29-428 (5) BP-2621-2183
78 GOLDEN DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-428-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRA('"rING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2183 PERMISSIONIS HEREBY GRANTED TO:
Project# WINDOWS Contractor: License:
Est. Cost: 3000 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:12/15/2021
TO PERFORM THE FOLLOWING WORK:
NEW WINDOWS
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: ).2 . cg6a
8,5,
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
IJ -fJ v r14C ioe5 ve -eC t �I
C/)LL�-t7 I l-IS Z1 - CAii- o I2-14-ZI �.
The Commonwealth of Massach etts Nov ? R
1 €: Board of Building Regulations and and ds 7 2021
Massachusetts State Building Code, 80 R I IPALITY
_ SE
w Building Permit Application To Construct, Repair, Rauay_dte q of eviseId Mar 2011
--�.` 70N MA 0706pONs One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: 1 ,V1_ ,..1. a7f g3 Date Applied:
Building4-vi 1....)4as,
12-1q-2011
Official(Print Name) Signature Date
Sn
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Ass ssors Map& Parcel Numbers
x.D-1ii GcEn- 1 1UE, fiot2- )-act' a7 42 9
1.1 a Is this an accepted street?yes ,/ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
10 y5LI .14 SO%1.1
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 l Private❑ Zone: Outside Flood Zone? Municipal ILVOn site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Eu31n3 uPi EC;PrS R6!Q.,Et.Kc.E.a rTh °taco 7
Name(Print) City,State,ZIP
'is GOLDCIJ Dalvt. 41R,-qL3 . 27w
No.and Street Telephone Email 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) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other J.Specify:_`4/' 70:44 AV.(
Brief"escr�i tion of Pro osed Work': /,,� ,
f p� 7v , . ,, 04,s
� G3s7
l..ef ,K � S'f 7Al. r� 5, U FAc�KYL Zq
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ faal.). (..,0 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:
5. Mechanical (Fire $
Suppression) n Total All es:$' D
Check No. �( Check Amount:
6.Total Project Cost: $ T Uvv, 4,, ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C 1 D-73 CS•Zq 70z3
rEsSE Ai3aJC- - License Number Expiration Date
Name of CSL Holder
��yy�� List CSL Type(see below) IACU Ett- e I U
No.and Street Type Description
/n� /�COU _ Unrestricted(Buildings up to 35,000 cu.ft.L
i.� r�)(1' ) 'h Old R Restricted 180 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
_ 2�i�""
SF Solid Fuel Burning Appliances
ti 1 --5- o-3(o(O 3ESSFTIRAacOCx@{-d(111°Ik., boik I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) h 810 + 2C.77
Stt 2T e-tsUALD'egS L ( HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
`,r7 (ivEt2Lc_ P 1),12 JEssE 33A cx@Gm it..4
No.and Street Email address
L u)F I)LE I inmR °i o t9 Z U i3-536-?Aco EV)
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 [ids 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 3 EssE ?CoC.VC, 144 i Sti\1.W'EW1 BtsuLDEes LLC
to act on my behalf, ' all matters relative to work authorized by this building permit application.
(" ID • l S • 2O1 t
Print Owners Name(Ele ronic 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 appli
ation is true and accurate to the best of my knowledge and understanding.
T Y IU • IS•26L1
Print wner's or Authori 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"
The Contnton wealth of Massachusetts
r
1Department of Industrial Accidents
1=L
. I.=u, 1 congress Street,Suite 100
Boston, MA 02114-2017
www.mass,govv/dia
11,ulcers'('ompeasstion Insurance Affidavit:Buikiersi('onlractors/EketriciansiPlumbers.
TU BE FILED WITH THE PERMITTING AUTHORITY.
Applicant lnfortrration Please Print l.etibi%
Name(Business,Organtz noun tndtvidual): S l etk-W`a eN .. ;;V.1\k DC- j2 t_.L C
Address: 11 Gv'F VeIC.)6 L -1?- _ .
City/State/Zip: Row 1=h.iC.I�, MIA 00(0A Phone#: 113- 5 36-?)(e,'v
Are tau an employer?Cheek the appropriate Iws: Type ef project(required):
1.01 ant a employer with eerspluyecs(lull rrdlor part-then t.• 7. 0 New construction
2 uuuaaa`j4l arse a sole proprietor or panncrship and have nu employees working for Inc in S. 0 Remodeling
any eapesety.[Nu wurkers'eorrrp.insurance re min.-d.l
301 am a homeowner doing all work myself.[t4u wurl vs'comp.insurance n,tlwro.L["
9. 0 Demolition
WO Building addition
4.0 1 am a homeowner and will he hang eunirartors to conduct all work on my property. I will
ensure that all eontrae'lurs either lw►e workers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors w ith no anpluyecs- 12.0 Plumbing repairs or additions
50 1 am a irem:rat contractor and I base hired the sub-contractors listed un the attached sheet.
These sob-co la ntractors ne e'rnplayecs and lease workers'comp.irnsuranrcc. 13.0 Rtwfn pairs
6.El We are a corlwrateun and its officers have exercised their right of exemption per Wit e. 14.❑Othei
152.:1141,and we Jesse no employees.[Nu workers'comp.insurance required.[
'Any applicant that cheeks box al must also fill out the section below showing their workers'compensation pulley information,
i Ik nuvwners who submit dais atlwlnit indicating they arc doing all wink and then hire outside er+ntractur.,must submit a new affrdas it indicating such.
:Contractor,that check this box must attached an additional sheet showing the name attic sutreuntractors and state whether or not thus enttities hose
employees. If the sub-contractors hate employees.they nutsi pmvidc ihcor workers'caner.policy invoker
I am an employer that is providing workers'compensation insurance,for mr,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 polity derlar ration page(showing the p.11e 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 S1,500.00
a d/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 c u er the pa' iften es of perjury that the information provided above is true and correct.
Signature: ds Date: I L• IS- LGLi
Piton • • 3- 53o- 3co£cO
Official use only. Do not write in this area,to he completed by city or town official.
('it► or Io►sn: Pernrit/Licensse#
Issuing.kuthorit% (circle one):
I. Board of llealth 2. Building; Department 3.CO Clerk 4. Electrical Inspector 5. Plumbing, Inspector
ti.Other
('ontact Person: Phone#:
City of Northampton
'yYH AMP`
ti ?5 s,
Massachusetts ��
i �,
t K, #', t DEPARTMENT OF BUILDING INSPECTIONS
inet
~.. " 212 Main Street • Municipal Building yJti c's
�; 5. Northampton, MA 01060 'Tlh, \1J
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: //-�'�ll�
The debris will be transported by:
Name of Hauler: <J ‘;44.7.
Signature of Applicant: Date: /*