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32A-166 (9) BP-2022-0314 64A HAWLEY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-166-001 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-2022-0314 PERMISSION IS HEREBY GRANTED TO: Project# 2022 REPLACE WINDOWS Contractor: License: Est. Cost: 5000 Const.Class: Exp.Date: Use Group: Owner: SHOCKEY INGRID Lot Size (sq.ft.) Zoning: URC Applicant: SHOCKEY INGRID Applicant Address Phone: Insurance: 64A HAWLEY ST 413-923-8612 NORTHAMPTON, MA 01060 ISSUED ON:03/29/2022 TO PERFORM THE FOLLOWING WORK: REPLACE 9 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: 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: I Ia • 1 • • f I � Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner � The Commonwealth of Massachusetts ' Board of Building Regulations and Standards FOR V , Massachusetts State Building Code, 780 CMR MUNICIPALITY USE (NI Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 r One-or Two-Family Dwelling z I This Section For Official Use Only Building Permit Number:B 2UZ2-o3/y- Date Applied: ,hi„,,,,7 •SS ir 3-zq-20z.Z., Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 690.WALE'S sr. 32A-4,40-0 o r 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: (ARC. — 0-- 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 ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: lM(,RIN S# OCKE1► 00K-14ADAF al i 0/1A 811)(0O Name(Print) City,State,ZIP (04 I4 Ml1LE11 Sr 1413-42?--8612 Inoir4i •ShockeY 1(YlottU . No.and Street Telephone Email Address CCM SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 12'' Owner-Occupied C V' Repairs(s)1W Alteration(s) ❑ Addition 0 Demolition 1. Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description f Pro osed Work': Ik t i 0 N - S U SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) `1. Building $5 goo ei, 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical S O ❑ Standard City/Town Application Fee ❑Total Project Cost3 (Item 6)x multiplier x `3. Plumbing $ 6 2. Other Fees: $ 4. Mechanical (HVAC) $ 0 List: 5. Mechanical (Fire $ C) Total All Fees: $ 00 a Suppression) o / Check No.j22 Check Amount: ' 6.'Total Project Cost: $ 5,p 6 C • 0 Paid in Full 0 Outstanding Balance Due: 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 Roofin Coverin WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D 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 .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 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. ►ni6Rlb St- ocK0 312oI2022 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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 11111=1,1=111 Department of industrial Accidents 100111111 , I PIMIRMH1 I Congress Street,Suite 100 •=11 .1111. MO.II.. .".. 3:_ Boston, MA 02114-2017 ... www.mass.govidia Workers'Compensation Insurance Affidavit:Builders/ContractorstEleetricians/Plumhers. TO DE FILED WITH I II E PERM!ITINfl AI l'IlORITI. AnDliCitnt Information Please Print Legibly Name(BasinewOrsanizatiortandividual): 4S OC,4„:eY Address:_ ( L -1-VA oxf sr. city/state/zip:tioki-v4AmPram i 1MA c 1°C Phone #: LI as -9 z?-8k I z Are yen an employer,Cheek the appropriate hex: Type of project(required): 1.9 lam a errnsloyer with _ employees(full nod part-time).* 7. 0 New construction 2ri I am a sok proprietor or partnership and have no employet working for rise in K. 0 Remodeling any capacity.[No workers comp.insurance mythical] 9. 0 Demolition 3fiaiam a homeowner doing all work myself.[No'motions'romp insurance required.]' I 0 0 Building addition 4.CI lam a homeowner and will be hiring 5.1nutructo rt to conduct all work on my property. 1 will ensure that all contractor's either have workers*compensation insurance or are sole I I a Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5 cj 1 am a pima!contractor and I have hired the sub-contractors listed on the attached sheet_ 130 Roof repairs These sub-contraetors have employees and have workers'comp.insurance); O.E1 We area corporation and its officers have exercised their right of exemption per WI c. 14.DOtho re-P 11Ce.1.Ylehilt- 152,*1(4),and we have no employees.[No workers'c.onm.insimmet required.] (14 tncI ads An applicant that cheeks box xl must also till out the section below showing their workers'compensation policy infecitaiticri. *I Ionicuymei s who submit this affidavit indicating they are doing all work and then hire outside Cbdtirit.CLOIA mart submit a new affidavit indicainig stab. Curitractors that check this box must attached an additional shim showing the name of the sub-vontrneturs and state whether or not those*Ionics have employees. If the sub-commetors have elrployecs.they must provide their workers"comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site infOrntation. Insurance Company Name: _ Policy#or Self-ins,Lie,#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number.intle‘piration date). Failure to secure coverage as required under MGE e. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprison at,as well 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 this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby cer ' 'y under the pains a Id pen et!ties of periuty that the information proLided above is true and correct. Signature: c 1.0.44,C1 0 4 Pity' 1) .1,, -5 1 A.15/213, 2,-1 Phone#: li i d3 - 66:11. Official use only. Da not write in tins area, to be completed bt city or town official City or Town: Permit/License li Issuing Authority (circle one): I. Board of I lealth 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other ('ontact Person: Phone#: S�5City of Northampton �?%•it tip : s�� �: ' ', Massachusetts . 1, + DEPARTMENT OF BUILDING INSPECTIONS ; Mi w ',' 47 212 Main Street • Municipal Building . fat Northampton, MA 01060 x:Phi TOO 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: \/Qjo 1eC1C1tr a Location of Facility: y E�StaP \rrON RD• rya tZTIAMAPTM i M A 010 6T) The debris will be transported by: Name of Hauler: 5Q-) - CSignature of Applicant: Atay Date: -3/Zt 262-2 City of Northampton 4c0,[7: k sus s Massachusetts '^!c� fit , ` al Er' DEPARTMENT OF BUILDING INSPECTIONS D g ` Ar 212 Main Street • Municipal Building y,,, Northampton, MA 01060 fs, . -'4 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT ' /1 (011 I, 1 f•&X) i\ 5 140[s-K-E'/ (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 qualify 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 t©" day of 1 VI(l,Y ( , 20 g R S1tocki (Sign re) Proposed plans: I propose to replace my existing old replacement windows with new replacement windows. A total of 9 windows will be replaced. The windows will not alter the appearance or size of opening for the window spaces, and will be double hung, white vinyl, tilt-in for cleaning style (as were the old ones). The u-value of these windows is;29. Ingrid Shockey 64 Hawley St. Shine�� 1 Northampton, MA 01060 �ude 40112-3 .g >i2