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32A-239-007
BP-2023-1292 2 POMEROY TERR UNIT COMMONWEALTH OF MASSACHUSETTS 7 Map:Block:Lot: CITY OF NORTHAMPTON 32A-239-007 Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-1292 PERMISSION IS HEREBY GRANTED TO: Project# bath reno 2023 Contractor: License: Est. Cost: 71520 THOMAS DOLAN 039281 Const.Class: Exp.Date: 12/08/2023 Use Group: Owner: ZESIGER MILLER DORIEN&JEFFREY Lot Size (sq.ft.) Zoning: URC Applicant: TOM DOLAN Applicant Address Phone: Insurance: P O BOX 297 (413)297-5164 SOLE PROPRIETOR CHESTERFIELD, 01012 ISSUED ON: 09/18/2023 TO PERFORM THE FOLLOWING WORK: BATH RENO 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: >2 . ck,i • Fees Paid: $465.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner /3C6 IVED The Commonwealth of ssac use tkp iwo Board of Building Regulatio ant Stand ids/ 8 FOR Massachusetts State Buildin Col• 780 CMR MUNICIPALITY npot 2� USE Building Permit Application To Construct, Repaitd y'`��u : it emoli• a Revised Mar 2011 One- or Two-Family Dwelling q c,�'•°N MgpEc oN 7o6u s This Section For Official Use Only Building Permit Number: 5P,l 3- 1 .4Z Date Applied: li.1,3l1Co5s ��i�� 9-18-2023 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers a` PoNeeet giwe 7 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'of Record: err---paRlEN Zes I,et2.. Al b f ary p#v h Y 4_ 5 0 060 Name(Print) City,State,ZIP a pow►eeoj -TQ1Mace Flpr 7 £l3-3zo- 153a No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other lie Specify: Brief Description of Proposed Work2: f 2.Q►nnve t�►n►(�Ty b sh o..�e> /�o��ucQ GJIyh AIQai Rertde Tia4 1.4iiilif >wJ I ept.a e , Ai e& rile fitooR New Day skIes.// , PL u nib ime , eh,,,,-„ucca_, 4,►ld ✓ea i3 / Bvi4/N+Ba1 is/fie-ill c{,vsefr , Alai Pay,+ To la , Reel-axe Jt,3 PLoOR- ,AltolitAdiriely SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ I 'pp 1. Building Permit Fee: $ Indicate how fee is determined: 530 Standard City/Town Application Fee 2.Electrical $ 3 ero ,�.n0- ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ /.4/ov j' ao 2. Other Fees: $ • 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No.Iv Check Amount: Cash Amount: 6.Total Project Cost: $ 7 I j 5ao ev )4 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cS —o31a t is—S—aat 70/4 DOX License Number Expiration Date Name of CSL Holder List CSL Type(see below) (> 6q X € sr No.and Street Type Description �,/1 U Unrestricted(Buildings up to 35,000 Cu.ft.) Ghee opo'e )a. 400A0 R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 9L3-e297-5/61e Tom DoLaN 06 0 itoucan. I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 0M D / 100 9'-98-ay �/ ! HIC egistration Number Expiration Date HIC Com anyName or HIC Registrant Name DiV e Sf' 7b -Doi A 61&.c fi v)-•Corrt No.and Street Email address /copee ma,011)0 4113- 'l-5)6'-1 City/Town, tate,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 . 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 it�-+ f�ati to act on m eha ,in all matters relative to work authorized by this building permit application. 9 rf _See 74 IV 4e.:23 Print Owner's/ (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. Svr/1/450°�o0 Print Owner' or Authorized Agent's ame(Electronic 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" e The Commonwealth of Massachusetts - Department of Industrial Accidents I Congress Street.Suite 100 Boston, MA 02114-2017 ..- www.mass.gov/dia fl u:kers'Compensation Insurance. f iidas it:Builders/Contrsctor^slEkctriebns/Plumbers. it)1 E:FILED N 1111 1 Illi PERMITTING AI TH()WT1', ADalkaat Information Please Print I:evihb' Name(Business:Organization Individual): 725/y) 7JQls chi,/ _ _ Address:__49 i'oA e S7 City/State/Zip:Cj/coffee /YI& o/5o' 7 Photo#: /j 'OZ?7_51641 Are',un an e•ntpktnre!( heck Ibe appruprtatc trot: Type of project(required): 10 I ain a:nipttava utth _.cmpioycew dull and or part•tuact.• 7. O New construction : arm a ttiie psuprudox or partnership and have no employees winking fur me in K. 'Remodeling any capacity [Nu workers'comp.insurance required.] 9. ❑ Demolition 0 I am a homeowner doting all work myself.[No workers'comp.uaurance moved.]' i_Q I am a horse owner and will be horn ttrarachon to conduct all work on my property. 1 will U❑Building addition ensure that all Warstun either have workers'compensation insurance or are sok 1 I.a Electrical repairs or additions pie.pn.tt,t:w tth no employees. 12.0 Plumbing repairs or additions yO I am a general contractor and I has c hired the sub-cuntraetun listed on the anadttal sheet thew subs:untracturs have employees and have workers'comp.rmlur.'aitC V 13 CIRoof repairs hi:We are a corporation and its officers hate clat:moed then right of exemption per hit&e. 14.❑Other"'" 152.ti 1i4I.and we have nu employees.[No workers'comp instrantt tequned.] 'Any applicant that chucks bus al mint also till out the swum below showing their workers'compensation poiH., information t IfVmeuwners who submit this a iiL%it indicating they are doing all work and then lure outside contractors must submit a new affidavit indicating such CContraettm that check this hot must attached an adehtiunal sheet shins ing the name of the sourer tractors and Matt'whether/r nut those entities have empl„ cis If the sub-contractors lute employees.the,trust pn'v ide their workers'Limp path cs ntant+:t I am an employer that Is providing worLers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name. �._.._ — Policy#or Self-ms. Lie. : Expiration Date: Job Site Address: CitytStatelZip: Attach a copy of the workers'compensation pocky declaration page(shelving the policy number and expiration date). Failure to secure coverage as required under MGL c, 152, ;25A is a criminal violation punishable by a tine up to Sl 500.00 and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a line of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of 1nvestigatrtma of the DIA for insurance coverage venikation. I do hereby certifh nder the pains and lice' f perjury that the information provided above is true and correct. Signature. /f�i?�L�i a Date: 62 f /1 ,?0,13 Phone c: Official use only. Do nut write in this area.to he completed by city or town official ( it or Town: Permit l_icrn♦e Issuing Authority (circle one): 1. Board of Health 2.Building Department 3.Ckyflotlra Clerk 4.Electrical Inspector 5. Plumbing Inspector (). Other ( ontact Person: name I: City of Northampton S`S • sir, - '^ Massachusetts2,-A DEPARTMENT OF BUILDING INSPECTIONS y pc �• 212 Main Street • Municipal Building � -^!e Northampton, MA 01060 JJ';N D(�`� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: l/a//ey Rect,'cLiiv .. The debris will be transported by: Name of Hauler: "Th./n ,(7D,L.G6`'1 oae ©`e/ £4'/b/sh ,S044'G s _ Signature of Applicant: d�yedvi. € Date: 459p71- /V oa3 1314 W- R W1 R st OVafiio N ty)s) ., 2%, . 't� F .+-'Do R► EA Z e 1$ v A tpo w‘�t,o y�-c a eckc,�e. { 1 Apt r? N,ew xsy No RThn-m pro u- n14 O toCo rRee .stivptr4„ rub Ne uJ C1 SHotAp,R `� r yr Tile, ft oit Glass pone 30 i Rove. = Shawei. •V A.it2 to G(.o e7' a � > 301 f .._ A%ew Tl{.a Roof; 70 in ?�b N M Gitti l corog Ma, OIUaa 1113-a 1-5 tag Torn DoLAu c a pot- •Lowt.- / N rt 1 ' w O