24C-178 (5) BP-2022-0614
187 CRESCENT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24C-178-001 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-2022-0614 PERMISSIONIS HEREBY GRANTED TO:
Project# KITCHEN RENO Contractor: License:
Est.Cost: 27293 PAUL GASS CSL077256
Const.Class: Exp.Date:08/23/2023
Use Group: Owner: PANNONI PAULA A& ELIZABETH G POWELL
Lot Size (sq.ft.)
Zoning: URB Applicant: PAUL GASS
Applicant Address Phone: Insurance:
58 SUMMER ST (413)387-9105
GREENFIELD, MA 01301
ISSUED ON:06/01/2022
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
el if >9 Tit •
Fees Paid: $177.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachuh tts iFort
Board of Building Regulations and anda ds *QY 3 M ICI ALITY
��, ` , Massachusetts State Building Code,780 R 1 �0� U r
Building Permit Application To Construct,Repair,Rettgl '�', olish a evise Mar 2011
One-or Two-Family Dwelling Ty4't1,07-o in,, ,, i,
This Section For Official Use Only 44°Tos ioNs
Buildin Permit Number: gp'�..) —f�/� ��Date Applied: -ILu►�J �1<0�5 / /C 6 I ZOZZ
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property' die :��C oill 1 1.2 Assessors Map&Parcel Numbers",cC 7
1.1a Is this an acceptteed street?yes L7 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:
Zone: Outside Flood Zone? Municipal On site disposal system 0
Public Private 0 Check if yes❑ p
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
j41I4-q FAA J.IOKit+ EL,t ZASETR `:b w E l,1_ IV D(lTlh A AA-p TO,tJ O \O( 0
Name(Print) City,State,ZIP
(.i35 cteEsccNt Sr. 4(3—S84-62-S8 hno,-,i3Zev-e"15 ens..K-a.f
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) 0 Alteration(s) fij Addition 0
Demolition $ Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: .
iN1 i t r. � cup .. sow. ' c2.4
SCTION 4:ESTIMATED CONSTRUCTION ClIgTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ / 01 7 13 1. Building Permit Fee: $ Indicate how fee is determined:
f 0 Standard City/Town Application Fee
2.Electrical $ to/ Q' Q 0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ t CIO2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ ` d 77
Suppression) Total All Fees: $
C� Check No. Check Amount:dash Amount:
6.Total Project Cost: 01 , l ❑Paid in Full 0 Outstanding Balance Due:
' t
SECTION 5: CONSTRUCTION SERVICES
5.1 Constr ction Supervisor License(CSL) O n 7 C� /ga��
U License Number Expiration Date
Name of CSL Holder 1J
se 5V st` List CSL Type(see below)
No.and Street Type Description
61
t _, `n ,y�_- e( U Unrestricted(Buildings up to 35,000 cu.IL)
-BUJ ► �t R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
`ill-311 — et I c6. Pi4itssPcsoi .per I Insulation
Telephone mail address D Demolition
5.2 Ilaiiistered
/HomeI /prrovementContractor(HIC) l66C//� f
$fr
� HIC Registrat_iLon Number tFExxpiration Date
HIC om an�y�Name or H C Registrant Name /� _
.L,►`^',"_' si- hv�e1�1 s 0 6:1 . JUt�r
No. d Street Email address
Gpttt2N ,tulle .0130 t q/3 -3i1--4)1O S
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 P. No . 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Q411-4.-I,as Owner of the subject property,hereby authorize G __S.
to act on my behalf,in all matters relative to work authorized by this building permit application.
Ph►iA- PAAI Arau t S (18 1 z.z.Z
Print Owner's Name(Electronic 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
containe ' ' application is true and ccurate to the best of my knowledge and understanding.
L--el c 5Iiila00-
Print Owner's or Authorized A 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"
- City of Northampton
.-- Massachusetts �w�
DEPARTMENT OF BUILDING INSPECTIONS ,�
212 Main Street • Municipal Building 3,� ��1
` F _:�►'� Northampton, MA 01060 jsfrj .4,.:
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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: uO (k, of ,e (-(e(k) -
The debris will be transported by:
Name of Hauler: W R VVttw ,vp.v-a 7
Signature of Applicant: a/1 Date:
, .
The Commonwealth of Massachusetts
Department of Industrial Accidents
'
I Congress Street,Suite 100
0r-,-2 it: '-,-- 'V fri
Viri ' Boston, MA 02114-2017
1.• -riwur. ,
www.rnass.gorldia
Ilaikers'('ompensation Insurance.Affidas it:Bu ilders/ContractorsiElectricians'Plu'fibers.
TO HE FILE')W Ertl'I"FIE PERM Fr I.INC A t I'llOR111.
Anolica.nt information Please Print Legibly
Name(Husiness,Orbantzation Inifivifinal): 40:1<sk, .6."
Address: 5 Sj itvov\ e-k, s4 -
City/StaterZip:__G,„,,,,,cci..0 ,rmo1/4-. 0( ( Phone#: LI 11 31(1 -q los-
,
fire!icon an imiployee(heck Mc apprupriatc i,os.: l"„V pC of project(required):
.,..0 I and a timployer with employees(full ainfor patt-time I* 7. j New construction
'.'..s.gi 1 am a Sok pnicirserin in Fa:-.1-1,:ship anti have no employees c'pi I,uni2 1..4 ITA::I: 8. rij Remodeling
an capacity [Niu workers...camp.Insurance required'
9. lia Demolition
30 i am a honsiamner doing all work.myself (No workere comp insurance required.]
10 ci Building addition
4.0 i am a flume-y*11m and will be hiring onamoors to conduct all work can lily ploperty. I will
ensure that all contracion.either have worker;curves-ration insurance or an sole II 4:3 Electrical repairs or additions
prtipnclitri with no emplo4:s i 2.1:3 Plumbing repairs or additions
,c1 I am a enteral contractor and 1 have hired the sub-contractors listed on the nached sheet.
13{:]Roof repairs
These sub-contntainl have cmipluyees and have workers comp.insurance
14.°Other
6.0 vie are a corporation and ha officers have ever L.ised their right of eleiription per Wit.c.
152..§144).and sse have no aniployoes.(N ,or kers'ciYinp insurance required I
'Am applicant thin cheeks bolt*ill mina also fill out the se,:rion helms showing their worker,'compensation poliv-y information.
+Homeowner.who submit this affidavit iiiihicathig they are doing all work and then hire outside ntractors must submit a new a Ifidas it indicating such
Luntractors that cheek this Iv.k must attached an additional sheet%bowing the name of the sub-contractors and state whether or not those entities have
employees It the sills-eon,....r.m,lime erriploy cc .Illec must rim,ide their workers-...vow isoliey nuanher
., .. .
I am an employer that is providing workers'compensation insurance for my employees. Below is list polio.and job Sile
infurtnation.
insurathx 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 and expiration date).
Failure to secure coverage as required under MOE e. 152,§25A is a criminal violation punishable by a fine up to$1.500.00
anifor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coveragt:‘unticalion.
I do hereby cer,,.-mnde the pains a pen hies of perjury that the information provided above is true and correct.
Signature: Dalt:. I 0
Phone#: i 1 .- . 3 gli .— to C
Offkial use only. Do not write in this area,to be completed by city or town official
City or Town: __ Permit/License#
issuing Authority (circle one):
I. Board of Health 2. Building Department 3.City/own Clerk 4. Electrical Inspector 5. Plumbing Inspector
(1..Other
( unmet Person: Phone#:
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All dimensions_size designations This is an original design and must Designed:4/6/2022
given are subject to verification on not be released or copied unless Printed: 5/2/2022
job site and adjustment to fit job applicable fee has been paid or job
conditions. 2 20 order placed.
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