17C-091 (12) 120 CHESTNUT ST BP-2021-1004
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-091 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2021-1004
Project# JS-2021-001718
Est.Cost: $15620.00
Fee: $104.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BENJAMIN JOHN 112410
Lot Size(so. ft.): 7187.40 Owner: STEPHENS MICHAEL
Zoning: URB(100)/ Applicant: BENJAMIN JOHN
AT: 120 CHESTNUT ST
Applicant Address: Phone: Insurance:
PO BOX 505 (413) 800-4253 WC
BERNARDSTONMA01337 ISSUED ON:3/15/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD FRONT PORCH DECK
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.
A - 1 •
Certificate of Occupancy Signature:I I 1
FeeType: Date Paid: Amount:
Building 3/15/2021 0:00:00 $104.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
‘,",, The Commonwealth of Massachtlsetts '
nor Board of Building Regulations and Stan ds MAR 1 FibR
Massachusetts State Building Code, 780 MR 5 ��'� OIPALITY
• L JSE
Building Permit Application To Construct,Repair, Renova);e eolish a evised Mar 2011
One-or Two-Family Dwelling a',,;',;;,'' '''=cr„f S
22 p This Section For Official Use Only -
Building Permit Number: !U F`'a//004 Date Appli d:
l. I
ti 1 / ii
Building Official(Print Name) Signature 7ile` -- e
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
I ao C fILLi nui- St • •Vi ,cam,Nfl MOO , C. 6 q
1.1 a Is this an accepted street?yes ✓ no Map Number 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
I i ChDLI! •le f hen S 1 Z 6 Gi i-nc.tit-S+ . 1 or e n CQ, M 4 O)o(g Z
Name(Print) City, State,ZIP
120 GIM471tjJ-Si-• 90g' S—Ce-392Q MJ Si-CO,.-ex,S a @3Mcu 1 . Co4-1
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2( y)
New Construction ❑ Existing Building 0 Owner-Occupied 0 Repairs(s) Alteration(s),/ Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of lased Wor ': `l j ' es..� ritk A_e..e
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 Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fe s: $
Check No iTheck Amount: ,01 Cash Amount:
6.Total Project Cost: $ /5 6 Z0 0 Paid in Fu 1 0 Outstanding Balance Due:
k
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS- 2-4 Jo
ee.n1 a-M r' fa • Sohn License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
P.0• (Soy Sr_95
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
n / M 51 '5'3 7 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
t1 I3—ZOO {ZS3 C-en c� ( etky Cl9-IS.c t- I Insulation
Telephone Email address D Demolition
5.2Q Registered Home Improvement Contractor(HIC) ] 706
J C- HIC Registration Number Expiration Date
HI Compan Name or HIC Registrant Name
•
• O • 16 x c ee_/,e BR S Euu (cL r S . cor'4
N .and Street Email address
+nn, M?k 01337 403-80o-L/Z s3
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 Iss a of the building permit.
Signed Affidavit Attached? Yes ll No 0
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 rN
to act on my behalf,in all matters relative to work authorized by this building permit application.
i-At co( s4 S 3/q/2
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.
C\ hr, 3 JJi
Print Own e '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.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
7 �
Massachusetts ? '
;i DEPARTMENT OF BUILDING INSPECTIONS
,', 212 Main Street • Municipal Building
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: \k 11,(d(.,1 q I,sx (3q k) . 0.T P 0(,Q/ 4
bIDCeCe
The debris will be transported by:
Name of Hauler: A-1,\ -I-not
iii'lleksieu n
f Applicant: Date: 3) Z
The Commonwealth of Massachusetts
►i ;... ,_f!i Department of Industrial Accidents
1_
pi =;:jot= 'j 1 Congress Street,Suite 100
-a _l f j=ay Boston,MA 02114-2017
y
:,.,.,,,, www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Buildens/Contractors/ElecMcians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/individual): E}2 p,7 t�e.L i 1 a-P.N.S
Address:_ F. 0 _ 6j0X .S C25-
City/State/Zip: -e-rnaszt6 on )N A- ot337 Phone#: Lf/ 3- Soo _ V2 S 3
Are you so employer?Check the appropriate box: Type of project(required):
l.dt am a employer with_..3.__ employees(full and/or part-time).'
7. ❑New construction
2.0 1 am a sole proprietor or partnership and have no employees working forme in 8. ( Remodeling
any capacity.[No workers'comp.insurance required.]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition
4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will
10 0 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
6.0 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#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 anew affidavit indicating such.
:Contactors 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 workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:. Aid.{,(.4.4_C_ r... -- ) .C.$2.__._CQ.m e(n(/.._.._
Policy#or Self-ins.Lic.#:_ y v CV 0.1-9 ? 'j00� 2r Expiration Date: / iq ( n Z.Z.
Job Site Address: 120 L-I-n Si- , City/State/Zip: U rt n C o / (•--a l4r- 01 0(i2
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.
I do hereby cert�fy `nder the pains and penalties of perjury that the information provided above is true and correct.
Signature: l/U� Date: 3/ L-f 2 f
3
Phone#: �/,3 CO -
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: P Phone#:
>f� 5' KS� + r6 i-;9'• 8x�x `' eq q, r g.a `�-, i d�� ce :� �µ ��,�, ,,5 yt :S
f'c 4 -
Atlantic Charter Insurance Company VDAC
NCCI Co. No. 29211 Policy Number WCV01484001
1.. INSURED: Prior Policy Number WCV01484000
BRJ BUILDERS LLC Producer:
Bearingstar Insurance, Inc.
199 BALD MOUNTAIN RD 375 Airport Road
BERNARDSTON, MA 01337 Fall River, MA 02720
Federal ID Number 001421546
Business Type: Limited Liability Risk Id Number:
SIC 1521 -236118 Residential Remodelers
Other Named Insured: Other Work Places
2. POLICY PERIOD: The Policy Period Is From: 02/14/2021 To 02/14/2022 12:01 A.M. Standard Time
at The Insured Mailing Address
3. COVERAGES:
A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states
listed here:MA
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our
liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 100,000 each employee
C. Other States Insured: Part Three of the policy applies to the states, if any, listed here:
COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B
D. This policy includes these endorsements and schedules:
See WCE105
4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates &
Rating Plans. All information required below is subject to verification and change by audit.
Code Premium Basis Total Rate Per Estimated
Classifications No Estimated Annual $100 of Annual
Remuneration Remuneration Premium
See WC 00 00 01
Minimum Premium: Deposit Premium:
$500 $5,290
Total Estimated Premium $6,718
Interim Adjustment: Annually Surcharge(s) 223
Servicing Office: Total Premium and Surcharge(s) $6,941
25 New Chardon Street
Boston, MA 02114-4721
Issue Date 01/26/2021 Countersigned By: c Date
Copyright 1987 National Council on Compensation Insurance Form: 100mvnt4
BR) Builders
)ESIGN - BUILD
P.O. Box 505., Bernardston, MA 01337
BRJBuilders.com 413-800-425
3/13/2021
Michael Stephens
120 Chestnut St.
Northampton, MA 01062
SCOPE OF WORK:
• Set up protection for ground
• Support existing roof system
• Demo existing porch to ground while maintaining integrity of roof structure
• Conserve Columns
• Grade existing soil as necessary
• Install new piers
• Frame new porch to match existing size
• Install new T&G flooring
• Build walls between columns and finish with clapboards and top rail trim
• Frame stairs and finish with composite material
• Install trim and lattice around porch
• Prime siding and trim as necessary
• Paint siding and trim as necessary
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