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38D-041 44 HARLOW AVE BP-2021-0150 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38D-041 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Siding BUILDING PERMIT Permit# BP-2021-0150 Proiect# JS-2021-000247 Est.Cost:$22500.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: BENJAMIN SYLVIA 097008 Lot Size(sg. ft.): 6316.20 Owner: FRASER IAN Zoning: URB(100)/ Applicant. BENJAMIN SYLVIA AT. 44 HARLOW AVE Applicant Address: Phone: Insurance: 123 MONTAGUE RD (413) 768-8393 SOLE PROPRIETOR WENDELLMA01379 ISSUED ON:8/6/2020 0.00:00 TO PERFORM THE FOLLOWING WORK:SIDING 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 Sienature: FeeType: Date Paid: Amount: Building 8/6/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner lie, The Commonwealth of Massachuse s !/ OR G and of Building Regulations and St dar �C ` ti chusetts State Building Code, 7 C 6 I LITY tiS _0, E BuAk P it Ap tcation To Construct, Repair, Renova ° olish foe Rev' ed M 2011 'o 17 One-or Two-Family Dwelling �'"r tip, '�oFo This Section For Official Use Only Building Perm's4�Iri ber: Date Applied: so tis EUJN Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: I1.2 s o s Map& Parcel Numbers 4N � (off �1v1✓, No W_.M X _ (14/ I.la Is this an accepted street. yes no Ma P Numr Parcel Number 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 OWNERSHIP' 2.1 Owner'of R cord: &, -\ H- F rase A&+VvL�v 6i SIA Name(Print) City,State,ZIPr TMnV l0� *t _586 -203 V111 e IAll Tri5et^, 6.1 No.and Street 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 Other ❑ Specify: Brief Description of Proposed Work 2: kAmAl cc,yCL WWI+C} 111,16'011 64-) -11; SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ a id� 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ O Suppression) Total All Fees:$ �� c Check No. Check Amount 6.Total Project Cost: $ J©0 I 0 Paid in Full 0 Outs ing ce Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS_0gX09 S 3 ap License Number Gx ira on Date Name offC L Holder ,.nn List CSL Type(see below) 6�3 Mme%h4ye— V No.and Street 0� Type Description 0D, ,f SII A 6�A 2�_I a U Unrestricted(Buildingsu to 35000 cu.ft. W d R Restricted 1&2 FamilyDwelling' City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding _I_ SF Solid Fuel Burning Appliances I Insulation Telephone T Email addr ss D Demolition 5.2 Registered Home Improvement Contractor(HIC) (6378 a �W► ^ �, 11 V HIC Registration Number Expwati n Date HIC CompanyName or HIC Registrant/Name No.and Strqet aI Email add s t, "V4L Mel 0137°L Ci /Town,State,ZIP Telephone 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..........❑ 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 re'l'ative ork authorized by this building permit application. ��►� �=r�rse r �� 1 - � S o�o� Print Owner's Name(Electronic Signature) tDate 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 in this application is true and accurate to the best of my knowledge and understanding. 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 owner 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. og v�Information on the Construction Supervisor License can be found at www.mass.gov/dps 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 halFbaths 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" City of Northampton r , tMassachusetts - i DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building D` Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 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: ca l Signature of Applicant: Date: The Commonwealth of Massachusetts Department of Industrial.Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov1dia 1lorkers'Compensation Insurance Aflida%it:Builders/('ontractorslElectricianv`III umber%. 1 '0 BE.FILED N I I'll Illt. PERM111INt:At'THORITV. Applicant Information Please Print Levibl% Name(Business Orpritntioa'lndtvidual I: ex ' AddreS•: Mot'A're"i, L_ V-18— C1t}','Statc Zip: MA O l V7 t Photic 4:� 610 -760- 0313 Art Nuu an employer?Check the appreprlatr box: 7)pr of project(required): 1.0 lam a employer with .. _........ _cnspJuyres(full and'or pan-tirex).' }. Q Nct4 CcMStrUc`tion 22)1 )1 am a auk poupnctor or partnership ata!have no employers working for rat in 8.� Remodeling arty capacity_(No wurkers'cuanp.insurance required.) 30 l am a hernwowvar doing all work rn)idf.[Aho workm'conigi_insurawt required-)' 9. Q Demolition 4.01 am a hunivowner and%ill be hirnrg aontracturs to conduct all work on ray property. I will 10E] Building addition emure that all contra c-turs either have workers'ournpe nsatiun imuramv ar air wle 11.0 Electrical repairs or addition-s proprietors with no employees. 12.F1 Plumbing rc-pain or additiun� 501 am a general cuntriwtor and 1 have hired the sub cwttra4wn fisted on the att"iwd sheet. 13.4 Roof repairs These sub-contractors have empluye s and have workers'camp.insurance.. e,.[]we am a ctorpmatiun andd its ovfticers have exercised their nglu of exentptwat per XIGL c. 14.E]Other 152,§1141.and we hmvv no etrgoluyxts.(No wurltcrs'eotnp.insurance ri:quirexl_i *Any applicant that chmks box a I must aLw lilt out the vection b.-luw show in,g their workers'eornpensatiun pulioy inhumation. t Homeowners who sidmtit dus affidavit indscaung they are doing all work and then hire outmd a contri tors must submit a new aflrulavit indicating such. 'C L,mractom that check thda box nlUi{attached an additional sheet shu%ing the:nine of the sub xvuractors oral 3,tuic whether ut not those entitiees have eYnpluyeei If tlw sub cuntractws have cmployies.they must pnwide their uurkers'comp.pulley nuint r. I am an emplq�yer that is providing workers'compensation insurance for m}'emplol•ee.. Belt)K-A the police'and%ob site information. Insurance Company Name: Policy#or Self-in.Lic. #: _ Exptr.oiun Date: Job Site Address: City,Statetzip: Attach a ropy of the workers'compensation police declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NGL c. 152, $25A is a criminal %iolation punishable by a fine up to S 1,500.00 an&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 eco,erage verification. I rho hereby certify under the pains acrd penalties of peritiq that the inliir»talion pri)vided uhore i% irue and correct. S mature: Balt• S Phone x: O ficid use only. D/o n(oi write in this area. to be completed by city or lervvr official Cite or Town: PermlIVLlcense Il I%suing Authority(circle one): 1. Board of Health 2. Building Department 3.(.ityffown Clerk 4.Eleetrkal Inspector 5. Plumbing Inspector G. Other ( eoni:iul Pvr-ttn- Phone#: