32A-079 (4) BP-2024-0952
24 GRAVES AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-079-001 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-2024-0952 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS 2024 Contractor: License:
Est. Cost: 32000 DOUGLAS GOODNOW 082188
Const.Class: Exp.Date: 10/16/2025
Use Group: Owner: KUIPERS CHRISTOPHER M
Lot Size (sq.ft.)
Zoning: URC Applicant: GOODNOW CONSTRUCTION INC
Applicant Address Phone: Insurance:
45 WESTVIEW TER (413)548-4561 WCC-500-5026062
EASTHAMPTON, MA 01027
ISSUED ON: 07/29/2024
TO PERFORM THE FOLLOWING WORK:
REPAIRS DUE TO WATER DAMAGE
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: 172-
Fees Paid: $240.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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The Commonwealth of Massachusetts i i
ai A) Board of Building Regulations and Standards }LW &P N a
WMassachusetts State Building Code,780 CMR MUNI �e1dTY z
Revise�,2011 cv o 0
Building Permit Application To Construct,Repair,Renovate Or Demolish a �i
One-or Two-Family Dwelling U! ..I 22 m i
This Section For Official Use Only W i o
z
�� �Building Permit Number: - • � �+ Date Applied: L _ ~
w
0
Lo ui 6 (-f agb Yo cA41.2— /..t..,_ l oic 7/7.X(29
Building Official(Print Name) Signature ` Date
SECTION 1:SITE INFORMATION
1.1 Property dr 'n S ',4
1.la I1.2 Assessors Map&Parcel Numbers
Iss this an acceptedVstrYeet?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? Municipals(On site disposal system 0
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'o Record;
CiN rDPI� 1�It --t NOfk aMp Mil, a/ 6 60
Name(Print) City,State,ZIP
a- 6r'A.0 -c kJ — 7?9 -910-WI C 'ij, �36 iv f /ali o
No.?In
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) I Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: d.�'s-6- 0 tI M 6-5P, I po-r k (v�/f�'
C„1 ,� ''„v r $ N?iZ✓ pt&-t(..( mot' ) " �t
PRR1flflK TO SSaicej'Rvu(c.. c.-1{ 7 Z.S 2N
SECTION 4:ESTOvrATETION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 3o,vso 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ /NO Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ // eo o 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fe O
I Check No. Check Amount Cash Amount:
6.Total Project Cost: $ 472) 6 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
'' Massachusetts ��s r,,�
L ,):.., .
u :::.1
f/ DEPARTMENT OF BUILDING INSPECTIONS
s,/ 212 Main Street • Municipal Building ..
mow•-- Northampton, MA 01060 si',h 3 ��'\`�
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND 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. Site plan with location of proposed structure(s)and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new / replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW / private land by Building Dept.
13. Stretch Energy Code -all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
O I &$ 6 o4A 'w License Number Expiration Date
Name of CSL Holder
!� W e 51—ka eta./. List CSL Type(see below)
No.and Street Type Descripti0n
fyr► bA 1 i'TVt o i o)-7 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
3 4 � r q o u�__ yak J J�M SF Solid Fuel Burning Appliances
J D �j✓ L' Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ) 1 r(j 3(( (i/a y 1
libeado �/S t, P C HIC Registration Number I iExpliration Date
HIC Company Name orHIC Registrant Name J
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 f 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
I,as Owner of the subject property,hereby authorize ,Do" / 6 a'd ('`)
to act on my behalf,in all matters relative to work authorized by this building permit application.
GJ ct st vefr- kt;p« f 7/etr/d—�
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.
GAS 3 Pie ie&P53 7/01-ri ci
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/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
r ` f Massachusetts A.
* 'At {
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t DEPARTMENT OF BUILDING INSPECTIONS
" 4.` �• 212 Main Street • Municipal Building ;��'
Northampton, MA 01060 ' ,) -.-jt'N�
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 i`r aifil
The debris will be transported by:
/h a-r k1
Name of Hauler: al "" VI f\
Prair`lnSignature of Applicant: , �` Date: �� a
-- The Commonwealth of Massachusetts
ar ' Department of Industrial Accidents
• r.1 1 Congress Street,Suite 100
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• s�
Boston, MA 02114-2017
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%linkers'Compensation Insurance. ffidasit:Builders!Contractors/Electricians/l'Iuntht•rs.
to BE F11t:1)V.11it'I 11E l ERM11TIING AUTHORITY.
ORI TY.
Applicant information Please Print t t.ihl.
Name(13ustncss Organizatiordlndividual): G6 45 d AAP w (0,--f,1 14, i (-
Address: !cJJ9 StL-1 Q-itl "•
City/State/Zip:e6- tk0- triV)^11441°>7Phone#: iiii'S---Y 1- C T(.
_______
Are)out employer,Met.the appropriate but: Type of project(required):
1. •I am a employer with,..__2-----i.nplossca(full:awl of part-ttna).• 7, a Ness construction
2.®I am a sole proprietor or partnership and have no enprkycts working for me in K. CI Remodeling
any capacity.[No wo tkers'pomp.insurance moved.)
9. ❑ Demolition
3.rj I am a homeowner doing all wort myself.[No workers'comp.iraxurame required.]'
10 D Building addition
4.(")I am a homeowner and will be hiring or:nu clo rs t0 et iduct all work on mar property. I will
u ensure that all contntetors either hate woken'compensation insurance ix are wle I I Electrical repairs or additions
proprietors with no employecs-
12.0 Plumbing repairs or additions
S0 I am a general contractor and I have hired the subcontractors limed on the attached sheet. 13_0 Roof repairs
These sub-contractors have employees and hate workers'comp.insurance.•
6.0 51'c are a corporation and nta officers have exac rsed then right of exemption per NW&c.
14.0Other. It/frire-e—
152. 1(41.and we have no employees.[No worker:'cutup.insurance required.] d 6-,h 6-,-4- r'-pAtr f
'Any applicant that checks box n I must also Iill cart the section below showing then w user.'compensation polity information.
'Homeowners who submit this afttda%it tuht:minl they arc doing all work and then hire outside emiras:tors must submit a new affidavit indicating such.
;Contractors that check this box must attached an additional sheet showing the name of the sub-eontnacuxs and state whether or nut those entities have
employees litho sub-contractors have employees.they must pnuvrde their workers'cutup.policy number.
l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. II
insurance Company Name:I', A( Pi Litt'04.
Policy#or Self-ins.Lie.#: W LC --5bS 56)4 " ' ) c.> k6txpiration Date////°%
Job Site Address: (?'kt- Oc-pVd.e S kit- City/State/Zip:/vb1 6171°a AIA °I°6°
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 e. 152,§25A is a criminal violation punishable by a line up to S1,500.00
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 iotator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjusy that the information provided above is true and correct.
Signature:yDate: 7/?J /1
Phone: 2 .5---'-ikr ., YS 6t
Official use only. Do not write in this area,to be completed by city or town official
Cite or Town: Permit'License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City flown Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: