32A-086 (2) BP-2021-2290
31 GRAVES AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-086-00I 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-2021-2290 PERMISSIONIS HEREBY GRANTED TO:
Project# RENOVATION Contractor: License:
Est. Cost: 39000
Const.Class: Exp.Date:
Use Group: Owner: WILLIAMS SARAH A &OTHERS
Lot Size (sq.ft.)
Zoning: URC Applicant: OTHERS WILLIAMS SARAH A&
Applicant Address Phone: Insurance:
31 GRAVE AVE
NORTH AM PTON, MA 01060
ISSUED ON:12/21/2021
TO PERFORM THE FOLLOWING WORK:
CONVERT KITCHEN AREA TO BEDROOM/HALLWAY, EXPAND BATH ,MOVE EXTERIOR DOOR
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:
lo CS",
II
Fees Paid: $254.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
-��J. The;Commonwealth of Massachusetts
4/..PCJ� 2 1�oard of Building Regulations and Standards DEC 1 4 20 ,2 1MUIi1 FOR/
E: '" 2021 11�Iassathusetts State Building Code, 780 CM ICIPALITY
USE
i
r ' 'Ming Permit Application To Construct,Repair, Renovate drtol>!s aJsed Mar 2011
'•' '1� One-or Two-Family Dwelling rl�;�;
A ?!
�� on/� This Section For Official Use Only ��
Building Permit Number: 47�AI' A.40 Date Applied:
' Iii • , ,, , .CR0167 1d-b-Ii
Building Official(Print Name) I Signature Da e
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Nu bes
31 Graves Avenue Northampton,MA 01060 a
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'
2.1 Owner'of Record:
Sarah Sargent Northampton,MA 01060
Name(Print) City,State,ZIP
31 Graves Avenue 719-651-3679 sarahsargent8820@gmail.com
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 51 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
Existing kitchen/breakfast area converted to guestroom and hallway.Bath expanded length wise 2'6"into existing large living area.
Vanity,tub,toilet being repositioned.Wall and island added to create new kitchen in part of existing large living area.
Outside back door being moved approximately 1'.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $27,500 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $5,000 ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $6,500 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$ '/
Check No. 10') Check Amount: A �`T
6.Total Project Cost: $39,000 0 Paid in Full 0 Outstanding Balance Due:
1 12!t411 s
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address I) Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street 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 0 No .❑
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
to act on my 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
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.
T
'14al i1 pea!
Print is or Authorized Agent's ame(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 in ui oration 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 Commonwealth of Massachusetts
d— Department of Industrial Accidents
4,.= 1 Congress Street,Suite 100
Boston,MA 02114-2017
r` www massgov/dies
Workers'Compensation Insurance Affidavit:Britders/ContractorsfEketricians/Plumbers.
It)BE FILED WRIt UBE PERMITTING AUTHORITY.
ADDI1Cant Information Please Print Leeihlr
Name lBusiness`thganizationiindividual): Sarah Sargent
Address: 31 Graves Avenue
City/State/Zip: Northampton, MA 01060 Phone #: 719-651-3679
Are:tor an employs?Cheek the appropriate boa:
Type of project(required):
10 l am a employer with ._...__ _employees(tall aad'or pavt•timc).' 7. 0 New construction
2C1 I am a sole pcopnetim or partner%hip and have no employees working for OW to K. Q Remodeling
any capacity.[No workers'coup.insurance required.]
30 I am a homeowner doing all work myself.[No*osiers'comp.insurance required.)`
9. ❑ Demolition
I(I Building addition
.1.®I am a homeowner and will be hiring wntraclon to conduct all work on my property. I will
ensure that all contractors either have workers-compensation insurance or are sole I I a Electrical repairs or additions
pruprieWn with no c'mpluyeca.
12.❑Plumbing repairs or additions
50 I am a general contractor and I have hired the sob-eontracturs listed on the attadied sheet. i 3C1Roof repairs
These sub-contractors has.:employees and have workers'comp.insurance.:
14.❑Other
6.0 we area corporation and os utTwers have exercised their nest of exemption per MGL c.
152.fi 1t4I.and we lase no employees.[No workers'comp.insurance required.)
•Any applicant that checks buy a 1 must also till out the section beluw showing their workers'compensation policy information
Homeowners who submit this altidas it indicating they are doing all w ark and thin hue outside contractors must subnut a new affndas it indicating such.
:Contractors that check this bus must attached an additional shot showing the name of the sub-contractors and state w lietlier or not those entities hose
employees If the sub-contractors have employees.they must provide their workers'comp.policy number.
I am an employer that is providing worriers'compensation insurance fir my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lac.#: -^ Expiration Date:
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 tine up to S1.500.00
and.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 certify under the pains and penalties ofperjwry tkal the Information provided above is true and correct.
Si'nature: c' � I)�it'.
i�
Phone» 719-651-3679
Official use only. Du not write in this area.to be completed by city or town official.
('it, or Town: Permilil.icense#
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: ^_
City of Northampton
Qaic H A rn Nib. ,:..
�' Massachusetts �4,. - ' ce
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lf
i DEPARTMENT OF BUILDING INSPECTIONS S z
` ..� 212 Main Street • Municipal Building '—. �c�
,.n.:. r.ra� Northampton, MA 01060 sbyy 3�0
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: Valley Recycling
The debris will be transported by:
Name of Hauler: Self
Signature of Applicant: ;�j Date: lam-/ I 1 i,g-e),24
City of Northampton
Oat NAMP C ,S .'. SI
Massachusetts ��?S' y►- �'�{
w 3.
`t i DEPARTMENT OF BUILDING INSPECTIONS
v % 212 Main Street • Municipal Building QC
Northampton, MA 01060 .v3.^
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
Sarah Sargent10/09/1987
9 (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
qualifij 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 14\ day of 1)Cc r ►'Y1`K-( , 20.21
(Signature)