44-132 (6) BP-2024-0346
474 EASTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
44-132-001 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-2024-0346 PERMISSION IS HEREBY GRANTED TO:
Project# ADD BATH 2024 Contractor: License:
Est. Cost: 78000 DOUGLAS GOODNOW 082188
Const.Class: Exp.Date: 10/16/2025
Use Group: Owner: • CAPTIVE ENERGY LLC
Lot Size (sq.ft.)
Zoning: GI Applicant: GOODNOW CONSTRUCTION INC
Applicant Address Phone: Insurance:
45 WESTVIEW TER (413)548-4561 WCC-500-5026062
EASTHAMPTON, MA 01027
ISSUED ON: 04/01/2024
TO PERFORM THE FOLLOWING WORK:
ADD 2ND FLOOR BATH TO ATTIC SPACE
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:
172
Fees Paid: $546.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of MassachuiLeteR 2 7 2024
Office of Public Safety and Inspections
Massachusetts State Building Code(78
Building Permit Application for any Building other than a One-ors wqr l fltael
(This Section For Official Use Only)
Building Permit Number.aI Y avG Date Applied: Building Official:
( SECTION 1:LOCATION
q1 l;Q�{�d''Ln�on�f� Atotlt
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❑ Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify: I4 H1C I,!►�S/.
Are building plans and/or construction documents being supplied as part of this permit application? Yes Er No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No
Brief Description of Proposed Work .fr d.Ma- i h dv i3 /(a 04% i 2r•k ILL /l (�_ S p�''�.
rjrtibk 'Lns�li*Ztan S)j reLk 1''iM ' .-JLdi C. 9 , 1-css.-41??,
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) 0
Existing Use Group(s): a hn Z.Sf 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 la/ E: Educational ❑
F: Factory F-1❑ F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H-4❑ H-5 0
I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-1❑ R-2 0 R-3❑ R4 0
S: Storage S-1❑ S-2 0 U: Utility 0 Special Use❑and please describe below: _
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ HA IIB ❑ IIIA ❑ IUB ❑ IV 0 VA 0 VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supp1 • Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
ench will not be Licensed Disposal Site ElPublic l El fr
Check if outside Flood Zone Indicate municipal Er required 0 or trench or specify:
Private 0 or indentify Zone: or on site system 0 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
01 011i(Son 31/ M�A. S T e if-STA6/Syi Mit D/ ° ). 7
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
6wn.e.r q•13 (D)1 5-1Y (.l3_ gy - 331-) .5eruice—e (gib'.h toll,Lana
Title Telephone No.(her s) Telephone No. (eeit) e-mail address
If applicable,the property owner hereby authorizes: k w pu is...-t$
pcu)16,s ( c, 4/?(✓ If WP)TWQw Tarr. a:5'N.Anuo'(�it Ali of ) '1
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❑.
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)
NI I. - -
Name(Regi trant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
6004U-01V &A S r.
Company Name
DO li 6( 6-S 6420 j G—i C3; o l c> 16 S (./ n r e-Stri ,"t" 1-
Name of Person Responsible for Construction License No. and Type if Applicable
t-I5 wav(viOt.i -frrreC.t. 16- 0 AA.MiTe.n MA- 6/0)-7
Street Address City/Town State Zip
113 _ry8 ors(, d 450...4,,,..,..eya.A.,...-•evA,
Telephone No.(business) Telephone No.(cell) e-mail address
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❑ No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ 6v6O Building Permit Fee=Total Constr lion Cost x (Insert here
2.Electrical $ 5 b t o appropriate m ' pal fac or) .
3.Plumbing $ 04°
4.Mechanical (HVAC) $
` Note:Minimum f =$ act municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 7 7 DO (contact municipality)and write check number here 3 7 3.
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 ac ate to the bestof my knowledge and understanding.
pbuLk s 6,41(.Jt1 / cow(rGc.Cb r/6(0.4- y 13 5(f f 41 ( 01ay
Please print and sign na e Title Telephone No. Date
i S ILIQ S'l/- UI,Q w 1 Q face E-641-hp61,141 IM 616? 7 016) sec(•vw erbl,s, .Go l
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: 3-zcf-zczy
Name Date
City of Northampton
T A
` w Massachusetts ��. . S��f``
DEPARTMENT OF BUILDING INSPECTIONS �`
t 212 Main Street • Municipal Building 2 ,,,a
' '" Northampton, MA 01060 s �W a7�'�`�'
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: U Pdl LG UV(
I
The debris will be transported by:
Name of Hauler: tkrk roit .6,, i,
3a-�
Signature of Applicant: Pc7 Date:
The Commonwealth of Massachusetts
' _"� { Department of Industrial Accidents
��� »� 1 Congress Street.Suite 100
t?r r �' TI
• Boston, MA 0 2 114-201 7
wwis mass.got/dia
.�. is t»kers'Compensation Insurance Affidas it:Buildersi('ontractors/ElectricianstPlunthers.
TO HE FILED% I I H I IIE PERM!El IM:Al IHORI ia.
Applicant Information y y� - Please Print Leeihls
Mi
lne(I3usines 'Orga /nvation IndtvtduaI): t i>f /1� Cn' T l
Address: Lis- W e 3TUl tAd ilelr'c
City/State/Zip: tiVit p'fib . N. o(b�7 Phone#: /3 I LjS I
Are yule an employer?Cheek the appropriate box: Type of project(required):
l.❑I am a employer with W„,T,..,,wmm ..._c' ogees(full and'or pan-time).` 7. New construction
2.0I am a sole proprietor or partnership and have no employees working for me in M. modeling
any capacity.[No workers'comp.inauranee required.] J
30 I am a homeowner doing all wok myself[No workers'comp_irourart`e required.] 9. ® Demolition
10 a Building addition
4.0 I am a homeowne 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 I i.Q Electrical repairs or additions
proprietors with no employees. 12.Q Plumbing repairs or additions
5 1 am a general contractor and I have hued the sub-contractors Listed on the attached sheet
These sub-contractors haw employees and have workers'comp.insurance. 1 .oRoof repairs
6.0 We are a corporation and its officers have exerciaed their right of exemption per MGL c. I4_ Other
152.$It4i,and we have no employees.[No workers'camp.insurance required.'
*Any applicant that creeks bus.1 must also till out the section below showing their workers'compensation policy information.
r Homeowners who submit this atItdao it indicating they are doing all work and then hire outside contractors must suhnut a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employee. If the sub-contractors have cnployces.they must provide their nt-rl.ers'e.•rnp rolls ntmnber..
/um an employer that is providing workers'compensation insurance Or my employees. Below is the polity and job site
information.
Insurance Company Name:_._ A t i.' L_.�
Policy##or Self-ins.Lie. »: D (O O Ca- Expiration Date: / a
.4 1 G 'rL (o ` . 1 No!'6 ^cc 42n k& gc'
Job Site Address: 1 p'� °� Cityr'Statetz,p: _._..__ .___Attach a cope of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,e25A is a criminal violation punishable by a fine up to S1,500.00
and/or one-year imprisonment,as well as civic penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 certify under the ains and penalties of perjury that the information provided above is true and correct.
Signature:625 Date: 3/? ?/
Phone#: Ltd 3- s4 4 -L6-6
OJjcial 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):
I. Board of Health 2.Building Department 3.City/low n Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
GOODNOW
CONSTRUCTION
"J[t Q- 411 t?V c dizoIa"
Goodnow Const.45 Westview Terr. Easth.
Cs-082188 HIC-195434
Sub Contractors list:
Turgeon Drywall
Wilson Plumbing&Heating
Matt Erickson Electrical
Dion Flooring
Jamie Montgomery Painting
Foam Insulation Jairi
Framing Goodnow Const.