22D-076 BP-2022-0316
48 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22D-076-001 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-2022-0316 PERMISSION'S HEREBY GRANTED TO:
Project# 2022 WINDOW &JOIST Contractor: License:
DOUGLAS B THAYER DBA
DOUGLAS THAYER
Est. Cost: 3000 WOODWORKING 107699
Const.Class: Exp.Date:04/07/2022
Use Group: Owner: E ANDREWS LISA
Lot Size (sq.ft.)
DOUGLAS B THAYER DBA DOUGLAS THAYER
Zoning: WSP Applicant: WOODWORKING
Applicant Address Phone: Insurance:
P O BOX 60322 (413)530-4785 6HUB6R15002A21
FLORENCE, MA 01062
ISSUED ON:04/06/2022
TO PERFORM THE FOLLOWING WORK:
REPAIR FAILED JOIST IN BASEMENT & INSTALL NEW WINDOW
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:
• a' . t .
� ! I
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
;� ! The Commonwealth of Massachusetts
J Board of Building Regulations and Standards FOR
rr' ' 1-
k7
Massachusetts State Building Code, 780 CMR MUNICIPALITYUSE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
cc
One- or Two-Family Dwelling
I This Section For Official Use Only
Building Permit Num,l,er:De 2022-131(0. Date Applied:
Ilr0,,..,, ✓C0s.5 41 '/c.:_ y-G,- ZOZZ
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
4 Floti:hc� �d ,�/ n 0 7 6
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
WSP 422 acre_
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 ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: /,
Gisa .HO(vew S Plove1c' it it G10
Name(Print) City,State,ZIP
4 ii FloYe4Cc Ro\ y« SS 9 7a 96
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s), Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units_ Other 0 Specify:
Brief Description of Proposed Work':
Repair Failod io ig-s i✓i 64Senr4 r
IN5}21 4 1Vc6. �.af ieeu. tL N a ."V
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ "-4 00_0. — 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ _ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire /r
Suppression) $ Total All Fees: $ (GS 00
Check No. 3 Check Amount: Cash Amount:
6. Total Project Cost: $ -ZUQa ❑ Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
i CS— to -26 ? o //Du
Qd Gl l —Th kV+ License Number Expiration e
Name of CSL H a S ier
Q0 o�n o-)C ( Q7 2a List CSL Type(see below)
No.and Street Type Description
P
NBC 0 co n lJ Unrestricted(Buildings up to 35,000 Cu.ft.)
Ove il A (J� tl d R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
, SF Solid Fuel Burning Appliances
41 —6j0—L 7 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I-7 c,O SS ��
00 U(�`IX S pt-th - HIC Registration Number pirati
Date
HIC Company N4ne or HIC Registant Name
No.and Street n — QtiallaS+1,14.2 YWtz i.coo
�1'Q �0 pC 6OT4 Z N alebt" _ EmaiVaddress5
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? YesIlk.
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 j l�'Gt,S
6��SP J
to act on my behalf,in all afters relative to work authorized by this building permit application.
�aga�
Prin Ownef s(ElectroIfr r Date
tName( natu e)
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.
Print Owner's or Authorized 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 register in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
progra guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
ass, ov/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"
City of Northampton
Massachusetts c' ''` x/t
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building IX ,�
$ . ,�
Northampton, MA 01060 „ j.i,
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: VC)lizi. 6-20C ('' <<��
The debris will be transported by:
Name of Hauler: )r:)0 LA ci1 q S ill u to -
Signature of Applicant: Date: -1)/O7q/-2 (2
The Commonwealth of Massachusetts
Departntent of Industrial Accidents
viliot=
, I Congress Street,Suite 100
;INF Boston, MA 02114-2017
www.ntass.gov/dia
is al kers' t'ompensatiou Insurance Affidavit:BuildersiContractorstElectricians/Plumbers.
TO BE FILED WITH THE PERMITJ'ING AUTHORITY.
,fiknolicaint Information Please Print Legibly
Name
I
(auttinessi'Org nizatioollndividual j:
„„,
Address: 0 0)c.
c4.1F ./.\ did ( )
City/State/Zip: Phone#:
Are yen an etriphryre?Cheek the appropriate taw Type of project(required):
Atli a employer with (fail sedfor part-timet,
* 7. c]New construction
20 I am a sok proprietor or partnership and have no mop kryeiti working for me in 8. Remodeling
any capaerty„[No workers'comp,imuratior requeed.1
• 9, 0 Demolition
30 I am a homeowner doing all work myself,(N workers'i:on p.insurance requirol)
Building addition
4:C3 I am a hoetwoortier and will be hiring i.Vtit/ACkle*to conduct all work on ow property. I will
ensure that al/contractors either have workers'compensation insurance or arc sole 11.0 Electrical repairs or additions
proprietors with no employem.
1 2.1:i Plumbing repairs or additions
5C:3 I am a general tontractor and 1 have hired the subcontractors listed on the attached sheet
I 3a Roof repairs
These sob-contracture have enmloyees and have wafters'comp.insurance.;
14.C:10ther Oep,
60 we are a corporation anti its offices-a have exercised their right of exeirenion per/s461..c.
152,II1(4),and we have no employees.[No ottc&comp.insurance required.)
Any applicant that checks box al roust slew fill out the section below Abow in their woriters compensation policy information„
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside ciantraetors must submit a new affidavit indicating tuck
;Contractors that cheek this box must attached an iddiuonal sheet showing thr name of the sub-coiuractori and lute whether or nut those entities have
employees. If the sub-contratiors have employees,they Inuit provide their workers, weal.policy number
lam an employ-et that is providing ovorAers conti)ensation insurance for My entployees. Below is the polity and job site
information.
Insurance Company Name: 1,,
/7
Policy#or Seltirts.Lic.#; 6 11 7c1 . 0 -7 Expiration Date: (-/.7 N
Job Site Address: () F/evc. 0(6, cityistateizip, N i
Attach a copy of the workers'compensation poiky declaration page(showing the policy number and spiration date).
Failure to secure coverage as required under lviCiL e. 152,*25A is a criminal violation punishable by a tine up to$1,500.00
and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violator.A copy of this statement may be fonwarded to the Office of Investigations of the DIA for insurance
coverage verification.
_.„
Ida hereby cent nder the pa" penaltits of periury that the information provided above is true and correct.
Signature: Datt.
6
Phone#:
Official use oniy, Do not write in this area,to be completed by city or town official,
„ ,
ity or town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2, Building Deliarrineut 3.City/Town Clerk 4.Electrical Ismopector 5. lionsbitg Inspector
6.Other
Muse#:
("ItAct