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32A-158-014 CONDO 201/202 (WRONG CONDO #203 ON PERMIT)
BP-2023-0397 17 HAWLEY ST UNIT 203 COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-158-014 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-2023-0397 PERMISSION IS HEREBY GRANTED TO: Project# SPLIT CONDO Contractor: License: Est. Cost: 54000 SCOTT NICKERSON 053156 Const.Class: Exp.Date: 01/10/2024 Use Group: Owner: SUNNY HAWLEY ST Lot Size (sq.ft.) Zoning: CB Applicant: SCOTT NICKERSON Applicant Address Phone: Insurance: PO BOX M (413)896-3347 0 LAKE PLEASANT, MA 01347 ISSUED ON: 07/05/2023 TO PERFORM THE FOLLOWING WORK: SPLIT CONDO INTO 2 UNITS —PARTIAL PERMIT FOR INTERIOR RENOVATIONS WITHOUT CREATING THE SEPARATIONS BETWEEN DWELLING UNITS 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: $351.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner is. j The Commonwealth of Massachusetts ( APR _ Board of Building Regulations and Standdds 3 2023 R Massachusetts State Building Code, 780 CMR Mil I+ USE Building Permit Application To Construct,Repair, Renovate Or'Demolisl}a RevisediMar2011 One-or Two-Family Dwelling ;`` ° I This Section For Official Use Only Building Permit Number: 6'/g, 4.4-,i 3 9 7 Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Xroperlyiil d fiess: (J 620/ a a 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accented street?yes V.-no Map umber Parcel umber 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 S ly:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage D' osal System: Public Private 0 Zone: Outside Flood Zone? Municipal On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 cOwner'of Record: JU 4 4 Thu)/e� s ew �P/l va& /�� ©/U3 1 Name(Print,' City,State,ZIP 13 (o &. ,e . gfi3 9Z1 23Vr (Gig e iooe01 t. No.and Street Telephone EmaibAddrelS SECTION 3:DESCRIPT OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Owner-Occupied 0 Repairs(s) 0 Alteration(s) Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work: SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ I/O/ 0 m e, 1. Building Permit Fee $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ / 0 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 4j 0 0 0 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$ Check No. 1436.4).Check Amoun . 351 0 6.Total Project Cost: $ / 00�1 ,--6 0 Paid in Full CI Outstanding Balance Due: City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building• Northampton, MA 01060 3?y .'tl'�M^ ti PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC. I. 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) c/Ss] / / /e A y License Number E irat' n Date Name of CSL Holder / List CSL Type(see below) l �"✓G tic No.and Street Description U Unrestricted(Buildings up to 35,000 cu.ft.) ` Restricted 1&2 Family Dwelling City/T wn State,ZIP M jMasonry d kQ Ili 0 l 3 y RC Roofing Covering• WS Window and Siding SF Solid Fuel Burning Appliances 8 la 3- ?6 ` 3; /2 sijt, r At(Nd I Insulation Telephone Email address C,rt.1 D Demolition 5.2 Registered Home Improvement Contractor(HIC) /51 3f/ 9' S�l. 13 t... Ar # le'. a HIC Registration Number E irati Z ate HIC Company Name or HIC Registrant Name No.and Street Email address 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 the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FORBUILDING PERMIT I,as Owner of the subject property,hereby authorize S-(o '`l(/-/e, rc to act on my behalf,in all matters relative to work authorized by this building permit application. „ i d/ate - SSvck-ea 3 3 0 1 3 Print Owner's Name(Electronic Signature) ate S TION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my ,,, e below, I hereby attest under the pains and penalties of perjury that all of the information contained in pplication is tr - and accurate to the best of my knowledge and understanding. Sco W Ai �PrsK.. /jZ O 4 Print • -r s or Authorized Agent's Name(Electronic Signature) ate 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.sov/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 Commonwealth of Massachusetts ...L.. . ., ce Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 -4, , 7.s.,.. .04. . www.mass.gov/dia 11.toters'Compensation Insurance Affidavit:Buildero'ContractorsfElectricians/Plu milers. TO BE FILED WITH THE PERMI HANG AUTHOR!II, Applicant Information Please Print l_egibls Name itiusiness,Drganization,lndivuittal): 520 # 25 Vf e_i_rii 0 c4 Address:ib -73-7L fil . . C'it 'StateiZipl s L2 ti444,1 NA 6/.3Y..? pi,„,,,, .: (-14.?-gn- _.27(/ _ ... ., Are}Oil MI VStour?I heck the appnupriale boa: I -I)prof project(required): I:Cat am •1,,,y,a,will,_ _ el:mph/yet:b.(full anitor part-tinx t...•.21<ss.ipietp 7. E3 New construction I am a sole priipnetor or partnership and have ilia employees.Working for me in H. c] Remodeling any capacity.(No wort:LW comp,insurance rev- ored I 9_ 0 DettledittOrt 3.1:3 I ara a Itunsoownin dining all Vo mit myself.[No workers comp,inaurant:e rectum:di 10[J Building addition la I ant a horniownin•and will be homy contractors to conduct all work on nty property. I will censure that all c:sittracturs either base xorkers'i.-rinvertaatiort insurance or are sole II 0 Electrical repairs or additions proprieuars.with no employees_ 12.0 Plumbing repairs or additions SCI I am a general contractor and I ha se bred the sub-contracton.listvd on the attached sheet. bat 130 Roof repairs These sub-contractorse employees and bas,e worker s'eomp.insurance,: 6.0 14.0 Other Yee arc.a corporation and Its officers have caerciseti their nglit of exemption per lisKiL c_ III.§1141.and..s,e have no employoes.[N winters'comp_insurance nanitnail 'Any applicant that checks box.g I moss aLNo lilt vi,t th.,..: ....,..ziott l•eloo.'shoo.Inv then u or Li 1. Ilkomeou nen.who submit dos affidak.it indicating they are ding all work and then hue‘,•unade corollas:toc,most salrnot a ne'-,, a tf1,1,-%IS usilicAimu•1,,k :Contractom that check this box most attached an additional sheet shov ins the name a the 1.11-eonts•ax.7tors and-gate v.heibet in nut thohe.eniltios lf the sub-coraractor lls',,,.:,a tr.1,0!et:.,Ow.,num prwode their viurtors'comp.pmlicy numbei lam an employer that Is providing worAers'compensation insurance for my employees. Below is the policy and/oh site information. Insurance Company Name: Policy#or Self-ins.Lie.4: Expiration Date: Job Site Address: City'Statelip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage a' retiontAl under MGL c. 152.§25A is a criminal olation punishable by a line up to S1.500.00 anikor one-year iitiprisonment,as wel as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy o ,,is statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. , I do hereby certify ut4e2;7palsts and pelt aide.' perjury that the information provided a he,re Is true urn!ciArrect Z Signature: ., Date: 3/361i3 (//,.? — .;i'd Official use use only.. Do not write in this area,to be completed hi dry or town officiaL City or Town: PermitiLicetise# Issuing Authority (circle one): I. Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 4: City of Northampton 448:4 T f.: " �.,45 yf. <,_ Massachusetts ., DEPARTMENT OF BUILDING INSPECTIONS Y , 212 Main Street • Municipal Building , ;* ,. Northampton, MA 01060 'S'-i;, 1,.�N 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: V lie AJ - /-`1 The debris will be transported by: Name of Hauler: SC,,, l/ 4/(c_Awe.," ter. Signature of Applicant: Date: Y;K-4.3 e City of Northampton Massachusetts • i , � �� � DEPARTMENT OF BUILDING INSPECTIONS „'�' 212 Main Street • Municipal Building `•.40CP‹'*"`" Northampton, MA 01060 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)