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38B-234 (17) BP-2024-0359 52 OLIVE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-234-001 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-2024-0359 PERMISSION IS HEREBY GRANTED TO: Project# KITCH HOOD 2024 Contractor: License: Est. Cost: 1400 AL SANCHEZ CONSTRUCTION 98377 Const.Class: Exp.Date: 06/06/2024 Use Group: Owner: ANNA WIECKOWSKI Lot Size (sq.ft.) Zoning: URB Applicant: AL SANCHEZ CONSTRUCTION Applicant Address Phone: Insurance: 286 MAIN ST (413)320-9567 EASTHAMPTON, MA 01027 ISSUED ON: 04/01/2024 TO PERFORM THE FOLLOWING WORK: KITCHEN HOOD 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: /(.7 Fees Paid: $1,400.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner /74N The Commonwealth of Massa a c79 '4,",�� t,, Board of Building Regulations and c9 .:,? OR Massachusetts State Building Code, 78 � ,� ? ^ O•Q I PALITY SE � Building Permit Application To Construct,Repair,Renovatt'b... , olish Re sed Mar 2011 One-or Two-Family Dwelling o,o� 359This Section For Official Use Only BLS s Building Pc it Number: /,�j/�� Date Applied: ',,/ kelvf,-) KOSS /`��lG�- //� . -Z(I-Z)Z Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers s2 © Gth s 1.1 a Is this an accepted street?yes NI, 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 a Required Provided Required Provided Required Provided R 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record:, A) XWI ! p`�-a1� O l Q6, Z 5 AMA kW/IJi C-1� AMP f Name(Print) City,State,ZIP 62- O/1uC S4 305-5ZY 8nS 5DMUe( .Or?VI *IOC ta) 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 0 Specify: Brief Description of Proposed Work2: T vsill►LL f c.,�''Gl'i 4 ... rY,Lv:1c--- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Iaterials) 1.Building $ (j ZOO D 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ d 0 9e ❑Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ ,[4 Suppression) Total All Fees: $ (�5 �d Check No. N� heck Amount: 7 6.Total Project Cost: $ ; 1 1406 0 Paid in Full 0 Outstanding Balance Due: r City of Northampton Massachusetts ,_ `,,;z i 4 i DEPARTMENT OF BUILDING INSPECTIONS : , 'A r� ' t 212 Main Street • Municipal Building Al;.,,,„ to Northampton, MA 01060 44 ar, 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. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 4 lv- S ovbiteiV License Number Expiration bate Name of CSL Holder 2 V j AdCvl •S_/ List CSL Type(see below) U No.and Street ` � Type Description f s Lk l 7 r/ d 0 (O U Unrestricted(Buildings up to 35,000 Cu.ft.) („1r `� ,t RJtV !"l l'1` 1 �f R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering . WS Window and Siding �� (�(�S / t • SF Solid Fuel Burning Appliances 41(3IN,,`et/1�c I Insulation Telephone Email address / /i 'Tv D Demolition 5.2 Registered Home IImnprovemeelntt.,C�Contractor IC) `A..2I/ t /2//,//�574 A l so It e tt- /VS HI/C Registration Number Expiration Date � HICmpapy Namg or HIC S'�trant Name No.and�)L�e ,t t— al sQAcluz-d€S4It `^r a j,�k Street/w � fI/,/ kf Az ul3 Sze 'Ck? Email address City/Town,Srt`ate,ZIP 'I"L IF U�V!i Telephone !7 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 XI 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 14IL-4- se...,�e- - to act on my behalf,in all matters relative to work authorized by this building permit application. J0%,14,ei- . mq y,,1-_Qr `s' '02? z y 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 d accurate to the best of my knowledge and understanding. it1t�tzf- N Saw 3/2_,-7 e Z4 Print Owner's or Authorized Agent's Name(Electronic Signature) Da 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" i 1\,\_, • The Commonwealth of Massachusetts Department of industrial Accidents 1 Congress Street,Suite 100 isz= Boston, MA0211.1-2017 --...:, 7 ulmsnass.gortdia 1.'or kers'("ntopensation Imurance AMtbv it:Builders/Contractersitleetriciansillti tri hers, TO LIE FILED M It'll THE PERMITTING AETHORIII, . Applicant I liforma don Please Print 1...eibil Name ilHusukcaw"Organtiation;Individual K A t,„carietti Ok Address: 2 66 Mail S'C--- 10/ A CP(021.• CityStateiZip: t--- hfct'll.4,f)itrA... M Pt Phone :-t-.-,-. F.--370 Art you an vorphry er?Check the a ppriapriate bait Ty pe of project(required): ilkii am a enspiklyer strakt eniployeas(full andkirpart-tiireni.* 7. 0 New c n onstructio 24 I am a sole proprietor or partnership and bash ao employed*work tor inie m I8 C:j Remodehmg any capacity,. Ni workers comp.insurance required] , 9. 0 DettldlittOn 30/am a homeowner doing all work myself Pie worlds'comp_temaraniv required"' 1 0 0 Budding addition 4,0 I sia a liorneowner and still he hiring codradons to conduct all work on ray property, I will motor that all contractors either hate Winkem'Mt VOCILViliC) irearrance or are sole 1 LE3 Electrical nil:ions or additions proprietors with no employees, 12.0 Plumbirw repairs or additions :50 I an a eiromai contractor and 1 ha.a hued the atib-currtraeturs Listed un the attached Area, 1 31:1Roof repairs these sub-turamiuis lo pit.) ees and has e workers'comp.oisuraricc.: 14,0 Other 6.Ej We are a camparAhrm and as.oftiss. • Lis er etitrelsed darter risks of exernmion per Mai c, 152,§It It.and tte has au oar+t ,. ,,i,workers'comp.insurance remota-ill *Any applicant that&erica box'al moat also fill out the section below shin*irm their*4 vier.*easomerwanun policy information. I tionicowrscrs oho tadront nos affidatit indicating they are&nag all work and then hoe outside emitractors mom submit a new affitiat it indicating stags reormacturs that the&this box aura ameba an additional shed dunk Mg the name of the inh-eontraetorst and state whether in not thoSt trIlditS iitY,..,.. ottriotea, [(the sots-comas,tiss base employ ecs.they mist pcovidc their workers'ecam,po iii., number I am an employer that is providing teorAers'compensation insurance far my empfooes. Below is the policy and/oh site information. Insurance Company Norm: . _ Policy#,or Self-ins.Lie.-;t: Expiration Date: Job Site Address:: City''StatelZip: _ Attach a copy of theworkers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NICIL c. 152,§25A is a criminal violation punishable by a tine up to S1.500„00 andior one-year imprisontrient,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 In‘estigations of the LIlA for insurance coverage verification I do hereby certify a er the/in Intl vanities altering that the information provided above true and Signature • correct el / / Date: ; 4 7 Z.(1- Phone t: 4( 3 3 ZO Official use only. Do aol write in this area,to be completed 1 chy or town official City or Town: PermitiLicense Issuing Authority trirele one): I.Board of health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5. Plumbing Inspector 4.Other Contact Person: Phone a: City of Northampton Massachusetts r , t DEPARTMENT OF BUILDING INSPECTIONS ft \.; 212 Main Street • Municipal Building ,e -5• Northampton, MA 01060 Y tier 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: Vail ILI R.e,tylitl The debris will be transported by: Name of Hauler: CCU(, citt a fi Signature of Applicant: Date: 2 2 tt City of Northampton 'd Massachusetts .� �. Ao ,, DEPARTMENT OF BUILDING INSPECTIONS .", r ""� 212 Main Street • Municipal Building `J b�` • + P 4 :., ' � Northampton, MA 01060 J,6'� ,y‘'�''� 7Y��a 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_. (Signature)