23A-152 12 MAPLE ST BP-2020-0782
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A- 152 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING P E R M I T
Permit# BP-2020-0782
Proiect# JS-2020-001359
Est.Cost:$49585.00
Fee: $322.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PAUL GASS 077256
Lot Size(sg.ft.): 15420.24 Owner: KAMINS KATHERINE
Zoning: URB(100)' Applicant. PAUL GASS
AT. 12 MAPLE ST
Applicant Address: Phone: Insurance:
58 SUMMER ST (413) 387-9105
GREEN FIELDMA01301 ISSUED ON:1/8/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-DEMO ATTACHED APARTMENT AND
REMODEL, RENO UPSTAIRS BATH
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 Sisnature:
FeeTyne: Date Paid: Amount:
Building 1/8/2020 0:00:00 $322.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
1y�a
City of N®fthNf l on R c t
Permit:
>n�` yjrw Building D@pNI`I ont ' `L C� /Driveway Permit
212 Main,Str at eptir,'Availability®®m 'iQQ ell availability__N®rtfja�lmp ®n, M 010 0 '14N ` 8 of Structural Plansphon@413=067=1240 F 41 = g7=1272PI nsof e ify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENO 7107� r ALIS A ONE OR TWO FAMILY DWELLING
SECTION 1 =BITE INFORMATION
III f n2ft Adding: _ This section to be completed by office
it� SI .
r rn� r; Lot / �� Unit_
ICG/ O I Zone __ Overlay District
€Im St.District____ CB District
990TION 3=PROPERTY OWNBRiNINAUTHORIZID Af3LNT
3.4 Ownor of Bogard;
kLe(L( NC kwN P3 a I sow CD,,,aw Ol 3.0 I_
Nam (Print) u mnt Mailing Addmss° t --SL rZ�
I 1 AV k k I n c\ Talaphona
Iti nature
3.2 k0adwd Am
rowSSvrkM�Iz s+ �Si -�l�(i ,�M tt
Nam@(PR Currant Mailing Addr®ss
g4�. !Ll 3—
fignahk T@I@ph@n@
INCTION 3:ESTIMATED CONSTRUCTION COSTS
Item E§timoted Cost(Dollars)to be Official Use Only
am feted b ermit applicant
1. Building _ (a)Building Permit Fee
S
2. Electrical (b)Estimated Total Cost of
Construction from B
3, Plumbing Building Permit Fee
d, Mechanical(HVAC)
b: Fire Proteanon
Gr Total= 9 *g*3*b*b Check Number
This n For Official Use Only
6 —aC - 1� Date - -
Building Permit Number: Issued:
signature; — P J
Building comm4sioner/Inspector of Buildings
c�•Q C*arc dp C� SCh, kI&T , @ -
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ® Replacemenmridows Alterotion(s) ® Roofing
Or Doors ®®
Accessory Bldg, ® Demolition New signs I01 Deeks M Siding=31 Other IM
SFief Description of Propowd
Work: Cor-flk�-t
Alt@rafion of @sisting b@droom Y@s No Adding new bedroom Y@s No
Attach@d Narrativ@ ftnwoting unflnish@d basement _Y@s -jL—No
Plans Atta@hed Roll - Shoat
Oa. If New house and or addition to existing housing, complete the following
@. Ursa of building°On@ Family —_ Two Family Other
b. Number of roorng in each family unit__ Number of Bathrooms
c- Is th@r@ @ g@F@ge attached?
d• Propos@d Square footag@ of now c@nstruetion- Dimensions
@� Numb@r of stod@s?
f. M@thod of Mating? Fireplaces or Woodstows Number of a@ch—
g, gn@Fgy Cons@Fv@tion ComPWIFI§@� Masscheok Energy Compliance form attach@dy
h. Type of construction
i. Is construction within 100 ft-of w@tl@ndsy Y@s No. Is construction within 100 yr. floodplain Yes No
j. D@pth of b@s@m@nt or collar floor b@low finish@d grade _
k. Will building conform to the Building and Zoning reguiations? Yes —No-
1- S@ptic Tank City S@Wer private w@ll_—_ City water Supply
jEeTION To-OWNER AUTHORIZATION■TO BE COMPLETED WHEN
OWNER$AGENT OR CONTRACTOR APPLiE$FOR BUILDING PERMIT
I, IAC`�i K1 NS ,@s Owner of the subject
pF®P@Fty
homby authors;:@ L
tcfon my b@h@If,ifl SII Matt@Fs ati au @@ by this building par it a licoficn,
Sig ture of Owner ®@t@
as Owner/Authorized
Ag@nt @ y declare that th@ st@t@ments and information on the foregoing application are true and accurate,to the best of my knowledge
and b@li@f,
Sign@d und@F @ins and P@n@Iti@s @Fury.
Print Name
ffi@tufa if Om@F/Ao@nl ®apt@
INCTION t-CQNBTRtJCTICN ILKRVIC �77�
8.1 Licensed Construction SupervisoP; T Not Applicobl@ ® /
Name of License Holder: J
��)�
Liceng@ atmbw
Explratim®apt@
Lf 1c)
506—turg Telephone
d-Home-limprovemmacems Not AppllmbW
1406511S
7noisMon N7mb@F
QKM & �JfC)t3Ooo
Addr@§§ Expft'®n 091111
Tol@ph®np YI3-3 31—
SECTION
r1—SECTION 10=WORKIRR'COMPLNiATION INiURANCO AFFIDAVIT(M.o.L.a,183,;38C(8))
Workers Compensation Insurance affidavit must bay comp1@110 and submitted with this applion lon. Iffatlilum to pr@vid@ this affidavit will rogult
in the denial of the issuance of the building @ffnit,
Ligned Affidavit Attach@d Yes....... N@,,,,.,
City of Northampton
�1
Massachusetts
+ +✓ DEPAXOF MUjL=NG INSPECTIONS a`•.
y' 212 ®t4@@t • }@}pal Building fid'
p� bio€thNWton, NA 01060
AFFIAAM
Hom@ Improv@mmi Contractor Low
Suppl@m@nt to P@rmlt Appllcatlon
`I'h@ Ofl1o@ of Consurna AMIrs and Husimss Regulation("OCAHR")regulatos the rmgistrntion of contractors and
subeontraotors performing improv@m@n%or renovations on dot whod one to four family homes,prior to
performing work on suoh homes,a contractor must be registorod as a Home Improvement Contractor
M.O.s.Chapt@r I42A rquiros that the"moonstruotion, alteration, renovation, mpair, modomir@tion, oonvoroion,
improv@m@nt, removal, d@molition, or construction of an addition to any pm=oxistinp own@r oocupi@d building containing
at l@@st on@ but not mom thon lbur dw@Ning units::::or to struotums which am adjao@nt to suoh msr'donco OF building'b@
dorso by contractors:
NAts.V the homeowner haN contracted with a corporation or LLC,that entity mast$p rsglst@rett
Type of Work-, Oe4 w K LL,4 N list,Cost: �1
1
Address of Work; D Q 62-
Date
2Date of permit Application;
I h@rvby oortify that;
Mpistratlon is not r@quired for the following rmason(s),
_Work @xoluded by law(oxplaln):
Job under$1.000:00
Owner obtaining own permit(oaplain); _
—Building not owner=oeeupi@d
Oth@r(sp@eify)"
OWNERS OBTAINING THEIR AWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD ARE NOT
ELIGIBLE FOR AND AA NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G,L,Chapter 10A,SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORD
PERFORMED UNDER THE BUILDING PERMIT,SEE NEXT PAGE FOR MORE INFORMATION,
signed under th@ penalties of p@Jury!
I horoby apply for a buildin It as the went of the owner:
0 t �6�' �- A��
Date Contractor Name HIC Reglstratlo No.
OR:
Notwithstanding the above notice,I horoby apply for a building permit as the owner of the above property;
i
Date Owner Nwo and Signature
i
City of Northampton
Massachusetts
DEPARTN9NT OF BUILDING INSPECTZ098 g�
212 N@jp s tre@t • @.jp4.j .1"
Northarton' NA 01060 'k
Debris Disposal Affidavit,
In accordance of the provisions of MOL c 40, 854, 1 acknowledge that as a condition of the building
permit all debris resulting from the oongtrUction activity governed by this Building Perrnit *hall be disposed
of in a properly li6ensed solid waste disposal facility, as defined by MOIL c 111, 'S 150A.
The debris from construction work being performed at:
/n V ' /Q-a
MC Y-
(Pleas@ print ouse number and street name)
Is to be disposed of at:
— - ease print name and location of acs i y
Or will be disposed of in a dumpster onsite rented or leased from:
U �f � Ik o-R r't+
(Company Narn@ and Address)
4sig —stureof Pe !p
ant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner%hall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachoseffs
Department of Industrial Aceldents
I Congress street,salts.100
Boston, MA 02114-2017
J( wwmmass.,gov1d1a
Work@rg'Compensation insurance Affidavit,Build@rs/Co XtratrtoWEI@FtriciNno/Plumb@m,
1'0 HE FiLED WITH THE PERMITTING AVTHORITY,
Applicant mat ion
N --
Address: 9J tL"&m 4.
city/s /z1p, Phone#: / 3 8J — D
Are you an employer?Cheek the appropriate h9v Typ@ of pro)@et(r@quir@d).
I,®1 am a employ@r with _employ@@s(Mli 9ndior part-*N)7# 7, ®N@w @aftoWntion
201 am a SPI@ propri for or partnership and have no employ@@.working for me in g, l @mod@llnif
any @apwity.[No workers'Pomp.ins"W. @@ r@gt1iFed.]
.�19rn a homeowner doing all work myself[No work@rs'Pomp.insurance required.]' 1volition
i
4.®19m 9 h9m@9wn@r and will N hiring @oolmlor4 to gondN@t all work on my property. I will 1®®l ttildto�addition
@9491@ that all @9ntrap19r4 either h9v@ w9rk@r4'9Q"VnWion in4Nranc@ Of ary sol@ I l,®Pl@t?tri@al repairs or additions
pr9pri@tors with no @mpl9y@@4. 12,[3 Plumbing mpitim or additions
g.®19m a general gontract9r ad I hav@ hired the 40-@nnomfors listed on the attached sheet.
Thesp sub-contractors hav@ @mpl9yees and hav@ workers'comp insurW@
h,®W@ are 9 Porparatiop and its officers hav@ @lt@r@ised their right of exemption p@r MGI c
159,11(4),and w@ hav@ no @mpl9y@@4.[No work@rs'pomp,insuranc@ mgtiir@d.]
r'slny applicant that @h@ck4 holt#I mast 9149 fill nut the section h@l9w showing their workers'pompensation poli@y information,
t Homeowners who s9hmit this 9ffid4v#indicating they are doing all work and then hire outside comm-pplors mnst 4Nhmit a new affidavit indipating sNch•
te-optractors that 0@0 this box most attach@d an additional sheet showing the name of the sub-contractors and stat@ wh@th@r or not thow @001i@4 hav@
@mployees. If the sub-@ontractors have employees;they must provide their workers'comp.policy number.
I Am an employer that is providing workeowI compensation insurance for my employtwg, &AIAIP/ti JhV p0UCy gffdJAb gftv
Information,
lnsuran@@ Conipmy Nom@€
Policy#or SO ing,bi@,#; Expiration oat@;
Job Sit@ Addr@mv city/state/zip.
Attach a ropy of th@ work@rg'romp@n4ation policy declaration peg@(showing th@ policy numb@r and vipiration tint@).
failure to Swur@ @ov@rag@ as r@quir@d and@r MQIJ C. 132, §25A Is a criminal vlolatton punishabl@ by a fun@ up to$1,500,00
and/or on@=y@ar imprisonm@nt,as w@ll as @evil p@nalties in the form Of it STOP WORK ORDER and a f4V of up to MOM it
day against th@ violator:A @opy of this statom@nt may be forward@d to tho Office oflnv@*tlgattons of th@ DIA for Insurance
@ov@rag@ v@rill@atioo,
I dA hetph,v ve OF the p onffenalfies of perjury that the Information provided a¢ove 's trN@and fAPrAek
Data,
A.OkIat mse An(v, 0a not wr#c in this arm,to he completed by city or town q Ml
City or Towill P@rmittLic@ng@
Issuing Authority(elrcl@ on@)I
1.Board of Malth 3.wilding D@pnrtm@nt 3,City/Town Ol@rk 4, Eketrical Inspector 5.Plumbing ingp@rtor
6,9th@r
Contact P@"onl Phan@#I_ —
ptvsg