11A-008 (3) BP-2024-1090
37 EVERGREEN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
11 A-008-001 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-2024-1090 PERMISSION IS HEREBY GRANTED TO:
Project# DECK REPAIRS 2024 Contractor: License:
Est. Cost: 18975 EDWARD RICKEY 96159
Const.Class: Exp.Date: 07/13/2026
CODDING ELIZABETH A. &KRISTA WATHNE CO-
Use Group: Owner: TRUSTEES
Lot Size(sq.ft.)
Zoning: URA Applicant: EDWARD RICKEY& COMPANY
Applicant Address Phone: Insurance:
80 SOUTH ST (413)695-7059
CHESTERFIELD, MA 01012
ISSUED ON: 08/26/2024
TO PERFORM THE FOLLOWING WORK:
REMOVE AND REPLACE EXISTING DECK IN SAME FOOTPRINT
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: $143.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
.r
RECEI
ED
&, The Commonwealth of Massachu tts AUG
• Board of Building Regulations and S dar 2 6 �424 / FR
�Vti Massachusetts State Building Code, 7 0 c S ALITY
�,T OP ise Mar 2011
Building Permit Application To Construct,Repair, en ®n N. ,�c oNs
One-or Two-Family Dwelling �A°t°s
This Section For Official Use Onl
Building d Permit Number: • Date Applied:
40„.../z, 1l4 6-2(...zom
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
31 f , Rd.
1.1 a Is this an accepted street?yes_ t/ 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
76' 7'j' 3 19' 70'
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 SewageDisposal System:
Public Cli Private 0 Zone: - Outside Flood e? Municipal li /On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1,,awner'of Record
k' <I rza6t A t �ald T49 k' 1.,ted c �I A 053
Name(Print) o City,State,ZIP
\ - 7 (u 1I r-c I kl09isri v/ 0-0eodd:^1 G,9n/ NMI
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building tli Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units I Other 0 Specify:
Brief Description of Proposed Work': "fit � 3 ateacr.. 0 &,L Ark
(5[1 n u.fircrie r1 r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ /S, 77 j,Oo 1. Building Permit Fee:$ Indicate how fee is determined:
2 Electrical $ Cl Standard City/Town Application Fee D
0 Total Project Costa(Item 6)x multiplier x 7
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Total All Fees:$
Suppression)
Check No. ' eck Amount:-I Cash Amount:
6.Total Project Cost: $ /? 9 75 0 Paid in Fut 0 Outstanding Balance Due:
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CJ - 016151 /3 0,24
(d/u z.cL ��,,,�y License Number on Date
Name of CSL Holder /
List CSL Type(see below) 0go -21e0A-i& ..42,t
No.and Street Type Description
PIA oio/2 U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,St e,ZIP R Restricted 1&2 Family Dwelling
_ M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
4//3 6?S 7es9 r,c. !/14:Me;n�p�vyern4,rfkeo I Insulation
Telephone Email address ,ca... D Demolition
5.2 Registered Home Improvement Contractor(HIC)
li Con HIC Registration Number E ' on Date
HIC Jame HIC Registrant Name
No.and Street �1 Email address
')))'7 Olcsi2 1 cji3 -67S' -7oS7
City/T��te,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 I • ce of the building permit.
Signed Affidavit Attached? Yes 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 i L te4.44
to act on my behalf,in all matters relative to work authorized by this buildingpermit application.
xit, bc,4L A Cock firq k g iv//z/t
Print Owner's Name(Electronic Signature) I. 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.
' c eY ) ay
Print Owner' Authori Agent's Name(Electronic Signature) Date
NOTES:
I. 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.govr oca Information on the Construction Supervisor License can be found at www.mass.govidps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,fmished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half7baths
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: /14.61
REAR YARD 7
0r0n +
' n I
SIDE YARD 79 _� --� - SIDE YARD ft!Oil
r M
FRONT SETBACK 76 0
FRONTAGE I5q.04
The Commonwealth of.Ilassachusetts
c - Department of Industrial.-(ccidents
1 Congress Street,Suite 100
triIr` Boston. MA 02114-2017
• www.ntass.go►'/dia
11+ukcrs" ('uutpensatinn Insurance Aflidas it: Buildersl('ontractorslhlectriciansiPlumbers.
to RI I'LLD 5 till 11W PEttAtu TIM Al itI0R1 11.
Applicant Infurtnation / Please Print I.e��ibls
Nln't1C(Bustn. .Organization Individual): cfIu Lo Z /,fit / 3 ,
Address: Y0 .nObw(l a
City/State/Zip: Osuldi,71L4 O/oI Z Phone 0: 5//3 -C9s 70S9
ter yaw as arphw Cheek doe apprepelem haw
Ty pe of project(required):
14:1 1 ors aerepfayee with etaph►yars(oast!andsit pattdmrt.' 7. 0 tic-tit"construction
2.60 I am a sole ptwpnetor of partnership and have no employees working tut the m 8. ®Remodeling
any amacity-(No workers'camps iwranx rc amid/-}
AO I am a burn►vwner doing all wank myself.No workers'comp insurance r.yuu.d]° 4. Q Demolition
a.Q 1 am a h*na►rwtier and sal be hying ooreravt m ev to r ka.-T an w ur&on my property 1 aid IO Bttlldut;addition
ensure that all contractors either hake winker."compensation insurance or are sole II.a Electrical repairs or additions
proprietors w rdr s►etlipiuy ,4Y}.
I2.0 Plumbing repairs or acWttton.
I am a general neral iamb-actor and I have hued the tarb'euntractura lasted on the medial sheet
Bits sub-aoasewrs Iwo employees rod bent wartressi coup.war:aY.' 130 Roof repairs
6 JJ We seea amputates alai its otit ea have exercised their tight el sacra atua per thin.c. 14.Q Othet
I52.41(4 aid we have ao employees.(No wortata comp.insurance required./
Any a0 plitau tint*Antis bias 0i acetic aka.till out the denies lithos showing then was'o>rta<viwation policy hat raaaaon
lk n►onwners nho submit this affidavit tndw:emi;they arc doing all work and then hire outside eontraeturs mica submit a TWIN affidavit indi.,tmg such.
Curio tans that cheek tins base must attached n additional sheet show n*g the chute ut the s;o era l rs and stab M 1 icier ut nut those colitis-s has e
'-aimoye.-s_ lithe sub-contractors fuse employees.they must pnvtd.their wutkers o mp.policy number_
am an employer that is providing markers'ca prawnua irtsrruac!far no employees. Below is the policy and job site
information.
Insutrtr!,c( .trtlpdny Name - _
Polar`) t.r Self-ins.Ltc.1P: EA Malkin I).:i..
Job Sete Address: C sty.State Lip: —
Attack a copy of the workers'compensation policy declaration page(Aiming the polity number and expiration date).
Failare to secure coscrage as required under'MGL c. 152.§25A b a criminal violation punishable by a tine up to S 1.5tX)_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 S250.00 a
day attains*ties iad.ttor.A copy of this statement may be forwarded to the Office of lnsevit}Latitnts of the DIA for utwrmee
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true aicd correct.
Signature: elteu.e t/ �.t l.[ 1) :: 'Jr
Phone �/
Official use only. Du not write in this urea.to he completed by cite'or town official
('its or Tow n: Permit:License
Issuing.luthorih (circle one):
1. Board of Health 2. Building Department 3.City Tussn Clerk 4. Fketrieal Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone 4:
City of Northampton
., - eti
, 1s s •• sic
' Massachusetts '�
ft, �i k, ••-!° DEPARTMENT OF BTJILDING INSPECTIONS i
.. - 212 Main Street • Municipal Building �- QD
mer '- Northampton, MA 01060 �srh, •^J
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: 1447 &il
Location of Facility: pYA 0 f O (7
The debris will be transported by:
Name of Hauler: L4, .L '-c,ceiii
Signature of Applicant: Cu�-� ,,c1 Date: V,V,;(751
City of Northampton
'.rltly,
•'' ti.-, Massachusetts v?S ('•
I- 44 DEPARTMENT OF BUILDING INSPECTIONS Q }
- 212 Main Street • Municipal Building
�' Northampton, MA 01060 st/ 3O\14C�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
1, (insert full legal name), born _ (insert month,
day,year),hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Massachusetts State Building Code,codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. 1 am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s)who owns a parcel of land on'which he/she resides or intends to reside,on which there is,or
is intended to be, a one-or two-family dwelling, attached or,detached structures accessory to such use
and/or farm structures. A person who constructs more than one home in a two-year period shall not be
considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for
and will abide by the Massachusetts State Building,C'ade's requirements for the supervision of the project or work
on my parcel, I am not engaged in construction:-supervision in connection with any project or work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or perso�ls for hire in connection with the aforementioned project or work on my
parcel, I acknowledge that I am re ' d to and will act as the supervisor for said project or work.
Signed under the pains and penalties o ' ry on this day of
(Signature)
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