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31A-096 (8)
BP-2024-1505 57 VERNON ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-096-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2024-1505 PERMISSION IS HEREBY GRANTED TO: Project# WINDOW 2024 Contractor: License: Est.Cost: 5000 Const.Class: Exp.Date: Use Group: Owner: LAWRENCE PAMELA HOLABIRD Lot Size(sq.ft.) Zoning: URB/WP Applicant: LAWRENCE PAMELA HOLABIRD Applicant Address Phone: Insurance: 57 VERNON ST NORTHAMPTON, MA 01060 ISSUED ON: 11/12/2024 TO PERFORM THE FOLLOWING WORK: REPLACE FRONT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector I'nderground: 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: 7 -2._ Fees Paid: S60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner L, rnai " i • CfV � , ' r Please email building permit if possible. V i ' 8 2024 r 1Z, The Commonwealth of Massachusetts n``:31:1‘1 ":40_:......alinaLleiltA, l n,nf�rn�cpBoard of Building Regulations and Standards •+ rWt Massachusetts State Building Code, 780 CMRL�1 Y US Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 6 ip- 1../aa, Date Applied: r- Building Official(Print Name) Si unc Date SECTION I:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 57 Vernon Street,Northampton MA 01060 1.1 a 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 II) 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-Public 0 Private 0 ' — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Pamela Lawrence Northampton MA 01060 Name(Print) City, State,ZIP 57 Vernon Street 413-387-8086 *hollylawrence64©gmail-com 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 Description of Proposed Work': Replace front windows.No change to size of window opening. Or f vwV SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $5,000 I. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑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) Total All F O Check No.N,I Check Amount: Cash Amount: _ 6.Total Project Cost: $5,000 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction 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.) R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances T Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) IBC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address 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 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 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. 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" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD NA SIDE YARD SIDE YARD_ FRONT SETBACK FRONTAGE City of Northampton Massachusetts t � c �, DEPARTMENT OF BUILDING INSPECTIONS v'pl'. r� *' 212 Main Street • Municipal Building 1. r Northampton, MA 01060 ; )V\`� 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: Triple T, Route 143 Brattleboro Vermont Location of Facility: The debris will be transported by: Name of Hauler: David Rowe Signature of Applicant: Date: \7(2( 2�{ lire Commonwealth of Massachusetts Department of Industrial Accidernn zetra.— t 1 Congress Street,Suite 100 Boston, .4 02114-201" wives.man s.gor/dia ti — Knvir.ers'Compensation Insurance Affidavit:Builders C ontrictor:Electrician:Plumber:, TO BE FIIED WITH THE PERtQTTLVG ALTHORTIY. Applicant Information Plea:ePrint Legibly Nye(Buslims&orpmz3non' ; ): Pamela Lawrence Address: 57 Vernon Street Cin State Zip: Northampton MA 01060 phone ...is 413-387-8066 ire yes an eaplayer_C heck tie appropriate boon: Type of project(required): : Q I ac a smp:a m ail= macio?vst i fU1 and c:part-un.I• i ❑New construction I ow.a sc:s propriotc:c:putna:siF and have no omplorso:working for me x S ❑Remocieling any capacity.(No xarka:t'ccetp.snsu.-ance rognirsd] I az a beae:mnar jo n al:work_sans[No woa d sct.comp insurance raq_ira ., 9 El Deniohhon 10 0 Building addition -®:an a hcrsoomynar and wi l b•banns ccnranor:to:ands:in xcic on_•prcparn• I nisi snsnts that a:1 ca=actc:s a.bar have workers :ontpor.:rscn ms:ran:s cc am solo 11.1=1 Decimal repass or addition; ?roptio=1 with tic=ploys*: ,. 1_i.0 P:tanning repair or addition: 1 art a carom:contractor and:have kind tbs.:uk-conaxtor:listed cis tins atta.had sw:. 13.a Dot repairs These sub-eentsaeton have smp o:•as:and x hat s ar,a a'cone n u_-anca: 14.EJother Window Replacem nt ❑tre:aro a co:potaticn and e:o�co:: .a:-a oanxi:od has nh c f sxam7ics per`.i:I: :;2.;let).and we hat-s no smp:o.-ra: ^.::mein.-,'cosw. Instnancs roq:a:?; •ray applicant that chocks box aim us:also fit out tha unction ba:ow showing thaw Weoia:I.cccpsn:anon posse;mfomsanoa r_icmoatuays who subsoi:this of-idr.t Altatms Cosy a.-s doing a:1 work and man has oatsldo coat-actors mu::s::bsi:a aox a3`ida', indicazac such :Contractors that chock the boa must aeae:ad an adlinoua::how thawing the aims of the sub-contractors and tuns whether or ants thoto anises hat•o arplcyva: If the:u^ticnra:tort ha+:a smFlo-.os:.roe must paov:aa.bsw rots cor.p policy sinter 1 am an employer that is providing workers'compensation insurance for my emplosves. Below is the policy and job site information. In:tnarre Company Nanne: Policy r or Self-ins.Lic.s: E2anration Date Job Site Address:_-_ _Cmh'State'Zip: Attach a copy of the worker:'compensation policy declaration page(showing the policy number and expiration date). Failure to secure°overage as required under 11GL c_ 152,§25A r:a minimal violation ptuu:hable by a fine up to S1.500.00 and;or ore-year imprisonment,as well a:iv l Pr---4hte in the form of a STOP WORK ORDER and a fine of up to S250.O0 a day against the violator.A copy of this.statement may be fora-aided to the Office of Investigations of the DLL for insurance coverage verification. I do hereby cenif under the pains and penalties of perjury that the information provided eboww is nue and correct Signature Date k /(a ! 2 -[ phi 413-387-8066 Official use orals. Do not+wile in this area,to be completed by city or town official 1 City or Town: Permit License= I:stung Authority(circle one): 1.Board of Health :.Builrlino Department 3.CityTown Clerk 4,Electrical Inspector 5, Plumbing In:pector 6.Other • Contact Person: Phone=: City of Northampton r• Massachusetts c • DEPARTMENT OF BUILDING INSPECTIONS 11. ?y ' rr ♦ 212 Main Street • Municipal Building V'•.. �a Northampton, MA 01060 ...... HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1, Pamela Lawrence (insert full legal name), born 11/7/1964 (insert month, day, year),hereby depose and state the following: 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. 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. 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 than 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 (o‘/ev'& v- , 20 zy (Signature)