31A-090 BP-2023-0843
27 VERNON ST COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
31A-090-001 CITY OF NORTHA PTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0843 PERMISSION IS HEREBY GRANTED TO:
Project# KITCHEN RENO 2023 Contractor: License:
Est. Cost: 23000 JOHN LEBHAR 075531
Const.Class: Exp.Date: 07/10/202
Use Group: Owner: WEST N HERMINE LEVEY
Lot Size (sq.ft.)
Zoning: URB/WP Applicant: JOHN EBHAR BUILDING& RENOVATION
Applicant Address Phone: Insurance:
(413)221-1913
ISSUED ON: 06/26/2023
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENOVATION
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:
Fees Paid: $149.50
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massath '-tts if) itto3).)71 t, F---
^_° Board of Building Regulations and • Ida ds `11N a 6 2 ALITY
Massachusetts State Building Code, 80 t4 4 ' SE
A
Building Permit Application To Construct,Repair,Re : a °ICIPrj,ir, .fish a 'evis-%Mar 2011
One-or Two-Family Dwelling A4,nroti�NSP
This Section For Official Use Only MaO7 so°Ns
Buildingpermit Number: ' ..)--3sci 3_ Dat Applied:
/ U)eJ � 5 6-Zia-ZQZ,
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
2-7 triAHOrs)
I-
lia Is this an accepted street?yes ) no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) CJ IA--
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private 0 Zone: _ Outside Flood Zone?Check if yes❑ Municipal X On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
ftu1 '►1"1 1-- ‘/Y by£.,.Sirs /tl Urtrtpbeitotc 0.4 / - 6 / ® 6 0
Name(Print) City,State,ZIP
7.3- V f 44 D'- S 1—( L41)3) 2vyj —5 3 2 0 111 v / I i jlidd9 ►le f. C.0 i"�
No.and Street Telephone Emil Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) l°( Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Props d Work': l''- _ f ire-ttL -' -i ,4_.-/$ (-GO%-
V 1-fc. 1 Al f)g w' 't/2-V j14--6M i— a." 'iv pi o>�.�
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ z e9 ezisp1. Building Permit Fee: $ Indicate how fee is determined:
f CI Standard City/Town Application Fee
2.Electrical $ ?�� ` o Total Project Cost'(Item 6)x multiplier x '
3.Plumbing $ l/ ere-7 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
co 0Check No. Check Amount: Cash Amount:
6. Total Project Cost: $
3 1 0 Paid in Full 0 Outstanding Balance Due:
5X Z. 6 , 5b 1Itt, Cc)
City of Northampton
4�M AA,tNr -.vw-
° � � 4ts. . .rr
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building VX% ab
Northampton, MA 01060 444,•
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: I
The debris will be transported by:
Name of Hauler:
cSignature of Applicant: ate: ‘(26 /2-0 �.�
r ,
The Commonwealth of Massachusetts
Department of industrial Accidents
1 Congress Street,Suite 100
*11 1....... Boston,MA 02114-2017
I
wwwmass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/ContractorsiElleetricians/Phunbers.
TO RE FILED%TIM'THE PERtilultiNt;AUTHORITY.
Applicant information Please Print L.ealblv
. i
Name alasinessforganuationandividuni): -71 ii P 1.--g-514-Pt(2--._ _
Address: 6c ,S?itlIP--- 97— . ..
city/state/zip: "94m .--/--i ' i40---- Phone#: y/3—z24 .—d. 1/ '
ArK yew los raspkweel Check der appropriate box: Type of project(respired):
I Ell I am s eraptityet%sit& ,_, employees;felt arsd.tx part-tiose).* 7. 0 New.construction
1—..Mok t AM a tok proprietor or portnathip and he no employees winking lur toe ia 8. ipill Remodeling
any'. 4.41aseity.IN.workers'taittm.imolai:me resparmil •
9. 0 DelnatittitXt
.10 1 ant it homeowner duxes all work myself.(No*takers'cutup ectemmee".;„,ir
ad
4C1 1 am a burgeon no and will be linos centractors to oanduct all wait no my propesty. 11611 to 0 Buikiing dition
ewaan time all euntrasaort either lane workers"compeinsamo eiviuraiwe to wit idle 11E1 Electrical repairs or additions
proprietois with so emplayees.
12.0 Plumbing repairs or additions
50 I am a mural contractor and 1 have hired the tioirsaritractoss bated en the wailed*beet.
13CIRoof repairs
Mote sub-eusouctors hose cimployet and base waders'comp.inioncire:4
i
• 60 We axe ovorpotatuas and its officers bane exercised their' right of exemption per MGL 4:-
14.0 Other
• 152,flely.wad we have nu employees.[Nu aorta' s'came.Omura:we requited.j
*Any applipara that&eclat box gl mint also fin out the$4:CtiUct below showing their waters eistapeoution polity iisformalioa.
t Horomos sass who submit this affidus it iodic-amp,they am doin all work dui then hire taitside eontracteismisill submit a f affidavit intlicaliag anis.
l'eutartetam that check this box usual ansaxed as additioaal dam showing the manic oldie suls-conaractias Old sane ift 6.1iset or own thaw'nunien how
employees. If the sub-cutorackas base Litrloytes.they num 4 4 sale diets +waters'comp policy mamba. .....,.......— ..
I am an employer that is providing workers'compensation insurance for ray ratplopres. Below Is the policy,atu I jab site
information..
Insurance Company Name.
Policy g or Self-ins.Lie.#: Expiration Date:
Job Site Address: City-Stately:
Attach a copy of the workers'compensation policy declaration page(showing the policy another and expiration date).
Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a tine 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 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 DIA for insurance
coverage verification.
I do hereb c f tinder the pains penalties ofperfary that the informann provided love is tree and correct.
Sisnature: C , Date: i 2-6 1 "2_0 -2_,-3
Plume#: 4 I 5.—2-7 ( — t 9, t
,.,
. 1 Weis,use only. Do trot;wile in tkis atm to be coarieted by city or town offidel
City or Town: Permit/License it . .
,
i Issuing Authority(circle one):
I.Board of Dean 2.Building Department 3.City/Town Clerk 4.Electrical Impeder 5.Moulting Inspector
6.Other
1
IContact Person: Phase it:
f
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) o 5 "3 j J 0,�3
AP L- -134.Jr'(L License Number Expiration Date
Name of CSL Holder ,
U O/ g ,5G ..._ List CSL Type(see below)
No.and Street Type Description
L�f k U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R I Restricted l&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding.
SF Solid Fuel Burning Appliances
it'-2ZZP-14(.5 41.P Cl I�W t � L6iv i Insulation
Telephone Email address D j Demolition
5.2 Registered Home Improvement Contractor(HIC) 1 4 . f3 8 i D/24>aS
S N'J HIC Registration Number Expiration Date
HIr Company Name or HIC Registrant Name
b �'CI ve i.— 57 1 .(bi, [al)c0,5 11a (O
No.and Street / , „J Entail address
W�~rFrri.-2 In4- 4!o301113 J 2Z1 `1I_3
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 .AC No . 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize Ft) 'N 1.-�.. i3 (+.k-(Z--
to act on my behalf,in all matters relative to work authorized by this building permit application.
14- ��� 1 t.4,. L-2.0 t y re rJ 6 12 C 12o 23
Print Owner's Name(Electronic Signature) Date
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 understandin
N-r' C 14-A-2 2,-6' /2- z3
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
i 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.tnass.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.) lid 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"