39A-055 (4) 68 LYMAN RD BP-2020-0724
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:39A-055 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Bath reno BUILDING PERMIT
Permit# BP-2020-0724
Project# JS-2020-001240
Est. Cost: $21790.00
Fee: $141.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ROBERT WALKER 034783
Lot Size(sq.ft.): 11020.68 Owner: BUTLER KYLE
Zoning URB(100)/ Applicant: ROBERT WALKER
AT: 68 LYMAN RD
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON:12/12/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM ON 2ND FLOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wring 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 Sienature:
FeeType: Date Paid: Amount:
Building 12/12/2019 0:00:00 $141.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northa ' ..
Department use
1i s't
pton �fes/ofPermit:
Building Department a��+ Cur ' DriveN?ay Permit
212 Main tret O� 2 Pate
wer/ eptic vailability
Room OQ Fpr
N ell 'vailability
Northampton, MA0 gM�Oiy� NS Two ets Structural Plans
s, phone 413-587-1240 Fax 413-58 - aF Site sans
Ap�C
er S ecify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMCIZISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
C� LjIv1ct 1Z-c,cQ Map�. Lot_ 1 Unit
AA �� v Zone Overlay District
Elm St.District CB District`
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
y C Z iyvju2 1 �TLu
Name( ri 47 Current Mailing Address:
Telephone
Signature
2.2 Authorized Aclent:
`.cam �.)OVrAnoWT-r,_✓K
Name(Print Current Mailing Address:
4 1--� -- S 1 — 122 4—
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building i .� _ (a) Building Permit Fee
v
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing CA O• — Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total= (1 +2 +3+4+5) , ' t' Check Number 75-
/Q� n This Section For Official Use Only
Building Permit Number: tJ t' CDate
Issued:
Signature: z i
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors F-1
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding[p] Other[O]
Brief Description of Proposed
Work: RCNtortAl-
VV'-
Alteration
NYSAlteration of existing bedroom Yes V""No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - heet
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. ension
e. Number of stories? C.
f. Method of heating? Fir aces 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 w rids? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or ar floor below finished grade
k. Will buildin nform to the Building and Zoning regulations? Yes No .
I. S is 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, i
property 'v V as Owner of the subject
hereby authorize 9c6 F�� W4KEyZ
to act on my half, in a atte relative to work authorized by this building permit application.
1-217
Signatud of O&6r 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 under the pains and penalties of perjury.
Print Name
��
Signature of Owner/Agent Date
SECT{aN 8;-CONSTRUCT USO ERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: '�" ��LQ� L,raPrL .SIC. _ G 5— O 3 4-1 1&3
2 License Number
J Sic R—y�C� C T� P►'t`�t�C-� Y V r7rA.4*%PT Wi A,%A L 0 1,fe I ZO Z t
Address Expiration Date
s'P 4- - �z_z_ �
Signature Telephone
Milli I III I limill MI IN 111111"Will�7 Not Applicable ❑
*,ey— 07-00.
Company Name Registration Number
3 5&,�-vac ►- ti, N o sz - I M� s 13 ! 7,0 e.o
Address Expiration Date
Telephone+IS-r%4- j2--f 4
SECTION 10„iGYD[2KERS'GOMPEI�ISATION-1�IS.l>ERANGE Af<FfD,4YiT(M G:L,c.152i-§,2� (6j)
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....... No...... ❑
-- City of Northampton
Massachusetts
w
` DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building J
Northampton, MA 01060
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:
6 b 1.`1yvv,.,� Z( . �G
(Please print house number and street name)
Is to be disposed of at:
C CI
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature 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
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lezibly
Name (Business/Organization/Individual): �—p�, ��� ` A.i 1-4--V U
Address: 23 S Vt'CtIZ
City/State/Zip: �16iLTypprvW_rUt,,, MA ototo Phone #: tVl� — fie4 — ►ZTa-
Are ygu an employer?Check the appropriate box: Type of project(required):
1. I am a employer with_I 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors ,�,,�
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 7. Li�l Kemodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees. [No workers' 131-1 Other
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 their workers'comp.policy information.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:_ A ( A
Policy#or Self-ins.Lic. #: W 6N 7-2L-,3 S-60 750-71y ICA A Expiration Date: 7&- 1 c�,
Job Site Address:— 69 l_w, q_p City/State/Zip: (V e .vQT M A-
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: I'L- L j t`'t
Phone#: l — 4-
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#:
14'-8"
2'-6"
T-6" 2'-6" T-0" 2'-6" T-2"
0
"v
GFCI
5'-0"VANITY 8
O SLOPE
BYPASS
GLASS
L — — DOORS
NEW CERAMIC TILE
FLOOR THROUGHOUT —TILED
o F RECESS
L
BATHROOM
LINEAR DRAIN T-0"
3'-3" BUTLER RESIDENCE
6'-8" 8'-0" 68 LYMAN ROAD
NORTHAMPTON, MA 01060
12-9-19
SECOND FLOOR BATHROOM PLAN
1/2" = 1'-0"