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29-428 (4) 78 GOLDEN DR COMMONWEALTH OF MASSACHUSETTS BP-2021-1852 Map:Block:Lot:29-428-001 Permit: Exterior Res CITY OF NORTHAMPTON PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1852 PERMISSIONISHEREBYGRANTED TO: Project# ROOF/SIDING Contractor: License: Est.Cost: 10000 STALWART BUILDERS LLC 107350 Const.Class: Exp.Date:05/29/2023 Use Group: Owner: VARGAS ELBIN&SUZANNE D Lot Size (sq.ft.) Zoning: WSP Applicant: STALWART BUILDERS LLC Applicant Address Phone: Insurance: 77 OVERLOOK DR (413)530-3680 FLORENCE, MA 01062 ISSUED ON:09/13/2021 TO PERFORM THE FOLLO WING WORK: ROOF & SIDING 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. Signature: . I1/4 Fees Paid: $100.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner O r.:13 N o The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR c. Massachusetts State Building Code, 780 CMR MUNICIPALITY rn USE o- ilding Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 cr: `�. One- or Two-Family Dwelling This Section For Official Use Only %;- Building PeW it Number: 80P-1I I FSa, Date Ap lied: '-. L zdz i Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property A des : 1.2 Assessors Map& Parcel Numbers 71 C o Air , 1.1a Is this an accepted street?yes 1. 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 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: .r / .t S o%�Gt/ p D/a Z Name(Print) / City,State,ZIP 71 G°/, y/?'530-3`8d fled'4Sco'4 No.and Street Telephone I mail Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s)% Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Pr9posed Work': ,S"fig// Q' jzze.c.i �rrG4�tr t}ii�, hs� a ss -Tr ih i /gyp If li d/ u i - 'camGyY ,c4c.0e/ 4-rye rr,Se SECTION 4: ESTIMATED CONSTRUCTION COSTS / !/ Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ /� vod v 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 1-ooP rui 90 SIC)).-,D 5. Mechanical (Fire $ Suppression) Total All Fees $ 0 O 6.Total Project Cost: $ /O °iD.oG Check No.ilea Check Amount t60 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS "l a 7 S 0 S 7,1 23 TS� 84..4e e License Number Expirati n Date Name of CSL Holder t". j//d /`lam List CSL Type(see below) No.an Street /LY Type Description Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,StatEZIP / M Masonry RC Roofing Covering WS Window and Siding j� SF Solid Fuel Burning Appliances y/:Ss —320 5J(J&h d e l!%1/. Insulation Telephone Email address D Demolition 5.2 Registered Home Im roveement Contractor(HIC) 70.5. �� S.T44�74 if f /`� HIC Registration Number Expira ion Date HIC Company Name or IC Regrstrant Name 77 a /Gv GAG Ssr� G4 1 / aAI No.and Street �� t/ Email address-P /orr9�t ,#4' 1/O7 —3c'1a 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 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 TSSL to act on my behalf, in all matters relative to work authorized by this building permit application. S lx z 6.h h t b,Y dr S A rvn*.d.-Ity. V�Sct� Print Owner's Name EI�'crtronib Si ure ( 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 accurat the best of m ow ge and understanding. Print Owners or Authorized Agents Name tronic 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" The Conttnttun-ealth of Massachusetts +.= 7111E Deportment of Industrial Accidents I Congress Street,Suite 100 y ,� ` Bowan, MA 02114-2017 vww ntass.gov/dia 11/a•kers'Compensation Insurance Affidavit:Builders/('ontractors/Ekctricians/l'luinhers. TO BE FILED N fill THE FERMI 11'1NC AlI'1'HORI'1'1'. Applicant Information Please Print Et-gilds Name(husines I'i)rgantzatton'tndrvaduall: Address: City/State/Zip:___ Phone#: Are ywl an entpbyer'('heck the appropriate hot: 1}pc of project(required): 1.0 I am a employer with employees Oil:rid in part-time).• 7. 0 New construction 1 am a sole proprietor or purtnerahip and have no employees working lor 11w in g. , 'emodeling -.7-'— any capacity.[No workers'comp.insurance required.] 30 I am a homeowner doing Ai work myself No workers'comp.insurance required.] 9. Demolition 4.0 lam a honleownem and will be hiring eontraclors to ewrJnet all work on my property. I will 10� Building addition ensure that all contractors either have workers'compensation insurance or are sole I 10 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions I ant a general contractor and I have hired the sub-contractors listed on die attached sheet. These sub-contractors have employees and have workers'comp.insurance. 30 Rtwfrepairs 14.0 Other b.©Vie arc a corporation and Its officers have exercised their right of exemption per N(,L c. 152.v 1(4).and we have no employees.[No workers'comp.insurance acquired.] 'Any applicant that checks box NI must also fill out the section below show ing then workers'compensation policy uilormatrun. °Hurneowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new atfrdasit indicating such. '•Contractors that check this box must attached an additional sheet slowing the name of the sub-contractor,and state v.het er or not those entities base employees_ lithe sub-contractors have employees.they must provide their w orker'comp.policy number_ I um an employer that is providing workers'compensation insurance for my emplo►•ees. Below is the policy and job site information. Insurance Company Name: Policy It or Self-ins. Lic. :=: Expiration Dale: 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 coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S 1.500.00 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 r the pains )enc es of perjury that the in f rmitiun provided above Is true and correct. *nature: Date: ZV" Phone#: 4,7?:S34" 7s8V Official use only. Do not write In this area,to be completed by city or town official ('ity or Tim si: Permit/License# Issuing Authorit% (circle one): I. Board of Health 2. Building Department 3.('it)il'own Clerk 4. Electrical Inspector 5. !loathing Inspector 6.Other ('intact Person: Phone#: City of Northampton r,„4 , Massachusetts �25�5 .. s�c'ce . t c is `4 DEPARTMENT OF BUILDING INSPECTIONS y j, Pn �� 212 Main Street • Municipal Building v, `a CN,,.. Northampton. MA 01060 �s1'.,, •`'‘J 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: , ki//m Location of Facility: ,307 S7 ,h7 The debris will be transported by: Name of Hauler: J$ai te/ 4/07 Signature of Applicant: '` :a/ Date:1/7/14