23A-041 (13) BP-2023-1037
42 MAPLE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-041-001 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-2023-1037 PERMISSION IS HEREBY GRANTED TO:
Project# RENO APMT#3 Contractor: License:
Est. Cost: 35000 PETER BUTTOLPH 067906
Const.Class: Exp.Date: 02/23/202
Use Group: Owner: TUR R MELODIE P
Lot Size (sq.ft.)
Zoning: GB Applicant: PETER UTTOLPH
Applicant Address Phone: Insurance:
17 B BRIDGE ST (413)687-3253
SUNDERLAND, MA 01375
ISSUED ON: 08/08/2023
TO PERFORM THE FOLLOWING WORK:
KITCHEN AND BATH RENO TO APMT#3
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: r
/4-6.0Ak- _52 (P1
Fees Paid: $245.00
212 Main Street,Phone(413)587-1240,Fa :(413)587-1272
Office of the Building Commis-ioner
Rec
The Commonwealth of Ma sac usetts U
Office of Public Safety and In pec •' ns AUG
E' I`ll d 20
Massachusetts State Buildin Cod (780 R) ~ 2
Building Permit Application for any Building other t n ate- o-Family llin
(This Section For Official Use Only) - 1NAmprnG INsPEc
Buildingri
Permit Number: k MA�����
p13'''' /d3? Date Applied: Building Official:
7a' ////9/ L i S l io/r CS�r SECTION,/ele LOCATION
Np3 �i Styes nA4L �/ Ci A+O v I Zip Code Name of Building(if applicable)
pAs(sesss rs/Maap�#`G Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used 471-rik If New Construction check here 0 or check all that apply in the two rows below
Existing Building Repair Iger Alteration V Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 1:117 No 0
Is an Independent Structural Engineering Peer Review requuired? n es ❑ o ❑
Brief Description of Proposed Work:E% T/QX /J 14.40r E C-" 7C146- I4I4S/ o'Athceg- S
- _ M - o•,i_ r �i 'iliz ie. = A/ !v EN`zeigia" .. ," /yera
4 •
-,, -74s7bv6 1/8'/t7d 'gily dzvE . ie ' /6"2. TO Pio -3-U .. -
SECTION 3:COMPLETI'THIS SECTION IP E)USTING BUILDING UNDERGOING REND ATIONJADlf IfiI ON,OR S—,
CHANGE IN USE OR OCCUPANCY V_ati)ei
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) CI
Existing Use Group(s): 6 -4► Proposed Use Groups):_66 J. __ OCT-Z..
? „7 ,,,, S$b ION 4;$LIuyNATG AND AREA
i%a7 (YaZ.14p/4 a 3o —o Existing 5�' Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) g a66-65 f<3b?i,/ pro ?39&3 '4
Total Area(sq.ft)and Total Height(ft) F76/ Sf c �f7/ /' "� •l /
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business V E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1❑ H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-I " R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA El IB CI HA IIB CI IIIACI IIIB ❑ IV 0 VA CI VB 0
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Trench Permit: Debris Removal:
Water Supply: Flood Zone Information: Sewage Disposal: Licensed Disposal Site
Public l Check if outside Flood Zone 0 Indicate municipal A trench will not be Po
Private 0 or indentify Zone: C or on site system 0 required V or trench or specify:
permit is enclosed 0
Railroad right-of-way Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable Is Structure within airport apprbach ea? Is their review compl d?
or Consent to Build enclosed 0 Yes 0 or No Yes 0 No
SECTION 8:C•NTENT OF CERTIFICAT OF O CUPANCY
Edition of Code: 97y Use Group(s): i 7 ' Type of Construction: *B64M1 10/T11 I /N--- f
Does the building contain an Sprinkler System?: 0 Special Stipulations: s/2)beg
DesignOccupant Loadper Floor and Assemblyspace: S�/N
P p
oFs_
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner .
) LO../E , 7i2, ilv6i1° /. c 6 crAic' 7LD IJI D"o6a?
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Oed/f/g/e 4/13- 1X-e89 - /fl_675_-' 741 ,3 Ae,&-r.e G'avrx '."
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
/
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number .
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Company Name
Pe7 AP ,dU// 7 A// (�6 CSL #CAS-- o.1,7906
Name of Person Responsible for Constryctio 3 License No. and Type if Applicable
/7 e � i�GET S/ r, il iP SUN06-'RL fiN.d /72, D/375"
Street Address City/Town State Zip
‘,19 Jo?53 *3 3a?S3 IL igOTTO C. n.i ?9,73//a om
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION A RANCE AFFIDVIT(M.G.L.c.152.§25C(6))INSU
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes D No D
SECTION 1Z CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor
Item and Materials) Total Construction Cost(from Item 6)=$ •f_ Cf0
1.Building $ " ,i< 4 . ,f c'c?X 7
Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$,.q 6"..—
3.Plumbing $ /d
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other $ Enclose check payable able to 6 r)/ a� / •U 4r_,(/
6.Total Cost $ 36A (contact municipality)and write check number here-Atc49
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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 m . wledge a nder ndin • .
- --1,`" , 43-a7-,50/A3
Please print an'i'o,...7--e , Tit e A
--, ho Telepne No. Date f
/7 45. 444 sr Su�1/� L i/�i - -/1�- C i,g76:— ,°1.80 -L P " - , eo,
t dre \ City/Town State Zip Email Address //�� //
'
za.
Municipal Inspector to fill out this section upon application approval: _1/� 8.816Z3
Name Date
City of Northampton
a0""'pro,
S '•- S
? Massachusetts a��s ic,�c
� . K
d - 1 4 il DEPARTMENT OF BUILDING INSPECTIONS � 4
\:"Z 212 Main Street • Municipal Building yJ,. ,D:
r Northampton, MA 01060 �SNh, %�`�'� . va:o yea
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: Oizz-2/ le-es/d.pvg- o�c3/ '..45-7717 -4'/73/6///1
v , A/bIAZ7TWW7A/ M rt
D/66 D
The debris will be transported by:
Name of Hauler:s
i-a CleYikrirt8770/ 413--ZZ'6-=' S te"
_t_y__ __
Signature of Applicant Date:
full_nameIlicense_noIlicense_type_nameIlicense_status_nameI
expiration_dateIaddr_line_1Iaddr_line_2Iaddr_line_4Iaddr_cityI
addr_countyIaddr_stateIaddr_zipcodeI
PETER L BUTTOLPHICS-067906IConstruction SupervisorIActiveI2/23/2024
12:00:00 AMIPO BOX 3671IIAmherst MA 01004lAmherstlHampshirelMAl01004l
(2,SL: .B'9 // CAL
From: Melodie Turner melodie.turner@icloud.com B
Subject: Liability Insurance n
Date: July di mel at 1:18 me ^% 9 77 (
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001 001 Personal Property Replacement Cost $ 500 $ 10,000
Deductible shown above apples per any Raw oearreacs
BUSINESS MMD ME.Admit lees Iretel.d NO Eisaeeley 12 Comwe.Kve Leeds.ONUwy Papua 40•Deye.
LWOKITY AND IEOM:AI EXPENSES
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Clang the appkabk-or 4;t.a;period
BLISINE 5S L.AIX.ITY COVERAGE ULS1S OF INSURANCE
L sheet $ 1,000,000 Per Occurrence
MCC!cal6xpcnxs S 10,000 Per Person
F re Lea Liability I 100,00 Any one Fie Eappsen
ADDITIONAL COVEIAIRE$
Some property coverages we aubpcl to 0adxabMs uptake n tie policy forma
Optional P.epertf Covereg.Description Units of IeeNreaee
LOC CLOG DESCRIBED COVERAGES
001 OM Contractors Tools Blanket Basis S 5,000
001 001 Contractors installation Covcregc 1 10,000
Contractors Enhancement
DounnolLiodameCArnmopoDomwption LIIRM/ef E mmmamo
Cmt-actors-payroll 12 ,GCO
Cult'actdrs l,abtI&ty Endo(sement
CHANGE NO PREMIUM $ TOTAL MAIM S 1,0451
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PETER BUTTOLPH DALE A FRANK IS AGY INC
17 8 BRIDGE 5T 2 AMHERST RD
SiNDERLAND, MA 01073 SUNDERLAIU MA 01375
Iaoinora 413-66S-8324 b9S9A
POINTS AND EN00RIEM ENT$1WHEDULE
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kiLsxnesso.ners 9P711,71 1UI.1!) Businessasrrers-Loverese For.
Bvsl'leSiOwnkrs 0P0417 t01/1C) Employment-Related Practices Exclusion
Buslnescoeners arms 103l15) Massachusetts Changes
sus lnelse.Iers 1000144 101/21) Massachusetts Changes • Intentiona1 Luse
Bualnesseeners DP0439 (07/02) Abuse or Molestation Exclusion
Muslnessooners BP0se, (07/02) Calculation of Premium
Bustnoccosnors 0P0517 (01/06) Exclusion - Silica or Silica-Related Duct
N1RIMtsmen►rc instill Insists arri art. of r ito n1Pt„r. Owl W.
tluslnessoaners B111S42 101;15) ERcl Pun Demise Related to Att of error
Bwinessomners BPOLIL 107/13) MA - Fungi. Stet or Dry Rot Eticl a Limitation
businesseseeers MOOS (07/02) excl•Year 2000 Computer Related L sex
Ekssinessomnors MPO577 (01/0f) fungi or aacreriu Exclusion (I.sabx1ity)
Buslnessomners BP1304 tOS/14) etc( • Acte„ of Disc). of into • td Bt Exception
Buslnessmners 014111G (07/22) Snow Removal Advisory
Businessoelrers SOOSI$ (07/22) Asbestos or 01fier Respirable Dust eclusic'n
Ekssinessooners 9S1S40 (07/22) Cyber Incident Exclusion
Butinessowners 5110544 (07/22) Roofing Operations Exclusion
0uslnessowners SM0545 107/22) Exclusion - Snow Removal Operatic'
Businessouners 581307 107/22) Safety Contractors (lability Endor t
Buslnessawers 9011001 (07/22) Equipment breakdown Coverage
Businessomncrs STM110 101/10 Notice of Terrorism Insurance Coverage
Musinessomners MOOS 107/22) Massachusetts Equipment Writedown Changes
Bustneisowncrc. See001 107/22) Safety Bridge Enhancement Endorsement
muslnessom er, 5E5004 107/221 Safety Contractors enhancement
Businessowners BP0701 (09/19) Contractors Tools and Equipment Coverage
Installation Limit $10,007
miaow limit 155,000, Mal$1UO0/trap
Rusinessarrers f1PO419 (07/19) Amend-Itqunr riab Exclusion Om tion)
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9usinessaaners 0P0430 (07/02) Abuse or Molestation Exclusion
BusInessoaners sPOSOI (07/0I) Calculation of Premium
Rusin sowners BP0517 101/06) Exclusion - Silica or Silica-Related Oust
Businessowners 9P7531 (01/15) Excl acts of Terrorism Outside the US
Businessoaners 0P3542 101/15) Eact Pun Conga Related to act of Terror
Businessoaners (IP960c 107/13) MA - Fungi, Met or Dry Rot Excl and Limitation
Buslnessowners 61,1005 107/02) Excl-year 2000 Computer Related Losses
BvslneSSoalners 093577 101/06) Fungi or Bacteria Exclusion (Liability)
Basinessowners 0P1504 (05/14) fact - Access or Disci, of Info - lmtd BI Exception
0usinessoaners 0Pv110 (07/22) Snow Removal Advisory
BvSinessowners S63518 (07/22) Asbestos or Other Respirable Dust Exclusion
Fiusinessawnert 561560 107/22) Cyber Incident Exclusion
Ruslnessowner. 560544 (07/77) Roofing Operations Exclusion
Duslnessaaners SDOSaS (07/22) Exclusion - Sno. Removal Operations
Buslnessowners SS1307 (07/22) Safety Contractors liability Endorsement
Bvsinessowners S1111001 (07/22) Equipment Breakdown Coverage
(tusinessaanvr% 514110 102/16) Notice of terrorism Insurance Coverage
Buslnesiowners 501100E 107/22) Massachusetts Equipment Breakdown C Mrytr.
Buslnessownets SBE001 (07/22) Safety B Wise Enhancement Endorsement
BuSlnessoeners SE1004 (07/22) Safety Contractors Enhancement
Dusinoteownort 6P3701 (09/10) Contractors Tools and Equipment cavorago
Installation Limit 110.000
Blanket (lett 15,000, Mar 51000 (ter
Bvslnessowners 9P)x19 f07/13) Mend-liquor flab Exclusion (Exception)
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Sent from my iPhone
Egl = RJellicAr41f4k ff t Uj RIM4444aCI464s.h1S: efvKt.J
s"ele]_ 0 1 Congress Street, Suite
7t t l_ Boston,MA 02114.201*
^ av -rrrass.govidio
`.\orlcers' Corrtoensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers,
TO BE FILED WATAA THE PERMITAING AUTHORITY.
4pnlicant Infer - Pies=Print 1..eret37
Name(Business/Organization/Individual): /2� /C 8tiO4/
Address': P o r63
City/State/Zip:— - 5Qr✓ ceediti 3 469/3 1-ie#:e y/3 (ps'?.- 3a53
Are you an employer?Check the appropriate bon.. Type of project(required):
IC I am a employer with employees(full and/or part-time).* 7. New construction
2. 1 am a sole proprietor or partnership and have no employees working for me in $. Remodeling
capacity.(No workers'comp.insurance required.)
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.['
9. ❑Demolition
10 0 Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 1 1.electrical repairs or additions
proprietors with no employees.
12.rAplumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGI.c.
14. Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they nasal provide their workers'comp.policy number.
.1 VP;an employer that is providing workers'compensation insurance for gray employees. ]Below is the policy and job site
ieafcrrrnraticra,
insurance Company Name:__.
Policy#or Self-ins.Lic.#: _ Expiration Date:
Job Site Address:hi L all an S-1.-.4 I ' " ' City/State/Zip: F I a rt h Ct_
Attach a copy of the workers'cOn penn4.a.'- _--. ,1aratfionn ip.. a(*mowing tine policy nnnvme --1 eiepirattktn dote).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine 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 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 do hereby tend . er the pains and penalties of perjury that the ivafarmatfon pravzr true and
dcorrect
Signature: Datc_ ./� .--/
O icial use only. Do not write in this area,to be completed by city or town official. ;
City or Town: Perrnit/LIcense# 1
Issuing Author'ntty(circle one): t,
IL I. 'nod of Health h 2.Bnni7dhsg Department 3.City/]('own Clerk 4.Electrical Inspector 5.!Plumbing Inspector
6.Other
Contact!Person: Phone#: 14
CQNZT RUC T iOit CON i hQ.W NEVI
From'
?Eta rTO _
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5 446' #A2 ' t of
To:
Jonathan Flagg
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code,section 107.1 allows for an exc usion from requirements for
construction control in certain situations.In accordance with cod• section 104.10, I request that you
grant a modification to waive the requirement for construction c ntrol of the project at
40 . /1l/1i/,‘ iZ—0Z -11/c •M. 4,T dt 3
because the work _ a r natures. ,ot affect structural el-ments,health,accessibility, life or fire
safety,and will be done in accordance with the prescriptve requi ements of the code.
Thank you for your consideration.
Respectfully,
PG n, t77y
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