36-002 (6) 1135 BURTS PIT RD BP-2020-0592
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-002 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERI'D CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BASEMENT RENOVATION BUILDING PERMIT
Permit# BP-2020-0592
Proiect# JS-2020-001015
Est.Cost:$5600.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sg.ft.): 9191.16 Owner: DEL BUSTO HECTOR
zoning: Applicant. DEL BUSTO HECTOR
AT. 1135 BURTS PIT RD
Applicant Address: Phone: Insurance:
1135 BURTS PIT RD (413) 219-0728 0
NORTHAMPTON MAO 1060 ISSUED ON.11/13/2019 0.00.00
TO PERFORM THE FOLLOWING WORK.-RENO BASEMENT -ADD BEDROOM
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: Rouih: 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 11/13/2019 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of North6mpt '° Status of Permit:
Building Departm � �J Curb Cut/Driveway Permit
A , 212 Main Street V Sewer/S.eptic Availability
` ! .^�, Room 100 NOV Vater ell Availability
Northam to M 01060 6 Ywo S is of Structural Plans
�. p ?Olg
\ �» phone 413-587-1240 F� -587-1272 Olot/ to Plans
-� r
- ^nor arAirp n;�in;c Othe Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 6 a- ,�O- 6W
Z
1.1 Property Address: This section to be completed by office
Map ace Lot 662— Unit
D/O Zone Overlay District
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: / Da
EC e2 1 (�lYf 66,1 &S7� /3S �u2�� Y'i ��n0✓Ce, /�'liffi D/d
NaNeirk) / Current Mailing Address:
Telephone
Si nature `I`/✓ // P / �o
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
-completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical i 00 06 (b) Estimated Total Cost of
(� U Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) 00
5. Fire Protection
6. Total =(1 +2+3+4+5) j (,d6) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: UU
y I
Building Commissioner/Inspector of Buildings Date
Cow
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DONT KNOW • YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DON'T KNOW • YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO • DON'T KNOW ® YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained ® , Date Issued:
C. Do any signs exist on the property? YES ® NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location: C
E. Will the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ® Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[0] Other[Q
Brief Description of Proposed —" �ga
Work: ED266M 2ESS (,(fir ND 0(,�} g se wtl.K,� �.(J►�
Alteration of existing bedroom Yes X No Adding new bedroom Yes N
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions UX
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS 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.
Signaturtof0wrer Date
as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed un er the pains a�ry�penalties of perjury.
L . lC�'vE1l,A SEC �S
Prin e /
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder.
License Number
Address Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-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....... .4 No...... ❑
City of Northampton
•. % Massachusetts
.,A a
I �1
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building J cam
Northampton, MA 01060 •...... �
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: � SEME4t �Ub f am f Ey'l SS P)Wbia Est.Cost: �a
Address of Work: 3 D U1�S J 0 f-1011EIVCZ Z A
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
ZC Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Date Contractor Name MC Registration No.
OR:
No ith tanding the above notice,I her apply for a building permit as the owner of the above property:
Dae I IFOwner Name and Signature
City of Northampton
�,C�, `: r•!,j. SSS....�....,Sio
Massachusetts
1. ( DEPARTMENT OF BUILDING INSPECTIONS
a 212 Main Street •Municipal Building Zv`ti .C1�
civ Northampton, MA 01060 f�► ��0
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 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 properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
113 �ud_. fV- iol
(Please print house number and street name)
Is to be disposed of at:
Vt 1/,e V I cc y C//'A/ ' � iAm �ON MA
( lease print name a d location of facilit )
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
4ature of Permit Applicant or Owner Date
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 Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
c
Boston,MA 02114-2017
www massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information I
�A \\ / Please Print Le ibl
Name (Business/Organization/, fl;�I,ndividual): G lJ C-& I1U-(VDiiAddress: I 1 3 S 9(A S
City/State/Zip: POUNM I m 0 �2 Phone #: W3 'v��C1
Are you an employer?Check the appropriate box: Type of project(required):
1.Q I am a employer with employees(full and/or part-time).* 7. []New constriction
2.M 1 am a sole proprietor or partnership and have no employees working for me in 8. C]Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.0]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 d Building addition
4.❑I am a homeowner and will be hiring contractors to conduct al work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.a 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs
fhese sub-contractors have employees and have workers'comp.insurance?
6. We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors 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#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
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 fine up to$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$250.00 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 certi d7ere p ins and p41Analties of per urh that the information providelaove is true and correct.
;4 Si nature: �L Iy Date: r ��
Phone#• ' �� ��1,7–
Official use only. Do not write in this area,to be completed by city 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#:
jig ,ZI
T7ii,
e 17
�► S� IY
rnsar�i/VI SS��3
Iw..:k.
Irr
F
Egress ,
*.:.,
e. window
MMI
y
s.a
ie, a 1�<< *drop ceiling height:7'x8"
-- *Egress window: 27"05"
p 18• *sill height:3'
•window: 31"x13"
*width of the room: 12'x8„
#3, is, 7 *length of room: 24'x8"-
3„ ? '• 16"
16" floor
NO
8002
y r : DoorWt
b b
R IV 4
C�
Wil 16"
t
16" s_D
FID
r �
♦n
, "nAm
' sut*i;era
WIN
AL
r
1
b
i
.I I
it r
b
carport
`
l
Ell-
4 Icr a.
17? ' MO'
f:
j
-
"Illm RUN
... ._ . .
.. . .. . . . .. . . . . . . \ �y :
: }< ® /out .
_Shan --Save to Favorites -Print
Wellcraft
27 in. x 45 in. Egress In-Swing Low-E Vinyl
Window
(4)Write a Review
Questions&Answers(6)
• Made to allow for easy access in an emergency
• Durable vinyl frame doesn't require painting and won't
rust
• Low-E glass adds insulation to your windov.,
Specifications
Dimensions
Grid Width(in.)
None
• 9
Jamb Depth(in.)
k
sd—
Product Depth(in.)
8
Product Height(in.)
45
Product Width(in.)
27
Rough Opening Height(In.)
40.875
Rough Opening Width(in.)
20.125
Width(in,)x Height (in.)
27 x 45
Details
Exterior Color/Finish
White
Exterior Color/Finish Family
White
Features
Argon Gas Insulated,Egress Window,lnsect Screen,Integrated Nail Fin
Frame Material
Vinyl
Frame Type
Block Frame
Glass Type
Low-E Glass
Glazing Type
Double-Pane
Grid Pattern
No Grid
Grille Type
No Grille
Hardware Color/Finish Family
White
Included
e
«
Screen
Interior Color/Finish Family
x
White
Lock Type
Lift Handle
Number of Grids
No Grid
Number of Locks
2