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38B-305 (2) 50 FAIRVIEW AVE BP-2020-1218 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38B-305 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2020-1218 Proiect# JS-2020-002051 Est.Cost: $5300.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES O'SULLIVAN 66335 Lot Size(sq.ft.): 11325.60 Owner: PETER ALFORD Zoning: URB(100)/ Applicant: JAMES O'SULLIVAN AT. 50 FAIRVIEW AVE Applicant Address: Phone: Insurance: 264 BUCK POND RD (413)532-1312 WESTFIELDMA01085 ISSUED ON.6/9/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF ADD 2 SKYLIGHTS 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 6/9/2020 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton >\"' �� Status of Permit: ..�}s Building Department `�.11'.4Curb Cut/Driveway Permit A , 212 Main Street ✓(�N ewer/Septic Availability A�; e Room `9 ter/Well Availability Northampton; 8 0 ?�� T o Sets of Structural Plans phone 413-587-1240 Fax�4 -1272 101:/Site Plans y, Othpr Specify A APPLICATION TO CONSTRUCT,ALTER, REPAIR,REN ©R DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Loty Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: �L ��� � ►:� - — ��s- yeas Telephone Signature 2.2 Authorized Agent: 44 G�����v13tJ � �oN� Q� (n c�1£L� Name(P int) Current Mailing Address: 413- Z-S-1)--( `f2-$ Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �� 0c (a)Building Permit Fee 2. Electrical w (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee l 4. Mechanical(HVAC) l 5. Fire Protection 6. Total= (1 +2+3 +4+5) Check Number This Section For Official Use Only ����� �� Date Building Permit Numb e : Issued: 4-2 Signature: Building Commissioner/Inspector of Buildings Date LOMB Tp-U CTI0t-J °@ 6MCA ST . N E.i EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) . ` MaMMMFra+.MI:N'+.rwA.��'�r..Y+�l�!'�%M'b7fw.t.-a.:w.k..a,Ye..var.i•s++•. u+ ...:✓V-]�...._.iYiM1•f�'r.W�M t11ra.N.vfVT-.ws..i..•t,+Nvin'.x.;aa1.NK ♦ ••4itMY':!.�, YMMnuMw.. ..+4W,:....u..T*'MWvavan+arYY.M nxaYy,/1MaaVMle•TVN,"N!.eMFYiM�C•.".•w...wswer.<wYYA`r... ... rsu MpWW>vgMalY+•+1`.+,+N.•y YY.gT"MM.rayy..:......,,.,...y..•ygaW+.•-..�vraW✓wTa.nelt .S 1 t z . :•.fir ryt \y ts.� '-. 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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors M Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [01 Other[d] Brief Description of Proposed S �T Work: 5T R� ��-1 fl L' E Q G-49-ft 64— �15-P Alteration of existing bedroom Yes_Yj 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 . 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 2 LJ�aR-� as Owner of the subject property r ,. hereby authorize t,�t� \1 ( A^1 �k,-r to act on y behalf, in all matters relative to work authorized by this building permit applicatio . 5 Signature of Owner Date PA E5 0 `)Ull �\4 A-Q Oftem 'v �13N 1 T VC710N 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. `�- I�V� �`-� ►J NSA-tic i l ati Print Name GL 5 20 Z6 Signature of Owner/Agent Date .'�..' • It'''i''!{'1 '1:l�.. •h 'Ali-. �.•ji�. ` .rt,.,._ - ,h t 7 C'•,;. .i"gf{tY+c •h ° `�,:?' � 3.:u 1 �ll.l� .. :.;t+7 _ -C:l ..Ir' i ?''. -•.:3; ... '. i, r? :,sr'),_. � r . I 7760.0417, ter." 3 -CAVILS ':""±Y:az:ExV6:leo v 7 . .. .yrU,SAVO m. ;%! 5. 1 yjf?mt,05' { 1 c.rr',Ltv.'' .! ' rti U::};• r:h; z mum d • Y !1 f r'�..«. �11r...lrr d'2s,>L1Gi4 ,. ,~��_YY'��r�Se�•��NT�.:L:S��[ .t Trod:; %t(y� SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: /( l /► Not Applicable ❑ Name of License Holder: ♦ 6 ll ` tU A N ,l� Licens Numb C... uQ C, 1JG l� �- l �,�Qb Mfg ��21 z-( A ress d�OV5 Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ 1(Y1-a k 56 Q-d t,�--5-t 2CGCTl O N / I/j Q y0 Company Name Re i trat72-1 Number 24`� ���� ��N� fZ� �l�S �i��' Imp, Address Expiration Date TelephoneZ -T 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....... -01, No...... ❑ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS �y o 212 Main Street •Municipal Building —-�fNorthampton, MA 01060 ti 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: (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) I L% � Zd Zo 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. J ` f t S'.)t..�' ...,r, I. • Y i• Ili .'1�:'i�� At '� 5! a"�i 2 1 ;'•;. f7; 4 is � i` Gi to•:'ii,c y fd ., .;�i l"7E- Ca�< „�• •ry;tR, i�`t I?i�',.� �34's � ,�':v. <'d1�j� '•i �klGi. ;t::'ti,.;,I i'fi d�..�i;ti�:'.F;,��1'Q'' .. .*r �sA!,�i �+i �,''l. �i,'as�} f�.. �. S ('.�,r,�..s ��{ i k _604�c'C"Q C4 f:, .: ..S�.�i '.�k.. :a L.c�! •^ C:. ;iy1c`/5:,i VO kY � ,.., siL�:.."r "� L: ::'-. 'f}i3\ d„7�r 7�^!'r. �;ti• <+ .�f-ii!�r�{;� �' X._�'S�' i �.� r 5���{��' R i {�.1•,i1� a..,?•,(h..Rw Al r.?i:i if`ti �3.}-•1{.S-F,it(:S' ; -rl•.;� r;�.�IL�l�..f CA,p�. '+', �ssi•u-''i�A 1«'r'�.S.i. .tt-���::�� �'R• ;7v. t.ry t i� r �tl`s:: ,ICRI• .. 1'S-, , .1.1•`+ ..'l�.kui:C'au C•4h�^ t � .�, , t. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AyolicantInformation PleasePrintLegibly Name (Business/Organization/Individual): OA L 19-1 156 N (_aN5( LUCr(d/y Address: Z,(4 44 7y�q(K.- PCK b 9--k�) City/State/Zip: W E5k_(-1 E Lb WDA- b 10 K5 Phone#: Lf(3— 7 Lf 2-8 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. []New construction 2Q I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling y capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.I I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all 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.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These 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.❑Other 152,§1(4),and we have no employees.[No workers'comp,insurance required.] *Any applicant that checks box#1 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby ce fy under the pains and penalties of perjury that the information provided abois ue and correct Si afore: Date: S Z_O Zp Phone#: Lt/,3 — 2-56 —7 8 Official use only. Do not write in this area,to be completed by city or town offieiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 7z"... t ...x........_.:s7z" .. .s..:x....:., ._... , •c, I apt: `� a f?SFJ.tat, ., +f!.' ., 3 f31'4,�'Sf3r- .'>aaJl:..�t3iP'�jl y t',5�:$itkrf%.ti7 �+. a' .t .';NK"..43. �;a::! :J' ;:k'^�'}5+,.1F._#sr:,t'• ,r}; - �' :� � 1�...telt' ';tt3*�U1.P•i.s;1i 1j+',,.�.,�'', {;.x;+txlet�j .,. ,yi:, - it"I.A,1i� �;c,°; s� �' ,._. . �, , ,�.: ...-x.•:::a���. ; :::.. ..:::tom: $_.� ��.,�-�:�.>K �r .. .. _..._,v...M-�•�,:. - _::7• -�:-.�.` - . 11,r a€ti�;rl ':i�L>r'. 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