24C-076 (5) BP-2024-0898
24 MASSASOIT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24C-076-001 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-2024-0898 PERMISSION IS HEREBY GRANTED TO:
KITCHEN/MUDROOM RENO
Project# 2024 Contractor: License:
DOUGLAS B THAYER DBA
DOUGLAS THAYER
Est. Cost: 80000 WOODWORKING 107699
Const.Class: Exp.Date:04/07/2025
Use Group: Owner: FRATKIN ELLIOT M & MARTHA A NATHAN
Lot Size (sq.ft.)
DOUGLAS B THAYER DBA DOUGLAS THAYER
Zoning: URB Applicant: WOODWORKING
Applicant Address Phone: Insurance:
P O BOX 60322 (413)530-4785 6HUBGR 15002
FLORENCE, MA 01062
ISSUED ON: 07/16/2024
TO PERFORM THE FOLLOWING WORK:
KITCHEN/MUDROOM RENO, REMOVE CHIMNEY
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: /62.
Fees Paid: $600.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
4.�C i F, 2424
OFpT
The Commonwealth of Massachusetts "o�Ty°q TNo 1NSP
It Board of Building Regulations and Standards o^'.Mq FCr/a �R
Massachusetts State Building Code, 780 CMR C 'AL TY
U
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: .249—•)''',- ;ell Date Applied:
ii
I5�t,r,—) /ss ,�2 7 IL 2ozy
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Addres • 1.2 Assessors Map& Parcel Numbers
9,k) /la 5 5sot1 cj C 07ra CO )
1.1a Is this an accepted street?yes lc 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.I,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check ifycs❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owners of Record:PaelCk �So`^ w JtA
re
Name(Print) City,State,ZIP
Z4 A035aSoA- $
No.and Street Telephone Email Address
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 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
C`
RPYuoc(e ' f i k Ph avt avl 1 FI'kttAve 56,0( p
�v(�0 VA �t�Plpade 1
Q
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 150 00G I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ bcti 0 Standard City/Town Application Fee
0 Total Project Cost'(Item 6)x multiplier0 0.O0t)x-7 -1--
3. Plumbing $ t Q oO 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: a 0 0
Check No.\('}6 Check Amount: \ Cash Amount:
6.Total Project Cost: $ *60 0 Paid in Full 0 Outstanding Balance Due:
4(1141 Si-0 COO
SECTION 5: CONSTRUCTION SERVICES
5.1 C nstruction Supervisor License(CSL) lU 76 q Q 417. 6
Q tc )t S h e q License Number 7 e
Name of CSL der u
U'Street OX GO p2 List CSL Type(see below)
No.andType Description
U Unrestricted(Buildings up to 35,000 cu. .)
1� � lQ flR Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) U r o
oa
9�0 0,0 S Thit tv HIC I4egistrafion Number Expir ion Date
HIC Compar�Nar�or HIC Re grant Name
6O 470,C �O7, u vk¢i I.CO &
No.and Street �� 3
J tJ� II� E ail adds
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 ,► 7 No . ❑
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 DO Ltd .Q,
to act on my behalf,in all matters relative to work authorized by�is building permit application.
db1e 1q (Ro se l 16 q
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.
Vt;e((igs tt _ V
Print Owner's or Alrthorized Agent's Ne(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/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"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
j `4
,,, . s' o c
Massachusetts �4,?f it!..
'` ' ` ' DEPARTMENT OF BUILDING INSPECTIONS Sig
i
J,' 212 Main Street • Municipal Building �'
Northampton, MA 01060 t
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: Va,IL CJ�Q •
C 1 c
The debris will be transported by:
vrNameof Hauler: � �� t) je
Signature of Applicant: Date: 740\
The Commonwealth of Massachusetts
1` ---, �._'t. Department of Industrial Accidents
i.1. 7' I Congress Street,Suite 100
. —-E i.' `` Boston, MA 02114-2017
www mass gov'/dia
No
114 nkers'Compensation Insurance Affidavit flu iklerslCentractors+lEkctrlc nslPlumbers.
TO BE FILED WITH H THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business'Organization,'IndtvtduaI): 1)0111�a.5 ' ' `""get, .. . E
Address: Fa C(1 Go 3 .a _
City/State/Zip: J10./ Pi .it Phone #: 91(3— S i()- V 7 ,S
Are yea as employee?Cheek the appropriate boy
Type of project(required):
1 Ant employer with, employees(full andior part-time).•i7. New construction
Z0 i am a sole prnpriaecv or partnership and have no c k>t c working for sue in 8. ►'`: ' i,ding
any capacity_[No workers'comp.insurance mourred_j
30 I am a homeowner doing all weltmyself.[No workers'comp.insurance required]' lltiort
10(J Building addition
4.3 I ant a homeowner and will be hiring c era zaorx to conduct all work on my party_ I will
ensure that all contractors either have workers'cnamemsation insurance or are ante 11.Q Electrical repairs or additions
proprietors with no employees. 12.®Plumbing repairs or additions
301 am a general contractor and I have hired the sub-contractor hated on the attached sheet_ I 30 Roof tVairs
These wls.cuntramrs have employees and have workers'comp.insurance.
6.0 We are a corporation and its officers have exercised their right of exemptionper Wit_c. 14.0 Other
152,0(4 and we have no employees.[No workers'comp.insurance required.]
'Any applicant that cheeks boat#1 sort ahotili out the section below showing their workers'compensation policy information_
t Homeowners who submit this affidavit indicating they*redoing all work and then hire outside ccuttrectors must:'.ubnut a new atTidavit indseating such.
;Contractors that check this hos must attached an;additional sheet showing the name of the sub•ctvur:o;toes and state whether or not those entities have
. .. •yees, if the sub-contractors have ....loyets.the must ptuvide their workers'comp.policy number.
I are an employer that is providing workers'compensation insurance.for ray employees. Below is the policy and job site
information.
htsurance Company Name: I vova iev f —
Policy#or Self-ins. Lie.#: ( ,Z 1 5 ('Oa J'' Expiration Date: i U J
Job Site Address: r / 1 ac5fk 50r ( S ) City/State/Zip: Nd✓ A
Attach a copy of the workers'compensation polky declaration page(showing the policy number and a pirallan 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 tine 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 untie the pains and penalties of perjury that the information provided a ve is u(e/and correct
Signature Date: 7 4y
Phone e: l (— 510 — 7 7 S
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):
I.Board of Health 2. Building Department 3.City/Towwn Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone 4: