23D-066 (4) 170 FEDERAL ST BP-2021-0965
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D-066 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-2021-0965
Project# JS-2021-001354
Est.Cost:$18000.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:. NU-WAY HOMES INC 013693
Lot Size(sq. ft.): 24742.08 Owner: NU-WAY HOMES INC
Zoning: URB(100)/ Applicant: NU-WAY HOMES INC
AT: 170 FEDERAL ST
Applicant Address: Phone: Insurance:
10 WHITE AVE (413) 563-0085
EAST LONGMEADOWMA01028 ISSUED ON:3/2/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:SI DI NG
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 si;4natn �.
3� -
FeeTvpe: Date Paid: Amount:
Building 3/2/2021 0:00:00 $60.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
AR/
1-3--8----‘0- --
The Commonwealth of Massachusetts
�, oarc of Building Regulations and Standards FOR
,i`e. 2 26Z1 assachusetts State Building Code, 780 CMR MUNICIPALITY
, 1.
:.�: i USE
_ 'r•''r;r, ; iding.Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
>i,
_ tv.r4 r=-rror� One-or Two-Family Dwelling
:....moo io S4ection For Official Use Only
Building Pe it Number: POI 21'* Date Ap lied:
Mk) �s / � Z-262)
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Nu b s
/ 70 f=c dP44,4/ Sr:
1.1 a Is this an accepted street?yes no , Map Num�� Parcc11�mber
P
1.3 Zoning Information: 1'll e t v Vs%9-/ 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 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP1
2.1 ffnn1OJ1/w)ner1 of/R(e�c�or HT/7 / / -
KMA✓i/ efr Sum` /'1/T, ,a/ V:'—
Name(Print) V/ City, StatS/ZIP
/0 G✓4i1Tf five- `y i3) 4;-Zi3- 00-r IVvwr�1-74...fes 6 0ea,..19ry Cd'r7
No.and Street Telephone (/ Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Buildin, Owner-Occupied 0 Repairs(s))& Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief escription of Proposed Work':
Work2:
f:l'�7�j(�/�'� 0/GY illy ,/ /lyll i //h 5//9��%1j /)e '- s/�G�/��
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 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 Fee $,Ti p /, Check No (60Check Amount: (JOCash Amount:
6. Total Project Cost: $ / ) l/ ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(C L) 05 Dj 3(7 3
--} / �aPif b�j
o Lj„J �� �„� License Number Expiration ate
Nameof CSL Holder f
/h 4 i�� j�t(' List CSL Type(see below) 6/
No.and Street / /� T}�g Description
- _�S late, tom/ j 7 O/�7 (�,', Unrestricted(Buildings up to 35,000 cu.ft.)
[-v�'l Restricted 1&2 Family Dwelling
City/Town, ZIP M Masonry
RC Roofing Covering
WS Window and Siding
C vi 3 G)
,�j SF Solid Fuel Burning Appliances
a-G j'I�UIr7�7dj�j�� ies4o r caw I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Num Expiration Date
HIC Company Name or HIC Registrant ems'
No.and Street / Email address
City/Town, Stat , IP 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 't fr 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: OWNER1 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 ac orate to he best of my owledge and u standin
6v4.) tr //AlvUA'ze (
Print Owner's or Authorized Agent's Name(Electronic Signaturk) 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
City of Northampton
0,, .AM: N:
? , Massachusetts y k�
it- A44-4 t t
DEPARTMENT OF BUILDING INSPECTIONS a
4- 212 Main Street • Municipal Building -, -
y Via. Northampton, MA 01060 PStn. '\'�
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:
// v �� ` gP
Location of Facility: 5S i" /' '
C �,
The debris will be transported by:
Name of Hauler: C/ 54 / nc'/> ✓/2
Date: 27.?-6)�'
Signature of Applicant: /
- The Commonwealth of Massachusetts
a Department of Industrial Accidents
W.
1 Congress Street,Suite 100
. Boston, .114 02114-2017
t wwn:mass.gor/dia
t t ' Ilurkers" Compensation Insurance Afftdasit:BuildersI('ontractorsf kctricians Plumbers.
to itt. 111_i:D WITH THE PERMI ri-iM;At-THOM-1'1'.
Applicant lnforinatiun )/ Please Print t.reibls
Name t13ttcanes-t?rpanizatton'lndtvidu:el): /yV V'(� J�,i-0 Z°3 .7 'Cr
Address: /o 6(I6, re: )961e
C'ityiStateiZip:Ai; M4e4-4, 677-aPhone#: Cg/31 L.S 6- 3"0 d 7-S -
tre,ea an tauploraer'Gall di/appropriate bet:
Type of project(required):
I.a l am a employes w rile employees[luil and or part•um i' I ` y conatruct ton
2.. I snt a sole proprietor or partnership and tease nu employees working for me an N. 0 Remodeling
ally a pxacaty_feu workers'comp.insurance n luircd..I
9. 0 Demolition
0I am a h maaswr.a deans:all work myself.INo workers'curry.smuraace monreel.j'
ID J Building addition
4.Q I am a homeowner and wall be hump donna zurs to conduct ail wank and an pm/lints. I a all •
as purr that all contractors either has a workers'corral.-nsairani insurance an are sole 1 i a Electrical repairs or additions
proprietors.w ith no employees
12.0 Plumbing repairs or additions
v.I am a cone ai contractor and I hose lured the sub-contractors Bated on the attached sheet_
these sob-contractors love employees and hose workers'comp.insurance• 1 Ruuf repairs
I,. We an:a a'f am and piss off ter%have exercised then aaa hi of cxc 1 .❑�� ----... .-
aapylrffii 'Tilpl3anl pet Wit.a.
1__.§114i.and we hasp nu anipIuya:s.[NO workers•comp.insurance required.f
'Ana applicant that chocks box al mast also till anti the scetion below showing thcsr%Litton's"compensation policy information_
s term x.wners who submit tins allidas31 indicating they are doing all work and thcar here outside contractors mint sahnut a new aifadas it nah aurnar such.
:Contractor,that check ttna box must attached an additional slits.-1 slaws mg the name et the slue-contractors and state whether or nut those entities lode
canplusaea If the sub-contractors have employees.they muai pins adr their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my emplooes. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-iris.Lie.#: _ Expiration Date:
Job Site Address: CitytState''Zip: __
Attach a copy of the workers' corn pe nsation polio declaration page(shoa►ing the policy number and expiration date)_
Failure to secure cos cr:t,c as required under til(.,L c. 152. s`25A is a criminal violation punishable by a line up to SI.SOO.00
and%or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 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.
I do hereb c e •under the pains and allies of p 'wry that the information provided above is true and correct.
Sienature: • * .%I' • Date: L/ V. 02(
Phone 4: L
Official use only. Do not write in this area,to be completed by city or town official
('it% or-I-own: Permit/License#
Issuing:authority (circle one): ,
I. Board of Health 2. Building Department 3.(Ilya-own Clerk I.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: .1