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23A-185
BP-2023-1539 160 SOUTH MAIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-185-001 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-2023-1539 PERMISSION IS HEREBY GRANTED TO: Project# PORCH REPAIR 2023 Contractor: License: Est. Cost: 15000 LOUIS MONTGOMERY 013471 Const.Class: Exp.Date: 11/19/2023 Use Group: Owner: E ODEA MICHAEL F&RENEE Lot Size (sq.ft.) Zoning: URB Applicant: LOUIS MONTGOMERY Applicant Address Phone: Insurance: PO BOX 951 413-268-2028 WILLIAMSBURG, MA 01096 ISSUED ON: 11/01/2023 TO PERFORM THE FOLLOWING WORK: PORCH REPAIRS 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: (� ! , . 'NT Fees Paid: $98.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVE[ The Commonwealth of Massachusetts 2O23 Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE DEFT.OF nUiLDIN6 y� rmi Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 vORTHAMrTON.MA 01060 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:&"2"5 6P`a)-',3- i S 9 Date Applied: IiLv�ns ///� �l'1 20Z3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers �ll O S, /14 rN s/ f/a—ctG 1.1 a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private 0 Zone: — Outside Flood Zone? Municipal On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 wner'of Record: enee 0 ' ec Florence , ►iA' ()+O(oa Name(Print) City,State,ZIP Ito 60041 .nSt i3�a3 HOboa rcoaldl@.con s+.nc+ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building tilt Owner-Occupied 0 Repairs(s))$ Alteration(s) ❑ Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: Xd�°jo i/e(r/GO/z $ 'r fi •r o /2 kl/S I% y gT8'/3o zc-A L2.st 2 /' ys/sx::,, /900/' 57 y w' TO' v S/S 'I" rig l'cv T/Jrc e:+r T ' l SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ !� 0 D U 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: q Check No.#) Check Amount V 6.Total Project Cost: $ /f7 a 0 0 ❑Paid in Full Q Outstanding Balance Due: City of Northampton ty� ifr, /: / �`� Massachusetts �- } a I * M a.. yam+ x,. elf � •t DEPARTMENT OF BUILDING INSPECTIONS ? 't i x, 212 Main Street • Municipal Building Northampton, MA 01060 yy 3''�~`` 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. I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Ld v•$ .777onr 4' License Number Expiration Date Name of CSL Holder S(, �9 �� coAr`,4 174/ List CSL Type(see below) e•/ No.and Street / Type Description PG.-, L/Ii.4..e �c�µy c � U Unrestricted(Buildings up to 35,000 Cu.ft.) Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 41/j_fZZ- O/Gd I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Laves ,T /V.0^-T(6v.�-4,..� /738I/ 03/27/2f HIC Company Name or HIC Registrant a HIC Registration Number Expvat�Son Date 51-Ae/77c04-rd/ aq, O•/SeMaltr/ * / No.and Street / Email address Gsi /i/7,�.�sci,tr ."1,4 Ili- O Go 52a S S/4,u 2is �C� �rsr.a�T 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 I,as Owner of the subject property,hereby authorize LgGts /h of ra o�Q")/ /�R s w et,e7eAp4..z•c to act on my behalf,in all matters relative to work authorized by this building permit application. {�- e-nGc 0 ' 17e a / oJPcL ©c+o►ber- 3fl aoa3 Print Owner's Name(Electronic Signature) Date SECTION 76: OWNERI 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. lo /yt"Ai 7GQrr•,^y//.r2(76. Z v)/�C,3 Print Owner's or Authorized Agent's Nanle(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" % t:\ Qie.6.40, ._... The Commonwealth of Massachusetts :-:---,,,-----'rr Department of Industrial Accidents 1 Congress Street,Suite 100 ..., Boston. MA 02114-2017 N. .,....._ ..., wrvwmuss.gov/dsa •-4.se 1).in kers'Compensation Insurance AlTidas it:BuilderidContractorsiElectricianv(Plu milers. TO BE HEED VI I III'I In_PERMI I-TING AUTHOR'I nolic ant Information Please Print Lecibls Name(iiiisiness,Organinition;Individual).: Address: City/State/Zip: Phone g: Arr. ,soo an casplary cr.?Check the appropriate bit: Type of project(required : 101 Jai a employer with, ernpioyees thin weator part-tnne)..' 7 D New construction 20 I AM a sok propnetur or ponnershrp and haNc no 1.-raciloyees%wiling for MC m g. fg Remodeling any Ltipacity.(No workers'comp.insurance stbrpirred.1 9_ 2 Demolition 30 I AIM a 110331431.4.43:t doing all WU*myself.[No%odic's'eump_insurance wooed"* i 0 0 Building addition 4,0 I mil a hornLowncr and V,ill be hiring contractors to conduct all w oil ots my property I s*th inewtre that all contractors either hale workers'compLmaation Mho:nom or arc male 110 Electrical repairs or additions proprietors with no einploye.L.,s. 12E.1 Plumbing repairs or additions ,ci I ant a general contractor and I hoe hoed the sub-contracturs Listed on the attaciled stiL,1 I 3.EIRoof repairs These sub-contractins laa‘‘‘e employees and bast workers.'comp.insurancc_; 040.We on:a cant and its officers hal.c cam:seal their right of esamaption per MCA.L 14_00111er 1.11,t.1141_and w c 11.11',‘no employees.[No*otters comp,instxrance requital 'Any applicant mat cheeks bok"1 met aim)till out the 50016011 below show ana their workers'compensation policy information t I lomeow iscr.who submit thl,arlidak.ii min:aline they arc doing all work and then hire outside contractors Mira submit 3 MOW Affairs ii Nadu:muss such :Contractors that cheek this box must attached an additional sheet showing the name of die mob-eUntille:Corti 31hi iliac 4,014.434.^3 Of nut GhU33 ealtie.s haw Linplovecs, If the sub-contractors ha,-.:eorrloy ce,,the:, moat provi&their w urkers*COMP.potk,).m.aiher 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Nam . ____ Policy#or Self-ins.Lic. it:. Expiration Date: Job Site Address: City/Stale/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dine). Failure to sectire4.overage as required under MGL c_ 152,*25A is a criminal violation punishable by a fine up to SI.500.00 and one-year impnsoninent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the siolator.A copy of this statenwnt may be forwarded to the Otlice of Investigations of the DIA for insurance coverage veriliefitiews 1 do hereby certify mirk,the pains mad'penalties of perjury that the information provided above is true and correct Signature: ----- - ___— Date: / /-3.1/4-3 Phone t: ---- Official use only. Do not write in this area,to be completed by cio or town official tit) or Too in PertnitILicense# Issuing Authority (circle one): I. Board of Health 2.Building Department 3.City'Tow n Clerk 4.Electrical Inspector 5. Plumbing Inspector 6,Other Contact Person: Phone#.: City of Northampton tii'► ,, p Massachusetts '" ' itDEPARTMENT OF BUILDING INSPECTIONS wito 212 Main Street • Municipal Building ; Northampton, MA 01060 �„cl, ,,,V 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: 5,n4_I( ,D„) / 7/2 /C Location of Facility: 5 /// -s T XV To ^` The debris will be transported by: Name of Hauler: Zoe,/s /ha.vTCo0 ,,s"7 /%2 :r A. /1"•i7e•ya-z/z-i/,* s Signature of Applicant: Date: /'.-?/ z_5 City of Northampton Massachusetts ` _DEPARTMENT OF BUILDING INSPECTIONS # 212 Main Street • Municipal Building , . Northampton, MA 01060 � HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born (insert month, day, year), hereby depose and state the following: 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 day of , 20_. 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