38B-213 (2) BP-2024-1101
18 FAIRVIEW AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-213-001 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-2024-1101 PERMISSION IS HEREBY GRANTED TO:
Project# addition 2024 Contractor: License:
Est. Cost: 900
Const.Class: Exp.Date:
Use Group: Owner: FOELSTER LUSARDI ANNA &MARK
Lot Size (sq.ft.)
Zoning: URB Applicant: FOELSTER LUSARDI ANNA &MARK
Applicant Address Phone: Insurance:
18 FAIRVIEW AVE
NORTHAMPTON, MA 01060
ISSUED ON: 08/29/2024
TO PERFORM THE FOLLOWING WORK:
DRYWALL ADDITION
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: ( P
Fees Paid: $75.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
----` D
The Commonwealth of Massach etts
Board of Building Regulations and anda ds AUG 2 F�'R
Massachusetts State Building Code, 80 • R � 2024 NIC PALITY
SE
Building Permit Application To Construct, Repair, Renos'a - `- •lish a ',•vise• Mar2011
One-or Two-Family Dwells NoarNA, .'_ "�INSPFcri.,
This Section For Official Use Only
Building Permit Number: eP"0,'-{"110 I Date Applied:
s /Z 8-X Zy
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: j-q Riev,„,,,, Ate. 1.2 Assessors Map& Parcel Numbers
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:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' f ecord: Ll
s ) A 50..r4; Po Ala 14c ,1 AA 01 ‘a
Name(Pr' t) City,State,ZIP
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
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ fW I. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 0 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 Fee : �
Check No. `71 Check Amount:
6.Total Project Cost: $ 'Ica) 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Al License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
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
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
A/✓ry HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
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 ❑ 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 a placation is true and accurate s -st of my knowledge and understanding.
iii
Print Owner's or Authorized Agent's Name(E ectronic 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. I42A. 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"
The Commonwealth of Massachusetts
rgiar,1?.' Department of Industrial Accidents
l" =_�N11= s' 1 Congress Street,Suite 100
-4=';Ti�=et Boston, M9 02114-2017
•''; =a,tt' www.mass.gov/dia
11 orkers'Compensation Insurance Affidas it:Builders/Contractors/Electricians/Plumbers.
U) HE: FILED WITH THE PERMITTING AUTHORITY.
Applicant Information �� Please Print Lergihl,
Name(ausint organization/tndwidual): 4 4r f Z -i 4f
------------
Address: ()3 F`'1 vt'ti, A vt
City/State/Zip: Nv4 G I 4 0 Phone #: 7-'1 J - 1 13' 11 S2-
Are you an employer?Cheek the appropriate boa::
Type of project(required):
in I ant a employer with employees(full and or part-time).• 7. D New construction
20 I ant a wile proprietor or partnership and have no employers working for roe in K. Q Remodeling
any capacity.[Nu workers'comp.insurance required_)
9. ❑ Demolition
3 I am a homeowna7 doing all work myself.[No worker'comp.insurance gwn.d)' /� )
4.0 I ant a hum�xow sn ner and will be hiring itr:lours to conduct all work on my property. I will l 0�� t uilding addition l/
ensue that all contractors either have workers'compensation insurance or an sole II MI Electrical repairs or additions
prolmetors with no employees.
12.0 Plumbing repairs or additions
50 I am a general contractor and I have hind the sub-contractors listed on the attached shim i 30 Roof repairs
these sub-contractors(save employees and have workers'comp.insurance. _
6.0 We are a corporation and its officers have exercised their right of exemption per MUL c. 14.Q Other
152..§1(4),and we have no employees.[No workers'comp.insurance requinvl.)
'Any applicant that cheeks box of must also fill out the section below showing their workers'compensation policy information.
t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affrdav it Mliooing such.
IConuacton that cheek this box must attached an additional sheet showing the name of the subcontractors and state whether or nut those entities have
employees_ If the sub-contractors has employees.they must provide their workers'comp.policy number.
1 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
infi,rntation. ����
Insurance Company Name: -_
—
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
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.(K)
and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to S250.00 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 certify under the pai and penalties of perjury that the information provided above is true and correct,
Sitrnature: - 4— Dale: Li L4
Phone#: 1._15 - 87 - 1L, 5-2--
Official use only. Du not write in this urea.to be completed by cite'or tumor official
(`iI, or1os,n: Permit/License
I s'I SS onnL4 A uthurit (circle one):
I_ I34)11t'd of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6, Other
Contact Person: Phone 4:
City of Northampton
.,..,.Sri, N.„ .• s,
Massachusetts ter, k- '<<
c.
{ u; L
-s Ai DEPARTMENT OF BUILDING INSPECTIONS 'i j„
j. 212 Main Street • Municipal Building 'J: c$
Northampton, MA 01060 J's1,y
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: \/evii‘e (Lec..yeituy`'
The debris will be transported by:
Name of Hauler.
✓lif k TD-th-r-r
Signature of Applicant: Date: -34 qI L31
City of Northampton
,‘„,eaAMPj
°.� SAS. siC
Massachusetts �4?. y.. 'e•
•
J { N V
\RFC ��'J DEPARTMENT OF BUILDING INSPECTIONS j j;
212 Main Street • Municipal Building J`, ,
Northampton, MA 01060 SsVh - `moo
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, krk '7/4,186
"� J'V� (insert full legal name), born (insert
month, day, year), hereby depose and state the following:
1. 1 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. I 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 Code'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 persons for hire in connection with the aforementioned project or work on
my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pain and penalties of perjury on this 11 day of Aluci , 202`i.
gite_. pi"
(Signature)
!E2�;
v
\ 14'-6" \
6-9" i 6'-21/2" \ 4'-0"
r I r
4'-9" \ 2'-0" 2'-0" \ 4'-21/2" \ 3'-6 15/16"
4 I --. c42�ti7ai�•1a -1
1 f
I I v
C I I / 1 M
i
n I i I I N
I U / / I I
I
il
14 — I IRI'- I I
I I
/ I I
i 4 .
I Up iNi
ENTRY H o
•
BATH` ,C.H.:8'-6- N I - I CI ,
-t,^• -• '/ it I I
..I o I C.H.:8'-6" ' I
. . 'a 3 I
F.F.:+3";C.H.:7'-8' /� ..: i _ '
•
N i c' o c o 0 of o IJ
I
/ I I
- 3j.. I J m
i
t REV 2568 I I NEW 2668 I ), /
f S1 1
co
co
17
2'-0"
6
C.H.:8'-3"
KITCHEN
F.F.:+3";C.H.:8'-3'
i —
I
vikPROPOSED FLOOR PLAN
3/8"=1 FOOT
BP-2024-0648
18 FAIRVIEW AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-213-001 CITY OF NORTHAMPTON
Permit: Addition
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2024-0648 PERMISSION IS HEREBY GRANTED TO:
Project# addition 2024 Contractor: License:
Est. Cost: 34400 VALLEY HOME 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: FOELSTER LUSARDI ANNA &MARK
Lot Size (sq.ft.)
Zoning: URB Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phonez Insurance:
P O BOX 60627 (413)584-7522 6H62301-1
FLORENCE, MA 01062
ISSUED ON: 05/22/2024
TO PERFORM THE FOLLOWING WORK:
REAR SHELL ONLY ADDITION
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:TU t365 O C (o.2 R 2 4 K
Rough: 4,-W Rough:Y(20�L ott-6J641 House# Foundation:
Final: Final: Final: Rough Frame:C g.7,i•vA cF
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation: 104 8•Zq 2-4/ S#'
Smoke: Final: UK •ter- Zcr SF
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. 77.--21e.
Signature:
Fees Paid: $223.60
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner