16A-035 BP-2023-1211
95 CHESTERFIELD RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
16A-035-00I CITY OF NORTHAMPTON
Permit: New Build
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1211 PERMISSION IS HEREBY GRANTED TO:
Project# NEW HOUSE 2023 Contractor: License:
Est. Cost: 460000 JAMES ROSS CS-074105
Const.Class: Exp.Date: 04/09/2024
Use Group: Owner: BECCA CONSTANTINE,
Lot Size (sq.ft.)
Zoning: Applicant: JDR BUILDERS
Applicant Address Phone: Insurance:
PO BOX 66 (413)374-7983 WC9024479
WHATELY, MA 01093
ISSUED ON: 09/13/2023
TO PERFORM THE FOLLOWING WORK:
NEW SINGLE FAMILY HOUSE
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:
1
Fees Paid: $847.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Z.—ak
File #BP-2023-1211
APPLICANT/CONTACT PERSON:JDR BUILDERS
PO BOX 66 WHATELY, MA 01093(413)374-7983
PROPERTY LOCATION 95 CHESTERFIELD RD
MAP:LOT 16A-035-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $847.00
Type of Construction: NEW SINGLE FAMILY HOUSE
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
XApproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
W -73
Si ture of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
P
RECEIVED ���� a'i�• �i
.$EP - 6 2023 the Commonwealth of Massachusetts FOR
Boa-d of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR MUNICIPALITY
b_ •= BUILqQ�jNG'�1 $PE USE
TION$
NORTHAMt'ffi011111 14g1 1TSt Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:'/ ' A 3- /1/f Date Applied:
Building Official(Print Name) I Signature /
SECTION 1:SITE INFORMATION
1.1 ro erty Address: 1.2 Assessors Map&Parcel Numbers
C/ffsrY_eno ,eo
1.1 a Is this an accepted street?yes ,X 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 Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Publio-a Private❑ Check if yew Municipal 0 On site disposal system
SECTION 2: PROPERTY OWNERSHIP'
2.J..,Owner'of Record:
f LA- COnJS A-J7'N O\OQ.)2
Name(Print) City,State,ZIP
I 10)-Co613-4'-W bCeCa,�c tafi .:���r.a�.�.c:;cict\
No.and Street Telephone Email Address V
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction P' Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: /Jf J S!xi&t i .' LtJJC Q '" nAThilodn*
/I2 1,412-- 6'14 lief I at/ 7 'y Nt� lSAsi� ar—.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) Total All Fees: qft
Check No.��71 'Check Amount: iJidl Kash Amount:
6.Total Project Cost: $ 4420 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction`Supervisor��77l� License(CSL) 617 /OS'
�or►3E5- � . ASS License Number Expiration Date
Name of CSL Holder
) 1 —? `5 List CSL Type(see below) 144
No.and Street T Description
Unrestricted(Buildings up to 35,000 cu.ft.)
i/1.2A , inn . 01 V7 ? R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
y1 37Y-7f v'f<'jd.—kv tiers Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) / V 7ss� T.2 c q
sbe [�./r;d1j e�5 i/VC, HIIC Registration Number Expiration Date
HIC,com any Name or HIC Registrant Name
Yv /3 (It jaw j�r��,'��c�S_ ' .�
No.and Street Email address
i q7-c . ,)1/9 • 6i01'3 64S 75�7
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 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 iRm•t5 '1 055 '&p. d Iv(to act on my behalf,in all matters relative to work authorized by this building permit application.
Rk-;tom..
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I h -by attest under the pains and penalties of perjury that all of the information
contained in this application i• - .I. : at- . the best of my knowledge and understandin .
(raj. . _ . ?Aj Z 3
Print Owner's or Authorized A: ` is Name(Electronic Signature) Date
NOTES:
1. An Owner who obtai s 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.) 14/0 (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) ! ti/O Habitable room count
Number of fireplaces Q Number of bedrooms
Number of bathrooms v2 Number of half/baths
Type of heating system 1}g RA 47 P✓�p boar- Number of decks/porches R.
Type of cooling system Ii-E4i- Pvt4"p Enclosed / Open /
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
O(HAMp
•��'" 4,', Massachusetts ?S�s ..- s�0'e
I i ,' Xi DEPARTMENT OF BUILDING INSPECTIONS ,n
•r - � 1.
212 Main Street • Municipal Building 0R Ps
\a r. Northampton, MA 01060 .rg�� 37. '
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: M1 /1.1 e .
C
The debris will be transported by:
Name of Hauler: T(Z —au I f 'Duvi, p -"re"+-uL_____
Signature of Applicant: ; Date: k.7,- .3'
\ The Commonwealth of Massachusetts
ip Department of Industrial Accidents
i �' I Congress Street,Suite 1011
_- �
••-"1= -� Boston. 3!a 02114-2017
? — www.mass.gor/dia
mass.got/dia
4.11,1
11eskers'('ompensation Insurance Aflidasit:Boiklers tContractorslElectrlcians/Plumbers.
TO Br.FILED►Y ITII T HF:PIERM1TT1l%G AUTHORITY.
.itllplicattt Information Please Print I_eeihit
io Name(Buscai Organtzatiort:Individual): cJ-tt�e- ,'l)t Ils-y9,12.-s j N C
Address: ? 30 w Lo L
City/State/Zip: (ii k 4 ILA , ern A, D 1 r c Phone#: Li/"3- 31 t/- 7S &-�
Are yea an eraplo+er!Cheek the appropriate boa: Type of project(required):
11.51 1 am a employer+kith Cc? employees(full and or part-Hertel.• 7. 1_!New construction
201 am a sole proprietor or partnership and have nu employees a irking fur ne 7n 11. Q Remodeling
any capacity-(No workers'comp.insurance required.)
9. ❑Demolition
31D lam a lion doing all autk myself.[Nu aortal,'comp.insurance required)'
4.0 lam a ltunraner and will be hiring ev n ntraou to conduct all work on my property. I will
10 Q Building addition
cv
ensure that all oontractur,either lace workers'ourcperoatron msurawc or are MAC I I.Q Electrical repairs or additions
proprietors*ids no employee,. 12.0 Plumbing repairs or additions
30 I ant a m cal contractor and 1 has c hired the sub-contractors listed on the attached AM.
These rob-cuntracton have ehe mpluyeesand have workers'cep.iun nstrne.° (3 Q Roof repairs
6.D Vs a am a corporation and its officers have exercised then nght of exemption per MU c. l4.[Other
132,§114),and ae lure no cirrpluyves.[No workers'ewnp.inswansx reuurreil.l
'Any applicant that checks boa=1 must also till out the section below show ing their workers'compensation policy iatfunnatiun.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new atIrdav it indicating such.
:Contractors that check this boa must attached an additional shed show ing the name of the xui-etas acwn and state whether or not those entities have
employee's. lids:sub-contractors.rs lase employees.they must pros ide their workers'comp.whey mmohr.
I am an employer that is providing workers'compensation insurance for girt•employees. Below is the policy and job.sire
information. I
Insurance Company Name d"�7" / C 11 i Co. _
Policy#or Self=ms.Lic.#: ilA VIC 90.7 t/L.j 7 9 Expiration Date: /. 7 9- 7 -
Job Site Address: 95 (Ae54rr 19c iii g 6 City/state/Zip:tf2lS 5 ,✓n'9- D701"
Attach a copy of the workers'compensation policy declarative page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152.1125A is a criminal violation punishable by a tine up to S I.500.00
andlor one-year imprisonment,as well as civil penalties in the form ofa 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 hereby certify u/ the pains and penalties of perjury that the information provided ubu►e is true and correct.
st,n:atutt: ,)i 7? I)t:, 8-- ?9-23
. ‘> IPhone»: 9( 9
Official use only. Do not write in this area.to be runrplrted by city or fawn official.
City or Town: Perrnit:I.icense b
Issuing.luthurity (circle one):
1. Board of health 2.Building Department 3.Cltyf1awa Clerk -1.EleciricnI Inspector 5. Plumbing Inspector
b.Other
( intact Person: Phone#: