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29-137 (3)
BP-2023-1693 311 RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-137-001 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-2023-1693 PERMISSION IS HEREBY GRANTED TO: Project# ADD BATH 2023 Contractor: License: Est. Cost: 15000 KUEL MCQUAID 051394 Const.Class: Exp.Date: 12/11/2024 Use Group: Owner: KLEIN PATRICIA A Lot Size (sq.ft.) Zoning: WSP Applicant: KUEL MCQUAID Applicant Address Phone: Insurance: 131 FERRY ST 413-537-5063 SOLE PROPRIETOR EASTHAMPTON, MA 01027 ISSUED ON: 12/07/2023 TO PERFORM THE FOLLOWING WORK: ADD FULL BATH IN BASEMENT 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: • O . 5r.11 Fees Paid: $97.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner CP4 z»_4.,* c• The Commonwealth of Massachuse `_ , Nov .2Board of Building Regulations and Sta rds 3 IP ITY W Massachusetts State Building Code, 78 CM USE Building Permit Application To Construct,Repair,Renovate Chsjp0 Revi d M 2011 One-or Two-Family Dwelling `."-N=�ir,-"G,Aispr on, MA o, � s This Section For Official Use Only �—� Building Permit Number: a/9^}.3"'W�%* Date Applied: 4,/i..—) 7255 /./--� /2' 72!/L3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Adj}ess: 1.2 Assessors Map&Parcel Numbers 3II an n _/ 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 CI Municipal Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ovylierl of Record: --* rot ri-rc a. ial.t:I., 1-/0 re V) e-e- 014" 6/10 Name(Print) City,Sta e,ZIP 3F1 210h 2—CI, No.and Street 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 Work2: Ad I i(," co (l 13 a . t to 8a5e,,,..ei;. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ g Onod✓ 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 2.®0 0 — ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ j 0 D U 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical Fire Suppression) ( $ Total All Fe '1 . Check No.� Check Amount: i n1 6.Total Project Cost: $ 0 00 — 0 Paid in Full 0 Outstanding Balance Due: r City of Northampton ,. �o� u.e;'� Massachusetts ` -CEI'i � F a> DEPARTMENT OF BUILDING INSPEC a ..,�� 212 Main Street • Municipal Buil3ing `�^�'� 'FF .' Northampton, MA 01060 a NOV 302023 DFPT OF BUILDING INSPECTIONS PROCEDURE FOR OBTAINING A BUIL .Sri: ;, a . ° in►,:, i D n WS, 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 Sp ecial Permit requirements(if applicable). 9.Energy Code—all new construction(Gut/Rehab) requires a HERS Rater r Thedavit City of 10.Please provide the appropriate fee in the form of a check made payable Northampton. b 6 ,6, 1„,,,,_, -f-kt,ra s ft n d...... 4 6 SECTION 5: CONSTRUCTION SERVICES / ,/� 5.1 Construction Supervisor License(CSL) LS -- a5 13 9 / 2//1II 202�- Ku l L. Q I l/l License Number Expira on ate Name of CSL Holder /3 ( rC-Sw 4List CSL Type(see below) No.and Street / TT Description r1_s 1x�-- / ( U Unrestricted(Buildings up to 35,000 Cu.ft.) 0. CAI f L_7 n/ Restricted 1&2 Family Dwelling City/Town,State,ZIP k M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances II-13-6 37-5D63 AllaQvoAct.K 6)�Wuti_ _ I Insulation Telephone Email address L0'+,+'L D Demolition 5.2 Registered Home Improvement Contractor(HIC) K'Je-1 ` U Ut HI©R gstrationNumber rO ^ & CL pir ion Date HIC ompany Name or HIC Registrant Name / t �cc- S' _ ALQuaV".l'i LI 6 9 w.at,(- Cn tat Npand Street 3- 37-6'063 Email adless 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 Issu ce of the building permit. Signed Affidavit Attached? ' Yes ® No 0 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 I<v e_( /(4 C, Qu 44 t Sto act on my behalf,in all matters relative to work authorized by this building permit application. /Il;o/ Z023 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. itt.c.„ Q /��3t)/ 262� Print Owne 's or Authorized Agent's Name(Electronic Signature) ate 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" k _ The Comntonwealth of Afassachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston, Alit 02114-2017 www.mass.govidia '1 or kers' Compensation Insurance Affidas it:Builders/Contractor-sfElectricians/Plumhers. IC)tit.IILED Sk till 110...PLRMI ITING AUTHOR111. Applicant Information Please Print Leeibls 4 e /r) 1 / Name 4 liususcs&DrganizatturCIndienktal): l Ac (..vu 0,.(6'l Address: /3 / t-C.c c- 4- city/state/zip: Fa5 -4, /44 , .... . Phone : Li- i 3 -6 3 4, .„ . , , 1 r c_son lin etatpliti.er?Check the appropriate hot: ..1.-, pe of project(required): i.C'l I am a emplolier skith emplopues(full dram part-time t.• 7. 0 New censtniction 2.1yrrant a auk prupnetaar or partnership und hare nu employees working for me in 8. 6-erketnodeling any urpaerty.[No workers'costly insurance required.] 9. D Denrolition I ant a Itormowner doing all vomit myself.IN°vikorluas`cow.iresurance requareal i 0 0 Building addition ;0 I am a homeowner and k$11.1 be hernar contractors to conduct till*irk on my property I will ensure that all contractors either hare%takers'L'UnlipL-113.111011 61111.11-4110:ix arc auk I I. Electrical repairs or additions proprietors IA ati no employees, 12.1120)lumbinit repairs or additions 01 I am a cameral contractor and I hare hared the sub-contractors listed on the attached sheet_ 1 3.1::1 Roof repairs The..5..:gib-torarActars haw employees ant!kak c$k miters'comp.otaur.mer„; 14.0 Other h.E]We are a i.-tyrpticabon and its officers has a:exercised then.rivin of eiemplion per Merl e. I..2,§If4)..anti vk e have nu employees.[No workers comp_insisance reytarred.1 ..„ applicant mat click-Ls box El mita a6,0 fill uut the seetron below hbow insi their Aorkerl.'eompermalhatt policy antornestron ' t fomeowners who Nlifillifi thii.Iftlikl‘it indicating th.."are doing all work and then hoe mom&eimtrachor,must inkrrnit a new affidavit indicating such ;contractors that check tiak box naist attaelwit an AddiLiunal sheet h4),.8 inE the name of the sith-ebntraetntS and Lif.:4,11ethlt IYr not those entatiositiVe employees. If the auts-eorni4LEOIN have emplOyees,die'y must proside their workers'comp,pulie number. l am an employer that is providing worAers'compensation insurtotee for my emplooes. Below is the policy and Job site information. Insurance Company Name: Policy#or Self-ins.Lic. -.',:. Expiration Date: Job Site Address: City;State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NIGL c. 152. :425A is a c-riminal violation punishable by a fine up to Si..500.00 araVor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.O0 a day against the violator.A copy of this statement rn.sy be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pain.s and penaltic8 of perjury rhut the information provided above Is true and(eel-reef. Signature: Xe,1 /ti . (..7321-1-1/.--) arty: /7/30/26 23 Phone;c: *9-13 - 53 7- 606 3 ' Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authorit% (circle one): 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 Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ?, 212 Main Street • Municipal Building Northampton, MA 01060 71; 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: kC7 ctoA C 40L\ (c`U7 The debris will be transported by: AuiiName of Hauler: �1 / � L �vc2�C Signature of Applicant: A. ( A KL, Date: f/ 3v 1=)Z7 City of Northampton Massachusetts 's a %, .` it.G y� t l_, g DEPARTMENT OF BUILDING INSPECTIONS .. s� ;4,= a 212 Main Street • Municipal Building >,5 C%' ; . Northampton, MA 01060 f�, ke 'at;��"��" 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. 1 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 1 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_. (Signature) 3 I (� �„� 1`Z iv(A ve_I NV ! I T Ii (LP}' 6419*JF+ fruCV`0. CT rCLV t_tuff: O` S © os e /e_kkf 13cL cs 1 ' ko S ,, b ciSew.e�� ,USe poo c ,}-o 0ooC ,fo 0�.fi dC ��