35-291 (9) BP-2024-1319
117 WOODLAND DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-291-001 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-2024-1319 PERMISSION IS HEREBY GRANTED TO:
• Project# 2024 BATH RENO Contractor: License:
Est. Cost: 40000 BONDE CONSTRUCTION 67758
Const.Class: Exp.Date: 01/02/2025
Use Group: Owner: LATHROP COMMUNITY INC
Lot Size (sq.ft.)
Zoning: WSP Applicant: BONDE CONSTRUCTION
Applicant Address Phone: Insurance:
205 PARK ST 413-529-2176 UB4K0538A1842G
EASTHAMPTON, MA 01027
ISSUED ON: 10/09/2024
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. 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:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 17P
Fees Paid: S300.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
r- --__.c,,o/L_ ,--
, -- _ -4,j
The Commonwealth of Massacjiusett,
orr
:i Board of Building Regulations and Standards i -8 FOR
Massachusetts State Building Co , 7 dR 2t7�4 M ICIPALITY
�;- 7- USE
r
Building Permit Application To Construct, Repair, Vatv;�'„ , ,,,Fr, Rev sed Mar 2011
One- or Two-Family Dwelling _ °'' f4A 0,os aNs
This Section For Official Use Only
Building
Permit Number: £i' -q- i A/ 9 Date Applied:
//4::::
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property• IDCVAddress LANI 1.2 Assessors Map& Parcel N alq I
1.1a 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:
Zone: _ Outside Flood Zone?
Public❑� Private❑ Check if yes❑,, Municipal Ikro site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
C-"R C-F1-A/14-) , kt N,‘A czt` 141e-71- AP-VD A), IA R Olab6
Name(Print) City,State,ZIP
_lt1 vA b�.iJ r9f2.. 1413 ail -6375 CAPE, -IANVfrm �"(�9
No.and Street Telephone Email Ad s
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 0
Demolition 0 Accessory Bldg. 0 Number of Units Other l "Specify:' p7 T.c I.4()t\
Brief Descripticiugroposed Work2• "e E_M e)F 4--I .g.40s-na.t,t ' -rae, 4 \-V t,._)e Q fT ig
}-wD 2. 1 e L .s[_i.TA_Laj ,rg.,Sl G to L pi-tT , Vivorry 1_16.4-li
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1. Building $ 2.1, 000 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
jobf7 0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ ID,r-Or) 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fe
Check NoQ14 Check Amount: 1) lP
6.Total Project Cost: $ 1--/0 000 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
LS-P(0 775s 1-2-z.(P
k 1:745147 License Number Expiration Date
Name o CSL Holder
List CSL Type(see below) �J
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
�I-1 A 1` `
➢ r •A k- 010 27 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
ui3 5Lq_Zl7b fn�, mail
OE` - I Insulation
Telephone mail address D Demolition
5.2 Registered Home Improvement Contractor(HIC) bc12 z� _ I ,2
+J�F v t> HIC Registration Number Expiration Date
HIC Companame 41.j5-r
Registrant Name
6,T5Sp•IZYz. "iT
No. Street �R idresP�s�Xl �
Ette.1A+Arrir:J ,tag- htD-z.,? 413 52SI
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 0 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 t�, - -)Li -
to act on my behalf, in all matters relative to work authorized by this building permit application.
A K 4 (cEEHMi I D-6-2 cf
Print Owner's ame(Electronic Signature) Date
SECTION 7b: OWNER1 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.
lb-
Print 0 ner'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
\\\\ \ oca Information on the Construction Supervisor License can be found at Nti\ \ iiriss. ()%_dp
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 eanu on►vealth of Massachusetts
_- Department of Industrial Accidents
'` 1 Congress Street.Suite 100
�t 'c~' Boston. MA 0?114-'017
'.0 n•r,w.mass.gov/dia
1lurkers' Compensation Insurance . ffidas it: Builders/('untrartorriElectricians,Plumbers.
10 Kt: 1 111.1)11 I I II Ha. I'f:KSlI I l IM. St I IK)RI I 1.
:applicant Information Please Print I tl ibls
Name (Business 0E a:rammerIndividual): ) i>r C_0k T1eVC."7-1I01.J
Address: aO5 "----Pati✓z-K 57
C'ityState:'Z.ir 5—►-1Au Ur3 , r"l 4 t e, 7 1'1.,11,' :: 413 cg 5S-9 52 _
Arr yam an employer.'( hock the appropriate 1rus, • 7. pe of project(required).
1 1 err.a cmpio 7 with i employees OW;and of peat-tltrtet.. 7. 1 Neys construction
DI am a sole paoprletur or partnership anti has.:no employix>workang for 111e in S. Reittodeltttg
any.opacity. o workers'comp.nt uranee requirexl I
I.). j Demolition
DI am a liomeow net dome all work myself.(Now orkcl.-comp.trtwratee required.''
I 0 j Building addition
is I am a I,mei'wtur and w ill be Mime contractors to conduct all..oak on my prop.'rts. I su11
censure that all:..nlr etor.eit er Isaac..inked'enrrlXnsanon uauran.v of are xd. 1 I. Electrical repairs or addition,
i -opraetots M.lib tto employees.
12.Lj Plumbing repairs or additions
4n I ant a general contactor and I base.lured the suh-c.etttactur..listed on the atta.hed sheet
[he,e sub-tontnicioh(lase employ ee>and has e w urker>':amp insurance. 13 Roof repairs
14.❑Other
h.D y1.:ire a.urlavaton and it.officers hase exer.t.ed then right of cu-rnphon per Mil_..
1 y_.;I t 41.and we has c no employees.(No worker,' cutup.lnsuranee tequated.
Il
'Any applicant that.heck.boa,I Irrust also fill out the.e.tutr lelow .}tow the their worker. eurn}K'n.atton pocks tnf...rtnatn 11.
•}k..lneu\.ner..who,ubnul this ai ti.t'it mdicating they are doing all wodk and then hale enlist&cuntraetors must slatrnit a new .aftidas it taxlt.attnk such.
:Contractor.that cheek thes box must attache)an additional sheet showing the Hanle of dre•sub-contractors and state s.lelh et in not those entrtts base
employee.. if the sub-costtractot.hase.mploycti,.the!, must ptoil&their marker,'comp.policy nulrlher.
I am an employer that is providing te'orAers'compensation insurance for my employees. Below is the policy and job site
information.Insurance Company Name 1 2M1EU.-E2 3 4),u e,, Co i _
Poltc•y =or Self-ms. Lie. 0-64 Ksopa3&bPa?4'2-ar Expiration Date._ 3 - 3--25
Job Site Address: 1 117 11Jao_DLV 17r~ sees Ctty State I.II� t�ITp > oioo
.Attach a cops of the ssorkers'compensation ln1lir, declaration page(shossing the Malin\ number and expiration date).
Failure to secure coverage as required under MCA_ C. 152. 25A is a criminal violation punishable by a fine up to S1.50001
ardor one-year imprisonment.as%sell as civ it 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 torssaided to the Office of Invrsttgattons of the DI \ kir insurance
coverage yerrtication.
I do hereby certify under the pains and penalties of perjury them the in/rtrmulion provided above is true and c orre'ci.
Si:Mat ureIliq I L.tc 10-'L," 2-9
Phone '-'1‘ 3 5 3 S-9 5Z9
Official use only. Do not write in this area.to be completed by cit)•or town official.
(•its or Tossn: Permitl.icense?t
Issuing Authorit% (circle une):
I. Board of health 2. Building Department 3.('itylossn Clerk 4. Electrical Inspector 5. Plumbing Inspector
b.Other
Contact Person: Phone 4:
City of Northampton
`ri_
�% Massachusetts
IP �
f t DEPARTMENT OF BUILDING INSPECTIONS (i ) :
' ,
;•
.,r 212 Main Street • Municipal Building
•-.-0„. Northampton, MA 01060 •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: 4-Lc c4c-' '---
Location of Facility: be:;If# & pT-D r3 , M 4
The debris will be transported by:
Name of Hauler: — a (L,t 5--v. y rI N
Signature of Applicant: Afyit„„,Lc----) fidie_____ Date: lb{`7'— /