38B-226 (2) BP-2022-1350
51 FAIRVIEW AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-226-001 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-2022-1350 PERMISSION IS HEREBY GRANTED TO:
ADD 1/2
Project# BATH/MUDROOM/KITCH RENO Contractor: License:
Est. Cost: 100000 RH1 CONSTRUCTION 055236
Const.Class: Exp. Date: 01/18/2024
Use Group: Owner: HODGE DANIEL J& LUCILLE G SCHMIDT
Lot Size (sq.ft.)
Zoning: URB Applicant: RHI CONSTRUCTION
Applicant Address Phone: Insurance:
128 RYAN RD 413-885-9038 7PJUB1K06038421
FLORENCE, MA 01062
ISSUED ON: 10/24/2022
TO PERFORM THE FOLLOWING WORK:
ADD 1/2 BATH&MUDROOM, 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:
0 • ,I • .y, ? '1 •
Fees Paid: $650.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
Z-01Z
File #BP-2022-1350
APPLICANT/CONTACT PERSON:RHI CONSTRUCTION
128 RYAN RD FLORENCE, MA 01062 413-885-9038
PROPERTY LOCATION 51 FAIRVIEW AVE
MAP:LOT 38B-226-001 ZONE
TI I IS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $650.00
Type of Construction: ADD 1/2 BATH& MUDROOM, KITCHEN RENO
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
TH FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I ORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:}
Intermediate Project: Site Plan AND/OR Special Pennit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits 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
I 1+ o ./0_ ___
Signat re of Building Officia
l 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.
' ' ' . ''L‘::C-8117- ---„ 111111,1
OCT 1 8 T e Commonwealth of Massachusetts
E �O�2 oar of Building Regulations and Standards FOR
,. as chusetts State Building Code, 780 CMR MUNICIPALITY
till/-/v USE
a:' $tti t A plication To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
b0__ One- or Two-Family Dwelling
~ This Section For Official Use Only
Building Permit Number: ;-D--1560 Date Applied: j
I
I „2 L )0 4
Building Official(Print Name) Signature Da
SECTION 1:SITE INFORMATION
1.1 Proper Address: 1.2 Assessors Map& Parcel Numbers
5.-\ l c\l r)..i PN't— 3g ?-2.40
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 El Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
i \ Ara:c .W : V \\X, &\- WMI O\U(o O
Name(Print) City, State,ZIP
5 \ c----0. (.j\.5—n%—371 le Ac .\No4C-1 I,&, e.‘,:I.(-0"
No. and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ISK Addition Er
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: j
Brief Description of Proposed Work': p�(��L
Co J 'Qix CD -n� 9AC�- -f_� C.11 A-C) ( --t1 1 Ct.t1 CZLhy\ (',-,s/�" S� '
-of" bum i
\''e-itt--\ 1?- O
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1000 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ CIUU 0 Standard City/Town Application Fee J�
0 Total Project Costa (Item 6)x multiplier(0 D x (#
3. Plumbing $ -) ' O 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $4 527'-
Check No33'7303 Check Amount:" ' Cash Amount:
6. Total Project Cost: $ ,OO e000 ❑Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts /'r
1 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
s� .ram P 4 �.
Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new / replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW / private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
F
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
‘11/\12)/YNA•,, Mak\C✓A License Number Expiration Date
Name of CSL Holder
`ate n c^ ` List CSL Type(see below) 1j
No.and Street C T e Description
6 (U% Unrestricted(Buildings up to 35,000 ct.ft.)
`.�� u td L R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
l` SF Solid Fuel Burning Appliances
'1`V c5 -4U�f jly.g(-6, ("kecoyc-,(u-A- I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ' Li �1 S
� � � G HIC Registration Number Expiration Date
HIC Corn any Name orIIUC Registrant Name
No.aka stk-y, �,��.�f\ .��
kM,"kit- tY R- D�0G Z-t 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 No O
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 *-Al NV ikCt_
to act on my behalf,in all matters relative to work authorized by this building permit application.
Oat\ \Iv r \ Ac.tt- "kr-ZZ
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.
W V-\ -Z 2
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 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 "3 Number of half/baths I _
Type of heating system Number of decks/porches �—
Type of cooling system Enclosed \ ✓ Open I `'
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
4
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD '..3 "1
TI "
I '
1 •-•
SIDE YARD I L t IL' SIDE YARD 1
.\n \e• 11-h
sQc,cc_.
FRONT SETBACK
FRONTAGE
City of Northampton
*' + Massachusetts*
., DEPARTMENT OF BUILDING INSPECTIONS ya
` 212 Main Street • Municipal Building
Northampton, MA 01060 mm• t
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: \JN4 -t R G
The debris will be transported by:
Name of Hauler: V 4_ •(Yl,et
Signature of Applicant: ate: V. ( i
J.-
, . The Commonwealth of Massachusetts
Department of Industrial Accidents
. :.,
am 1 Congress Street,Suite 100
Boston. ,I1A 02114-2017
WWW.mass.govidia
Workers'Compensation Insurance Affidai it: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH'THE PERMITTING AUTHORITY'.
Ainslie:ant Informsitios Please Print Lenitdv
Name filusiness,OrgantzationlIndividuai): c\--‘-k- , (.4L5
.
Address:_ ,..\12\0(••. vr 0-\,
City/StateiZip:_ k cArc."-14,-(..- OA.Ps- 0\04.1.- Phone #: L\k -----sys---403 V-
Art yew all empkilittr?Cheek the appropriate hot: Ty pe of project(required):
1.0 I am a employer with empluyves hull out or pari-umc t...* 7. c)New construction
.2E3 tam a sok proprietor or partnership and have no employees working for me in 8. Et-Remodeling
any capacity.[Nu aiarkers'comp.ensurance required]
9. Demolition
.z.0 lam a ht/ITSCOV•ver doing all work myself.[No workers'comp insurance0 required]'
I 0 CI Building addition
4"E3 I am a hornmwner and will be hiring oontractors to ooradtkt afl work on etty property. I will
ensure that all cormacton either have workers'mumensatton insurance or are sole li.0 Electrical repairs or Additions
imp newts with no employees,
',.. 1 am a general cuntractor and I have hired the sub-contractors listed on the atiasthod thee&
12.0 Plumbing repairs or additions
13.rj Roof repairs
Thear will-contractor%have employees and liaise*mien'comp.insumnee.;
6.0 14.0 Other We art a l'imaccation and its otTmers have exercised their right of exemption per MGL.0..
152_§i(4 t.and tA't IOW no,..7171,,,,....c... 1 N..,*oriels'Ciltilp.insurance required.1
'Any applicant thin cheeks box t:1 mum also till out the section below showing their A urkixa'col:ripens:mon poi ts.-y mf.„Tmatton.
'1 lomeowners who submit this airsitivit indie.ating they are doing all work and then lure oubidt C011tral:tor,n mot>uhnut a nevi affidavit indiLatme.,u...1..,
..Curitrtictors;that check this box must attached an additional sheet iht.ra,ing the name of the sub-contractors and state whether or not[ose mtititm has
..-r irk')ee,i. lithe sols-coutractors base employ res.they must pro..ide their workers"eomp.Nile:,number.
I am on employer that is providing workers compensation insurance for my employees. Below is Me polity and job sire
in lOrnration.
Insurance Company Name: k1\\91.-A3 /-112'sir..Ato —
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: \ ' .r•'‘kr-\&izAA) w-C City/State.7_ip: 1.111-st.,rir\s" (A- alai)
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MILL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
andior one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator.A copy of this statement may be for.Aided to the Office of Investigations of the DIA for insurance
coverage senileation.
l do hereby certify under the pains and penalties fp • . that ,inlOrmation provided above is true and correct.
Signature: Dte 7.2.7 ,
a U
Phone : .---::
3\ 'a() )-
Official use 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/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
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