30A-054 (6) 44 LIBERTY ST BP-2021-0051
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-054 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-2021-0051
Project# JS-2021-000080
Est.Cost:$24550.00
Fee: $160.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRIAN WORGESS 106973
Lot Size(sq. ft.): 15855.84 Owner: MAITINSKY JEAN-PAUL
Zoning: URB(,100Applicant: BRIAN WORGESS
AT: 44 LIBERTY ST
Applicant Address: Phone: Insrrrance:
680 BAY RD (508) 680-6271 _ SOLE PROPRIETOR
AMHERSTMA01002 ISSUED ON.712012020 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENO 2ND FLOOR 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 signature:
FeeType: Date l'aid: Amount:
Building 7/20/2020 0:00:00 $160.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
_.......__.._.__._.. _ice
JUL 2 0 2020
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iY�Fc,�i�v%f M sachusetts
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Boar o ut Ing oft and Standards FOR
f; Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
7 �
Building Official(Print Name) Signature to
SECTION 1:SITE INFORMATION
1•l1/l!Property,d Azr4us'� 1.2 sesso�s Map&Parcel Numbers s t ,
1.1�an accepted eet?yes no Map Number Parcel Number 7
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood.Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner'of Recor
1 OaV4 - 4G Z
Na e P ' t) City,State,ZIP
qq
No.and Street �T Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work2:
Jh+ t
SEC ION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
1.Building $ `Lf VD a 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $
6 ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ Too 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Tota]All Fees:$
'j Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ Z'7 $5p Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
13
5.1Construction Supervisor License(CSL) 4.15 — 'O`�.�� 3 s � 7-1
1
IAA W��GSS License Number Expiration Da e
Name of CSL Holder
(.�►o jj�� �' List CSL Type(see below)
No.and Street+, Type Description
on k,*4%
'M 09 O 1 OCOZ U Unrestricted(Buildingsu to 35,000 cu.ft.)
Y" ( R Restricted 1&2 FamilyDwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
` SF Solid Fuel Burning Appliances
S ( • oswoo joeiz .,,r I Insulation
Telephone Email address ; D Demolition
5.2 Registered Nome Im rovement Contractor IC) 18(2.0 y 70 it
Zo
Cir Iein1 10®(-9GSS HIC Registration Number E pira on Date
HTC'' — ito N--or.i
sC is nt Name
`and treet
A d tW2, �f Lr ,`� ' Email address
Cit /Town,State, IP Telephone hon '• GOI/V%
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes.......... 0 No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
,' -<a rJ Pw.y 1 r'✓InI,A-44$ 7
Print Owner's Name(Electronic Signature) — Date
SECTION 7b:OWNER'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 i lication is a and accurate to the best of my knowledge and understanding.
Wgf/,xv Z-0
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an o%imer 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_govloca Information on the Construction Supervisor License can be found at ta,xnv.mass.eov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
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"
The Comnnonwealtli of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
✓, www ntass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information ' y Please Print Le;ibly
Name(Bus iness/Organization/lndividual): Lir 1�/J (�P CS s
Address: (330
City/State/Zip: 40 to / DIW Phone#: (,-�C>
Are you an employer"Check the appropriate box: Type of project(required):
I.❑I am a employer with employees(full and/or part-time).' 7. ❑New construction
2. am a sole proprietor or partnership and have no employees working for me in $, remodeling
any capacity.[No workers'comp.insurance required.]
9. F1 Demolition
J-�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10[]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 I LEJ Electrical repairs or additions
proprietors with no employees.
12.Q 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-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. 14.0 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 subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
1 ant an employer th-art-is rovidinb workers'compensation insurance for uty employees. Below is the policy and job site
information. I
L i�1�p��• w
Insurance Company Name: IJ a
Policy#or Self-ins.Lic.#: l,, �j G / Expiration Date: 10 1z,1Z.o z.a
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 certifyunder the�ains and penalties of perjury that the information providedt
above is true and correct.
Sitmature: W Date:
Phone#: Q- 1
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#:
111t;, The City of Northampton
Building Department
Y
212 Main Street
QRA7E0 NUE"" 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:
Location of Facility
The debris will be transported by:
Name of Hauler m k,�4— �v
Signature of Applicant: Date: 10 Ziozo
Mathews Brothers Proud Supplier of Customer
MAME
Ailk 'WS QUOTATION
Tel:
&BROMERS
- -
AMERICAB LDEST INOOW MANUFgCTURER
Fax:
Email:
BILL TO: SHIP TO:
QUOTE# STATUS CUSTOMER PO# DATE QUOTED
481567 None 1/15/2020 1:16:38 PM
QUOTED BY TERMS PROJECT NAME QUOTE NAME
Chris Skiathitis Brian Worgess 44 Liberty Ave
LINE# DESCRIPTION QTY LIST PRICE NET PRICE EXTD.PRICE
100-1 1 $363.18 $240.50 $240.50
Walcott New Construction Awning Picture
AP3618,Picture,White,Insul Low-E&Argon
6 9/16"Primed Finger Joint Jamb(All Four Sides), F
w/Nailing Flange,5/4 X 3-1/2 Flat w/o J-Channel Matches --���--------���-------"''
Exterior Frame Color,w/Sill Nose, 1/4"Added To Width and
Height of Units With Extensions.See O.S.M.for dry
dimensions.
Unit 1:UFactor:0.25,SHG:0.32,VLT:0.58,CR:60
Energy Star Qualified(Northern)
Opening: 36.25"X 18.25"
O.S.M.: 35.75"X 17.75' Tag: Unit A
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