43-148 (12) BP-2024-0790
111 WHITTIER ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
43-148-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-0790 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 2024 Contractor: License:
Est.Cost: 12000 JAMES ROSS 104530
Const.Class: Exp.Date:01/21/2026
Use Group: Owner: CONSTANTINE RUTH H
Lot Size (sq.ft.)
Zoning: WSP Applicant: JDR BUILDERS
Applicant Address Phone: Insurance:
PO BOX 66 (413)374-7983 WC9024479
WHATELY, MA 01093
ISSUED ON: 06/26/2024
TO PERFORM THE FOLLOWING WORK:
12 REPLACEMENT WINDOWS
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:
coati: 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
.2_
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
s The Commonwealth of Mass husetts JUN 2/ ),),„ 1
Board of Building Regulations St" s c OR
a
ti CIPALITY
Massachusetts State Building Code>8 ,44, ,A, USE
Building Permit Application To Construct,Repair, Rcnovat • a R ised Mar 2011
One-or Two-Family Dwelling �Ao'oso04,
This Section For Official Use Only
Building Permit Number: Ai'--4).44-7g 7 Date Applied:
Ito 1.5s 1///Z 6 zii Zvzy
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 I Pro{�e�r�' 'i
Address: C 1.2 Assessors Map&Parcel Numbers
�/
r 1 1 h <r' f o,r`d,1 c_k_ M A
1.1a 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:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' f Record: ,fin
1 tk Ast-a!MI ill— c-lore nest 1"lA Oi42
Name(Print) City,State,ZIP
111 1A/�hi/tier 5fi /o. 14i3 s- $?S2 rco4S'fraA @ Nwt(,Con\
No.and Street Telephone Email Addr
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:/in a 011.5 (/2)
0.•Z 7
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire -----. '
Suppression) � - Total All Fe f
trip ) Check No. 1t U Check Amount: `1 v
6.Total Project st: $ 4 ,0v-,, 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) cc 104 S 3J uf-2!` 26
l l e X A A Jtr I C v C S License Number Expiration Date
Name of CSL Holder
v .)"2"
z List CSL Type(see below)
No.and St t Type Description
(e�1i4 /y Mc- 01093 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
L'I13 3 7/ Cot(
A k y e?Q/� i I �� SF Solid Fuel Burning Appliances
1< �J I Insulation
l elephone Email address D Demolition
5.2 Registered H me Improvement Contractor(HIC)
5D,2 ,; J��s ill C JV q 7ss 3- 9 - 2
HIC Registration Number Expiration Date
HIC Company N e r HIC gi r t Name
( 7) S cp f .l. Mu Glc93 Ivey 0 I-012 Bo: 1J.N. Ccfrs
No.and Street Email address
u/3 37Y s 0‘/
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 Pi( 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 A I e 'Ai-der (pS C /3.� R Qw I eler c ,n C
to act on my behalf,in all matt elative to w thorized by this building permit application.
Ciith(1,01506-i-in.k.. 4(f(vi
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest undo-the pains and penalties of perjury that all of the information
contained in is a plication is true and accurate to the best of my knowledge and understanding.
/}& CA1cr fCSc 4-ZI— Z`l
Print Own s or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building pennit 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
Nwnber 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 Contnsonwealth of.1Iassuchusetts
tt==y11=el Department of industrial Accidents
= vi1- 'i I Congress Street, Suite 100
.ii;= Boston, MA 02114-201'
• tia�asy wwte.niass.got'idt i
1l urkers' Compensation Insurance Affidas it: Builders,( untracturs'hieetriciansrl'lumbers.
IA) BE FILED S%I III 711E l'FR II I t IM:At IIIURI 11.
Annlicant Information 1 Please Print Lecibls
Name(Business, n rgantrntion'Individual): ID IC I.?.. 1 Cie
S i 4 L
Address: i 7 7 S9 Roc I
City/State/Zip: W L fr/ 1 M'' "+t'9 3 Phone #: C1f3 ? 7 V -SoC/ �.
Are you as employer?Cheat the appropriate box:
Type of project(required):
I. I am a eugdss.r nntth __A___crnployYcs(full andot patt-time).' 7. O New construction
2 0 I.,tit a Ito kc proprietor or partnership and have no employees working for mac in 8. Remodeling
any..rl'acrty.]No workers'comp.insurance neyuircal I
9. Demolition
30 I den a hunico%net doing all work myself.]No workers'comp insurance required)'
4.0 I sm home ow Iwnuw net and will be hiring eontraeturs to conduct all work on my property. I will
10 O Building addition
emus that all contrastun either base worker.'esxrapenutron insurance or are sole 11.0 Electrical repairs or additions
prupneton v.ith no employees.
12.0 Plumbing repairs or additions
Sc=1 I am a general contractor and I base hired the cob-contractors listed tin the snatcd sheet
These sub-contractors hase employees and has a workers'comp.insurance. 130 Roof repairs
l4.0Other
6.0 R'c are a corporation and us officersbaveexercised their right of esenaptiun per hfGL c. ----
152.$1(4),and we base nu employees.[No worker.'comp.insurance required.]
'Any applicant that chocks box al must also till out the section below showing their workers'compensation policy information.
r Homeowners who submit this affidasit indicating they are doing all work and then hue outside contractors must subunit a new atlidas it indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities Iawe
.-employee-s. lithe sub-contractor lane employees.they must pros ide their s.orkera comp-pulley number
i am an employer that is providin,tg reorhers'compensation insurance for ntt'employees. Below is the policy and job site
information. Sr I CC iI (4 `
W Insurance Company Name:
n
Policy#or Self ins. Lic.#: qD )' 'i _1 v -)9 , Expiration Date: ( - 2 9- 2
Job Site Address: 1 l4 L:flier S t City/State/Zip: 0 of 1-1,,,pIoh I^-'3 S.
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 S 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 S250.00 a
day against the s iolator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certi .fete the pains t id penalties of perjury that the information provided above is true and correct.
Stt;naturr: I)alc >t/— Z ( _ Z
Phone ::: LI/ 3 -7 7 q — CC- i
Official use only. Du not write in this area. to be completed by city or town official
('ill or Town: Perntil/I.icense b
Issuing Authorit) (circle one):
I. Board of Health 2. Building Department 3.t its[l-awn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone 4:
City of Northampton
j�'•..- Massachusetts A. *).. e
1I ,' ' DEPART?. NT OF BUILDING INSPECTIONS S A1. ,
�'+� '�` r 212 Main Street • Municipal Building Jk. OD
- 141Z/ Northampton, MA 01060 J• 3;O°�
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 ✓'!1, y pe CyC/'"J
The debris will be transported by:
Name of Hauler: TO R &o, /'-rs
Signature of Applicant: Date:
44P--------- (P-?/ - 2