38B-289 (3) BP-2022-1509
278 SOUTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-289-001 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-2022-1509 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 barn repair Contractor: License:
Est. Cost: 33010 DALE HAWLEY CS-055048
Const.Class: Exp.Date: 08/29/2024
Use Group: Owner: A MCKOWN ELIZABETH
Lot Size(sq.ft.)
Zoning: URB Applicant: DALES STRUCTURAL &CARPENTRY
Applicant Address Phone: Insurance:
P O BOX 273 (413)667-3149 WCC-500-5008253
HUNTINGTON, MA 01050
ISSUED ON: 11/22/2022
TO PERFORM THE FOLLOWING WORK:
BARN REPAIRS
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 VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
$ 3:/61
Fees Paid: $215.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts
4 t
`' I Board of Building Regulations and Standards FOR
iT Massachusetts State Building Code,780 CMR MUNICIPALITY
,. USE
Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling _
CD
This Section For Official Use Only
Building Permiter Number. �� ' 2^ /SO q Dat pplied:
14L=vta) /110,5 �
11.22-2clzz
Building Official(Print Name) Signature Date '
SECTION 1:SITE INFORMATION
1.1 PropertyQ�v SI-P �T 1.23sc Map&Parcel Numbcrs01 /7
1.1 a Is this an accepted street?yes no Map Number Parcel)umber
1.3 Zoning Information: 1.4 Property Dimensions: II
Zoning District Proposed Use Lot Area(sq It) 'rootage(ft)
1.5 Building Setbacks(ft)
Front Yard Sidc Yards Rear Yard
Required Provided Required Provided Required Provided
'1.6 Water Supply:(M.O.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public Private❑ — Check if y Municipra,On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1' Owner'of Record
KC ;/4- X e.v.) f c 1< lbl o>o t o
Name(Print) City,State MA: -
Y8 ,S 9 0 4-k- 5 T, _ frit3-3a0-5 403 _.Nli 5stiatg ! niC4.T A.)e-1-
No.and Street.. Telephone Email
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building . Owner-Occupied% Repairs(s) Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg.0 Nutnber of Units Other ,lZ Specify: ein pit) sT_ __ V,, A\ Pr";I"
Brief Description of Proposed Work': Re 1 1oL.E (Cl e G _S1` /l e- 0 i'1' {Z e�A..t A
�/ �iP A +Ai(./C0es-rr 0.a sa.tJ, ( I
-� --XT icRsr- A C! ` s .-
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building $ sp I. Building Permit Fee:$ Indicate how tee is determined: +...
3$/D��' 0 Standard City/Town Application Fee
2.Electrical $ 5)0 Total Project Cost3(Item 6)x multiplier 4' x 33'0/U
3.Plumbing S 2. Other Fees: $
4.Mechanical (HVAC) $ List
5.Mechanical (Fire
Suppression) S Total All Fees: _
6.Total Project Cost: S Check No_�'A Check Amount: �1S V Cash Amount:
3_► 0/O • 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
G5 o sso eas ay
I.iccnec Number Gspi ion D
Nan)*holder
/J x List CSL Type(see below)
No.and Street Q �� — Description
Unrestricted(Buildings up to 35,000 cu.It)
A C�_.!L!V/, Q 050 R R ricted 1&2 Family Dwelling
itylCotwn.Stab., 11' i\3 Masonry
RC Roofing Covering •
— DVS Window and Siding
LI /� SF Solid Fuel Burning Appliances
'1 �—6 !`./14 9 V)_ I Insulation
Telephone Email Cr,01 I) Demolition
5.2 Registered Home pro'cmcnt Contractor(HIC) .� �Nu 8�a 0��
IC egi is! t own Numbcr Ex irati Date
111C (man
py 'a iI1C jt istrant Name IC
No.and et �� " C/Q Ema12 GL�A/ • COCD ✓I'`
City(fown,St21te,L[P Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.5 2SC(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 ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Owner he subject property,hereby authorize pp e 57•7wG/UPJd•� +cR N eat �
to act on my behalf,in all matters relative to work authorized by this build rmit application.Atid �/
e, • .((, z iz —L l//i1Ok9
Print Owner's Name(Electronic Signature) (rate
SECTION 7b:OWNER1 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.
e 7- 4//
Print Owner's or A • eA,4gei Name(Electronic ignature) 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(WC)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 behalf/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"
s -
Office of Investigations
} 600 Washington Street
Boston,MA 02111
" www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
1 _
Name (Business/Organization/Individual): �a`� �( XeS 51(a.a , C
Address: V. - .6 e x a7 3
City/State/Zip: Phone#: /f/.-(c(0-
Are you an employer?Checl t e appropriate box: Type of project(required):
1.❑ I am a employer with 4. n I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. n New construction
listed on the attached sheet. 7. ❑ Remodeling
2_0 I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g. Demolition
workingfor me in anycapacity. employees and have workers'
p tY 9. ❑ Building addition
[No workers'comp. insurance comp. insurance
required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.[1 Roof repairs
insurance required.] t c. 152, §1(4),and we have no employees.[No workers' l3.[ _
Other ��, 5l;Q0,10E41
comp.insurance required.] e O4 LS
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
XContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number_
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: A-55,c. / e $ cG 'Ce CO
r
Policy#or Self-ins.Lic.#:66/ C< - coo - S'ooga5-3 f a / . Expiration Date:
Job Site Address: 978 Sorb S 77, City/State/Zip: i 9 •01660
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine 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 fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify lender the pains and penalties o perjury that the information provided above is true and correct
Signature: � G 8 at' Date: //' /A 02
Phone#: `f l3 -j.V -3121 9
Official 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):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CQNSTRfl.LION DEBRIS}k 1L)AV '
-for all Derc:_fic.r jai Renovation Vigreati
•
, In accordance with the provisions of-MM.Chapter 40§54,a condition of demelri .re=oovation
permit is that the debris resulting from this work shall be disposed of in a properly licensed
• waste disposal facility as defined by MGL Chapter 111 fi154A.
The debris will be disposed of in:(i.e.,dumpster on site,transfer station,incinerator or landfill if
known) 231( ".-rtst1„ ,p4794.) /k,D.
0 /4) , 4/4 ctite 11,..wi IN? , itht3litg-ditie4),
Location of Project / • , o
(lithe debris will not be disposed as intimated.the holder of the permit shall notify the
bmldI goSrml in writing as to the location where the debris will be disposed.) O!O k
4113-5s'7-9,A '?
The debris will be transported by: 1>„1 le /e ��
Name of
Signature of P' rt applicant Date