38B-038 BP-2024-0697
14 LASELL AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-038-001 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-2024-0697 PERMISSION IS HEREBY GRANTED TO:
Project# STRUCTURAL REPAIRS 2024 Contractor: License:
Est.Cost: 28500 ROBERT WALDEN CS-075223
Const.Class: Exp.Date: 11/27/2024
Use Group: Owner: G. GEORGE, MICHAEL
Lot Size (sy.ft.)
Zoning: URB Applicant: ROBERT WALDEN
Applicant Address phone: Inurancel
PO BOX 604 (413)695-0539
GOSHEN, MA 01032
ISSUED ON: 06/04/2024
TO PERFORM THE FOLLOWING WORK:
STRUCTURAL REPAIRS AND ADD BULKHEAD FOR BASEMENT ACCESS
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: 72_
Fees Paid: $185.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
Cmoti ‘• en 91ore e 49elyeofora /ei.e -
RECEIVED ,a,u p/Qii51Lo •v /&ct °4s
he C mmonwealth of Massachusetts
''Y Bo rd of Building Regulations and Standards FOR
v 3 C�24 MUNICIPALITY
Ma sachusetts State Building Code, 780 CMR USE
DEFT.OF sum' •1"=' 'i 0!it Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
NORTNAVIPTON r,%A o,oeo One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: B U • -1-`'1` o'7 Date pplied:
j/ ,, -- &5, /& 6.3 Z62/
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property
Address: P t A. F 1 1.2 Assessors rs�Map&Parcel Numbers
g
1.1a Is this an accepted street?yes no J " ' Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:L J F? Mt L -2/18 1 4,0
Zoning District Proposed'Use Lot Area(sq ft) Frontage(II)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
fo ' zo ' t5' /CD l /1 ' v ,S '
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public l Private 0 Zone: _ Outside Flood Zone? Municipal% site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
AA 1 thi-E l-2- is Fa 26:1 E j4avt-AI- To D 1 aid
Namd(Print) City,State,ZIP
°v h C,II.EsG T S-1--- 4 (n2, • I `i4 ry%GEa1 er"~ ef +.1t,(-OM
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building Owner-Occupied 0 Repairs(s) . Alteration(s)A Addition 0
Demolition ' Accessory Bldg. 0 Number of Units 2... Other 0 Specify:
Brief Description of Proposed Work': 6-FLU C111t -- G f1,Fvu1 10&I I v..t
f- sir Ito r t.l.s Art—T -R-T1D"- S "tom
tt,t A-P4 -rt E o n�-�,d 6 uC-1!-- i ft-c-c FS 5
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ �2��cn I. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ CIStandard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ i
Suppression) Total All Feel, Ql
Check Not 1 vCheck Amount: ` V�
6.Total Project Cost: $ 2 lr; , Cl Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-675av3 027/076.?y
/`Dtj.i f toA-LQtT/ License Number Expiration Date
Name of CSL Holder 1
List CSL Type(see below) U
141A-114 S PG 4 0)( le o y Type Description
No./ and Street
�P D5 7V /✓(A- 0 1632 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
41?(09 O53gr n9cl law fi it o4"maII, Cory 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
£44'L /3 1��0�3 oB/d3iono�y
Xoi36- r 1-
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No aat ndStreeA S tied/&4Jvl Q ho-f-Ina i I. CA'm
t
th0 5 NZ-ry ✓IAA' G l b 3e)- c/C3-(o9.5—QS3 9 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 .O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize C2d'L v\\ A-1 C /2--1.—..,
to act on my behalf,in all matters relative to k auth ' ed by this building permit application.
`t �,t,.
1 .e .,r 1 c-- Z
PPnnt Qwner'same(Electronic gnature ate
SECTION 7b:O RI 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.
Print Owner'sor AuthorizedAgent'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"
File #21
APPLICANT/CONTACT PERSON:GEORGE, MICHAEL G.
P.O. BOX 102 GOSHEN, MA 01032
PROPERTY LOCATION 14 LASELL AVE
MAP:LOT 38B-038-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid' $30.00
Type of Construction: ADD NEW BULKHEAD FOR BASEMENT ACCESS, ADD 2 ROOF CANOPY
EXTENSIONS
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION
PRESENTED:
i/ Approved Additional permits required(see below) For all projects that need additional reviews ci :. 0.
as checked below,please see the Office of Planning& SustaPermitpage or scan here
inability �•7 6 �_•.
PLANNING BOARD PERMIT REQUIRED UNDER:§ * t •
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
/77-Z 3- 22-ZOZL1
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all
required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit
granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&
Development for more information.
........
E4c CE1'',. ,.
l File No.
1 I MAR iq 2024
I I.___. .__.__�... -..ZONING PERMIT APPLICATION (350.4.4)
t _.. ' Please typd'''iP this fillable PDF or print and hand-write all information and return to
the Building Inspector at the Building Department (212 Main St.) with the $30 filing fee by
check and money order (payable to tpe..City of Northampton) or credit card (in person only).
1. Name of Applicant: Mx d/1i) o (' �( Email (reo/ (, r� #�ear�j�I�/�Q ie . Ci
c 1 �
Address: G � �SL�¢.�(J �/f(` lephone: L11,� ---(') b ,Li
2. Owner of Property: 1 ei'1,13 Q Gr cO\{) V--
Address: I1 j 'J Ni /Ji' 1
L.I j4 —(. tV "'telephone:
3. Status of Applicant: Owner Contr ct Purchaser Lessee u Other (explain)__.
4. Job Location: • (:)
Parcel Id: Zoning Map# Parcel# District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING D PARTMENT)
5. Existing Use of Structure/Property: 1 . �t 11 .1 .{/Yy \-/a.'1
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
TE i& cC E S
E L4o izaOF_l.41/4-►,Lo r L 1 Ey---r- -b5 tot 3 2, C. --
6-1-rirti 5-1 -~(> 5
7. Attached Plans: Sketch$lan _I I Site Plan • Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW El YES u IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ___a_ DONT KNOW YES
--- IF YES: —enter Book------ --gage -- ---- and/or Document-4
9.Does the site contain a brook, body of water or wetlands? NO 1 -_ DONT KNOW _ YES Ill
IF YES, has a permit been or need to be obtained from the Conservation Commission?n
Needs to be obtained l 1 Obtained , date issued:
(Form Continues On Other Side)
6/7/2023
-- -- —
ll I
Hwow
p1A�/wM-C[D
At
Al
LEGENQ l T....,....AAI.
. 000 PM Pam
• N.OM 1.000
O 0001 tunic
b VTa1T'POLO T EPROM
O OAVTARY PVAMTXI .n
2SUMINARY
•mp
• for A s
e MMTOI IM/TOP
0 0. 04 a- o_ o. o. 0I w,----w 04 - oa-- UM r I
TF wcouwr .VOlOR10P p
- 110M OP PAYRCIr m LASELL AVENUE z I
o1ow.Ao MIIO► \ — ,--
!i
- Oa•cA1R MO
001Yw010 ° A»' -\ AI'W-- iMM 1 _. t rQ
t
I rE14-1 ! li
,. ,
MOOR T.PVNTAPi $ t'OT c.&.as Etti-p
40[p MI 100MOTEAL ,- - TA[IT..r �T (-i� t
r[as . sanlXireoc "r / Fir•DOURO 7 q
ta
f II"111 ' 14 ! s
•
fa mA1 PLAN NOTES. + \\`�.X\\\•1\\ L I
1OM nfu Y100MC0 t•OMw.0.MOM RR Mw PAii M 1YI �• \\ 0110tOC f.T11A01 7XJIMMY Pt M• 0 Y`A r�!
TAX MP MO LW M VAT °01 � I KW OM►Ail Pa �+
.O K MO PAM a TAX T 0.
a TVO:RM[C OMIT 10110. t l W1f'YA N[l�O. TAX T i N LOT o
XLL-0Yd'mXO.AI NFTECi.t•.A E10,IMG XOr Y
a PICTIRTT NMO 0001 MOW N.ATROOMTI AM M[OA0f4 001 S
IOW AVAWOOOM. IMTAT0 1OX 1ATOO 1M M,1M ME AOR 10IMPSWN11H O.010 •'OCR•Q K • a
IMPS MO AYMARA RAO.
la POOR w
TAX IVII10 OPO
A OVnATOw OYOM AR{MOO W M MOO.®WTV,. I.Qf is
.10160... —MEL-
a Y1amR MOB mow R M M.OX 00 MT OLT AO a 015Tw• Gila SGi
MAT 11Or R OAOR POOR TO AMT f.00TIMTXOA TM[•111TTTO
OMX.00TACT'0 04. AM MVO ALL 00011R000 VTarT10 11I-- L'L�
nAOWOO a/M MOM.
lair— —
A 10100I0.1 AOOAM 014.0K OJr M1 LAME,TO PLOOMAOL OaA10
SO Ram,OYMT O AROA(RA),AMO 016 0000 YO01AT1O 1011.001
WOW
1TC}MT 01 PROM.01 TM SIT. METE AROM 1MVT MOT Om/ OtM•OO.000DM
[004-T ET ONIN MOM w1 AOCVT[0 OY T 0 9. IOW RROra
DOAart0n a OM004.0 E 000.00W(OII). An 1lr,114[ TA.[O...�•
Ana.O L T In C POMO R OMOOAO'M 410MTf.TM
RAM OWL M R OfOW TIC a.,0100 MCAT.* MIN MO N ARIAS AXj\)-2S-43-OOt
$am4T TO MM.00 CO TM 1CT1.MV NC M.V V11PR
R1O11a0OX AWE A VS.ART'QM0 w 011.1101(COArO) n.s orw Tn.
0meeTw 0001 A
r
Commonwealth of Massachusetts
qtDivision of Occupational Licensure
Board of Building Re ulations and Standards •
Cons tw• rvisor
' CS-075223 _ I pires: 11/27/2024
ROBERT T W/tLDEN t
2 MAIN ST/P.D.BOX604 ;,.
Cornrnisstone
GOSHEN MA'11032
�O(yVd1'3 J
..:.:.?.2.3.4._., V.
T. . ......
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs 8 Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Individual
Registration Expiration
162073
ROBERT WALDEN
ROBERT T.WALDEN
2 MAIN ST a./..Glpk'
GOSHEN,MA 01032
Undersecretary _
City of Northampton
'
Massachusetts `��
141L " ' DEPARTMENT OF BUILDING INSPECTIONS Pt
"" -r 212 Main Street • Municipal Building O\ ,1�
Northampton, MA 01060 'rf1%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:
Location of Facility: v/t tt-y CL/cL /NFr 23 y E I1-S7? a77r, ,2 p
The debris will be transported by:
Name of Hauler: &bta&C
Signature of Applicant: Date: 2 C/
The Cottuuonlcealth of Massachusetts
'k„..
Department ojlndustrialAccidents
'�I �y 1 Congress Street,Suite 100
r : Boston, MA 0211 d-2017
ass N r
.�.,� www.mass.gov/dia
11 others'Compensation Insurance Affidavit:Builders/C:ontractors/ElectricianslPlutubers.
TO HE FILED wrut TH4 PERMITTING AUTiIORrrv.
Applicant information Please Print Leeiblr
Name(Businc organrrgtiorb1ndnidual): Ge'z iz C Petio '9vi //✓C..
Address: 3 ge72eS/4/2C- 172,416 cei 577 N eo x- /®a
City/State/Zip: G1 G 5 , / I14- 0/03g Phone#: 4//a-a 4' 8 -3 3(o 0 _
Are you an employer'?Check the appropriate boa:
Type of project(required):
1.®I am a employer with 33___employees(full and'or part-time).• 7. 0 New construction
20 I am a sole proprietor or partnership and have nu employees working for ore in S. ®Remodeling
any capacity.[No wutbars•comp.insurance required.]
30 lam a hoeowner doing all work myself.[No workers:rental.insuratre�e manned.)'
9. ❑Demolition
m
4.0 I am a honowner and will be hiring contractors
to conduct all work on my property. I will
1 0 0 Budding addition
at
ensure that all contractors either have workers'cornpennelson insurance or are sole 11.Q Electrical repairs or additions
prtrprictors with no employees. 12.0 Plumbing repairs or additions
S0 I am a general contractor and I have hired the sub-contractors listed on the attached Meet13 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.: _
61:1 We arc a corporation and its ufficea have exercised their right of exeurption per M[iL c. 14.0 Other
152,¢1(6).and we have no employees.[No workers'comp.insurance required.]
`Any applicant that checks box al must also fill out the section below showing their workers compensation policy inforrnation.
°Ilonrcuwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new atTulav it indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and ante whether or not those entitle,have
employee.- If tb.sub-contractors have employees.they must pros ide their workers'comp.policy maab:r.
I am on employer dust is providing workers'compensation insurance for my employees. Below is 1he polity and job site
information.
Insurance Company Name: /in O672 /(141 //V S(J 2/1 N� Ca r
Policy#or Self-ins.Lic.#: L-C4Pa 1,L�C-t(r.-. <DOC//O-S"OO Expiration Date: 0510//o0a-6--
Job Site Address: I f//& C..A 5t-I L Alf City/StateeZip: ,/V, 2M-A, it//N/o-D/OGo
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 S1.500.00
andlor one-year imprisonm t.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator. co 'oft ' s tement may be forwarded to the Office of Investigations of the DiA for insurance
coverage verification.
I do hereby certify under the ins and allies ofperjurr that the information provided erbot•e s true a d correct.
Signature: D::t . 3- 31 z
Phone#: //3'oZ67 - s.:"3(vp --
1'
Official use only. Do not write in this sa•ea,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#: