31C-076 (3) I I FORD CROSSING BP-2021-0083
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV.Block:3 1 C-076 CITY OF NORTHAMPTON
Lot:-1 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BASEMENT RENOVATION BUILDING PERMIT.
Permit# BP-2021-0083
Proiect# JS-2021-000129
Est.Cost: $18500.00
Fee: $18500.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License: .
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): Owner. ELKIN JAMIE
ZoningL Applicant. ELKIN JAMIE
AT. 11 FORD CROSSING
Applicant Address: Phone: Insurance:
1 I FORD CROSSING (413) 433-3896 ()
NORTHAMPTON MAO 1060 ISSUED ON.7/22/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-BASEMENT RENO
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:
FeeTvpe: Date Paid: Amount:
Building 7/22/2020 0:00:00 $18500.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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,_. The Commonwealth of Massachusetts
z°
t Board of Building Regulations and Standards FOR
5 r;, r'J Massachusetts State Building Code,780 CMR MUNICIPALITY
Do m Iry USE
8 i o Building Permit Application To Construct,Repair;Renovate Or Demolish a Revised Mar 2011
o Otte-or Tiro-Fandl),Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature -- &
/ SECTION 1:SITE INFORMATION
/ 1.1 Pro o a dd `Sl 1.2 Assecgors Map&Parcel Numbers
vvV// P1 Oce � /C.
I.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: — ;�\ 1.4 Property Dimensions:
Zoning District Proposed I se 11 Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Rcquired =Provided Required Provided Required ProAded
1.6 Water Supply:(M.G.L c.40,J54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 OMr'of Re�$rd:
' ) � ��
1 1�
Name(Priv City,State,ZIP
1) ted Srbes:7 8 Gµ•,A 11 .
No.and Street Telephone Email Addreis
SECTION 3:DESC ON OF PROPOSED WORK=(check all that apply)
New Construction Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) V1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify
Brief Dippon of opd Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
item Estimated Costs: Official Use Only
(Ubor and Materials)
1.Building $ 1. Building Permit Fee:$ l Z 1 Indicate how fee is determined:
$ 1(Standard CitylTmm Application Fee
2.Electrical
a ❑Total Project Cost'(Item 6)x multipii )o�x O S
3.Plumbing S 2. Other Fees: S �T'�—
4.Mechanical (HVAC) S List:
5.Mechanical (Fire $
Suppression) Total All F $
Check NX Y--Check Amount- f 2' Cash Amount:
6.Total Project Cost: S r �� JWaid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
r4A License Number Ac
Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.R.)
R Restricted l&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 Rome Improvement Contractor(HIC)
oy MC Registration Number Expiration Date
MC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(IYLGJ—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 Issuanie of the building permit.
Signed Affidavit AttachedT Yes.......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,a of the subject property,hereby authorize
to act on my 7N-.
>Sigpnature)
relative to wor by this building permit application. .
Print Owner's Date
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below,I he by attest under the pains and penalties of perjury that all of the information
contained in application i and accurate to the best of my knowledge and understanding.
72-1
Print Owner's is Name(Electronic Signature) Dare
NOTES:
1. An Owner who obtains a building permit to do his/her ovrn work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(RIC)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
Av.,w.mass_=ov/oca Information oil the Construction Supervisor License can be found at wwtnv.mass.!goy/dus
2. When substantial work is lanned,provide the information below:
Total floor area(sq.fr.) O 3 0 (including garage,finished basementla�s,decks or porch)
Gross living area(sq.ft) D Habitable room count
Dumber of fireplaces Number of bedrooms -2
Number of bathrooms Number of half/baths
Type of heating system j^) Number of decks/porches
Type of cooling systemts EncIosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
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The Commonwealth of Massachusetts
Department oflndustrralAccidents
v, I Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
`V- rkersr Compensation.Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTMG AUTHORITY.
Applicant Information G L l Please Print Legibly,
Name(BushtessIOrganizationtlndividuai):
Address: 1) F•Mtr-b C'O$5/ !V
City/State/Zip: Iv O'Aif NA Phone#: % 3 3 3 3
Are you an employer".Check the appropriate box: Type of project(required):
l.❑I am a employer with employees(fall and/or part time)_' 7. V[] ew construction
2.❑I am a sole proprietoror parmcrship and have no employees working f9rme in 8• emodeling
any capacity.[No workers'comp.insurance regnued I
3.❑I am a homeowner doing all work myself[No wad='comp.insurance required.]t 9 '❑Demolition
4.�am a homeowner and will he hiring contractors to crmdtet all work on my property. I will 10❑Building Addition
ensure that all connactors either have workers'compensation msurmee or are sale 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet
These sub-contractors have employees and have workers'comp.insurance.: 13.❑ROof repairs
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#I must also fill out the section below showing their workers'compensation policy ikon
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
iContractors 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 wod ans'comp.policy number.
an employer that is providing-workers'compemurdon insurance for my employees. Below is the po ' job site
inf n.
Insurance Comp
Policy#or Self-ins.Lic.M Expiration Dim
Job Site Address: City/State/Zip:
Attach a copy of the wo mpensation policy declara age(showing the policy number and expiration date).
Failure to secure c ge as required under MGL c.152,§25A is a violation punishable by a fine up to$1,500.00
and/or one-y onment,as well as civil penalties in the form of a STO ORDER and a fine of up to$250.00 a
day a . the violator.A copy of this statement may be forwarded to the Office of Ira+ s of the DIA for insurance
rage verification.
I do hereby certify u in and penal' ' perjury that the information provided above is true and correct
/ Date: e . Z
Sit7nature
Phone#:
Offu ial use only. Do not write in this area,to be completed by city or town offuiaL
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#:
City of Northampton
Massachusetts
A DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building �a
' ._�► Northampton, MA 01060 51
" V
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
he/she resides or intends 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."
The building department for the City of Northampton wants any person(s) who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection
(before work is concealed), insulation inspection (if required) and a final building inspection
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspection are made
1, understand the above.
(Home o n /resident's signature requesting exemption)
I will call to ssc edule all required building inspections necessary for the building permit issued to me.
Date 07 - ) O ll
Address of work location ���� Cc-o S S ► ti 41
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The City of Northampton
Building Department
,. 212 Main Street
Northampton,Massachusetts 01060
Phone(413) 529-1402
Fax (413) 529-1433
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, S 150A.
The debris will be disposed of in:
Location of Facility_ _
The debris will be transported by:
Name of Hauler_ _ _ - _
Signature,of Applicant: _ ___ _ Date:_
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Jonathan Flagg <jflagg@northamptonma.gov>
to zoestoes
Good morning Jamie,
Per our phone conversation, I will need the size of the bedroom window as well as the distance from the floor to the window sill. A
If you have any questions, please feel free to contact me.
Jonathan S. Flagg
Building Commissioner
City Of Northampton, MA
413.587.1338
Jamie Elkin
to me
2 by 4 studs, pressure treated plate...
window is 36" off the floor
thanks
Jamie Elkin
413 433 3896