: 27A LYMAN RD Applicant Address: Phone: Insurance: 27A LYMAN RD NORTHAMPTONMA01060 ISSUED ON:7/19/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:BATHROOM RENOVATION 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. s Ial • ,r „ 9 ''1 • Certificate of Occupancy Signature:' I FeeType: Date Paid: Amount: Building 7/19/20210:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner c r— r- The Commonwealth of Massachusetts FOR j ) rn riv Board of Building Regulations and Standards Massachusetts State Building Code,780 CMR MUNICIPALITY Cr ,' ' USE r l Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling v t- J This Section For Official Use Only __ ' _ ' 'ermit Number:819.. ,7aM ( f' Date pplied: • /.....,&Oil-) CUSS 7- 1 q-zort Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION M 1.2 Assessors Map&Parcel Numbers G K J, 1.1 a Is this an accepted street?yes 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 0 Private❑ Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 2caner'of Recoil:.L. frl�/d-,f'tcv�l� Avoi axt'0✓�, - eigre# Name rmt) City,State,ZIP 2.-/¢' L j'W `t i✓1 0 tW3)3Y.r'16% o(IeC f1Idk//.rYr1 , No.and Street Telephone Email Address al,//.4p'rl 'ILEECTION 3 DESCRIPTION OF PROPOSED WORK?(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) At Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work: rvi.) —9 [Di ice' to y*i ,� 14-7 '�-- —/ iL/ /d 6 (iA2' tevit is— c3 tl 01CW101,14:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only $ r 0 1. Building Permit Fee: $GS= Indicate how fee is determined: 0 Standard City/Town Application Fee 2411.111111 ' $ 600 0 Total Project Cost'(Item 6)x multiplier(40 x/0 Oc'D 31.11111P1 $ liDQ© 2. Other Fees: $ 4411.1.611. (HVAC) $ List 5.Mechanical (Fire $ Suppression) Total All Fees:$TotalProject $ Check No 4 1,1 Check Amount: 0vq .-"Cash Amount: ��C) 2/ 0 Paid in Full 0 Outstanding Balance Due: City of Northampton _ Massachusetts • ��. `{ 4i' , DEPARTMENT OF BUILDING INSPECTIONS �: V+' r 212 Main Street • Municipal Building9J Northampton, MA 01060 s •,, PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS, RENOVATIONS, ROOF MOUNTED SOLAR, ETC. 1. 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. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new / replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit it requirements (if applicab)e).� . , . • . .. .. 9. Energy Code- all new construction'(Gut/Rehab) requires a HERS Rater Affidavit • Lt)� G cio—o y /Vac/h/frif �cJ� Aid SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email ad' ess D Demolition 5.2 Registered Home Improvement Contract;r j al . 142. •� _ 1�1' �H1C Registration Number xptraho Date HIC y 1 n or HI Restra i t Name ' AGCBI / `I t"- ,nA /4 Ua ( rooffltd . _/" r � No and Sire t -or Email address �o,� ,¢.DiGYj 77 City/Town, State,ZIP Teleph.'e SECTION 6:WORKERS' COMPENSATION INS ' -CE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and s emitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building pe •'t. Signed Affidavit Attached? Yes 0 No 0 SECTION 7a: OWNER AUTHORIZATION TO BE OMPLETED 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 ,VEILON 7b:OWNER1 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. r tieA/- Mi//Q.rleagir 411411—2! 'i or Authothied Agent's Name(Electronic Signature) Date 4 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/oea Informatitin on the Construction Supervisor License can be found at wwnv.mass.adv/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" \ The Commonwealth of Massachusetts �` Department of Industrial Accidents 1 Congress Street,Suite 100 - Boston,MA 02114-2017 �' • www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FII.,ED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: • City/State/Zig: Phone#: Are you an employer?Check the appropriate box: Type of project(required): LI:I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. tgi Remodeling ti any capacity.[No workers'comp.insurance required.] 9. 0 Demolition I am a homeowner doing all work myself.[No workers'comp.insurance required.]t am a homeowner and will be hiring contractors to conduct property. I will conduct all work on my10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.gElectr-ical repairs or additions proprietors with no employees. 12.4,P1umbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance? ep 6.0 We are a corporation and its officers have exercised.their right of exemption per MGL a 14•❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also 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 must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure celbe; ge as required under MGL c. 152,§25A is a criminal liolatiDn punitlaable byyatfine At to;1'10Q0.00 and/or one-year imprisonntent,as well as 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 this statement may be forwarded to the Office of Investigations of the DLa for insurance coverage verification. I do hereby c•rti undo the pains and penalties of perjury that the information provided above is true and correct / 1 ' e./ .. Date: 1 t!e zsti rhone 'f _I Y43)3ff.ibi 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Qa1 HAA1�.O _ .. Massachusetts #� � �C DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building •.sr+ Northampton, MA 01060 ifOMEOWNERS'EXEMPTION,ELIGIBILITY Mi•WAVIT' I, 14401€i+M(/16..fea4e/ .(insert full legal name), born — (insert month, day,year), hereby depose and state the following: MAT II OW 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. 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 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 /BP ,day of i�l , 20 lR y (Si tur ) .° , ., • �•, va��r The City of Northampton "f`�._ •` Building Department :' 4 212 Main Street ��ORA'E°ytl"P5 Northampton, Massachusetts 01060 Phone (413) 587-1240 Fax (413) 587-1272 L i L CONSTRUCTION DEBRIS AFFIDAVIT • (FOR ALL DEMOLITION AND RENOVAT ION PROJECTS) In accordance with the provisions of MGL c40, 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, s150A. The debris will be disposed of in: Ditd—DOF7 x-e Location of Facility I KJtTl1--)lpa-2/-) (0/0re The debris will be transported by: Name of Hauler 2I ,42AI, Di...)66F5A/F, Signature of Applicaniel Date: /4 f2L/