23A-233 (6) 147NONOTUCK ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1896
Map:Block:Lot:23A-233-
001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1896 PERMISSION IS HEREBY GRANTED TO:
Project# 2021 KITCH RENO Contractor: License:
Est. Cost: 47000 DALHAUS CARPENTRY INC 101628
Const.Class: Exp.Date: 11/17/2022
Use Group: Owner: FOWLER JEFFREY P& NATASHA R YAKOVLEV
Lot Size (sq.ft.)
Zoning: URB Applicant: DALHAUS CARPENTRY INC
Applicant Address Phone: Insurance:
11 CHERRY ST (413)977-6094
NORTHAMPTON, MA 01060
ISSUED ON:09/21/2021
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
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:
4 f • )2 .
Fees Paid: $305.50
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
1r_--- R
EC
1 //V/�
The Commonwealth of Massachusetts
Board of Building Regulations and Standards SAP FO
\ 1 Massachusetts State Building Code, 780 C R 2021 M ICI ALITY
r r),,,T U E
Building Permit Application To Construct, Repair, Renoyate4 Aent4 ' z-a� R ised Mar 2011
One-or Two-Family Dwelling At'-_2.: r.q 07osiONS
This Section For Official Use Only
Buildin Pennit Number:;; LP... -I g< ` Date Applied: d
C-'--V I tJ`/ 5-% / %11-702i
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1,Li oper Ad ess:k., 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:
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 if yes❑
SECTION 2: PROPERTY OWNERSHIP'
/ , ' r`'��"`] ��..a.r / ✓ Yak \o lo'Z
Name(Print) City,State,ZIP
\�� N o v v►e- SA-- 913 30°ice`{ rV \4.�a'1 .�e0\1 ,,�- .\ �,�^
►
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied lik Repairs(s) W Alteration(s) 14 Addition 0
Demolition fit Accessory Bldg. 0 Number of Units Other 0 Specify:
Brie#Description of Proposed W rk2: ;P.Vvny g , \ I
0, pi,otr\ceS, (p*A $ v.r . k
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 4�. W 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ 0 Standard City/Town Application Fee
• 0 Total Project Cost (Item 6)x multiplier x
3. Plumbing $4 lN� ,w 2. Other Fees: $
4. Mechanical (HVAC) $ 6 s,51.) i,.. List:
5. Mechanical (Fire $
Suppression) � A Total All Fees: $ 0
Check No.2030 Check AmotvPil' 3O5� Cash Amount:
6.Total Project Cost: ell,Opp.t,0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.11 1Construc 'on Su rvisor License(CSL) C S 101 a� L
-1-i Ak S \ c' Civ S License Number Expiration Date
Name o CSL Ho der V
List CSL Type(see below)
0 < ,e t 5
No.and Street Type Description
&4 YN NIA 01 0-a-1 q Unrestricted(Buildings up to 35,000 cu.ft.)
Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
yC13 ,11 601 44hSCG'( f,1�/ I Insulation
Telephone Email ddress �J/ D Demolition
5.2 Regis eyed Home Improvement Contractor(HIC) ' / O r� Q�fo c `v `� HIIC Reogiistrati n Number 4819_,_
ir ion Date
C Company� e or HIC Registrant Name
4f' �b tl`).C.-- 4/a AS(h v%.�"..�yy£9 11n-a i I.t or—
F
No.and Street (/ // ' nail ddress
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...........SE
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 D, 1 1 ',Ai S 6,1{-Velr\--1-\
to act on m behalf,in all matters relative to work authorized by this building permit aiNplication.
a' - \ {�)2/1
Print`Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest und• the pains and penalties of perjury that all of the information
contained in this application is true and accur�, • /to th est of y knowledge and understanding.
ns c,� GrS c / gyp). .20011
Print Owner's or Authorized Agent's (Electronic ignature) 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.govioca 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS �
212 Main Street. • Municipal Building
Northampton, MA 01060 �ty; jg
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:
hr
Location of Facility: \) Gt \\el PC.1 (
The debris will be transported by:
Name of Hauler: &\J-..)\\P\
Signature of Applicant. Date:_cr r ,
. \. The Commonwealth of Massachusetts
lii Burr==stelZ Department of Industrial Accidents
1 Congress Street,Suite 100
zatst= Boston, MA 02114-2017
www/MISS-govidki
l'•urkers Compensation Insurance Affidavit:Builders/ContractorsiElectricians/Plumbers.
VII RE FILED WITH THE PERIWITI'ING AUTHORITY.
Applicant Information Please Print Legibly
Name t BusinctwOrgantrattorc Ind t v idua 1): .\. it7> 4re /VN\-.
Address: 1 [ r\t\ep sk- _
AG
City/State/Zip: c?a A ,,12,./..,\p -,w, /V1VN Phone# LI, 13 Cill
Ave e as employer?Check the appropriate box:: Type of project{required):
1.0 1 arn a employer with „___employees(fall=dot part.bitnet• 7. Nevi construction
20 am a sole proprietor at partnership and have nu employees wooing for me ut /I. / Remodeling
any capacity,(No workers`comp.LTISttilliettX regional.)
9.. id Demolition
30 I am a homeowner doing all wort myself(No workers'coop.insurance required]*
la 0 Building addition
4,E1 1 ant a homeowuct anti will be lumig contractors to conduct all wink oti rity propert). I will
noun:that all contractors either haw workers'etimperwation insuninic in are sole I I y Electrical repairs or additions
proprietors with no employees. 12.1,4 Plumbing repairs or additions
50 I am at gelleitti coturailor and I last hued the sub-contracturs listed on rise attached sheet
13 II Roof repairs
These subsontlactors have employees and halve workers'comp.inionance..;
I 4,.0 Other.
ti.:?4,We are a corporation and itat officers have exetcised their right of exemption per tIGL C.
I S2., I{4).and set have no ariptiyees.(No workers'camp,insurance sequired.1
•Any applic-ieti that chicks box'1 must also till out the section below showing their winters'compensation.p.olicy iinfonnation.
Homeowners who subunit tilts affidavit inthcating they*redoing all work and then hue outside contractors must submit a new affidavit indimting such.
;Contractors that cheek trig box must attached an additional sheet showily,the name of the tiotseontroctues and state whether or not those=noes have
employees If the sub-euistractors have ernplo:.ces,they most pro hie their workers'comp, tiiey rwt:41vt
I atm an employer that is providing worAers'compensation insurance for my entployees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.40. Expiration Date:
Job Site Address: , CityiStateiZip:
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 tine up to$1,500.00
artiVor 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 v Mlator.A copy of this statement may be terwarded to the Office of Investigations of the DIA for insurance
coverage verification. /
I do hereby certify end' the , , or',•penalties of perjury that the information provided above is true and correct.
Si vlature. .., ,
_....--- Date:_Sre t • I 0( I
‘11111117
Mote tt: 4 1'..- c 1 A b oti
... . .
Official use only. Do not write in this area.to he completed by dty or town official
,
City or Tow n: PermitiLicense
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Chy/Town Clerk 4. Electrical Inspector S.Plumbing Inspector
6.Other
5
Contact Person: Phone#:
City of Northampton
Massachusetts 4A.? - {"
IfDEPARTMENT OF BUILDING INSPECTIONS 9T
-< w 212 Main Street • Municipal Building ,
tE rr
Northampton, MA 01060ti1�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
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
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 day of , 20 .
(Signature)
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