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38B-002 (36)
BP-2022-0286 142A WEST ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-002-001 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-2022-0286 PERMISSIONIS HEREBY GRANTED TO: Project# 2022 RENO #142A Contractor: License: Est.Cost: 110000 DAVID JAGODZINSKI CS106068 Const.Class: Exp.Date: 11/12/2023 Use Group: Owner: SAFE JOURNEYS LLC Lot Size (sq.ft.) Zoning: URC Applicant: A& s BUILDING AND REMODELING INC Applicant Address Phone: Insurance: 123 DEPOT RD (413)230-9160 N HATFIELD, MA 01066 ISSUED ON:03/24/2022 TO PERFORM THE FOLLOWING WORK: DEMO ALL FINISHES &UPDATE PLUMBING/ELECTRICAL &NEW FINISHES 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:g I, • 41 , - TO 'I I . 1 Fees Paid: $715.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner File #BP-2022-0286 APPLICANT/CONTACT PERSON:A & s BUILDING AND REMODELING INC 123 DEPOT RD N HATFIELD, MA 01066(413)230-9160 PROPERTY LOCATION 16 PAQUETTE AVE 0'42 A- We-5T'61) MAP:LOT 38B-002-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $715.00 Type of Construction: DEMO ALL FINISHES &UPDATE PLUMBING/ELECTRICAL &NEW FINISHES New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS.BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR SpecialPermit With Site Plan Major Project: Site Plan AND/OR SpecialPermit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding SpecialPermit _Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Perm its Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Signature of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. r------ ---- 7 i 1 - ' CJ CV L-Z/ 114o = The Commonwealth of Massachusetts , Board of Building Regulations and Standards FMUNICIPALITY -IL I`"1: coMassachusetts State Building Code, 780 CMR -IL . . c\J .- _ USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 C. One-or Two-Family Dwelling G.rq This Section For Official Use Only ding Pgrr—n- plumber:13P-2022 .02$4, Date Applied: 03/23(2v2L ___ laic ul►� Ss .// /- 3-Z3-Z02Z Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers N a A Desk S�. (i b Psqu �vE) 38 f3 0o 2.- 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 Private Cl Checkif yes❑Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ��JI/� Ni e E.e. �Cvte.yb t �t- C City,)State,ZIPS 1� oo ( MASS b(D00 34 0 \'-rnpo St-. (13-9a .- 1f?e Plariedran 6e imi``l c641 No.and Street Telephone Email A eid SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s),E1 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: 7)„N.p ,,Si. c',.his(r,es, owl 0 1(0 0ut.1n.vt 4(e cif/c41 cALeGt y.c - -knOrlre 5. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ L?� �� Q 1. Building Permit Fee: $ Indicate how fee is determined: !J i ❑Standard City/Town Application Fee 2.Electrical $ IC4 0O O,°° 1 0 Total Project Costa (Item 6)x multiplier Co x )1 O' 3.Plumbing $ in O )©,c0 2. Other Fees: $ 4.Mechanical (HVAC) $ /�r 060.ea List: 5.Mechanical (Fire $ pp Suppression) Total All Fees: $ 17)5, 66 Check No.dCoO2,Check Amount: Cash Amount: 6.Total Project Cost: $ I i O MO. ❑Paid in Full 0 Outstanding Balance Due: i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) G5— 1OGDOCA c i ,R,3 —0,.,.ck c?rtc�U Z�1"1.5 � License Number Expira on to Name of CSL Holder J List CSL Type(see below) 1C , ?a? 010(4 No.and Street Type Description (t l� U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP , A S. ( ) 1 O�969 R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding f�/ / ,/ / / SF Solid Fuel Burning Appliances Il 5Q3o'9f(00 aStudfdr C LEI AO�it''if I Insulation Telephone Email addre D Demolition 5.2 Registered Homee Improvemennt Contractorr (HIC) 161 A-e S W ��0., T e�-U e`G..- .�+C..- HIC URegistration Number I l xp' ation Date HIC CoCoinpanyName oorr IC Re list ant Name p No.and Street Email ad s Al, Ff t/4Ie(t/ . Otao co Li/ 2YO1l'O 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 'ti` 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 —Dc(vta �_ tV't to act on my behalf,in all matters relative to work authorized by this building it application. 1,1.0 31013i . Print Owner's Name(El c Signa 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 a ication• true and accurate to the best of my knowledge and understanding. 7kVId 1..b4 iPrint Owner's or Au d gent's Name(Electronic Signature) ate 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.) i7`j (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) 9 I< Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms I Number of half/baths Type of heating system 4 covvo( A-1r Number of decks/porches Type of cooling system — Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton ,0 c ,�� SAS ". Sid p �'� I Massachusetts ��2 h.- '(e *:. S. tl ' '� ''( DEPARTMENT OF BUILDING INSPECTIONS � g 1 v '�� 212 Main Street • Municipal Building r ,.4- Northampton, MA 01060 s6 y _ 00 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: A-5) 00(6k) 6u, (4(0) ,Ai re( e i S ,c `iela ll , The debris will be transported by: Name of Hauler: /1'25Oct - uLIdLv Ud le C4.e. ''S Signature of Applicant: Date: 36-3 a.)-. The Commonwealth of Massachusetts ill... ... Mali—. __�„�, Department of Industrial Accidents • _:�I s 1 Congress Street,Suite 100 • ?� _= Boston, MA 02114-2017 - www mass.gov/dia ,tee... Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. 'IY)HE FILED W rill THE PEILLll'1TINC Att7'HOR 1.1*. Applicant Information Please Print EeLibis Name(Husincss`Organization�lndividual l: 1 r el .�l'A (ir c-(1t^ /et t✓1 t .1-(,N_L Address: 1 a3 per oi- /J qq City/State/Zip: A i, He/i e/ /1 ,,(i�i�•i /)/4�n Phone#: "l`3�0/.5Q'C/ Art you an employer'Clerk the appropriate bus: Type of project(required): LC]I am a en toyer with __, _ .employees(full and or part-firm:I.' 7. O New construction 20 lam a auk proprietor or partnership and base nu employees working for me in 8. aRem t; nL required.] dxielin any capacity.[No workers'.amp.tnsurared.] 1 �'' Dem olition 30 I am a Iwneuwnr doing all work myself.(No workers'comp.insuranice required.]' 10 Q Building addition 40 I am a homeowner and will be hiring contractors to conduct all work on my property. I...ill ensues that all contusion either lose workers-compensation insurance or are sole II 0 Electrical repairs or additions proprietors w ith no employees_ 12.0 Plumbing repairs or additions 30 I am a general contractor and I has c hind the orb-contracture listed on the attached sheet_ these sub-contracture lam se employees and hasc w orker.'cop.insurance. 13 Q Roof repairs; 6. a an a corporation and its officers base exeniscd their right of exemption per AttrL c 152 a 1t4t.p and we hasc no employees.(No s urkars•comp.insurance requircd.J 1-1.QOtltef *Any applicant that checks box al must also till out the section below show my their wur►crs compensation policy information Homeowners who submit this attidasit inhxatmu they arc doing all work and then hire outside contractors must subnut a new atfidas it indicating suds. Contractors that check this bus must attached an additional sheet show mg the name of the sub-e ntracturs and state whether to not those unities Fuse employees. If the.sub-contractors lass crzployccs,they must preside their workers'comp-pulley number. I am an employer that is providing tvortters'compensation insurance for mr,employees. Below is the policy and Job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: Expiration Date: •- -.. Job Site Address: CityiStateiZip: Attach a copy of the workers'compensation policy declaration page(showing the police number and expiration date). Failure to secure coverage as required under MGL c. 152. §25A is a criminal violation punishable by a line up to S1.500.00 andhor one-year imprisonment,as to ell as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of tlti,statement nta'. he forwarded to the Office of Investigations of the DIA fur insurance coverage verification. i do herebysettlfruno n. nd! n ' of perjury that the in/rrrmation provided abo► is tr e and correct Sienature: / Date: e)3 Phony r. Official ate only. Do not write in this area,to he completed by city or town official Cit or Town: Permit/License p (going:Authority(circle one): I. Board of Health 2.Building Department 3.('itsil otsn Clerk -I. Electrical Inspector 5. Plumbing Inspector ft.Other Contact Person: Phone#: I 51-11" I I 11'-41/2" I 27'-71/4" I 12'-11 1/2" I I 4'-11 1/2" ?1'-2"/44'-4" 4'-3" I 7'-4 1/2" ?�'4"144"-41" 9'-10 1/2" g'-8"I4'-8{ 5'-4" I 12'-11 1/2" �"� c N- N M ,- O Clay,*- iN ROOM 4 cY . in F 00 ROOM 10 15.07 ft2 NI- fi 93.53 ft2 p a. �ca(ooM^ o �i . . 1,ro,�ec,.,,.. z„ ' ROOM 8 K 1�.'� ROOM 3 144.39 ft2 ROOM 6 180.88 ft2 Eo 136.58 ft2 `v N ktf,:‘,N F MN v cy coN 61 "' '6.81 N al) 40.09 ROOM 11 Okkite A- ) _ stc.%cs c L ROOM 1 3.99 ft2 -v. RC.00M 9 214.00 ft2 N1 40.50 ft2 Z., t0 co L9 R I 25'-9 3/4" I 9'-0 1/2" '-0"/3'-10I 7'-9 1/4" 13'-0"/6'-8"I 3'-3 1/4" I 3'-3" I 25'-9 3/4" I 26'-1 1/4" Mark Dean - 142A 2022-03-22T21:54 Second Floor Adjusted -Arch B