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38B-175 (2) BP-2023-1681 196 SOUTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-175-001 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-2023-1681 PERMISSION IS HEREBY GRANTED TO: Project# CHIMNEY 2023 Contractor: License: Est. Cost: 8100 PETER SHEPERD 077611 Const.Class: Exp.Date: 05/25/2024 Use Group: Owner: WEINMANN, CHARLES J. & ELLEN M. TRUSTEES Lot Size (sq.ft.) Zoning: URB Applicant: SHEPERD MASONRY &SLATE ROOFING Applicant Address Phone: Insurance: 32 FOREST AVE 413-658-5935 GREENFIELD, MA 01301 ISSUED ON: 11/29/2023 TO PERFORM THE FOLLOWING WORK: CHIMNEY LINER 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: • a' • ,/J . CS2ara Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner ' -r-ig'------1: A" .- V ..!.) NOV 2 9 The om onwealth of Massachusetts '' ��23 FOR L.3m1sTfuBseuti ding Regulations and Standards MUNICIPALITY agar State Building Code, 780 CMR USE — n �JF.UI(!?In;f tAJcPE,TI ---- i-' C�rirl#iali atio To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 •-•-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: giD, i'3 I P J Date Applied: 4„., 6-4 //- nn.zq -7075 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address1.2 Assessors Map&Parcel Numbers 9bb Soots . J' 1.1a 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: Zone: _ Outside Flood Zone? Public l( Private❑ Municipal l On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.t//P�nerl of,Recprd: Name(Print) City,State, IP f/ SaL//J Si l N 727--Y//j f//010 V e14) lhvi�4/M , CO 0 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(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: Brietpescription of Proposed Work'-: % l/ 'ive ('# 41e/,+/SP3' S (.. 4,- p-tf i A ' • 0 4Ve'' fit c_., CA,' it, I,G/ e rj Alp e n lv14.05 O ' ram• 1/ �I 1 Q4 IIMIM7artbirMIZI 'faA•-r1 1 r rhirr1weot / C 3.4 ' tti hi*A+ AA/. Awe 3 %boo t- p*Ir.. 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 Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fee Check No.� Check Amount: 1/ Cash Amount: 6.Total Project Cost: $ 51 00,DO 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 6 c776 f/ �Q 2mZ r,( Pe-Ert— e.. sf License Number ff Expiration Date Name of CSL Holder C3 2 eeS List CSL Type(see below) No.and Street Type Description /,Zit a- 'f� y ©o D ) Unrestricted(Buildings up to 35,000 cu.ft.) (J C Ir ( R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 47 6 cf—SY� Sfr6&" 10OZ PGls,1H'J I Insulation Telephone Email address rerM D Demolition 5.2 Registered Home Improvement1ve Contractor(HIC) 776575 CV/29h,Z9 Pe tEiL V- 5 f�C-t'E 6-0 HIC Registration Number Expiration Date HI.c Name or HIC Registpt Name 15;;r .ce5 F- /Vet L 1A)C�` -- M . Pelext5i/60 e 604 k%1 • Co►ti ;�sid to. 0/33 / 4(l3 61rn;5-933' 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 12 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. ��VI ► wt; iVI YI 21/Le4-4-- �,P��,,,.yyt vt t✓I 1 I 17 70 yg 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. Pam P 1 spi war--1) .3..t. b `z �r� ill f S/.9a23 Print Owner's or Authorized Agent's Name Electronic Signature) Date g ( gn ) 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 Information on the Construction Supervisor License can be found at 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" ?to 0t 0 0 CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton r ..� Massachusetts ', DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �� -a f Northampton, MA 01060 sstrjl. i..,,.,. . 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: C SI-Q cv 5h"n CP11d€ ) Y �P The debris will be transported by: Name of Hauler: fir16 er SC-°`'( itei4 Li Signature of Applicant: ir.� �' Date: /7r 7204-3 The Commonwealth of Massachusetts k y Department of Industrial Accidents _ :ties 1 Congress Street,Suite 100 �:m eke Boston,:MA 02114-2017 <y, www.mass.gor/dia 11z,rkerx'('ompensation Insurance Affidavit:Builderxi('untractom'ElectrkiansiPlumbers. 10 BE I ILEU W1111 111F. mithlITIING AllTllO)tl 1 Y. Applicant Information Please Print Legibly._ Name f ltusrtuss tk rani m'1ndrsvtduaI1: .5 I'EPF(LD rq I M L J Address: ,j Z +Oft-3 At - . CityiState&Zip:free 1c( IMP. CI3C) Phone #: 1113 /• -8-S-?'3-S Sri".ton as employee?Cheek the appropriate hos: Type of project(required): 1. t a let er with a Lvs 1 full andvr 1 Uttt t.` "Q }' T44 y pat' 7. ❑New construction 2 tam a sole proprietor or partnership and have no employ Cos working for tnc in 8. [I Remodeling any rapucd (!so wllskets'comp.insurance rcyuurd.( iJ 301 am a I>,ancvwna doing all work myself.[Nu worker,'comp.insurance require&&' 9. Di Demolition 4.0 I am a homeowner nt r and w ill he hiring varnih:tom to conduct all work on my property. I w ill ltl 0 Building addition ensure that all contealtots either have%others'compensation insurance or an sole 110 Electrical repairs or additions proprietors with no employees. 12.E3 Plumbing repairs or additions 50I am a general contratot and 1 curve fared the sub-elntraiors listed on the attached sleet. Thew sub-ctntrretun have employes and have wotkets"instep.insurance 13.� r IrepatC t;.0 Wt ate aclnptnatarn and its officers have ei c,t:rsed their right utexempnun per NIiL L 14.Id Other et //3 C V')j 132.(P!4).and we hate no cntphiye+es.[No workers'comp.insurance nyuin<t I 'Any applicant that chi. ka box#t MUM also fill out t sec tion ction below show mg their workers'comper to ann pokey infunnsiion. nlxt'llo wnera ski submit this aftidat tt nnhcatrng, they an doing all work and tiwir hire masa:Lunn:lc ors roost submit a new affidavit indicating such. :CCCwMracturt that cheek this Mix must attached an addittonai:had showing the mime of the sub-contractors and state whether or tot!!hove entities hate cltu+ta 4ec Ift'nc uih•c;crtnottars hate irnpto•tte.. tie.;nnti.t pz.ti to sheer ,.v,.,zker'0,:17,� lr.�lit}number. I rant an employer that is prursding workers'compensation insurance for my employees. Below is the policy and job site information. y Insurance Company Name: ✓' '�d _ t9 /4I4544ad iv — f Policy#or Sel ins.Lie.#: E.spiration Date: Job Site Address: /7e mar✓A 51' (its Stag sir: /ld i OIIP ' /yl�t 6/°40 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). failure to secure coveruge as requtred under MGL c. 152.§25A is a criminal violation punishable by a tine up to$1,5481.00 andior one-year rmpri,crntnent.as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement nut be forwarded to the Office of Imcstigations of the DIA for insurance coverage s e rificatton. /der hereby t ertif y a the pains and pe ' s of perjury that the information provided above is true and correct. t. SL-nJnarc- [Kit.: 2 r O Phone: II/3 65 5'3{ I Oflacial use only. Di)not write in this area,to be completed by t-ity or turs•n official. t (-its or'I own: Permit license# - Issuing authority (circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector b.Other ( ontact Person: Phone it: