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18C-062 (3)
B P-202 1-2051 157 PROSPECT AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-062-001 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-2021-2051 PERMISSIONIS HEREBY GRANTED TO: Project# 2021 BATHROOM RENO Contractor: License: Est. Cost: 3950 Const.Class: Exp.Date: Use Group: Owner: MORRISON, ELAINE SANDRA Lot Size (sq.ft.) Zoning: URB Applicant: SANDRA MORRISON, ELAINE Applicant Address Phone: Insurance: 157 PROSPECT AVE NORTHAMPTON, MA 01060 ISSUED ON:10/22/2021 TO PERFORM THE FOLLOWING WORK: BATHROOM RENO-WALLS, TILE,SHOWER, TOILET, &LIGHT 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: • �' y . y • Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner t .. , 1 0 I is� The Commonwealth of Massachusetts . ? L� Board of Building Regulations and Standards FOR - -� i o Massachusetts State Building Code, 780 CMR MUNIC USEALITY rN�v uilding Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling El This Section For Official Use Only N 'Crtt umber: 2O2 1—2 QS 1 Date Applied: (0/1 B(Zo 21 � EU /D-2)-ZVZ c. il� �Oss �/� ) Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 perty, ddress: 1.2 Assessors Map&Parcel Numbers , '] R-aseci-Ave, sec- 0 b Z --n Q 1 1.la Is this an accepted street?yes j( no Map Number Parcel Number 1.3 Zoning Information: 1.4 Pros ftyDutmensions: 92 Zoning District Proposed Use Lot Area �y(sq ft) Frontage(ft) b 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 Private 0 Zone: Outside Flood Zone? Municipal On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 , •of Recor 1 ` �D/✓,/�j A O i e 1 0 /a ne Dr'r i� ESON NO i 7l a W 1p Name(Print) City,State,ZIP 157 PrDcoect' Ave. q1 -rod-tgq/ ela,;lenmas l@pMa,7,c0v No.and Street I Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied%( Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition , Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: RenloVe. drywall -Fro /4 CPAMr-oo,n Remove. s1ov✓erwalk ropiace SA ouilems; hp10t ' v4nily, rip/6ce -t, le , r,rlgce, C e i l in 5 1 i5h1- SECTION 4:ESTIMATED CONSTRUCTION COSTS I Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building $ 750 1. Building Permit Fee:$ 6 5 Indicate how fee is determined: 2.Electrical $ oZ D D 0 Standard City/Town Application Fee 0 Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 3000 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Totalal All Fees:$ o,, 3 C� hide-- ooy aback Amount: 6,5 ''I 6.Total Project Cost: $ 7 ❑Paid in Full ❑Outstanding Balance Due: City of Northampton ,41111) Massachusetts �� '/11I tj�,,,,, i DEPARTMENT OF BUILDING INSPECTIONS { 10. 212 Main Street • Municipal Building uF ,,a t ,,., % IL.) � Northampton, MA 01060 sSyN, Ar-)• • 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: Location of Facility: V a /l e y flec7 ChM' The debris will be transported by: Name of Hauler: L/°1 i r1 e. Morc, c B/t/ Signature of Applicant: Date: is/I /L/ City of Northampton !r• Massachusetts �� c'<< < DEPARTMENT OF BUILDING INSPECTIONS '" 212 Main Street • Municipal Building �vti ' Northampton, MA 01060 SSYn ,^�C HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT �/� 1, c iq In e S / 110rYi'1O/l (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. 1 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 >Uday of ©C f ,20_2,1 6444 (Signature) ?3aTARV6141.- '''474k The Commonwealth of Massachusetts Department of Industrial Accidents a°0 ' 1771 1 Congress Street,Suite 100 Boston,A1A 02114-2017 orww.mass,gar/Via others'Compensation Insurance Affidavit:floiklersiContractorviElectricianstPluntlicrs. BL HILL)xlLI It'1 ILL rf.11.111111NC:At 711()R11;S. Applicant Information Please Print 1..tgiltls Name t tiustnes,0rpaturztion todisida1411._ -— Address:. City,'Slate Phone iv: .4.rt)eak as emplel,er"(bra opprepriatt hat: pe of project(required). I Am curio,at,Aatt onielo}co, Ma and in pArt.botrt 7. 3 No,cun,tru,-1,0„ 20 I am a penpnetee nannenbm and hese eterlo;,‘, Lni or rr, w S. 0 Rt.intnieiing 4.,artacey rs.R.,mortal: ,onIff,enOttanui ttNiknult ST-i9_ 0 151/4nnolition aen lannee*ean Jetty all Ltenuramx evelaned 10 D Budding addition 40.111,1 honstutin ant and t.%id ht.:hnine uunittztennu totruhttl Of nark on trn.plutpult!. %111 ntrdlite tho all eontraanes etthel ha‘c*driers°,,enTensatnnt unwranee ol ate:pole i Eltsetrii.-al 1143815 or silditions propreetora ntth no employ et.y i 2.0 Plornbin repairs or additions i gperk.-141entradletth Ana I ILO httnul the Oth,ourtnetutotu toted unt the anadwet sleet 3.0 Roof repairs wh-,:outnu.-sots hake employee.and lee*,e nutlet,:contr.ursurame 14.E3 cm-1cl #, V. etetelared then ngle cycle:rum Fel Nfird, 15Z,cs I 14t. sJsee hai.s: emrinyeex [No*mien"yixnet Insure:tee required I 'Any appiaeam tine ehnek.e Nee vl mine abo till nut the*ecteen belts*stansing then*tarS,ga,,,',ocapemanon pulazy triformatem. iLerneouvre-rs saynnth atetaava trein-aims they thistly A/hunt&And then hare undtAtalt enntraetur.must aubnul a ne*atfeeLaY d endl=uns Ondttethrs,that chevi tho,box mu,/Iglu:bedinalittnenal Aeet silo*mg the name eit the sak*coresaeter..end"Lee*huliteT lant antintel iuote snlanialt•enuLI the sui,euteracturs basv intmln)eet„they must prtA ale their *otter,"comp.piOney number I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insuranec Ciirnpany Name. PubAt or Self-ins.L . LApiration Date. Job Sale Address: Sure Attach a cop,of the vs orkers'compensation policy declaration page(shooing the policy number and expiration date). Failure to secure coverage as required under SIGE c. 152.§25A is a criminal violation punishable by a fine up to SI.500.00 and or one-year impnsitornent.as%sell as cis il penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the s tolatur.A copy of this statement nu be foruarded to the Office of Investigations of the DIA for insurance cosi:rage scn11caton. I do hereby certify under the pains ontl penalties of period'that the information provided above is true and 4-erred. —Z./ Phone t" q 1/6 -g'6) -(5)q91 Official use only. Do na write in this area,to be„completed by city or town official l'ity or Toon: Petanitel.icense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.Clot n Clerk 4.Electrical Inspertor S.Plumbing Inspector 6.Other Contact l'erson: Phone it: • • SEC11ON 5: CONSTRUCTION SERVICES 5.1 Consiruetion Supers isor license(CSL) License Number Expiration Date Name oFCSL Holder List CSL Type(see below) Ni�.:uad Street � --- Type Description U Unrestricted(Buildings up to 35.000 cu. Ii-) _ R Restricted 18.2 Family Dwelling City.Towit,State.ZIP V1 Masonry RC Roofing Covering WS Window and Siding } SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(II IC) BIC Registration Number Expiration Date -Hit Company Name or IlIC Registrant Name No and Street Email address City./Town.State ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152.§ 25C(6)) Workers Compensation Insurance aflidm,it 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 0 No... 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1.a Owner of the subject property,hereby authorize to act on in behalf in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT`DECLARATION B\ 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. ' - /0 - to-21 Print Chvner's or Authorized Agent's Name(Electronic`Sumature) Date NOTES: 1. An Owner who obtains a building ptimit to do hiker own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor WIG)Program), sill not have access to the arbitration program or guaranty fund under MI.0.1. c I I2A. Other important information on the HIC Program can be found at v Wu.mas'.eovioea Information on the C orostruction Supervisor License can be found at www mass_goo`rdos 2. When substantial work is planned,provide the information below "Total floor area(sq.IL) (including garage. finished basement/attics,decks or porch) Gross living area(sq.fl) 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 he substituted for`Total Project Cost" , x->rszx;5°x,.3., _.v ,-n Your Confirmation number is 20211018558200 Date of Confirmation: 10/18/2021 NOTE: When paying by ACH (Checking) it will take two business days for the payment to be debited from your bank account. Your account number is not verified until this payment is presented to your bank. They have the right to return this payment if unable to process this transaction against your account. Your request for payment(s) of$67.50 has been received and is subject to approval by your financial institution. No email was entered so a confirmation was not sent. Account Information Payment Information Name: ELAINE MORRISON Payment Type: Credit Card Note: QUICK PAY TRANSACTION Payer Name: ELAINE MORRISON Card Number: **************9874 Transaction Information Transaction Quantity Amount Fee Payment Type City of Northampton -Building 1 $65.00 $2.50 Credit Card Department Misc. QP Permit Option: Building-Zoning-Sheet Metal Permits Full Name: elaine s morrison Phone: 916-806-8991 Property Address: 157 prospect ave Notes: Total: $67.50