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32A-167 (3) BP-2024-1217 58 HAWLEY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-167-001 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-2024-1217 PERMISSION IS HEREBY GRANTED TO: Project# BATH RENO 2024 Contractor: License: Est. Cost: 3000 RICH DENNO INC 066189 Const.Class: Exp.Date: 10/20/2025 Use Group: Owner: S WADE ROBERT N&AUDREY Lot Size(sq.ft.) Zoning: URC Applicant: RICH DENNO INC Applicant Address Phone: Insurance: 551 FLORENCE RD (413)584-0852 FLORENCE, MA 01062 ISSUED ON: 09/19/2024 TO PERFORM THE FOLLOWING WORK: BATH RENO POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Build in„ Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Dri%eN%ay 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 ' Fees Paid: $125.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner c 0) Sep The Common , ea of Mass'aebse s lili, tz Office of ' • is eit1945 nspections 0 Massachusetts Stat- : tot ./305,dik ) Building Permit Application for any Building o 1 tti�'€At wo- amily Dwelling A 0,0,0 S (This Section For Official Use Only) Building Permit Number:A Y- /?f 7 Date Applied: Building Official: SECTION 1:LOCATION N5�Sjreet ity c City Town Zip Code i - Name of Building(if applicable) f _l J1. e4— 8a 4-•1W7 Assessors Map# Block#and/or Lot SECTION 2 PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building Repair.4. Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No461 Is an Independent Structural Engineering Peer eview req ire ? 0 Yes 0 No+ Brief Description of Proposed Work: ti )-11 p)t 1 ,et-6 v. bk.ri'a.M A eV./ SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 HMI 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3 D I-4❑ M: Mercantile 0 R: Residential R-1D R-2 0 R-3 0 R-41Sr S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB 0 IIA 0 IIB 0 IIIA 0 IIIB 0 IV 0 VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Licensed Dis sal Site 0 Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Po Private CIor indentify Zone: or on site system 0 required 0 or trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes❑ or No 0 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: City of Northampton Massachusetts _._ ' �f DEPARTMENT OF BUILDING INSPECTIONS ,.„ �c-' 212 Main Street • Municipal Building �. Northampton, MA 01060 ssF%h. ,6°' PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL & MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS 1. 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 & Hard copy). 3. Site Plan with location of proposed structure(s) and setbacks. 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 CSL and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (if applicable). 8. Note any Conservation and/or Special Permit requirements (if applicable). 9. Driveway Permit (if applicable). 10. Proof of Water and Sewer entry fees paid (if applicable). 11.Trench Permit (if applicable). 12. Initial Construction Control Documents filled out and signed by the Registered Design Professional in responsible charge. 13. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton SECTION 9: PROPERTY OWNER AUTHORIZATION Name leo/ Address Property Owner - ,"Z t N.�AFriks 4 'Raffia f t Ia r ft o toY/1 1� �'Name(Princde.42,0/e. No.and Street City/Town f )(GCC %laA Zip Property Owner Contact Information t• of £I, -Zl i 0 9WW - - il000ke Title Telephone No.(business) Telephone No. (cell) e-mail address r IA net•/373 @' If appli able,the prop owner he by authors (J /� fr Iv 6vaneet-iiv(. .cthAph ,ietij:_egai yni9- i. 371 or. ._.G Name Street dress City/Town State Zip r to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. rip SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O. Otherwise provide constructs n control to . see section 107 in the code as re.uired. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) —s' - Q Name(Registrant) Telephone No. e-mail address Registration Number ,m Street Address City/Town State Zip Discipline Expiration Date Q 10.2 General Contractor 6k, ---0— Into Zh L V" Company Name \v 'Pt bit D -," 4 v t D414/ f 9 Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip // .10 at B g e 7 - - �14i Y"L4rb /.�t`iella, G Ali ti$/• 8 Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes D No D SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ all C7a) Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)=$ . '3.Plumbing $ // C 4.Mechanical (HVAC) $ Note:Minimum fee=$ ` (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ A .J i ,. 44 contact munici•ali )and write check number here SECTiuN 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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. Q,//i i!� c, hjld__srh-C., en1171NiGti► 4 _1.11_ D 807 Please print and sign name Title Telephone No. Date 51?"7 G/r 44 X 1 fr/rill F 12 L 0/46 1•L 4A,v e-# ./ Street Address City/Town State Zip Email AVIN Municipal Inspector to fill out this section upon application approval: le//L� 19 z2'I Name Date CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton Massachusetts w{ 4 # :G DEPARTMENT OF BUILDING INSPECTIONS ? ,° 212 Main Street • Municipal Building A h A L Northampton, MA 01060 i0 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: Lc I/e 1V (1) The debris will be transported by: Name of Hauler: _Jdl) Ale ewrr, Signature of Applicant:—�� ! z.,, Date: gill) FlL The Commonwealth of Massachusetts Department of Industrial Accidents oil —' = 1 Congress Street,Suite 100 t - tt,_ _ � Boston,MA 02114-2017 -;, f:' www.ntass.gor/dia Workers'Compensation Insurance Affidat it:Builders/ContractorslElectriciansiPlumhers. I'0 BE FILED M 1 111 l 111.PERMITTING AUTHORITY. Annlicant information Plea.c Print I.eoihl' Name(Husutcs,Organization Indsvictual): %e.rdt hha . 14afk Address: ,r'c»r,:,t741 City/State/Zip:/2d/,k4, jeAf.e., Phone#: -SW/•©8 47_ Art year an employer?Cheek the appropriate boa: 'i'ypc of project(required): l.p 1 am a cmploya with etriptoyces(full and+ex part-time!-• 7. n New construction 2.11 am a sole proprietor or partnership and have no enipkyees workona for me in $.1tyl Remodeling any capacity.(No workers'carp,cnaurance F required.) y El9. Demolition 3 D 1 ant a hOnYWW7ttY doing all workinsuranced.myself.[No workers'et1141, require 4.01 am mW a hucwner and will be luting contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contrac-tura either have workers•dampen atton insurance or are sole 1 1.0 Electrical repairs or additions prupnetors with nu employees. 12.0 Plumbing repairs or additions 50 I am a general contractor and I have hard the soh-contractors listed on the attadi d sheet_ 13.0Roof repairs These subcontractors have crripluyem and hasc wonker.comp.insurance.: ti ke arc a corporation and its officers have exenvcd their nght of exemption pet Mt,L c. 14.00t}let 15«§114).and we luve no employers.[No workers'comp.insurance required] •Any applicant that checks bun u1 must atau 1111 out the section below showing their workers'compensation policy information. Homeownerss who submit this affidavit indicating they are doing all work and then hue outaidc contractors moat submit a new affndav at indicating such. tcontreeton that cheek this box must attached an additional sheet show inn the name of the subcontractors and stare 4 hcthcr or:lot those armors-,Ira•.c employees. if the sub-contractors base employees.they must provide then. 0.0:kers comp.policy nwmher I ant an employer that is prot'iding workers'compensation insurance for MS employees. Below is the policy and job site information. Insurance Company Name: Policy x or Self-ins.Lic.4: Expiration Date: Job Site Address: City/StateiZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MCL c. 152,s§'25A is a criminal violation punishable by a tine up to$1,500_0) and or one-year imprisonment,as well as civil penalties in the tbrtn of a STOP WORK ORDER and a fine 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Sitntature: -� ��� c Mite. 7//P64 Phonez: (-3 f)fficial use null. Or'Not write in this urea.to be completed by city or town official. fits or Town: Permit/License Iti Issuing Authority (circle one): I.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Initial Construction Control Document • To be submitted with the building permit application by a Registered Design Professional for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Date: Property Address: Project: Check(x)one or both as applicable: New construction Existing Construction Project description: I MA Registration Number: Expiration date: ,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning=: Architectural Structural Mechanical Fire Protection Electrical Other. for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: I. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3_ Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code_ Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Control Document'. Enter in the space to the right a"wet" or electronic signature and seal: Phone number: Email: Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans;computations and specifications that you prepared or directly supervised_If'other'is chosen,provide a description. Version 01 01 2018 Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107.The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Tel-ephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date - Name(Registrant) Tel-ephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals.