24D-091 (9) 76 NORTH ST BP-2021-0030
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-091 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:GARAGE BUILDING PERMIT
Permit# BP-2021-0030
Project# JS-2020-001979
Est.Cost:$25000.00
Fee: $163.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sa. ft.): 8145.72 Owner: PARSHALL TIMOTHY&PAUL MATYLAS
Zoning URC(100)/ Applicant. PARSHALL TIMOTHY & PAUL MATYLAS
AT. 76 NORTH ST
Applicant Address: Phone: Insurance:
76 NORTH ST
NORTHAMPTON MAO 1060 ISSUED ON.7/10/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE OLD GARAGE. BUILD NEW GARAGE
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:
FeeTylpe: Date Paid: Amount:
Building 7/10/20200:00:00 $163.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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a 3 i---
o The Commonwealth of Massachusetts
co Board of Building Regulations and Standards FOR
o t Massachusetts State Building Code,780 CMR MUNICIPALITYQa USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
5 One-or Two-Family Dwelling
x This Section For Official Use Only
rmit Number: r ,3� Date Applied:
_�Building Official(Print Name) Signature
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
-7(0 NA o't+%. `�" 71-( 1? 0 �
LI a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
( I�� 0. 1 I-1 ') 0
Zoning District Proposed Use Lot Area(s4 ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1>Zd
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Pub lLc Private❑ Zone: Outside Flo ne? Municipals On site disposal system ❑
Check ifyes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
POL'A �t(AYI6L5 'v��� U!t� ��
Name(Print) _T City,State,ZIP
-760 aR--T�A TT -rW PAS ��
No.and Street Telephone Email Address a C v
SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition - Accessory Bldg. Number of Units Other ❑ Specify
Brief Description of Proposed Work': SemoQe a-�raRzi,%,ave
0.T c4a�Vu�r�v 1lC 0. kZ f1 o�u0.
aN k\ , 4io La f L' +11
Ga,c-*<k900t.
SECTION'4:E TED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
1.Building $ ;kl5 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees --��
Check No. _qju Check Amount'' Cash Amount:
6.Total Project Cost: $ Q 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
RIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.G 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...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S 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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
111
2
Print Owner's or Authorized Agent's Nalne(Electron Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an o«-rer who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.govioca Information on the Construction Supervisor License can be found at w-ww.mass.govldns
2. When substantial work is planned,provide the information below:
Total floor area(sq.fr.) --vc (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Dumber of bathrooms Number of halftaths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
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The City ofNorthampton
Building Department
212 Main Street
aIN� 1,ay
Northampton; Massachusetts 01060
Phone (413) 587-1240
Fax (413) 587-1272
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance with the provisions of MGL c40, s54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility as defined by MGL c 111, sl 50A.
The debris will be disposed of in: t-tc e-J&4t
Location of Facility we,�-f r ~ e 1C
The debris will be transported by:
Name of Hauler Gze-&o �-
Signature of Applicant: Date: 7 7
City of Northampton
Massachusetts n �L, r
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t DEPARTMENT OF BUILDING INSPECTIONS
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212 Main Street • Municipal Building �i3ti, r
<_ Northampton, MA 01060 �sg` ti1dC
HOMEOWNERS'EXEMPTION ELIGIBILITYAFFIDAVIT
n
Ilk (67
(insert full Iegal name), born _ (insert
month, day,year), eby depose and state tlw following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.83.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR IIO.R5.1.2:
Persons) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one-or two-family,dwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in
a two-year period shall not be considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code,
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this .day of 20,�Q
tyV wr- i
(Signature)