23A-024 (2) BP-2024-1410
31 PARK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-024-001 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-2024-1410 PERMISSION IS HEREBY GRANTED TO:
Project# ALTERATIONS 2024 Contractor: License:
Est. Cost: 3400 STAHLS SPECIALTIES LLC 105598
Const.Class: Exp.Date:07/06/2025
Use Group: Owner: C DRISCOLL ROBERT J&ANN
Lot Size(sq.ft.)
Zoning: URB Applicant: STAHLS SPECIALTIES LLC
Applicant Address Phone: Insurance:
211 CHESTERFIELD RD (413)475-2501 WCC-500-5024941
WESTHAMPTON, MA 01027
ISSUED ON: 10/28/2024
TO PERFORM THE FOLLOWING WORK:
ADD INTERIOR DOOR, EXTEND OUTDOOR LANDING &REBUILD STEPS, REPLACE WINDOW WITH DOOR IN
GARAGE
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: 172-
Fees Paid: $75.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
I
JJ If lf..,,s'J
W$14
The Commonwealth of Massachusetts `1 OCT 2 4 20
F
Board of Building Regulations and St daT OF M IC ALITY
Massachusetts State Building Code, 7 R.047HA,g,h'or,NspEc E
Building Permit Application To Construct, Repair, Renovate Or Dem ti' 1otb rise Mar 2011
One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: •6i "61-`l / f(O Date Applied:
go h) l J`Nu a• /1 10-Z8'Z02,,
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: e--- i 1.2 Assessors Map& Parcel Numbers
1.1 a Is this an accepted street?yes Vo 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'of Record:
0 (fir- peal 1 ✓ \$1- iCMAIle i 4' 1 O /o39
Name(Print) City,State,ZIP
ro• Qok 4-3- '113- s 5"1 7.*y Et
1(4n-41/Alel bFOJ h;te62,Dvta I. co,—,
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) BlVAddition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Add door F-a w. &.e{raow ;,.fv `re0 I.— .
.2X (Ct tki4 � a^C( f e ki r S'4e e S 6 s' o ,- fict c K Cif'', /-i,
Ugh 0V' t•A. IG;.'ale i 0tAeik et"lam
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ Zl 550o I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ?o o 0 Standard City/Town Application Fee
❑Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List: ___
5. Mechanical (Fire
Suppression) $ T• al • 11 7 : $
• ' l.fi Check Amount: /‘
6. Total Project Cost: $ 0 ' in Full 0 Outstanding Balance Due:
City of Northampton
•
Massachusetts 4`� %{
1 .� . DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building yvi cD�
Northampton, MA 01060 rSfr ')<-
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS, RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
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 and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new/replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code —all new construction (Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C S --S c g -i/ lL s 2-7.5
Tay v. A cL( License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
tan S kctlid 4 No.and Street Type Description
�N
1. ►,„C V p 4 M—` 0 0 Z� U Unrestricted(Buildings up to 35,000 cu.ft.)
�J t Restricted 18(.2 Family Dwelling
City/Town,State,ZIP 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) 0,1 10 .T /
//� Z �� oS" 2o2S
STo'k(5 ,c C tQC-k S ILIC Registration Number iration Date
HIC o�anv Name or IC Registrant Name
No.an•dStrec ,� (,<y 11✓I S
WAS " IO c- rtA °l ot? Email add
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
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 ( 4 -lAks S 1 `7
to act on my behalf,in all matters relative to work authorized by this build hg permit application.
TeAgirge—
°o ?S�
Print Owner's Name(Electronic Signature) .r,rar'r 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 4p I ',ca 'on is true and accurate to the best of my knowledge and understanding.
i- -. IPAYAlge— Pti
•weer s or Auth4..zed Agent's Name(Electronic Signature) Dat
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
\<<„1 mass 'uca 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
► Department of Industrial Accidents
•
NBI 1 Congress Street,Suite 100
Boston, MA02114-2017
_, www.mass.gor/dia
11 ru kers' ( onlpt•nsation Insurance.1fdas it: Builders('t►ntraetors'Ele tricians Plumbers.
I U FtF- F it F I)1s 1 1 11 1-111: PERMiIT!I\(. At 1 110141 1 1.
Annlicant Information Please Print Lti ibis
Name 1!Justness 0rgantxatnm Ind It iduali: SN- A.
Address: I Sk. _ J
City State/Zip: Stet- per., 1 Phone `-( ( g Lf 7
Are you• employer'(lark the appropriate hot: Type of project(required):
I. 1 am a ern ph't..r with .j employees I lull:and or part-lint:l' 7. New construction
20 I am a sok proprietor or punnershtp and hase pas emplt»ce.working for me in K. enwtklnng
.apaett)-ENU workers'camp.Insurance nyuired.J
9. Q Demolition
OI am a hotn.VKn.r doing all work myself.INU work►ss;curry emu:unix mowed"t
4.0 I am a lisrnoawner anti Nall is hiring cantradon to conduct all work on my property I will
10 O Building addition
ensure that all contractors either hate workers'contnper_wmal enswnnce or an:sole 1 1.0 Electrical repairs or additions
pt opncton w ith no.nnpl,ryeei,
12.0 Plumbing repasts or additions
5.0 I am a general contractor and I hat e hired the sub-contractors lr.t►d un the atta.hod sheet.
130 Roof repairs
hose sub-cunstractors have employees aril Isar a worker.'comp.insurance.,
(sip We are a corporation and nu officers hat c excu rsed their nght of exemption pa MU_c. I .CiUthe1Y�
152.t 1141.and we have no employees.I W workers'comp.insurance required.j
*Any applicant that chocks box al must also till out the section below showing then scwkcrs'compensation policy information_
r It nseowswrs who submit this affidavit indicating they are doing all work and then hue outside eontrastors must submit a now affidavit indicating such.
:Contractors that cheek this tot must attaclxd an additional sheet show ens the name of the suh-contractor,and state whether or not those emetic,hate
employee, If the sub-contractors hat.employees.they must pros ode their workers'comp policy number
I am an employer that is providing workers'compensation insurance for nil'employees. Below is the polity and job site
information.
Insurance Company Name:_ .A . f"_l t!l }vt.ea
Policy#or Self ins. Lice 4:_ W C-C— Sb 640. 5-0 Zee(R Y I Expiration Date:_ 12-(e�LS
Job Site Address: 5 1 a K S ect. Cite State Zip: --C- ( _ 1
Attach a copy of the Norkers compensation policy declaration page(showing the policy number and e.piration date).
Failure to secure coverage as required under`1GL c. 152. §25A is a criminals iolation 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 tine of up to S250.00 a
day against the violator. A copy of this statement Inlay be forwarded to the Office of Investigations of the DIA for insurance
co%erage ceritication.
1 do hereby • tiro'under e ainc and pe'nalties of perjury that the information provided above is true and correct.
S:tnaturc I),it: I01ICI Zt/
Official use only. I)o not write in this urea.to he completed her city or town officiaL
City or Town: Permitilicense k
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.Cityrrown Clerk 4.Electrical Inspector S. Plumbing Inspector
b. Other
( ontact Person: Phone 4:
City of Northampton
Massachusetts �v{ :.. ''
z i DEPARTMENT OF BUILDING INSPECTIONS ti !w x
*- ' 212 Main Street • Municipal Building vr. cDb
Northampton, MA 01060 'r4'I 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: tL €1Z Lc� I
The debris will be transported by:
Name of Hauler: C 'fx,W 5 3 /0-I0-Q-4C5
1
A TIP Signature of Applicant:
pp Date: I 6/23/2 U�
/
City of Northampton
,; Massachusetts �k?S �4�
i')
DEPARTMENT OF BUILDING INSPECTIONS R�{* 212 Main Street • Municipal Building -J�
Northampton, MA 01060 �sNh
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born _ (insert
month, day, year), hereby depose and state the following:
1. 1 am seeking a buildin: ''rmit pursuant to the homeowners'exemptio I • the permit requirements of the
Massachusetts State Bui , ' g Code, codified at 780 CMR 110. ' . .3.1, in connection with a project or
work on a parcel of land to w. ' h I hold legal title.
2. I am not engaged in, and the projec • work for w 'ch I am seeking the aforementioned homeowners'
exemption, does not involve the field ere .'on of ,nufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's ' finitio, of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of . d on which h- .khe 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 f • • structures.A person who constructs more than one home in
a two-year period shall not .• considered a home owner.
4. I do not hold a valid Mas 'chusetts construction supervision license and, except to the extent that I
qualify for and will abide 'y the Massachusetts State Building Code's requirements for the supervision of
the project or work on y parcel, I am not engaged in construction supervision in connection with any
project or work i solving construction, reconstruction, alteration, repair, removal or demolition
involving any ac ' 'ty 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 day of ,20 .
(Signature)
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