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38B-219 (10)
BP-2024-0382 17 FAIRVIEW AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-219-001 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-2024-0382 PERMISSION IS HEREBY GRANTED TO: Project# 2024 PORCH REPAIR Contractor: License: Est. Cost: 8500 MATTHEW KOZUCH CS-106644 Const.Class: Exp.Date: 09/25/2024 Use Group: Owner: POTTER DAVID R&CRISTIANO A MAZZEI Lot Size (sq.ft.) Zoning: URB Applicant: MILL RIVER DESIGN BUILD Applicant Address Phone: Insurance: 30 BAKER HILL RD 4133418893 WC2-3 1 5-624269-01 3 FLORENCE, MA 01062 ISSUED ON: 04/05/2024 TO PERFORM THE FOLLOWING WORK: REPLACE PIERS&DECK OF SIDE PORCH 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: /// Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 4i The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR I` Massachusetts State Building Code, 780 CMR MUNICIPALITY USE = Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:r3,'20Z4—(9382— Date Applied: /4 VfN /20 53 1/ 14- 5-202.11 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Propel Address: 1.2 Assessors Map&Parcel Numbers - VA t rti; _c.i g.8 2 19 -Oa/ 1.la Is this an accepted street?yes t/---no Map itlumber Parcel Number 1.3 tZ/o� Information: 1.4 �pe�Dimensions: �$ 35 i t 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 Zon ? Public Private❑ Check if yes Municipal On site disposal system [3 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record; . fr T ^ ,Q AM-- a/QO Namerint) City,State,ZIP 11- 'I' w I Q- ck 3 &ye 8'P(3 c f,, F. s,im qzz e:i ,Lo o. co,,, No.and Street Telephone Email Addres' SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) Er Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.❑ Number of Units I Other 0 Specify:� Brief Description of Proposed Work': ill to -e- �1 y e(Y 4de,.t' �C At' colt, lO rc_Gr 1 S`A- 5 ' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ t SCO 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 $ Total All Fees: $ 65 °� Suppression) Check No.2•21 Check Amount: Cash Amount: 6.Total Project Cost: $ `j'S OC7 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-1066,rL' z-V `7 7 f KO2VC`n License Number Expiration et- Name of CSL Holder ' j 3© ( V& � \o, e. i', List CSL Type(see below) No.and Street Type Description VI 0 r' 1\A ^ o(O 6 [J� Unrestricted(Buildings up to 35,000 cu.ft.) 1 �G e/ 1 V�, / R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding I ( �9 r SF Solid Fuel Burning Appliances 3 U O¢G 3 (�:1 l l�‘jj CC ZSQ cAct I,COP I Insulation Telephone Email address \I D Demolition 5.2 Registered Home Improvement Contractor(HIC) f -7 4/ZO L \ 5 .0L& Q HIC Registration Number xpiration ate HIC Company Name or HIC Registrant Name No.and Street PA I l f Ir'1 V ey ice ��lA l� co, t` k 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 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 VA t' f 1j•e �cs iq n Lit Id to act on my behalf,in all matters relative to work authorized by this building permit appl cation. to t S V'f t.c‘ZZe_t 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. 0...-0- Kb-2_ �. 4 6- 7-c( Print Owner's or Authorized Agent's Name(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 H1C 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" The Commonwealth of Massachusetts /, Department of Industrial Accidents _;mil= 1 Congress Street, Suite 100 _ �f= Boston, MA 02114-2017 www.mass.gov/dia I. \Vcwkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aonlicant Information Please Print Legibly Name (Business/Organization/Individual): ,` /1 /J/ !k.I V(' d' , 1 e S /ft R /01 Address: 30 6,3,G.Q,N V t Al ) City/State/Zip: c( EJ e Q..t/1,Le MA 0/a ?.Phone#: L//33l}( S'p'g 3 Are you an employer?Check the appropriate box: Type of project(required): 1.EI am a employer with ,3 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. [ 1 emodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition, 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.0 I am a homeowner 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 11.Q Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.Q Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. \ Insurance Company Name: l Y)-e N\J v a\ ?� / / Policy#or Self-ins.Lic.1 #: W�..�_ J �.S - (�^ l� Z�a1 0 3 Expiration Date: .� Z Job Site Address: t "I Fc.d('V l C. &J ➢e City/State/Zip: F 10 re 4CL_ ©IOG Z Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 certiiffy�under the pains and penalties of perjury that the information provide above is true and correct. ti Signature: •1 K Date:3 3fl`Z-til Phone#: q( 3 La 8-1,3 Official 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • a MAMA City of Northampton ?-. •:- •5\:- ... ..flee'. Massachusetts �: x_ ,, ram; �` L-J4' ,.: .Ki t:',. ,1,: , . ' •� DEPARTMENT OF BUILDING INSPECTIONS �� , 212 Main Street or Municipal Building v/:. • _Ca. ,.-R Northampton, MA 01060 'Ps... •y.-;0. 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: r Location of Facility: \,10,1 kQ,.\ i\e c,� . AA. The debris will be transported by: Name of Hauler: j l,I( ��eC j5iqil �vr/c" ; Signature of Applicant: /2 .- 1 Li,JA Date: Zc ;) 111111111111111111111111111, \ in Ni __.7- , u, , (-- immilmik____ iiii �r ^ - 1 \ (37- ^ 1 ,h x ci, \-• ,I / u) d t- _ -4-