38B-082 (2) BP-2021-2229
165 SOUTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-082-001 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-2021-2229 PERMISSIONIS HEREBY GRANTED TO:
Project# RENOVATION Contractor: License:
Est. Cost: 5000 SMILEY HOMES LLC 114958
Const.Class: Exp.Date:05/24/2024
GIBBONS, JOHN GREGORY & ALESSANDRA
Use Group: Owner: URBANO
Lot Size (sq.ft.)
Zoning: URB Applicant: SMILEY HOMES LLC
Applicant Address Phone: Insurance:
58 MAPLE ST (207)653-4310
EASTHAMPTON, MA 01027
ISSUED ON:12/01/2021
TO PERFORM THE FOLLOWING WORK:
ADDING BEDROOM TO UNIT 1 ,CONNECT 1/2 BATH TO FULL BATH
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 MAYBE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I` • ./ + >2 (Pi
I I
Fees Paid: $65.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
r.--�t�
/.
The Commonwealth of Massachusetts '•� ./ ,/
�, FOR
Board of Building Regulations and Standards/ NO y c ICIP '1TY
C; Massachusetts State Building Code, 7 CM c� /'USE;
/,/;3
Building Permit Application To Construct,Repair,ReIIttavatc - olish a�'1 Revised Mar 2011
One-or Two-Family Dwelling ' 'f,.,I,ii^,,, i/ r
/, i(:/
n This ection For Official Use Only `�� "^;JFcr, i�
Building Permit Number: W- A i- qua Date Applied: r��v°�ti"
/Eui•-..) 42o,5 /(�� 1Z- /-ZOZ)
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
165 Swu.4v s*( t1, ILAA,c44+0 t A14 otob4 3g B oe I
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
utkg (6 007, 5-0
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) N/A ('1,( t itt+ v,i7✓ vu o✓-k
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private❑ Zone: _ Outside Floodone? Municipal�On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Sahh 6ib6$hS 40.a Al¢S 'Jk U,V6CONo Nov a4#61nI MA- OI0(o 1)
Name(Print) City,State,Z 'b b sti 51T 9 W`q►l.t,oW
143 Litnt,olw Av.e z,4 dgt-0:31 Jy`.
2o;a.b'}t-6B3 ) alt.9144n0@9Wyil.i,ewt
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building X Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units I Other CI( Specify: .6"0)00101/0
Brief Description of Proposed Work':itddly\y Secovt(� b e (1r(Nvv1 + kAVtI L q,iAd (nv1Ylet
(l1 U f 1-,,c t'k route 4-0 -�•t Li I 44„r o w\ W-1 -‘,.. uasv W i vl U,h t\- t
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ y t/0 0 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2. Electrical $ ( 0()0 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ Total All Fees: $
Suppression)
Check No. Check Amount: *,1
6. Total Project Cost: $ 5 Op() 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor l License(CSL) )114 9 c f oS -220 2 y
SM l l`e-S 1-L.C. License Number Expiration Date
Name of CSL Holder I
5t M A O Sf U
List CSL Type(see below)
No.and Street Type Description
,� � M U Unrestricted(Buildings up to 35,000 Cu.ft.)
Restricted 1&2 Family Dwelling
City/Town, II' J'1 State,Z A b OL R
M Masonry
RC Roofing Covering
WS Window and Siding
}/� �p I n I SF Solid Fuel Burning Appliances
20�-. (0C-3.C1310 ►6a'`S�I I&/( 9 i l�Lbt/Vl I Insulation
Telephone Email ddress D Demolition
5.2 Re istered Home Improvement Contractor(HIC)
Swtg2 S LLL 19t53' La.13 .zozZ
HIC Registration Number Expiration Date
HIC Comp y Name or HIC Registrant Name •
5 (Ip4 s I q ct46,1-I.•a,tpfi4^ AP P (2)u.z 1- rldt6W11 14 gllha i I.CCIAA
No.and St et 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 Issuance of the building permit.
Signed Affidavit Attached? Yes Di( 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 GI � S
!V wit te
to act on my behalf,in all matters relative to work authorized by this building petit application.
74411 Gib6Corti
AI¢4s4401 ct(bu,fru) ((. 2 V , Z 0 2
Print Owner's Name(Electronic 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.
.3-014,tn C 3)1)6w i
41ess 41 Ltd°cw , U U 11'b (2,4)7/1
Print Owner's or Authorized Agent's Name(Electronic 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"
.=.".1 The Commonwealth of Massachusetts
kBostp? a Deportment of industrial Accidents
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1 Congress Street.Suite 100
_.
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on.MA 02114-201
__.„,,,,.,3.-1, mass.garldia
11 utken'('oalpensativa iasurancc ;tffidasft.Huildert/(a tractortariectrki*a1JPIaatbent.
1(1 BE PILED N 1111 1111:P :itMIflI G A(JTIIO1111Tti'_
.lntsiicant Information r Please Pri�� ibis,
Name tilt,„ttr5,1hg.tnttaItiHb tad s%'Alai):. N4i-ilq,,,A C. e... 3 ��,y Drr
City/State/Zip: F-Cl 'kszt.y iptOV ._I`1;k (A O1'Itonr g ,a�.o7 6.7 q31 d _y
An Tau as c.apts)ar`I tiry I.Ow rppruprLS9.but: Type of project(required)
i.❑i am a rrrriol,cr tort erirt iscvs trait tailor paN onto." 7. 0 New �ttnstl uctutrt
:01 as a waste pruprusar r,a pretnashsp arui ha+e eau rep&Yynns wraters far arc us 8 (, sideltng
an tapiat),to worsen con c. enueranct re iscresi)
g ❑Drmuliburl
30 t sat r it+,utarss»ucy dome;ail awaa na}9r heti. t I o*utters'comp trourit rcr moipsered 1'
10 El Building addition
4 Q I ama boinet+w nr ar wtt 1s J It banns la eunJ m uct ail work. my property 1 M d1
crew'•dial all c.,ertreaurrs tuner have irowiecrs'cssrnprn,atrsn a-our:a..ti car are suit 1 1.Q Liertrscal repaint or additunis
murmurs want au ctrrptuyttira
12.❑Pturninng repaus or additumar
seat I am 4 yarrrrd cuew AA*aai I have hurl Ins Buis-s.untrrtttm listeJ ues the aiukhol st
J 130 Root repairs
$ these uth-weittuttur.tint unir40yrt.atw.i have".whites'uaatp rhurratrte
1 a.0Other
tr we a curprxatwsa Matt ds.dtw+rx have etch wx•t then tt{;ht ut tt,:usp hoo per Moil c
iS2 41(41,and ae hate tau mtesk,stes 1 ,•urier+ Lump Insushi.c tcquur i.1
•An)isfplaanl that chard,hot at rasa aim fd l out the+ecu+m txkra shawuss tiara workers'cuntpcna taatt pals.-y wnturrtuttwcw
Il,ms<vwasia win..isnsst au+atlikta.tt nair:atug thy ate diving all-sort and then hue mantle tualraciurs want.admit a nen atialas rt ma a.ei►.
Ee vats A.Wry that crr:,.t Ihs,i•art thrust artatlrd an adthtsua l shots+hna ins the name of tb,meh vunitacurs and state w.h i11aer,.:a,t tlar..:enthuses have
cr,:pi,oes' II thn..uh...+rritv.ha*Law eirtfk,yau,duel rant pro,,id tt,nr ..,.e Eh,. 'rep t•.,... ntnntt•t
I am an employer that is providing willies-a'compensation insurance for ntf employees. Below is the troth i and job siie
u1l,,rrnuliun.
inuu-.utce Company Name
Polity or Self•ms.Lie.#: Expiation l?air.
Job Site Address: City Siatr.'?ip-_ __ _
Attach a copy of the workers*caetpeasatioa poky decbratisa page(showing the polies asmber and esplratioa ter).
Failure to WC uric toscraw am required unskr MOL c. 152.§25A it a criminal viuiation punishable by a tine up to SI.500_00
and or ottc•scar imprisonment,as well as civil penalties in the funs of a STOP WORK ORDER wind a fire of up to S_5O.tx)a
cite against the►aolatcr A copy of this statement may be funs;udcd to the(Alice of insestrgaliuns of the DIA fur uu,urance
cs.s\crags s ettticalltUt.
.
I do hereby ce t , der thr whirs and penaltie►u/popery that the informutton provided abuts. is true and correct
StioLttute C MIL' (I Ail a0a1
Pbtr(lc;: aD7 013 L31
Official use unit. Do nut write us this area.to be t untpletcd by city or town official
('its or lows: Permit" iccssc a
Issuing;'euthorit'(circle one): •
1.Board of Health 2.Bahkting Department 3.City/Town t leek 4.Electrical Inspector 5. I'Iunthing inspre for
6.Other
• Contact Person: ._ Thane : _____ _
_ City of Northampton
0"
Massachusetts
¢� { L DEPARTMENT OF BUILDING INSPECTIONS r
212 Main Street a Municipal Building �� s
'�<.. E Northampton, MA 01060 rr�. ,\�•
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: 1)u ley 'Deal LI!r‘)
Location of Facility: Z'3(-1 E4 i tle4cvip4c v, 141� �pJ "L,��,-�Lti+ `Ulf 61606
The debris will be transported by:
Name of Hauler: Nat t (ky
11,141,eon
Signature of Applicant: //W a ,,,k Date: I/2\17R6