46-027 (2) BP-2023-1243
7 FERRY AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
46-027-001 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-2023-1243 PERMISSION IS HEREBY GRANTED TO:
Project# alterations 2023 Contractor: License:
Est.Cost: 10000
Const.Class: Exp.Date:
Use Group: Owner: B MCKINEY KEVIN M& MARIA
Lot Size (sq.ft.)
Zoning: SC Applicant: B MCKINEY KEVIN M& MARIA
Applicant Address Phone: Insurance:,
7 FERRY AVE
NORTHAMPTON, MA 01060
ISSUED ON: 09/11/2023
TO PERFORM THE FOLLOWING WORK:
interior modifications for insulation
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:
• af . )2 . 3-11 •
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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The Commonwealth ofMass sett,'Ife \' FOR
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Board of Building Regulations*~ dards 1, �l
ICIPALITY
Massachusetts State Building Cod ; �! R USE
Building Permit Application To Construct,Repair,Re t. -, Demolis '-vised Mar 2011
One-or Two-Family Dwelling '1 4;1%
This Section For Official Use Only 706,i0.4
Building Permit Number:63P}.3-. /01-4(S Date Applied:
i USN - ���— 1 I'//"
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: . .re`Cc-.4 ipVE' 1.2 Assessors Map&Parcel Numbers
1.1 a 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)
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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'o'�Record: '/ Net..-( on
KS of-4-1,0,0\y--)---0,i\ M - , o //�^
Name(Print) City,State,ZIP
irk l ' \1 e L0?o 3 v\Act.-'l 0i10 v>ncL.;,An
No.and Street J Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': e7A \0 0 c-- ` 0'r VA )C.—i ) (i LA Ci.
f C�
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1 V 00 01. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ _ � 0 Standard City/Town Application Fee
0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression)
Total All Fief
Check No.0 Check ount: 06
6.Total Project Cost: $ f 0t 000 0 Paid in Full 0 tstanding Bal Due:
•
City of Northampton
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'DEPARTMENT OF BUILDING INSPECTIONS 1 z'
': 212 Main Street • Municipal Building
Northampton, MA 01060 ' S'11V V 7\'s�"
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PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. 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)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
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 of the building permit.
Signed Affidavit Attached? Yes 0 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'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 understanding.
C/k k ‘4\V\
091_11)2C123_
Print wner's or Aut orized Agent's Name(Electrom 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,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 Alassachusens
Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
‘ or kers t'ompensation Insurance Affidavit:BuildersiContrattorsitleetricians/Plumbers.
TO BE FILED WITIIIIIL PERNIUITING AUTHORITY,
Annlicant Information Please Print 1-esiblv
Name itiusiness,'Orgaruzation;individual V
Address:
C'ity'StatelZip: Phone#:
.._
raisployer?it lurk'hie appropriate hos: Ty pe of project(required):
191 am a envie!.a yin/__ empivyeei(full inutor part-timer...• 7. 0 New cottstructiOtt
20 I am a bola propnekir ut portrunslop and have nu employees writhing for me in 8. 0 Remodelin ,,
airy ciipiiciry,[Nu workers'comp,insurance wowed]
9. 0 Demolition 31::j I ama huirioriwner dome all wed myself.INo'workers'curie.miuranoe rertuirctiT
twill 100 Building addition
4, I am a liamixweitest and will be hiratisOallink..4rJraii)saileldiset Itit Work Ma my property.
iautire that all co/Am-tun eidum haw isorkers'oiraspertaation EfellitrACILT or roc sole 1 I a Electrical repairs or additions
ptomains with ear tniployoal,
12.0 Plumbing repairs or additicms
1,0 I am a INITCTai Cuntractur and I ha i,e hued the sub-euntractans listed un the artai.bed sheer
134:3 Root'repairs
?Lieu:sub-cuntracton.have employees and Italie workers'comp.maUMM:C)
4.
6.0 We use a ootpusition and its tacos have exercishen ed t right or comoirtion per W I 0 Other c.
152.f 1(4 and we have tte einpJoyces.[No*utters'cianp.insurance required]
*Any applicant that ehocici box n1 mast*bra rdi our the iksctiaat bdtrOr abo%ins,Cho(v.i,itle.T.1.`....1mupectiallcm pala..1,tadocinattom
*notneow viers who submit Chas atradrii,it tnidavating they arc doing all work and than bile outside contractors must sAihnut a me*affidin til indicating such
:Contractors that cber.k this box must attached an additional sheet shooing the name of the sub-euntractors and .r.ait:wilt:1114:r in not thuae CIIIIEleh.hire
%anpluyees. if the%Lib-t:uniractbr.Kase employ errs,they must pro1/4ide their werkers'comp.why.;flUtEibt:f
- —
lam an employer that is providing worAers'compensation insurance for my employees. Below is the policy and Job site
Information.
Insurance Company Name: —
Policy 4 or Self-ins.Lie. 4: Expiration Date:
Job Site Address: 7 Fe q-,r)`Ave City'StateiZip: f-HAW\-00 i 44A 0 k 0 00
Attach a copy of the workers'corn pe % tion policy declaration page(showing the policy number and eipiratihn date).
Failure to secure coverage as required under NIGL e. 152,§25A is a criminal violation punishable by a fine up to S1.500.00
atutOr one-year imprisonment.as well 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 of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under t pains ant nalties of perjury that the information provided itho ,e is tree 'rind correct,
Signature: Mite: 017 I 1 7 °7_5
Phone g:
Official use only. Do not rvrite in this area,to be completed by city or town official
City or Town: Permit/License 4
Issuing Authority(circle one :
I. Board of Health 2.Building Department 1 City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.()tiler
Contact Person: Phone#:
City of Northampton
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Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS r,
212 Main Street • Municipal Building
Northampton, MA 01060 ts �•�
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: \ICt.\ \ 1;4C—tigA. Y\Ct_
The debris will be transported by:
Name of Hauler: Ke v ; V�� „��� e
Signature of Applicant: Date: jzoz ?3
City of Northampton
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Massachusetts �'' �,r
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ee DEPARTMENT OF BUILDING INSPECTIONS �:
a!Kw a 212 Main Street • Municipal Building '�,. <4:-
,y.rc.. Northampton, MA 01060s!jy 4,1tV
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
i� �t / OJ26J /CC
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I, he K II'kcW. . Vw1P (insert full legal name), born _ (insert
month, day, year), hereby depose and state the followng:
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 I day of crew00e V. , 202.3
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(Signature