18C-017 BP-2024-1494
297 HATFIELD ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-017-001 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-2024-1494 PERMISSION IS HEREBY GRANTED TO:
Project# KITCHEN RENO 2024 Contractor: License:
Est.Cost: 19000 KUEL MCQUAID
Const.Class: Exp.Date:
Use Group: Owner: COLLEEN WILE
Lot Size (sq.ft.)
Zoning: SR Applicant: KUEL MCQUAID
Applicant Address Phone: Insurance:
131 FERRY ST 413-537-5063 SOLE PROPRIETOR
EASTHAMPTON, MA 01027
ISSUED ON:11/06/2024
TO PERFORM THE FOLLOWING WORK:
KITCHEN 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: 41/70—.
Fees Paid: $142.50
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
lk
Erne Mal i
The Commonwealth of Massachusetts O
ak
Board of Building Regulations and tandards 6 ICIOP LITY
V,04 Massachusetts State Building Code, 80 CIO- 2��Q
Building Permit Application To Construct, Repair,Reno G.N.T �� h a l ised ar 2011
One-or Two-Family Dwelling oh,41 l bao is
LL This Section For Official Use Only
Building Permit Number: 4,r0OS7�/7g9. Date Applied:
/Cu'..i &'55 /12 11-L-Zo2y
Building Official(Print Name) Signature Date
������ C� SECTION 1: SITE INFORMATION
1.1 Property AO_dress; .J� 1.2 Assessors Map& Parcel Numbers
ZG`l04
1.la 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'of Record:
Name(Print) City,State,ZIP
zc') Ha iead Zoe 49(42396 c.4)1 IQ ndl lr t 1 .esYY)
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 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Des�criptiot�of Proposed Work': j�- pe��,:,�� ic, kn Gt^ t..4 L{);t^ ��'U✓
ei,A.„, s, sCLw..pvik .41/4.� 5u t 1 weed S r �t; � -1 l
05� '
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ r 44 c,Q D 1. Building Permit Fee: S Indicate how fee is determined:
f 0 Standard City/Town Application Fee
2. Electrical $ 2`Sin b 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing S 2, 60 0 2. Other Fees: S
4.Mechanical (HVAC) S ) List:
5.Mechanical (Fire S
Suppression) Total All Fee ��
Check No. \ heck
Amount: it
6.Total Project Cost: S
Q {' ❑Paid in F1 0 Outstanding Balance Due:
City of Northampton
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Y -;� Massachusetts A.�
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building Sv lb
Northampton, MA 01060
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)1
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by appliant.
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 Affi avit
10. Please provide the appropriate fee in the form of a check made payable to: Th City of
Northampton.
(141'6°
d
.'
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) ./'r 061314- /Z./ I 1(2e Z�
/'l V'U M c. a u cl.r License Number Expiration ate
Name of CSL Holder
r i F`� List CSL Type(see below) U
No.and Street Type Description
E. �\45;' it 6(o2 7 RU - Unrestrictedesctd1 (Buildings up tol 35,000 Cu.ft.)
City/Town,State,ZIP /'"I R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
'�l33 7 _o . u��. kc+ 6 i InsSoluldation
Fuel Burning Appliances
Olo� l I Insulation
Telephone Email address D Demolition
5.
egistered Home Improvfinen Contractor(HIC)e !D oval030 ez6
V c, am- HIC Registration Number E irati n Date
HIC Company Name or HIC Relpistrant Name
131 1 s cc2 S &owl d.k.tX a 6wutxt. Covtk
N.A.and Street Email address
aJs k,,,,��
\„ Q vN, MA (-N3- -37—SoC,3
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 kc. -e.( 14 C Qua
to act on my behalf,in all matters relative to work authorized by this building permit application.
Ce)1‘00J.1 UJ l 112 Cc_Lcf24 // ('Z�Z�
Print Owner's Name(Electronic Signature) Date
SECTION lb: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 application is true and accurate to the best of my knowledge and understanding.
/(v4 `"`.G 0.4 . d // (Zo Z,4
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
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
i 'oi Department of htdustrialAccidents
r =»11rk[4:c A 1 Congress Street,Suite IOU
�C. ww i. r.r
:w—' ' _" Boston.MA 02114-2017
, , , wrti n inass.gov�ldia
%l inkers'Compensation Insurance Affidavit:Builders[ContractorsfElectricians(Plumbers.
TO BE SHIED WITH THE PE RMCITINC:AtJTHORITV`.
Applicant Information Please Print I.egibh
`
Name{Busanrss'Urganixttirin'itudiuidtttrl?= Ke U C• �zE.0 d
Address: I3 1 re, .,`
4.--
City StatefZip: & Mt Phone#: � (�v-c37-- a6
.%re you as employer?Check the appropriate boa: 01027
Type of project(require[!):
1-0 n a employer with. ....._....._eu oyees(lull mct�`u part-tiarrel.r 7. '�e�i construction' I am a sok imaprtetur or piStacmhip and have nu employers working fur me in
Remodeling
any capacity,.(No worters'comp.insurancerequired.]
301 a s hutpeawuer doing all work myself.(No workers'conc.imuu ur ce required.!
9. ❑Demolitionam
4.0 tarn a homeowner and will be hums ei thata�ttrac'cora to conduit all work on my property. 1 will I Q Building addition
ensure all eontractoes either have workers`conifx=n n:satrun insurance or a sole i l. Electrical repairs or additions
proprietors with no employees.
12.®Plumbing repairs or addition,
501 am a general contractor and I have hired the sub,COntrseturs!hated on the attached sheet
These sub-contractors have employees arid have workers'comp.insurance.; 13 Roof repairs
I
6.0 We are a commotion and its officers have exerosed then;[nght of exemption per MU c. i 4. Other
152,§l(4 i.anal we have nr:e.employees.(Nu workers'comp.insurance required.(
'Any applicant that checks box ni must alw all out the z.ctualt below showing their workers"compensation policy i(for natroara..
Ikmeown¢rs who stitnnii this affidavit indicating they are doing all w otk and then hire outside ccniracturs must submit a new affidavit indicating such.
$t~'ontraerors that check this box must a niched an additional sheet showing the name of the snla-c srttractera and state whether or not those entities hose
employees. If the cols-contractor,have employees.they must provide their workers"comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: _
Policy 4 or Self-ins.Lit,4: Expiration Date:
Job Site Address: C"icy/Stat&Zip:
Attach a copy of the workers'compensation polio declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152..425A is a criminal violation punishable by a fine up to SI.500.00
andror one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S2.50.00 a
day against the violator.A copy of this statement may be forwarded to the Office of lnvcsii<<attions of the DIA for insurance
coverage verification.
1 do hereby certi y wider the pa s and penalties ttf pe 'or)•that the information provided above is trut and!correct
Signature:ture: C- Date: i 6 Z 62-`f
Phone#: ti-/ 3" 61 (- S o 63
Official use only. Do not write in this area.to be completed by thy or town official
City or Town: Permit/License
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
1
City of Northampton
Massachusetts
•
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building y` `��
Northampton, MA 01060 s}'jv �.1A�
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:
A(J
Location of Facility: `✓lt,t l ►<-eL2 c.(•e.. A/6-<-1-1k.CLW4lA-0V\._ PA
The debris will be transported by:
Name of Hauler: kki /" (
Signature of Applicant: Date: ///6 z0Z
City of Northampton
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`C 1�;: car...f• l'•f..,
Massachusetts c
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DEPARTMENT OF BUILDING INSPECTIONS 9l }p
~eti i 5:' 212 Main Street •• Municipal Building 'y ,CSC
* `+ Northampton, MA 01060 41/'.,,,fj�0
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), b rn_(insert
month, day,year), hereby depose and state the following: 1
1. I 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 thax 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 pains and penalties of perjury on this day of ,20_.
(Signature)
I
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