24D-088 (10) 60 NORTH ST BP-2020-1052
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-088 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2020-1052
Proiect# JS-2020-001783
Est.Cost: $23000.00
Fee: $149.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SCOTT CALLAHAN 97309
Lot Size(sq.ft.): 8886.24 Owner: FREY JOHN D&JENNIFER K DIERINGER
Zoning: URC(100)/ Applicant. SCOTT CALLAHAN
AT: 60 NORTH ST
Applicant Address: Phone: Insurance:
33 WESTVIEW TERR (413) 320-6269
EASTHAMPTONMA01027 ISSUED ON.411412020 0:00.00
TO PERFORM THE FOLLOWING WORK:RE-DECK EXISTING SIDE DECK, NEW
HANDRAILS AND FRONT STEPS
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 4/14/20200:00:00 $149.50
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
o Department use only
rrrr City of Northamptdn qp9 Status of Permit:
Building Department 3 Curh�Cut/Driveway Permit
r 212 Main Street"* �' Sealer/Septic Availability
L` 1'�.� G `
t Room 100 A °4/z�Q�in, Water/Well Availability
' Northampton, MA 01060 �N A,'spF Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-127�� o'°.< Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION -fo56
--/c/a-t f j a 110- tW air- �j
1.1 Property Address: r This section to be completed by office
Map .24D Loty Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
f r e ti's^' Sf
Name ) n Current Mailing Address:
f� Telephone
Signature"
2.2 Authorized Agent: I
Name(Print) Current MaTrg Address: yah? `[ r�✓1
S' Telephone
ECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 00 v (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee l
4. Mechanical(HVAC) ! ��•
5. Fire Protection
6. Total=(1 +2+3+4+5) O Check Number
® This Section For Official Use Only
Building Permit Number: LO- �U <'aJ`o� Dat ed: i �(, e Yyj`/j y /
Signature:
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition 0 Replacement Windows AAlterations) EDRoofing
Or Doors Fl
Accessory Bldg. 0 Demolition New Signs [I]] Decks [[] Siding[01 Other[01
Brief Description of Proposed r .w,, , /��
Work:-,, f 'J f (L Q X��t c Q C I V�c F�/�1 t It-f�,ll�.S 1�J Lel I�,k9r(Z- 4 (—
Alteration of existing bedroom Yes_ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. 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
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-
1.
o_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
' Y f A4 as Owner of the subject
property
hereby authorize C \C'•�r�r
to act on my behatf in all matters relative to work authorized by this building pe it a
3/30
Signature of Owner Date
as Owner/Authorized
Agent herebi-cleclare 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 Na <�
of Owner/Agent Dale
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: LNNo�tApplicable ❑
Name of License Holder= coyk
(/ ` v
License Nuffiber
Ad" F Dole
Telephone
9.Registered Home Improvern t Contractor. Not Applicable ❑
Company Name Registration Number
1 - 3-�-- Via-/
Address Expiration Date
Telephone k `
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...... No...... ❑
City of Northampton
Massachusetts
DEPARTMENT OF BUIWING .INSPECTIONS
212 Main Street • Municipal Building
Nortbamptm, MA 01060 3,,4
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: �� ��C�� Est. Cost: CY2
Address of Work:
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
_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 HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
The Commonwealth of Massackusem
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
t www massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name (Business/Organization4n(lividual):
Address: S_- � E/
City/State/Zip. 1 ac -r\ Phone#: M3
Are you an employee Cheek the appropriate hoz Type of project(required):
1.[]1 am a employer with employees(full and/or part-time).* 7. ❑New construction
am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
my Capecny-[No workers'comp-insrnance reyrrued-]
9. Demolition
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]T
❑
10❑ Building addition
411 1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will
ensure Ural all contractors either have workers'conation insurance or are sole I I.0 Electrical repairs or additions
proprietors with no employees. 12.E]Plumbing repairs or additions
5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs
These sub-contactors have employees and have workers'comp-msnnanoc-:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]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.
Ido hereby cerci under the pains and enalt'es of perjury that the information provided/ /
abovet
is true and correct.
Signature: ("1
Date: v I J C;�C vo
Phone#:
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/Licease#
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#:
City of Northampton
Massachusetts'ov
u DEPARTMENT OF BUILDING INSPECTIONS y. r
212 Main Street •Municipal Building
x
Northampton, MA 010604
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:
(gpb "\JL>v -�m_ '-�>-T
(Please print house number and street name)
Is to be disposed of at:
(Please print name and loc tion of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(__,) /71-
(Comp
y Name and Address)
Signature of Permif 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.
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