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29-016 (11) BP- 023-0071 32 HICKORY DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-016-001 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-2023-0071 PERMISSION IS HEREBY GRANTD TO: Project# BATH RENO 2023 Contractor: License: Est. Cost: 7100 RYAN REGAN-LADD CSL060508 Const.Class: Exp.Date: 12/22/2024 Use Group: Owner: TRUSTEE FEICK ELIZABETH C, Lot Size (sq.ft.) Zoning: WSP Applicant: RYAN REGAN-LADD Applicant Address Phone: Insurance: P O BOX 59 413-530-1561 SHUTESBURY, MA 01072-0059 ISSUED ON: 01/20/2023 TO PERFORM THE FOLLOWING WORK: BATH 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: • * . Ti . 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 FOR wr Board of Building Regulations and Standard4441 MUNICIPALITY Massachusetts State Building Code, 780 CMR ��a USE Building Permit Application To Construct,Repair, Renovate,Qr DemoliA a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Buildin Permit Number: 8i".2.3— 7/ Date Applied: cuiii(Zs Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 3 Z 4(ck0.- A r 1.la 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 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ,, 11 l'%/a a be+&► Fe i s u r v,(-c_ l�1 CS 1 G 6) D Name(Print) City,State,ZIP 32 fi-i cloyr.4 ,r. 4t6 5gii-toe& 13-VQ,ht-t5L('Te(t-ic..c_orr. No.and Street Telephone Emal Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building& Owner-Occupied 4 Repairs(s) ❑ Alteration(s)1431 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Descriptioni11 of Proposed Work': �T�hi'1k, A ,a -{-o b ghpk."e,r- (i el Q�c1S--,:•,e1 ID 0.At-r - O M• r'�1C> c.4.Q. etW'+t. sic i e r& �r�.w�r ci 2 C ca V e •-o,r-4jb, �clvc�te 1oc �,. eX J �� r, re 10 c c4�t \ 91ti-i--5 azig re m4av E 1 et.15-4‘r.c w(`\ rNt t,_, 1\ 'irk E.t..) - raw.►J s SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 7,060 1. Building Permit Fee: $ (15'-i Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ ` a) 2. Other Fees: $ 4. Mechanical (HVAC) $ • List: 5. Mechanical (Fire $ Suppression) Total Alles: $ Check No.3127 Check Amount: ( �' Cash Amount: 6.Total Project Cost: $ i ` 00 , 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0 Co 056 1 L 17.21 2-Li _ l� License Number Expiration Date Name of CSL 148Ider "/0 4 1 •e�� I List CSL Type(see below) v No.and Street Type Description V►11J� Cis bU r ©167 Unrestricted(Buildings up to 35,000 cu,ft.) Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding �/ SF Solid Fuel Burning Appliances r S30�v tp I re y t- (aAA b Insulation Telephone Email address V •COM D Demolition 5.2 Registered Home Improvement Contractor(HIC) i Zv. 3n— z� Registration(o (n Ivpzti t D`e rc' � HIC Number Expiration Date HIC Corn an Name or H e e �� t?v\ e rc�a�nlaAA60t ct wz.% 1 No.and Street t{l 5 30 l S(o Email address hu te. 130 c- ()1nf? , cOl \ City/Town,State,ZIP Tel phone 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 .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 ---a ar e n_ LaG1C to act on y ehalf,in all matters relative to work authorized'by this buildingpermit application. Print ner s Name(Electronic Signature) 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 o the best of my knowled 1 e and understanding. „,, ) ) Z Print Owr's or Authorized'Agent's Name(Ele•,o i Ignature) 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 C'onuno►threuldt of.11assachusetts 1 tr on Department of Industrial Accidents . = ��,� 1 Congress Street,Suite i00 '• ii . 'E4I y Boston, MA 02114-201' ., t ti¢-'i www.nlass.gor/din %loikers'Compensation Insurance Affidavit:Builders/Contractors/Electricians,'Plumbers. It)BE FILET)W lilt'111E I'ERAII rIING AIrlII(11(171 Applicant Information ( Please Print Libly Name tHusincss'(hh;amiationlndividual): �na IS,1='CJz)k-N ` L�� Address: 14-taq j,3evvdt:lk (I i76b, 5-c'1 City/Stale/Zip: 5WA _i i)(-� Oa 6 t0 72__ Phone 0: Lit 5 5 3 v .. (`-Lc, .tre sine an employer'r heels the appropriate Inlu Type of project(required): 1.0 I ant a elllploy cr re riff employees{lull:Ind or part-trite 1.' 7. 0 New construction 20 am a plc pmpndul or parincr•.lup and hart no employees working for me m $.{a ,.Remodelin any capacity.INet workers'comp.insurancenyuar:il.I �l 9. ❑ Demolition t. 1 aim a lioneA,wrkr Joins all murk myself.I`o wttrkcts`comp_insurance required]" 10 0 Building addition t.E1 1 am a h,lmeYea Ike and will be hums u tlraclors.to conduit all work on my privet te. I w ill eouun that all etnaracttn.either lure sunken'compensation Insurance or:WC toter l 1.3 Electrical repairs or additions proprietor,with no employees. 12,21...Plumbing repairs or addition. S I am a sacral contractor and I lose lined the.ub-cuntr:lciors listed tin ile atiacherd.Jk-rt. Thew sub-contractors has.:employees and/use eeoc crs'comp.rmu k ruc.' 13 Roof repairs 14.Q Othet 6.0 We are a corporatism and its officers hare exercised then orb;of evemptHai pet%kik c_ 152.,§lell.and eec lace no employees.t!Va,workers'comp.insurance rectum:J.1 •rtny applicant that checks bin al mutt also till out the Ned10111 I.Chalk sbow imp their%twins eonlpe7r.alitmn pulley information_ `1krnxctanets eehu sulnmt this aftetkl%it Indicating they arc dour:all work and then hue outside contractors must submit a new atlrhasit irwhcating such. :C'onrr:ktot.that check this hoe must attached an additional.led shaming the name ot the sub-eorar'ac'tors anti state%bether or not ilium:entitles bane employ cc!, It ilk sub-cuntracetas luee c-nipluyccs.they most pros Idcthem workers'vtmp.l..thcy iiuml.rl I um an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance(Company Name:_ _ Policy#or Self-ins.Lie.#: Expiration Datc: Job Site Address: City State,rLip:__ _ Attach a copy of the workers'compensation polka declaration page(showing the policy number and es tion date). Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a line up to I.500.00 ardl'or one-year imprisonment.as well as civil penalties in the limn of a STOP WORK ORDER and a tine of up t 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. I do hereby certi nder the pains d penalties of rerjurr that the in formation provided above is true and correct. Signature: a i1 a,J.— CPL v Date //l�/2 Plume : Official use only. Do not write in this area.to be completer)by city or town official ('its or Town: Permit/License 41 Issuing.luthority°(circle one): I. Board of llealth 2.Building Uepar(ment 3.City/town(Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other ('untart Person: Phone#: City of Northampton r' , ,1` ' Massachusetts �;� � - • DEPARTMENT OF BUILDING INSPECTIONS z d► 212 Main Street • Municipal Building Q ` Northampton, MA 01060 jNh, 3r��^`` _______ 1 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: k7. \�-e ,�c_ c°\tv‘cs 2.3 `I al_stk r,wit). c K. RJ A,e),(----)-L.- \e-,•-f-1/2-c--v\__ Vk 13,_., The debris will be transported by: Name of Hauler: �� 1 v. �1‹:, c ?vY ,1d, res-r. rCL[_+c) t.• Ll _ � .�z „<�/,� Date: Signature of Applicant.; zL � f /fs1.? o 6 e r-e r'-. A ;"a..%,v%vEt fi 4! /. 1 Sal *- C\\ \ ?.) 5,--- \‘‘ 7 \ 6 )''m I oac______ - 5 joy v c)•>�i Yl i . I 1 ttni. // P.Y,1 S T-1 N) i--7 ",-.DD SVC)(Ma J+ 'e' 1. 3 u fit d _37D1( a 11 D1 ci-1-. , 1 \ i-c i 1 i '