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43-010 (4) BP-2024-1265 115 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-010-001 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-2024-1265 PERMISSION IS HEREBY GRANTED TO: Project# STAIRS 2024 Contractor: License: Est. Cost: 2000 Const.Class: Exp.Date: Use Group: Owner: SULLIVAN PATRICK Lot Size(sq.ft.) Zoning: WSP Applicant: SULLIVAN PATRICK Applicant Address Phone: Jnsurance: 115 WESTHAMPTON RD FLORENCE, MA 01062 ISSUED ON: 10/02/2024 TO PERFORM THE FOLLOWING WORK: REPAIRS TO FRONT ENTRY STAIRS 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: 472 Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ��u c WI, The Commonwealth of Massac 'setts sep /�Board of Building Regulations and . �0A s R S' CI' • LITY Massachusetts State Building Code, 78 t ii' rti 4e ��I U U . . Building Permit Application To Construct, Repair, Renovate 4 z -. •lish a evise• ar 2011 One-or Two-Family Dwelling .4'�;s,, This Section For Official Use Only go' ,otc Building Permit Number: AP -) y- /26 ti" Date Applied: ,efut...) s.--, /4)47621 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Addres : 1.2 Assessors Map& Parcel Numbers iitf i IC a>�i•'wrif o6 Ft,reNc Mk �C71,Z 43_ Ow— Go % 1.1 a Is this an accepted street?yes LA no Map Number Parcel Number 1.3 Zoning Information• 1.4 Property Dimensions: �eS.dgift;a( it-It�ll-1 !00 Zoning District posed Use Lot Area(sq ft) Frontage(ft) 1.5 Building SetbacksPro(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 Sr Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ('d' Check ifws❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 ner'of Record: a rA et( rt �cLGi v� FL��tAIe ' ,,� o Z N e( nt) City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s)tit. Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': RQQ(xd .Croat'' entf 64.14es to eei Vl + f lu-LL Fro nfi ektheruN %tared r4;r i S decLiA boa. aS GO eaCh l l►nS p&s ii Y LexA/ ! ! ! A.)* fort;h dock (fri +vy kgre (m.t.t55010 _. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 2_1000 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.allICttttal $ ❑Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanics& (HYAC) $ List: 5. Mech Suppression) ^ $ Total 'F ChetCheck Amoun 19 6. Total Projectinpat: $ Z,tro-O 0 Plid4 ull 0 Outstanding Balance Due: ION 5: CONSTRUCTION SERVICES 5.1 Caastruction Supervisor License(CSL) 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.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,State,ZIP Telephone () ECTION 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........... ❑ 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 4 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. j/,-7tiC-/- M 5a tiV/0 47 f 3 u/ L i 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 What substantial work is planned,provide the information below: Total fl ilea(sq. ft.) a ryr1 (including garage,finished basement/attics, decks or porch) Gross liviot area(sq.ft.) Habitable room count Number of*plhpes Number of bedrooms Number Of bathrooms . . • Number of half/baths Type of hag system Number of decks/porches Type of cooliqspittel Enclosed Open C i 3. "Total Project Square Footage" may be substituted for"Total Project Cost" \A-0 * ,S/ l ,r' 1E >> Sdji, t I SSW S./tas!--, 2/IL m�S � ��'; c _,..„ oc...F .Q.,...,,,-,--14, N . / [ ugh ems) ' S \t P r 0-DS City of Northampton •j,�t 4AM/;Oi 2-k Massachusetts ,� 1) d l DEPARTMENT OF BUILDING INSPECT IONS4 +1r 212 Main Street• • Municipal Building \a :•� , r.a Northampton, MA 01060 JJ�"jv 30\\o • 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: Z1Dut r 6*w >c QA JJo1111`r-uvv^vQ ''m AA o xo The debris will be transported by: Name of Hauler: igiA 900-6cic i•,lu-r) Signature of Applicant: /4 7—, Date: � � 0/2 y City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 9'•. /• � 212 Main Street • Municipal Building yvy,_ O'` Northampton, MA 01060 "•4. HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, ?Article p? 51A t i vAj r/3 o/ Z'/ (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 1 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. 1 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. 1 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 pains and penalties of perjury on this 30 day of S�/ , 20 2.7l (Signatu The Commonwealth of Massachusetts ) { Department of Industrial Accidents ==h1fi' 1 congress Street,Suite 100 }} Boston, MA 02114-2017 1v www.mass.gov/dia )huskers' Compensation Insurance Aflf;dasit:Builders,K'oniractors/ElectriciansfPIuintiers_ It) HE FILED WITH 1 HE PERMITTING AUTHORITY. Annlicaut information Please Print I.etibi% pie-aNiaMC(Business Ucganization'ind sidu ll'. j(G} (,J L l / v/,j.) Address: t 1 S w crS nei4/1 pp-J ILO () City/State/Zip: ���(>^�C� /1'L� ,p 06 2 Phone#: 1113 — S-� �f c r Are yea an employer?(Irk the appropriate boa Type of project(required): b0 1 am a emplovu.with _____.employees(full arrdi'or pate-tinsel_' 7. ©New construction 20 I am a sole proprietor or partnership and have no employees working for use in S. Ca.Remodeling any capacity[Nu workers'clomp.insurance required.) 301 am a orrIC unit doing all wank myself.[No workers'comp un imur ►c moored.)j' 9. ❑Demolition h 4.01 ant a homeowner and will be hiring contractors to cold uet all work on my property. I will 1 Q[3 Building addition sou enure that all contr-a-tun either have workers"01)(12pensation insurance or are sole I I a Electrical repairs or additions ptopnetors u all nu employees 12.0 Plumbing repairs or additions 50 I am a general contractor and 1 have hired the sub-emu-scion listed on the attached sheet 13CI Roof repairs These sub-cuntractun has employees and bast workers'comp.imwttrrrce.: a.❑we are a corporation and its officers have cnen iced their right of exemption per MCiL c. 14.t.J Other 152.i I44),and we have no anployees.[No workers'comp.ioramanec required.) •Any applicant that dieeks box al must also till out the section below showing their workers'compensation policy information. 'hlwneuw nose who submit this atTorktsit indicating they are doing all work and then hire outside contractors m ut submit a new affulasit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hasc employees. If the sub-contractors have employees.they must provide their workers'comp.policy number. I um an employer that is providing workers'compensation insurance for on e►nployees. Below is the policy and job site information. insurance Company Name: Policy#or Self-ms.Ltc. #: 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 1.500.00 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 violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cos erage verification. I do hereby certi •under the pains and penalties of perjury that the information provided above is true and correct. Aignature: '` �t L+�+--,. Date= 7/5 CJ 2 Phone a: I( Official use only. Do nut write in this arca. to ht•t omplefed hi'city for town°flit tot ( its or Town: Permit:License Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector b.Other I Contact Person: Phone 4: mm� 11