36-292 (7) 74 SOVEREIGN WAY BP-2021-0922
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-292 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ALTERATION BUILDING PERMIT
Permit# BP-2021-0922
Project# JS-2021-001564
Est.Cost: $3700.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 60504.84 Owner: LYONS DANIEL&MARLENE
Zoning: Applicant: LYONS DANIEL & MARLENE
AT: 74 SOVEREIGN WAY
Applicant Address: Phone: Insurance:
74 SOVERIGN WAY (413) 588-6093 O
FLORENCEMA01062 ISSUED ON:2/26/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATE AND INSTALL DRYWALL/PANELING
IN WORKSHOP
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.
IL
Certificate of Occupancy sip„naturco'
FeeType: Date Paid: Amount:
Building 2/26/2021 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED i wait, . cu ) -1 .
r` 1 I
lt ,, FEB 1 9 2021 The Commonwealth of Massachusetts
CIoar¢of Building Regulations and Standards FOR
' assdchusetts State Building Code, 780 CMR MUNICIPALITY
OF Mil'r �r IN F�rioNs USE
,,c,n?H4'Bit_ildiif p' it Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building ermit Number: 1 p"e� i ' { 2 2— Date Applied:
cv►��o�, Z-Z5-Zozi
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
7Y Sovert-I v/ W4 y 3 6 242..
1.1 a Is this an accepted street?yes I, no Map Number Parcel Number
1.3 Zoning Information: I 1.4 Property Dimensions•
Z A 3 a ✓esIle�.f14( - kd 6 v, ss'd [' (•39 1� 7
Zoning District Proposed Use CA owl 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:
Zone: Outside Flood Zone? .
Public fe Private❑ Check if yes❑ Municipal 0 On site disposal system
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owne 'o Record:
K�' I Mur/144 e t rav►l rim ehe-e At- sfv�i - It',r-
vne(Print) City, State,ZIP ,✓
7�( Ca✓Q✓et GI/ar yf2 fl -aof1 (f4bu cfyAis & Y ,
No.and Street / Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply)
New Construction 0 Existing Building Sr Owner-Occupied IV Repairs(s) 0 Alteration(s) Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Y f ,3c /k �t/f (41 u at/� aMe ff, y
xleoor w.�lcc4r,a e/ a tI, e 4� • I ?t,c i�
to 4 a rke A i4117ftge4d
41 lcv dK q14 pi, •t1 "it!�rd1 ("del fc .
v
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ d O a 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application F
2.Electrical $ ee
70 d 0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No.I l7,11 Check Amount O Cash Amount:
6. Total Project Cost: $
1 70 a 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Q LU u W!(( (V (.t/'n f License Number Expiration Date
Name of CSL Holder
dec qi J List CSL Type(see below)
No.and Street , t i dec 14_ 4 ���f� Type Description
�Y �7 U Unrestricted(Buildings up to 35,000 cu.ft.)
A441/ R Restricted I&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 Improveme t Co ractor(HIC)
U W N 'A W([ � td/o HIC Registration Number Expiration Date
HIC Company Name or HIC gistrant N '
' - f 47vc
No.and Street Email address
City/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 0 No .0 ////1—
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 #/it-
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 7h: 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.
ll ii a `yin 2 - I( -21
Print Owner's or Authbrized 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.gov/oca 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 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"
City of Northampton
THAMp
As- ...��. SAC
•►�' Massachusetts 4' •
-- '<<
R $t DEPARTMENT OF BUILDING INSPECTIONS 9 /�
212 Main Street • Municipal Building vd� �Cs
qt .' Northampton, MA 01060 f,.; ..- N'
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, t 4 IA d re it Li s (insert full legal name), born (insert
month, day, year), hereby depose and state the 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.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) 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 it day of � , 20 2/.
i nature(S g )
The Commonwealth of Massachusetts
t'—' 'f Department of Industrial Accidents
_ii ?!t.: - 1 Congress Street,Suite 100
3-► • Boston. 314 02114-201"
;.,:�� owl .masss.gol/dia
VI*kers'Compensation Insurance.tflidas it:Builders)('ontractors!Elrctricians l'luinbrrs.
'10 HE FILED 1111 ill 1-11E Pt:RM I I iIN(:At 1'HORITI.
Applicant information ` Please Print Lettibll
Name I Kusurcss organ►zatwn Individual I: Q(/ e l i [ I Pi/ ..._..
Address: 7'' r 1tie✓€ War
City-State/Zip: f.3710.tout i:e ./(4— d iod z-via Phone #: fill • S 89,60?—)
.srr...a.ewapl.yer't 1ua the appropriate hot: Type of project(required).
10 t am a employ,cr with en(1to►ers(hilt and or part-tine t• 7. ®New construction
fam a sok proprietor on partnership and hate no curio:ices-s w intuit; toe Inc in K. O Remodeling
t.Jpiest).{No*oiler.'comp.ns.unaner tequittai 1
� � ; 9. Q Demolition
1 ],
.. t and a tpinmit O net/iWnr'aft workm)]I:lt.iSto w vitas: m comp. ir-u c�t .�
`� 10 0 Building addition
4.0 I ant a tkln sunlit and will he hiring eiaaraaturs to conduct all Noel on art pt.pnty. I will
moue that all contractors eithe-t hate sorter eaanpen,:ttlan insurance or aae fink 11 Electrical repairs or additions
prtipnetots with no en:Otttees.
12.0 Plumbing repairs in additions
I am a utetielal contractor and I hate hired the wti-runlractata listed on the attached sheet
I hew subcontractors hate ompluyces and hate wixler i*i.usn'.nisurarlec. 13.1:21 Rox►f repair
6.011e are aap.raaton and its takers Fat c eseivised then right of exemption MC&c.
14., t$thrt if/ti'� (
.ir
152..1(4 and w e hate no en"loya v-s.1\o workers'comp.insurance penmen l /q S K 44tht
•: pl\ia.apuani that eho.ks sox a I must also till out the section helots stwu my they wor►c&con t:m.1 umn Tithes mtttrinatron. �r
'tk risen Nude+whit submit this att-tdattt nadwauire they are doing all work and then hue outside even-Ai:tors moat su not a new alYtttarit 1.Aical.ag sach-
•(ontraetors that cheek this toot must attached an satdili nat sheet sh n i imp the name iii the nth-e nitraels.us and slate wltettwT or not those,entitle.hate
onq,10:k oo. It the sub o.,tiiraetoes fate rriuployees,they ritual pros oak their workers"au trip.piths)manic;
I am an employer that is providing worAerr*compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Polk\ .:or Self-ins.Lic_4: Expiration Date:
Job Site Address: City'Stair.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 ►tolation punishable by a line up to S1_300.(X1
atutor one-year imprisonment.as well as civil penalties in tlx:li►rtn of a STOP WORK ORDER and a fine of up to S250.(10 a
day against the s tolator.A copy of this statement may'be forwarded to the Office of investigations of the DIA fur insurance
cos crage ventication.
I do hereby certif�yk
underr th/e pains and penalties of perjury that the information provided above is true and correct.
Signature: I �L `c Daly 2 27 - 2(
Phone«+: 11 l 3 - �--• 6a Q 3
Official use only. Do not write in this area.to be completed by city or town ofcial.
('its or Town: Permitli.icense t4
Issuing.tuthority (circle one):
I.Board of health 2. Building Department 3.('its Town Clerk 4. Electrical Inspector 5. Plumbing inspector
6.Other
( ontact Person: Phone 4:
City of Northampton
''t Massachusetts
`' A k N
��} DEPARTMENT OF BUILDING INSPECTIONS
rr^ 212 Main Street • Municipal Building Jj �
� •� >* Northampton, MA 01060 ssNh, T�~� `
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:
J1 Pec7044,Location of Facilit " a e Z y 3 F, .4.4 /` if Ndi ri ax..x4t?
The debris will be transported by:
>
( zpq ( a K,�'C 4 t Af, 7 C( �/v�t 4-4 6IA4 (A? / P1-P4,.,G ,G(�
Name of Hauler: 0 wO-. )
`1/?•5r. ii-•6a?3
Signature of Applicant: `u "-'e ( Date: 2 - 2 Z " Z/