23A-039 (13) BP-2023-1471
56 MAPLE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-039-001 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-2023-1471 PERMISSION IS HEREBY GRANTED TO:
Project# ENTRY DOOR 2023 Contractor: License:
Est. Cost: 8600 MICHAEL PRIGNANO 104390
Const.Class: Exp.Date: 01/08/2024
Use Group: Owner: NORTHAMPTON HOUSING AUTHORITY
Lot Size (sq.ft.)
Zoning: GB Applicant: HILLSIDE BUILDERS &REMODELERS
Applicant Address Phone: Insurance:
121 WEST STATE ST 413-218-5247 H1WC241467
GRANBY, MA 01033
ISSUED ON: 10/20/2023
TO PERFORM THE FOLLOWING WORK:
INSTALL NEW ENTRY DOOR
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: $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
RECEI V r'
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OCT 1 9 The Commonwealth of Massachusetts
Z Office of Public Safety and Inspections
Massachusetts State Building Code(780 CMR)
oRrHa f 7^fc • • Pe it Application for any Building other than a One-or Two-Family Dwelling
01060 (This Section For Official Use Only)
Building Permit Number: Date Applied: Building Official:
SECTION 1:LOCATION
fob:n MA-Adr
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2 PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration O< 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 0 No Ctt.
Is an Independent Structural Engineering Peer Review required? Yes 0 No El
Brief Descriptiop of P posed Work:
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L✓;nddv- Af0 ffa,M;AC2 CJ,cnejCc - (J 't e0 re,,:�J
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft)
Total Area(sq.ft.)and Total Height(ft)
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 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-ID R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2❑ U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IB ❑ IIA ❑ IIB ❑ ILIA ❑ IIIB ❑ IV CI VA 0 VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public 0 Check if outside Flood Zone ElIndicate municipal 0
A trench will not be Licensed Disposal Site El
Private 0 or&identify Zone: or on site system 0 required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Northampton Housing Authority 49 Old South Street Northampton, MA 01060
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Cara Leiper 4i - 584- 4030 - - ExecDir@NorthamptonHousing.Org
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
Service Net
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 0.
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
(-- -; ik;j-e_ pt,,./.0)erc- cv\c_i l 'ell-lo)e kis. c
Company Name
A;chutel (1- f ri /i0 C 1c / O
Name of Person Responsible for Consi�ction License No. and Type'f Applicable
1 �( wts� s c (r-rcvi. y 01a33
Street Address City/Town State Zip
- - t{t 3 -V 5 /-7 Prui)1 knC' �`a;/- cd,.
Telephone No.(business) Telephone No.(cell) a-mail ec,
re s
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT (M.G.L.c.152.§25C(6))
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 0 No 0
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ v Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ I I C)O appropriate municipal factor)=$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 9 600 ,. 0O (contact municipality)and write check number here t
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 bes of my knowledge and understanding. �,
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Please rr t nd s / rtie Telephone No. Date
I'1 f ec t Crf�by 0/ a? > 12 r( y n°'1O e OJ Mtit` / GUi
Street Address City/Town State Zip Emaa1 Address
ZMunicipal Inspector to fill out this section upon application approval: / (C /d• Zd'zoZ 3
Name Date
56 Maple,
Tobin Manor new door
DDS requested that the existing first floor apartment have another egress. To do this we are
removing one living room window and putting door in its place with public access sill.
Remove existing window.
Remove framing and finishes below window.
Install new ThermaTru energy star rated 3/0x6/8 door with sidelights in opening, existing
header, kings and jacks to remain.
Pour small slab of concrete between door and sidewalk
Electrician to add lights, switches.
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The Commonwealth of Massachusetts
r c*�, = 1, Department of Industrial Accidents
mi= 1 Congress Street,Suite 100
_ '1 Boston,MA 02114-2017
www.mass.gov/dia
imi
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Lf;fk;o'( gvl'/c C() -1- R e n dA is it
Address: 1) ( W(I + 7 4 cf--cee-t-
City/State/Zip: 6 i< /Phone#: 44( -1 II 0 c V77
Are you an employer?Check the appropriate box: Type of project(required):
l. am a employer with employees(full and/or part-time).* 7. El New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. 0 Demolition
10 0 Building addition
4.0I 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 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repai s.1
These sub-contractors have employees and have workers'comp.insurance.: `I/) V
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other r
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 must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. J—� T L C-4./
.fJ_Insurance Company Name: L IA A,IX/
Policy#or Self-ins.Lic.#: ti- L C,L(Sgt6Expiration Date: 6 i_c x t
Job Site Address: 6 1 1ztOl e fr.. 5 City/State/Zip:frd(' -(1. d
Attach a copy of the workers'compensation policy declaration page(showing the policy number and ex iration date).
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 ify under e p ns and penalties o • that the information provided above ' true an correct.
Id Signatur Date: 15 /&J 3
Phone#: (I (3 (c, 5 )-c7(7
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
Y
1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: G Aotele_
The debris will be transported by: Ircicita
The debris will be received by: Ufr\ Kec, C n
Building permit number:
Name of Permit Applicant pp /4,6,,e(
Date Signature of Permit Applicant