38D-049 (2) BP-2023-0789
33 WINTHROP ST COMMONWEALTH OF MASSACHUSETTS
Map:B lock:Lot:
38D-049-001 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-2023-0789 PERMISSION IS HEREBY GRANTED TO:
2023 REPAIRS/KITCHBATH
Project# RENO 2023 Contractor: License:
Est. Cost: 40000 BRIAN FRANK 102740
Const. Class: Exp.Date: 08/03/2024
Use Group: Owner: VOLLINGER MARY N
Lot Size(sq.ft.)
Zoning: URB Applicant: B.E.FRANK CONSTRUCTION LLC
Applicant Address Phone: Insurance:
29 RIDGE RD (413)512-0822 WCC-500-502-704
ERVING, MA 01344
ISSUED ON: 06/15/2023
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO PORCH,KITCHEN CABINETS AND 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: , , +' , 52 , 5.117
Fees Paid: $260.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Buildinc Commissioner
Nol"
�;ECEIVinewomm.EI)
The Commonwealth of Massachusetts
,=:t: Board of Building Regulations and Standard- aoaFOR
{ Massachusetts State Building Code, 780 CM' ICIP IT
�° US
Building Permit Application To Construct,Repair, Renovp e OPP glitre *N.,,NS ,r 20 I
One- or Two-Family Dwelling RjH4mr,_ INSPECTIONS otosn S
This Secti n For Official Use Only _
Building ermit Number: `10-13, —7 t9 Date Applied:
e
-�,� ,1Z 6-/5-z3
Building Official(Print Name) Signature 1 Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
33 0i n-hi m p 6+'
1.1 a Is this an accepted street?yes < no Map Number Parcel Number
1.3 Zoning,Infprmation: 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❑
Check Zone: Outsidedif yes❑Flood Zone? Municipal On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
F,Lki' Vo\Iwh4_ec k Se cc Wtcpi �o r~th n?p 4✓1 Mk O(o(a
Name(Print) 0 City,State,ZIP
'3 3 W(n--%ra() S-4" 35k•4411-701 er-orsa C aol •can-)
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction ❑ Existing Building Owner-Occupied 'I5 Repairs(s)Art Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work': (1.o r1 040- .Q )C 1541 n), co rein F•loo r 1 Rajr t'�5' eck
5‘,?Pa'rks Cm.a ne,� ncti7 caerkntsl 1 rpt a -e xvs-k•,nt I�c in bi s 1
re no u -e. Jc r i 0 M
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
i • (Labor and Materials)
- 1. Building $ gD,op . 1. Building Permit Fee: $ Indicate how fee is determined:
,..e 2. Standard City/Town Application Fee
2.Electrical $
c• 0 Total Project Cost3 Item 6)x multiplier x
� 3.Plumbing $
c 2. Other Fees: $ ( p
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees:
�O— 4 t/W`lJ
Check No.k 7i Check Amount:
6.Total Project Cost: $tinI be d 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
�,
Massachusetts : e
`r DEPARTMENT OF BUILDING INSPECTIONS ft
'na 212 Main Street • Municipal Building
Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
1. Building Permit Application signed by legal owner and tilled out
by owner or authorized agent.
2. One set of plans and specifications of proposed work (Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction (Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
0
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Z+
14
14f'!Q'ri 7 / L License Numbeerr Ex iration Date
Name of CSL Holder
�7q List CSL Type(see below) LI
No.and Street
L �v Type Description
g M-^ D'3�� U Unrestricted(Buildings up to 35,000 Cu.ft.)
t��/'�' R Restricted 1&2 Family Dwelling
City/Town tate,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
( SF Solid Fuel Burning Appliances
103's72 002n- b,e.rI 1�co.s Avr.0 �.'�'� I Insulation
Telephone Email address V L.v... D Demolition
5.2 Registered Home Improvement Contractor(HIC) iQq$
6r041'1 ` HIC`Registration/ Number xpiration Date
HIC Comgany Name or HIC Registrant Name
No.and Street iC �/ �re, kLtt�tEmail a coils ,e/-�+
�_i^vw} mix otii/ IL7 Off a't Email addr a
City/T (vvtn, 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 X 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 6.g', nr..'t k- &A-11 )..c4cm
to act on my behalf,in all matters relative to work authorized by this buildirg permit application.
6/en- VOW f fC✓ 14113 IZ3
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGTITDECLARATION
By entering my name below, I hereby attest under the pains and penalties perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
eriaa &lb 6ii3/23
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,frnished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitab.e 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 Commonwealth of Massachusetts
-Tit illti****.
1
Department of Industrial Accidents
1 Congress S1(k)treet,Suite 1
Boston. MA 0211,1-2017
, ,..., ww,c.inass.gov/dia
— Ilorkers'f'onipensation Insurance Affidavit:BuildersiContrattorsfElectricians/Plumhers.
111 Ilt.t ILE It'kV I Ill THE PERNIEITING AritIORIIV.
Applicant Information Please Print Legibly
Name lliusines-wOrgaritzationAntilvidu4: Z . e". j15-,,h.
Address: 2M etct 6.e_ 1121
City/State:lip:6N 10,5i VA.14- 0 t3 914 Phone P: 471/5•--STI,,,,,,,Z, :-e)g, 0?-;27, ._. ,... .,„. ..
Art rim at ernalayert Cheek ine so proortaie twttl 1
-I)pe of project(required):
liA9rn a employsa with _toe, employees(1 and orpartdirwe' 7. 0 Ness construction
In i at a sole proper or pattherslup and have nu erupt AVricalg for arre.ni I b. Et!,,'emodebng
any eapaerty.[No workers'comp,kraiLitaabX katilataril
1 9,, 0 Demolition
.50 i am a horisoomuter tionaN all Watt myself[No workens`tonal.Insurance reepared 1
1 3 0 0 Building addition
4[3 I aro a horraiowner lied Wall he hump'contmeturs to courtact till work no my ptop_lk Iwili
ciestak that all contracturs either has e workers'oarrepsnuation Mattrance or aTe sok 1 i sC:1 Electrical repairs or additions
ertoprtetani with no employees.
i 24J Plumbing-rejialis or arida ions
§0.1 am a pettealcontrctor ad I Luce hared the sub-eorderieturs tatted on the attached sheet
i 30 Root repairs
These sub.o.suraciani lust eloistayees and has e'A arkeri'cramp.treaty:met,:
I 1 4t,0°dna
Oa We ure a emporahon and as offiversi hex e exercised there tight or,xerription pet kit it_c
1 52.§1(41,and 44e haw no employees.rth,*Ort.e.s; •comp,insurance retplusali
*Any applis au that s is,:eks Kw 41 man,sho rill or the seettom below show mg then workers'eonthensation laThey ra i,v aiaK Lon
t ItadriaviViarts Abu stanna tins affistaert indscatina they are doing all work and then hire outside etearactors meow sellout a new affielas a end waratE ala...11
4,:itintractoni that check this.box naut,7 anaeherl an additional sheet show inv the name uf the suis-contraeaurs and state,,,,,healer or not Chin eattaies„have
employee-. If the Nab-coratraLELas[IX :...-arplo:,..a:-...th,:,Imp,'ra. ,sic tht.it 4 vrkcn‘>,,:olrip,Na,..-y.nur11,-.3
I am an employer that is providing workers compensation insurance for lay employees,. Below is the policy and job site
information.
Insurance Company Name: ig1-114 ___
Policy iv or Self-ins, Lic./-t: (0._)CC..-'5-72_01 --S-0 a-10(i -20.234- Expiration Date: Si3!IA_
Job Sue Address:E3 1/..)fil 4h(af+ S-/-7- City State'2 ip 411-1A 4..1 "- Hn_ aiefe,4
Attach a copy of the workers'compensation policy dectaration page(showing the policy number nag expiration date):
Failure to secure coverage as required under MGT c. 151 §25 A n a criminal %iolatiun punishable by a fine up to SI.5(X).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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification,
I de,hereby c ' t er the pa' .1 and penalties of perjury that the information provided above is true and correct.
i
Siunature: / Date: le,,(/3 Z3
Phone#: q / oit. -9---
Official use only. Do nig write in this area,to be completed by city or town official
CitY or Town: PermitiLicense,
i Issuing Authority(circle one):
I I: Board of Health 2.Building Department 3.City/Toon Clerk 4:Electrical Inspector 5: Plumbing Inspector
6.,Other
t'ottlact Person: Phone. ;
City of Northampton
aia.t rr
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
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: 10 ( 231 )t-0)
The debris will be transported by:
Name of Hauler: 6, c - CAL.5414-e_47r _
Signature of Applican • Date: (o/(3J3
City of Northampton
`, Massachusetts "fr_
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
r - Northampton, MA 01060 sb• 1"0.
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_ (insert
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 ,20 .
(Signature)