32A-243 (3) BP12023-0112
131 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-243-001 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-2023-0112 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS/BATHS 2023 Contractor: License:
Est. Cost: 78500
Const.Class: Exp.Date:
Use Group: Owner: KEYES ELAINE T
Lot Size (sq.ft.)
Zoning: SC/URC Applicant: KEYES ELAINE T
Applicant Address Phone: Insurance:
131 BRIDGE ST
NORTHAMPTON, MA 01060
ISSUED ON: 01/31/2023
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO CEILINGS AND WALLS, RENO FULL AND HALF BATH
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:
Fees Paid: $511.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
ei All
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The Commonwealth of Massachusetts r `� 0
n / OR
1U9 Board of Building Regulations and Standards; o� ' �C�
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Massachusetts State Building Code, 780 CMR ,;rtiq,r�,,,•,r US�r�1
1/4
Building Permit Application To Construct,Repair,Renovate Or Dem sl FcT,Re ised 14zr 2011
One-or Two-Family Dwelling " '0'� c`v�
This Section For Official Use Only
Building Permit Number: —Z 5— 1/ Z, Date Applied: i
t :=-1l,s %Z //�%G- l• 3 i-7623
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
A dr • 1 t( I,��
r 1.2 Assessors Map&Parcel Numbers
nAgm,
1.1 a Is this an acc pted street?
�/t?yes v 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 Proviced
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private CI _Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
11,1,0t11111.1<tye(1"' gitgletThiVT3N\ )4_ - 6 k'o6 -0,
Name(Print) City,State,ZIP
12,, Vi eV Si- . , N 413-Zso-S$3 Oismt\v 6210 .(terNo.and Telephone Email Ad ess
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Add tion 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
r e
of Proposed Work2: - a - S aY`il' i of.. t' - ci
I1 40r i ' ,�i,� jet ,
u. 11t_i1_. d .. ( V
In 'If no) .or'in.\ RA 1 ' 14 1 r tM, 0 nuw -►re-flitce„,ftW cd,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 'l S10 a0 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ / �d 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:� h✓!/!/
Check No. Check Amount:
6.To IVi 14 ❑Paid in Full 0 Outstanding Balance Due:
c
City of Northampton
Massachusetts
' o DEPARTMENT OF BUILDING INSPECTIONS Si
212 Main Street • Municipal Building yy • a
Northampton, MA 01060 — �a
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR,ETC.
(. 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. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction(Gut/Rehab) requires a HERS Rater Affidavit,
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No,and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE A}II'IUAVIT(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 0 No ❑
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
to act on my behalf,in all matters relative to work authorized by this building permit application.
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.
Electronic Signatur..
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"
...:s.N...is"- The Commonwealth of Massachusetts
,
($•#. Department of Industrial Accidents
1 ; 1 Congress Street,Suite 100
Boston, AL-1 02114-2017
WWW-mass.gov/dia
Winters'Compensation Insurance Affidavit:Builders/ContractersiEketricians/Plumhers.
It)RE FILEt)V)Int THE PERM111ING AUTHORITE.
Annlicant Information Plea se Print I.eei ills
Name (tiu1 -,.,01-Zafill-lt1011,I rid l'i hillal):
Address:
City/State/Zip: Phone#:
Ate you an employer?Cheek the appropriate hot: 1
,t Type of project(required):
to 1.„,:s employer with_ _employee%tfult maul part-time I• ! 7 0 New construction
..'.:. I am a suit propriekir or paimership and have no employees working. for me in -, ti. [94ertIOdelirig
any capacity,[Nu*LttiCrik'ciamp„trislaraLtoc rettliared-]
9_ 0 Demolition
oillm ;.j 1 a hoicieriwricr dome all work myself.[No workers°corm,insuraawe tesparail.
10 0 Building addition
4. I 3/11 a himienwrIef and will Se luring contracturs to conduct all work of my motimly, I Will
IIIMillis
ensure,that all contractors either haee workers"compensation mourance at arc sole 1- 1 1,0JE1ectncat repairs or mlitititnIS
proprietors with no employees.
12.! Plumbing repairs or additions
5C3 I am a general contractor and 1 have hired the sub-corstractors listed on the attached them
; 13.0 Roof repairs
These sub-controcsor%have employees anti luve workers'comp.insinsince)
i6.0 14.0 Other We are a commotion and its officers have exercised then right of eaemption per 5,1til c.
152,§li 41,and we haNe no employers,[No*driers'Cl71111p-insurance required]
Any applicant that checks box PI misfit also till our the welkin below showing their workers'compensation Falk"Mrmailvt)
+Homeowner%who submit this atiiiLuit indicating they are doing all Work and then hoe smail ontrocums mika Ailmill a me*at:id3.1E imaicaLatig illch-
7.C.ingractimi that check ths%bet mina attached an additional ait Nbt.w inn the name of the aul"-cuntractor and,rate y.itethirir or not Ilium:,mliticA
emplovces If the sub-cow:lc:,,I,l'..J,..:61'mplu,,,,,:*.th,.-!,ardent rrun idi:Mcir worLer,." nip pki.11,::?..nultiber
I am an employer that is providing WiPfieri.compensation insurance for my employees. Below iA the policy and job site
information.
Insurance Con-pally Narne: _
Policy#or Self-ins.Lie.ti: Expiration Date:
Job Site Address: City:State:lip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a tine up to S1.500.D0
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 forwarded to the Office of Investigations of the DL&for insurance
coverage venlication.
. ... ,
I do hereby certiXE under the paiw,and Ides of perjury that the infornitailln provided above is true and correct.
4 111.111111111.111 efAs4.-o- (. -.7
11111.11111111111111113‘ I 202,3
Phone v-:
Official use only. Do not write in this area,to be completed by city or lawn official
City or Town: Permit/License#
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone ilc:
r _
...4„... City of Northampton
�., Massachusetts
,., .,
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building :
Northampton, MA 01060 �'sssPe �3�,%
qiiiisomitIMMIMPRIPPPiPumar
(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: 016e I d1 \. 1N,c-q ' (RIO /v\ �Q iA
MAO
The debris will be transported by:
Name of Hauler: `/M( V V
Signature of Applicant: 09,24(.., / 4.6. Date: 1\42073
City of Northampton
Massachusetts ',
fro 7 k. , *
r
�
g DEPARTMENT OF BUILDING INSPECTIONS 1
` 212 Main Street • Municipal Building ,.,
Northampton, MA 01060 °,t
Mill MIMI
HOIG OWNERS'EXEMPTION ELIGTBI AFFIDAVIT
kp 'n1, El air-e ( � (insert full legal name), born D (nser,
month, day, year), hereby depose'and state the following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one-or two-family dwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in
a two-year period shall not be considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this ( day of 24'3
X , 111.--se..! /' -74(...e.ci
(Signature)