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24C-113 (8) BP-2024-1533 7 FIFTH AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-113-001 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-2024-1533 PERMISSION IS HEREBY GRANTED TO: Project# 2024 WINDOWS Contractor: License: Est.Cost: 0 JAMES BENNETT CS-118566 Const.Class: Exp.Date:02/05/2027 Use Group: Owner: ENGHAGEN LINDA K&KATHLEEN M BECKER Lot Size(sq.ft.) Zoning: URB Applicant: JAMES BENNETT dba BENNETT&SONS Applicant Address Phone: Insurance: 69 RIDDELL ST (413)522-0593 GREENFIELD,MA 01301 ISSUED ON: 11/18/2024 TO PERFORM THE FOLLOWING WORK: REPLACE WINDOWS 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. jr Signature: !�/I[=.-.- Fees Paid: S60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner F.-- The Commonwealth of Massachusetts NOV 77 1 5 Board of Building Regulations and Standards '�24 OR Massachusetts State Building Cod 780 CMR -- _ MUNICIPALITY USE Building Permit Application To Construct, Repair, Renovate roolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Numbe 2-O?4-1533 Date Applied: ___,.. ..:,_ 5- `/IC/L= //'/g- Building Official(Print Name) ature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 5 Ave zyc - <<3 -ool I.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: UR/3 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 CI Municipal_ '?Outside Flood Zone Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name� � pl�� ha5��� _Print) CIs 5�� �� Nam (, ma c Doo 41;3 ° 310.3 to jhDecrl C ►a(I. (.4Y11. No.and Street Telephone Email Addfcss SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work: \0 Sat, C)e.,c.v W1 tJ��S U feAckbr o. 2-4 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 25,00f3 I. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fewti Check No. Check Amounit.1 OP Cash Amount: 6. Total Project Cost: $ 25 i 00. 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) I I(�3/_( 215 121- JAINts3 at License Number Expiration Date Name of CSL Holder efi 'glad/2' a( .'n Sq— List CSL Type(see below) No.and Street T Description (=ye a,1 Q() ft 0 IJ()/ (UJ Unrestricted(Buildings up to 35,000 cu.ft.) lr ` Restricted 1842 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering - WS Window and Siding SF Solid Fuel Burning Appliances ft 52 ZUS93 koh Sys . \af9eS e gelt 1 Insulation Telephone Email address Cein D Demolition 5.2 Registered Home 1 .provement Contractor(HIC) ZIZ 6'131� ?VIMn► w 1 I HIC Registration Number Expiration Date any ame or HIC Registrant Name Ftt Ci ' ,+( bennelt .Y1S' Email address 90)11. l No.and Street fact fun 6ai 52,z. l3 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 Issuanncce of the building permit. Signed Affidavit Attached? Yes 0" No........... O 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 authoriz NE T to action my behalf,in all matters relative to work au ' ed by this b ' mg permit application. 1P nt Owners Name(vIE. .kNoectromc 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. nt Oth \1 C)R1\65N 11 t 2W wner's or Akithorized Agent's Name(Electronic Signature) Dhtc 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 coca 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 r1j 7+°$ i� r '` Massachusetts �� '� )rt1► -VDEPARTMENT OF BUILDING INSPECTIONS x.:;,o" • 212 Main Street • Municipal Building :,.. CDC 4) Northampton, MA 01060 'rpfh• 3,•301 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: bra_.11 f r•l ( 1 (�61--) The debris will be transported by: f Name of Hauler: "anUl Seri i1-0- Signature of Applicant: Date: (II 1 541 ` ". The Commonwealth of Massachusetts 471-1—':): Department of Industrial Accidents : i Congress Street,Suite 100 A '',,,:.____'A. yl Boston, ,1:fA D2114-2017 www mass.gor/dia 11oikers'Compensation Insurance Affidasit:Builders!Contractors/IiectriciansiPlurultrr.. 7O 1W PILED N t lit'fHE PERM I.11NC Al'THORITli. Applicant Information Please Print Leuiblt Name t Hustticss organization llnd__mdual): Y1(It?�n_�t Address: (Q� �c�(flail,( 9--. City/State/Zip: O -fi`e-ld 00)1 Phone#: l-0.3 52-2 (DS93 Art:ynr an employer?('keels eke appropriate but: Type of project(required): t.©t sere a employs with . .. employees t full and'ur part-tunes.' 7. 0 New constriction 21am a sole proprietor or partnership and have no employees working for rise in 8. 0 Remodeling any,apa.dy.[No workers'comp.insurance required.[ 0 I am a hcw unswncr doing all work myself.(No workers'comp.tttsuraunce required.[' 9. 0 Demolition 4.0 I am a tonxvwnr and will be hiring eontntetors to conduct all weak on my property. I will I 00 Building addition ensure that all contractors either have workcn'compensation insurance or an:sole 11.0 Electrical repairs or additions proprietors w felt no employees. 12.0 Plumbing repairs or additions ' f am a general contractor and I tune hired the sub-contractors listed on the attached sheet. 1 3.0 Roof repairs These sub-contractors fuse employees and have workers'comp.Insurance.: 6.0 Vic arc a corporation and its officers have exercised their night of exemption pet Wit..c. 1442 O!}ltr W� � I<'_..I i•t i.and w c has.:no employees.[No workers'comp.insurance required.' 'Any applicant that checks lox nI must also fill out the section below showing then workers'compensation erns.,uifunnation. t ltomcuwnets who subunit this Aldus it indicating they arc doing all work and then hire outsiok contractors must submit a new affidavit indicatmg such. :Contractors that check this box must attached an additional sheet showing the nuns of the sulrcout:actors and state wterther ut nut those enl tic's base employees If tF•sub-.untractur,.have enetlosees.they must pros ide their 'Aortas'cxrmp_policy nwnlscr. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: — Policy#or Self ins.Lie.#: Expiration Date: Job Site Address: City StatciZip: 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 tine 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 coverage verification. i do hereby certify under a pains nd penalties of perjury that the injormation provided above is true and correct. Signature: ,' Date: I1 115 I 2-41 Phone#: 110 —I( �`) - c 2:2 - 3 Official use only. Do not write in this area,to be completed by city or town oljicicrl City or Town: Permit/License#1 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#: