35-156 (12) BP-2024-0726
808 RYAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-156-001 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-2024-0726 PERMISSION IS HEREBY GRANTED TO:
Project# BATH RENO 2024 Contractor: License:
Est. Cost: 6500 DAVID SCHOEN 077835
Const.Class: Exp.Date: 03/16/2026
Use Group: Owner: DAVID SCHOEN, ALISON &
Lot Size (sq.ft.)
Zoning: WSP Applicant: DAVID SCHOEN
Applicant Address Phone: jnsurance:
14 GLENDALE WOODS DR (413)345-0053 Sole proprietor
SOUTHAMPTON, MA 01073
ISSUED ON: 06/12/2024
TO PERFORM THE FOLLOWING WORK:
BATH RENO
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 I.rame:
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: 17P
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Ric •
Cj� t,
Li
The Commonwealth of Massach etts �LN
.W
Board of Building Regulations and tan 6 `Val ICO ALITY
Massachusetts State Building Code, C TNq&���o/ SE
Building Permit Application To Construct,Repair,Renovate Nt' evis d Mar 2011
•One-or Two-Family Dwelling 44°jo6i s
This Section For Official Use Only
Buildinggvii,-)
Permit Number41 ,/cj_7.?6 Date Applied:
a, /� 6-1 Z•20zy
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
808 Aare..,... ILA. ais--. l $ 6 - o a\
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:
Zone: _ Outside Flood Zone?
Public 1 Private❑ Municipal 131<nsite disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
IN ar.j ..fl S L>.,,e,•�.,p 60 t-24\e*.t.. *' .,. 'let 14 . o tom 3
Name(Print) City,State,ZIP
14 44-4,,feria.'•. ,vmti"e. 403` 3 tl$-'toS' Se-Nla..".Q owuks<.e.1v
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) IE4 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: ,
Brief Description of Proposed Work2: Fig-VOW!�N. 150 _4ZNr•*oe,V --'`4)0 (DI )-i(JOC.O
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ /i qbo 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ �- El Standard City/Town Application Fee
� _d 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing S t f,"clp 2. Other Fees: $
4. Mechanical (HVAC) S List:
5.Mechanical (Fire
Suppression) S Total All Fees:kJ
Check No002. heck Amou t: V,
6.Total Project Cost: S 4 8 coo 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
.0-i!.t.?. NS...... S
'! .' M Massachusetts 4 '' Si
DEPARTMENT OF BUILDING INSPECTIONS 7'.
212 Main Street • Municipal Building O. �ca
Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR, ETC.
I. 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 now construction(Gift/Rehab) requires a HERS Rater Affidavit .
10. Please provide the appropriate fcc in the forru of a check made payable to: The City of
Northampton.
.
•
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) c S- O 7Ze 35 ,( 64 (L 6
b�v.1:::. S tt_�a..�Y\ License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) V Ape f(,r I 4#.4.A
(4 6-1�v..X�� _ wr2teziA 'laL
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
60 w 'NYA. O k C Z R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
Se..L...v►A v .4,4i.t Iv SF Solid Fuel Burning Appliances
41/7.. 3 5 -boon, I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
MC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
.s.4.
No.and Street 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 0 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
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.
Xcl�tk.v1 b S�ko�� , ( 7i 'Y
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 HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/das
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
1* c�!/ 'Dt pttrunent of Industrial Accidents
•
�= 1-_ A / Congress Street,Suite 100 .
Boston, MA 02114-2017
www.mass gov/dia
-_ 11 pikers' ('ontpensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
I-0 HE FILED%1 ttH THE PERMITTING At I HORI 11.
Applicant information Please Print 1.ellibls
Name(13usincss-'Ot ntzationtlndnvidual►: I)o j c..4) .______c`LC o_ tr______�----
Address: (4 G l-t-,.,t. t,,--, A 5 t(J tit
City/State/Zip: S 0e.,��rr•.+"J.�eytr. wN.•.r. Phone#: e/3— 3 ../ - — O o ,3.
Are you no employer?Cheek the appropriate but: a 10 7"o
Type of project(required):
1a 1 am a erployer with_ __ c:t rk.),:es 11u1!and of part-time!.• 7_ ❑New construction
20 l am a sole pruprietra or purtnersbrp and hate no emplavexa working for me in K. entodeling
any capacity.[Nu workers'comp.insurance monad.] i.:!
9. ❑ Demolition
3 am a hunxsownet doing all work myself.No workers"currp_insurance required.]"
10 0 Building addition
•ILEI lam a homeowner and will be hiring coniraeturs to conduct all week on my property. I will
ensure that all contractors either have workers'compensation mauraru1 or arc sole 11 a Electrical repairs or additions
proprietors with no employe .
12.0 Plumbing repairs or additions
50 I am a general contractor and I have hind the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance.: 134:1Roof repairs
h.❑We are a corp,xation andits officers have exercised them ngbt of exemption MUc. 14.El Other
152,;ill 41.and we hate no employees.[Nu workers'cutup.insurance required.) .
•Any applicant that chinks box sr mist also fill out the section below shim tag their workers'cunrpeukatton policy information
ttomeow•ner;who submit this atrulavit utdieatitig they arc doing all work and then hire outside contractors must submit a new affidat it indicating rush.
:Contractors that Cheek this box must attached an additional sheet showing the name of the sub-cLVa for and state whether or nor[lime+untie~have
employees_ If the sub-contractors!rage 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:
Policy#or Self-ins.Lic.#: Expiration Date:
cab Site Address: c?s.D QItet-,...._ 1?.e.)... CityiState/Zip: 'tip Y't.ye(ti_.__ v.L.c? 6
A ach a cope of the workers'coinpensatiou policy declaration page(showing the police 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 cn it penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance
coverage vesication.
I do he by certi! niter flee^ ins at penalties of perjury that the information provided above is true and correct.
Shinano G�:c.v- Date: .2
hone#: `// ? - 5 '5 - o
r-
Ofcial use only. Do not write in this area.to be completed by city or town ofcial
City or Town: I'ertnit/License#
Issuing Authority(circle one):
I. Board of Ilealth 2.Building Department 3.C'ityrrown Clerk 4.Electrical Inspector 5. Plumbing inspector
6.Other
('ontact Person: Phone#:
City of Northampton
,! `�f Massachusetts A.
`'\
.A, " dr
t "' 1 I 'is 0 DEPARTMENT OF BUILDING INSPECTIONS s a
,„,, r''i:` ,,, 212 Main Street • Municipal Building J,. `a
V;,,a7 Northampton, MA 01060 �,
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: i1 .6L.1lrl 12_1• L\I cri 1 -tnG _
The debris will be transported by:
Name of Hauler: —0^v i S���`r---
Signature of Applicant: �� Date: 6 ? / Z1.-i
City of Northampton
s,
• Massachusetts e ..
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 b�. .)\
HOMED RS'EXEMPTION ELIGIBILITY AFFIDAVIT
1, (insert full legal name), born _ (insert
month, day, year), hereby depose and st•to the following:
1. 1 am seeking a building permit p rsuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Co•e, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which old legal title.
2. 1 am not engaged in, and the proje,t or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the fief •rection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land .n which he/she resides or intends to reside, on which
there is, or is intended to be, a one-o two-family dwelling, attached or detached structures
accessory to such use and/or farm struc res. A person who constructs more than one home in
a two-year period shall not be considere. • home owner.
4. I do not hold a valid Massachusetts construc 'on supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts 'to Building Code's requirements for the supervision of
the project or work on my parcel, I am not enga;4 in construction supervision in connection with any
project or work involving construction, recons ction, alteration, repair, removal or demolition
involving any activity regulated by any provision o he Massachusetts State Building Code.
5. If I engage any other person or persons for hire in con •ction with the aforementioned project or work on
my parcel, I acknowledge that I am required to and will ' t as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day o 20_.
(Signature)