37-080 BP-2022-0265
54 PLATINUM CIR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
37-080-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0265 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 9000 BURL BELISARIO 100030
Const.Class: Exp.Date: 10/23/2023
Use Group: Owner: AUSTIN CHQUETTE
Lot Size (sq.ft.)
Zoning: SR/WSP Applicant: BURIS GENERATION HI&GC
Applicant Address Phone: Insurance:
31 EXETER ST (413)222-2914
EASTHAMPTON, MA 01027
ISSUED ON:03/18/2022
TO PERFORM THE FOLLO WING WORK:
NEW ROOF
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
• V • .>2 'NT
Fees Paid: $40.00
212 Main Street, Phone(41 3)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
, ' liefA 11 /
The Commonwealth of Massachusetts 1 8 2022
Board of Building Regulations and Standards F R a
W
Massachusetts State Building Code, 780 CMR''rM1TapntJJro,h MUNICIPALITY
TFi4 �, n IM1JP SE
Building Permit Application To Construct,Repair, Renovate Or-)�emot'ishi '•r�qtrod Mar 2011
One-or Two-Family Dwelling -----_-
This Section For Official Use Only
Build g Permit Number: j' p- a 3--. -Ob Date Applied:
i r �JC IZ3-I S-2t72z
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 7ty 1is7- 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'
2. Own r'of Recoil: / 0 y 77-
0/w/ce/7,90 oeo
Name( t) i City,State,ZIP
2o1(I/a 0/'U!/2 CY �u ,cndc SS re d2() mac.anreet Telephone Email A ress /�
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s),g Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 60 D Gy, c� „ r•c �jX e j i7,7/7
f J f
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ _4 9 0 0 D 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 $ �i�
Suppression) Total All Fees: $
Check No. I14 0 Check Amount: Cash Amount:
6.Total Project Cost: $ 00 0` 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5 Construction Supervisor icense(CSL) O fJ ,O� j�/2 L �� 2
e �/'LD tic {� License Number Expirati orf/Date
Name of CSL or
f
c/7/ List CSL Type(see below) 0
and
�� TypeDescription
11 0/CJ/1 7 7 U Unrestricted(Buildings up to 35,000 cu. IL)
R Restricted 1&2 Family Dwelling
ity own,State M Masonry
RC Roofing Covering
WS Window and Siding
�/ •������/� bekortouwe
'�1�� SF Solid Fuel Burning Appliances
I Insulation
Telephone Email ad D Demolition
5.2 Registered me Impro meat,Contr I // �/ , g Q 20 zir
de..ty
��� ��� lHlC ReEgistration Number xpirat on Date
m Nam HIC gas t Name •
/ �l�' belr'SgrCa b��� .4 /780•c o,s
an 7� OIQZ 0_2 ZZ 2,'/9
Email .'
itytynown,Stat ZIP �� / ��Telephone
ei
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 VA----- 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 ' jJsLIYU) u r i
to act on my behalf in all matters relative to work authorized by this building permit application.
( uS+ i 3 ch o Vm l l i--
��- �2�Z 2_rn 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
co ' ed in this application is and accurate to the best of my knowledge and understanding.
, 3//-2/1 0 Z ?
Print Owner's or uthorized Age ame(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 Commonwealth of Massachusetts.
I" .1 = Deportment of Industrial Accidents-Y-•
:.Its
1ff b 1 (Congress Street.Suite 100
- r
--. Boston. MA 02114-201
4 k'.vlstma.ss.g►or/dia
- U urkers'('unnpen%a$ion Insurance Aft-Wm it:Builders!("ontrarturs l ctririansr Plumbers.
f0 B1:FILED 1►11117]!k rI:RMITIFIN :AI 11111R!11.
Applicant Information Please Print I.egiblt
Name 111:u+tins 1)rEanuat[on.Itulnidua11= ( �/P(te a (6'1 07 ' / 2
.
Address: 3 i $ i C/
City/State/Zip- i it iiu /r a/ //i7 C/O Phone#: ,�(� ' 2 2 . JLp
Are i.e>M lelrg�INK:'II Are* / Title Pun: --_
Type of project ireyuired):
i. I alit a 4:11110144.7 wMh inn pitoyecs Will andxn parl-tiirc b..
/ 7. ❑ New construction
".T1 am of ..k tat.prhiai inIoiliie%Itrp anti have t 4-n4+latd• sz-+wtaknrp tt•t me in II 0 Remodeling
-- an}a'apacttl-i`o workers'comp.m rtrancc rn niscall
9. ❑ lkinolition
4.71 I am a Imincr•wtt.-t J,.tnr all work ton-wit.I\o wurke't+ comp:_insuratuc rcaguu.d 1
l0 fl Iiuildiiii addition
41.0 lam a 111tnwN.xatct and%%ill he his inns.nllkJ&tors ki coo d um ail it( k on inn g.rr.p.-rt}., I VAll
a7evlite 11131 all ca nix htr,eilltl•I Lute C &%I1i COL1.1110rin..411141111 ubni;anee or arc mule I I.0 Electrical repairs or additions
propncks+/sith no ornpl.tica'._
I2.D Plumbing repairs or additions
'30 I am a}ctw-ial contractor and I tune hilcJ III(sul,-c.tntaactins listed on the altachCJ shed.. 130 Roof repairs
itwsc+ul,-c1N.ttactnslisleenipdo!, s andha%C norlcis %syrup.lIIWt3UlC-•
Oth
6.0*it:arc a ati r poranon atld tts inlets%ha%a ev.rcr,c.I shell twillpttt Ill c aena,t/per 511 d_c. 14.0
er
IS .M I(4)..and VI,t Ion a:no 7tp•loacc,.I No 4.4.e a t. steop.[coin:l lcgt lrcJ.I!
•Any appheam that chock%trios 3I must 41.0 Wit.net the W4:11010 hed..w%lam:nit Ihcir workers'eunp.cI1.ation robe% Inluronarion..
*II soon ICrs nh,sul,intt this atriatl%of inthcatini'[leo%an:Jlnnc all n,tk and stela hut:uutsuhc contractors muse submit a nt-n atl.dalit rndicatm,such.
: anti cti n%that chock shim hos rnn.I attallled an additional sheet shimmy.the battle of 11r:walk-tti lti arts%anti.rate nlielhci to not this anions-%haac
canplol,cc^s it tine.nl,-l.+sal/:terns.113%c ettp.ient-CS,.thcs 111111t i,itt,idc Their .a.ttktts"comp.gestate rrumtittet.
I am an employer that is providing worbers'ran pensation insurance far air employees. Below is the police and job site
information.
Insurance(Company Name: -
Policy#or Shc ins.Lie.#: Ls.piratrun Date:
lob Site Address: (itv"Stat&Zip:._.
Attach a copy of the nurkers compensation policy declaration page(shutting the policy number and eapiratiorr dates.
Failure to secure coverage as r ' d under 1vMGL c. 152.w_�5A is a criminal violation puinslial,lc by a tine up to S1.500.00
and,Or ore-scar imprisonment.a. lit ell as civil pi:nahics in the Iona of a STOP WORK ORDER and a line of up to S250110 a
day agamst the violator.A co. I i is statement nary be forwarded to the Office of In%estigatrons of the DNA tier insurance
CO \CT aLC t CriIicaIit'n.
i do hereby certify Mn , •palm,a d penalties of perjure that the information provider/above is tare and correct.
r =•Itat o flailc: Date: W/-77/
l'11.i11r..
1//3 212 -29/ (
Official use unit. Do not write in this area.to be completed by city or town official
('iI ur'1-osn: I'ermitl.icense d1
Issuing:authority (circle one):
I. Board of Health 2.Building Department 3.('it%?Tow n(lerk 4.Electrical Inspector 5. Plumbing Inspector
b.Other
Contact Person: Phone#:
I
City of Northampton
y �•'`� y Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS ;
212 Main Street • Municipal Building yJh CDC
Northampton, MA 01060 .PSNh,
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: LI/7 //(y Re Cc ' (/iii c'
The debris will be transported by:
Name of Hauler: 13 C,Q}/'/ 3 i/e'r-CP/ L6i t !!J
Signature of Applicant: Date: 3// /.Z .Z