17A-063 (4) 251 BRIDGE RD BP-2019-1367
GIS#: COMMONWEALTH OF MASSACHUSETTS
MaD:BIOck: 17A-063 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cateeow ROOF BUILDING PERMIT
Permit# BP-2019-1367
Proiect# JS-2019-002203
Est.Cost:$7265.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RICHARD PALMISANO 89485
Lot Size(sa.R.): 8929.80 Owner: FABEL EMILY
Zoning: URBH00y Applicant: RICHARD PALMISANO
AT: 251 BRIDGE RD
Apin icantAddress: Phone: Insurance:
87 SHATTUCK RD (413) 374-2719 0 WC
HADLEYMA01035 ISSUED ON.513112019 0.00.00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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:
Driveway Final:
Final: Final
Rough Frame:
Gas: Fire Department 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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount: - -
Building 5/3120190:00:00 540.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use on y
City of Northampton status or Permit
Building Department Curb CuVDtlyewsy Permit
212 Mein Street Ser nsdINplic A.11st llity m T
Room 100 WatmlWell AVeilability
Northampton,MA 01060 Two Sets or Struclurel Pians °� ff1
phone 413-587-1240 Fax 413-567-1272 PIoVSIte Plans ig <
Other Speedy D w m
APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION V /-/� �{.! O tX) 1 l I
1.1 ProoartV Addres ^^^f/fThis sss Dan to be compN[ad by d W
asl 6(bp 2� , �P� Lot o0 3 Unh
Q Zorro OwrNy oistrld
Elm St Dia no CB Obblq
BECTION 2.PROPERTY OWNERSHIPIAUTHORIZEO AGENT
2.1 Charter d Record: r
lr M a., F ► asi �r,�A Rd ,AL>�M�.
Nam PrNtl C tk1sItkp ros4:
Neal
21A.dhol AM-
rJ I'A\ O7 — tteLF�
agrea.e
$7 S�.atru�� �y�T Ocv3s�
comes Maim AEM1w:
q 13.544-
Telephone
SECTION 3.ESTIMATED CONSTRUCTION COSTS
Item Estimated Cast(Dollere)to ba OMdW Use Only
cpm Ie1etl b Brett a liwpt
1. Builtlltg n"'1 (a)Bull Permit Fee
2. Electrical /O (b)EaSnrled Total Cwt of
Construction from 5
3. Plumbing Building Wrmit Fee 'Q�jLP
4. Mechanical(11VAC)
5.Fire Protection
S. Total=(1 +2+3+4+5) 1 Check Number
TNsSxeon Fw ONNMlt O.ly
Building Permit Number: Data
Iseuetl:
Sigwmm 5-30 -May
BulNliq CpmmluipneNlnepedprcf Bass,. Date
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
i
Section a. ZONING Col mformaden con W Completer.Permit can se rented we To reorients information
Existing Proposed Required by Zoning
This oolumn to be filld in by
sixth,Rpmnent
Lor Size
Frontage
Setbacks Front
Side L IT L R.
Ree,
Budding Height
Bldg.Square Footage %
Open Space Footage %
fla uwminusbldxa wvd
e ofParking Spirces
Fill:
wNmee Ismm
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW �( YES O
IF YES,date issued:
EYES: Was the permit recorded at the Registry of Deals?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Documents
B. Does the site contain a brook,body of water or wetlands? NO (gi- DONT KNOW O YES O
IF YES,has a permit been or need to bis obtained from the Conservation Commission?
Need,to be obtained O Obtained O Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES,describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES,describe size, type and location:
E. Will Ne constriction activity deWrb(clearing,grading.excavation,or filling)over t am or is it pert of a common plan
Nat will dist ab over t acre? YES O NO t
IF YES,then a Northampton Storm Water Management Permit from Ne DPW is required.
SECTION 5.DESCRIPTIONED FIORK ficireack all inpollesible)
New House ❑ Addition ❑ Replacet Windows AlbMionls) ❑ Roofing
er DoonmenO
Accessory Bldg. ❑ Damoll". ❑ New Signs [o] Decks 117 SMinglCTl OUnrfq
Brief cesrMeU 2t f/rk5 IL I qd.) ted(a.�.G` ra rck J�/.w,lu
Work. of ex �r� -�'
Attached of..Iwogbetlmom s No Addingnewbeharl bdroom Yes No
Attached Nartahve Ranovaeng unfinishetl basement _Yes No
PWns AhacheO Roll -Sneer
ie.If Now house and or additionm I he followin
e. Use of building:One Family Twn Femlly Omer
b. Number of moms In each%.It,uni: Numfaa of eMM1mama
c. Is there a garage attached?
J. Proponent Square footege of new construction. Dimensions
e. Number of stories?
f. Meewtl of heating? Fireplaces or Wootlatmmi Number f each
g. Energy Conservation Compliance. Motortruck Energy Compliance form agached?
h. Type of comWction
I. Ismnstmctionxilhint0aa.olweuaMs?_Yea No. Is conatructbn whin 100 yr. floodpteq Yes—No
1. Depth of basement or caller floor below finished grade
Is. Will building conform to me Building and Zoning regularleal _Yei
I. Septic Tank_ City Sewer_ Friends well_ City water Supply
SECTION Ta-DINNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. as Owner of to subject
pgpemy
hereby suthbdae W-t5�o
or act my behalf.In at ellen relagve te work summarized!by rale building nemil appliwdon.
� 5� at icusearaters
a Iy one.
I, lA� ore ownedAnmorlied
Agent retry declare two the snharanls and Information on me lorefift application are bud arq accurate.te.the bealof my knowledge
act ballet.
Sig ;¢r,has Mpenalties of perjury.
endl0 xlilr . S41/
sgmum a ownnrgenr Dole
SE"M 8-CONSTRUCTION SERVICES
C n r NMApplicable ❑
Neme of Llwnw HolMl: 50M1ck �— Lfw
uwnw Number
c RB �.d �0 3�Sf av
E�Iretbn Dek
§0 �At '�3- 52(9-Is8a�j
s wwn i«e«on
H Not Appllcable ❑
90 CDS Iq
Comoanv No. Regislralion N inter
ai�lao
Address l� Expiration Dale
TelapNana
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAL c.152,§MC(8((
Workme Compensation Insurance agMaM musk ba completed ant submitted 1sRN Nis application.FaAure b pmstde Mw alfitlavg wpl result
in Na denial of Me issuance of the building pemlil. -
S' nWMd.vs AllacNed Yea..... No...... O
City of Northampton
Ylaeaachaeatte >•- �
i
1 x®aaMax or enxaoxxc xxasacrxoxs ;F
zu a.i� sc:o.c .wwase.r emimoa s ` c
xorcn. ew ozsso y,
Debris Disposal Affidavit
In accortlance of the provisions of MGL c40, S54,I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a propery licensed solid waste disposal faalily,as defined by MGL c 111. S 150A.
The debris from construction work being performed at:
iS( �/'ccbae IreQ .
( lease print house numb and street name)
Is to be disposed of at:
(Pleasemill name and n f facility)
Or will be disposetl of in a tlump r nsite rented or leased from:
ompany Name and Address)
Sig re of Permit Applicant or Owner ate
If,for any reason,the debris will not be disposed of as indicated,the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Mossaehusetty
Department of IndustrialAcctdents
1 Congress Street,Suite 100
Boston,MA 01114-1017.
www,mays.gov/dia
Norkers'Compensation Insurance Affidavit:BuildeWContmetonXiectricians Plumbers.
TO BE FILLED WITH THE PERMITTING AUTHORITY.
Allfilinst lnf rmafion I Please Print Legibly
Name(Bwonc,VOrgen ermymd.y,d :
Address:
City/State/Zip: A Phone#: 4^
Areyoit-11knie>cbwarheapp.W whoa: Type of project(required):
111,41�—,ccolaywwln els 7. ❑New construction
z❑1en.wle popimwpennersFipantlltwena employ:awmine rw—in 8. Remodeling
er,enpstecy[Nu cow ors com,.ini—retained l
IF11—horeeo:.nedcinge0wonwm:n
myself Oewodts' pinww
. yt—enredl' A QDemolition
ildin iaddition
<.Ql am abomeownw am win be ni.n:gwnvtates w sawn al wm4 an my re,en, Iwin IO�Building
we gnat an eooaacwseiNw naw.wwnwi rempeaneion imaraneewen Bole 11.0 Electrical repairs or additions
pwpriaon win m employees. 12,Q Plumbing repairs or additions
5r(ran agn:wal counter,and(usee hies thew6cwmazlon Balch un Ne'Iwi dugs I�RWfrepairs
rocsewb¢nn oars ,eemploy smdbawe &e,icomp.insmere.
6.❑Weve a ewptNionentl In oybcen Fave exertisa]Heir rigMa(ewnpim lar MGL c. 14'❑Other
152,§o4t,mWwenevenoemployae.INo rkyni ramp.insum[ertp:imdl
•Any applicant"'u'lue"Wx pl muu elw fill am:he welien belowsMwN81Mh wehas'compowoion polity iNanre,im.
I H.—rens conn sadnil nit nmdavil iMice:mg:rey are Mmg ell ww4 and 1nm hurt-new eonwturs=a vnmil arcw amdavil maiming inch
ICono-soert est,crack nit Wx..it aaazned an addinonel snew rowing ne.—efMe cob<ontrulwt anE vee wnelaa,r nm Note worst nave
emplarem Ifthe wbrvnveuort hive employee.they meo pmvme: or woken'eamppanty wenow,
l am an eraPloyer that6proviQing workers'cumpemntio0 iasumnceformyemyloyes. Belowistbeyo4cyandjobsile
oBib's ,don -I '
Insurance Company Name: j kj r� T 9
Polity N or Self-ins.Lk.#/: pTTI.6-(pB)-1'33f- l T � Expiration Date:
Job Site Address: d5-1461,e( f R@ . City6tate/Zip: FdAeWlER A4 ()/O&:)L,
Attach a copy of the workers'compensaillon policy declaration page(showing the policy number and expiration date).
Failure to secure coverage in required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment.as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurnex
coverage ver' tion.
t do hereby r(h andpenaldes ofpinee,tmnh,lnfermmionprmvidedaboveu ue art correct
S t n ) I Dae
Phone 413=�4 — /O p!q
Of,ciat use only. Has smtwntein this areq to be comp(#al by wiry or town gIiirial
City ar Town: Permlt/Licensc#
Issuing Authority(circle one):
t.Board of Health 1.Building Department 3.Cityamn Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#: