25C-237 (3) 201 BRIDGE ST BP-2021-1011
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-237 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2021-1011
Project# JS-2021-001726
Est.Cost: $12500.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BELISARIO BURI 100030
Lot Size(sq. ft.): 8799.12 Owner: RAMOS ESMERALDA
Zoning: URB(67)/SC(33)/ Applicant: BELISARIO BURI
AT: 201 BRIDGE ST
Applicant Address: Phone: Insurance:
31 EXETER ST (413) 222-2914
EASTHAM PTO N MA01027 ISSUED ON:3/16/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:STRI P & SHINGLE ROOF
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:
hough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
1.1 l• 1
Certificate of Occupancy Signature:
FeeType: I)atc Paid: Amount:
Building 3/16/20210:00:00 $75.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
MAR ! u �0?1 r 1 f I
1 r,
The Commonwealth of Massachusetts
Vt Board of Building Regilt4WPd-Sta da ds% FOR
Massachusetts State Build Codo,. 8!t}C 3 MUNICIPALITY
.._ ___ USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildiisui
ermit Number: _9- p/-/01 J Date Applied:
N //053 // - _
3 Its-Z021
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Prop3%ddr t'� g
1.2 Assessors Map&Parcel Numb
1.1 a Is this an accepted streetes 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 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 net-'of Recokd:f
Sher"ctl 012V3010 S jNoi amp oi ? 17 O/c 6a
Name(Print) City,State,ZIP
D1 etude f 213 -3 ?/3ss- , (s► ieroI do rain 05x r�o4c0,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building I/Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other • Specify: RO• 1 , _
B117 Des 'ption of Prop9sed W rk2: Z .a , l _ e ,,,i 4tC(..0 "rBRA
Ir
PA)i ej-kil ulp - 0 e i ' ' /
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
A, �
1.Building $ ! S 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 (I-IVAC) $ List:
5.Mechanical (Fire .�
Suppression) $ Total All Fees: $ -/
�O 0Check No. (3(� Check Amount: Cash Amount:
6.Total Project Cost: $ / g0Paid in Full ❑Outstanding Balance Due:
City of Northampton
�S
Massachusetts ^�>
DEPARTMENT OF BUILDING INSPECTIONS S r
-f" 212 Main Street • Municipal Building J.)LI
Northampton, MA 01060 sl, �-)\'\
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW/ private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
5. -instruction Supervisor ' ease(CSL)
roo. a3D io/25/2I
9.`/ r(l: a )�/ License Number Expiration Date
N.,, - of CSL Hol
3 1 g.)6° � List CSL Type(see below)
No.and S t Type Description
'ion 14 D/0 � 7 U Unrestricted(Buildings up to 35,000 cu.ft.)
S m / [ R Restricted 1&2 Family Dwelling
ity/Town,State,ZIPT M Masonry
RC Roofing Covering
WS Window and Siding
' �7 / , SF Solid Fuel Burning Appliances
1l`'f/3� G 2-�'�/4 �D I),rLD Lau V'I 7 I Insulation
Telephone Email address D Demolition
54 Registers Home Imp vement tra/c r IC) ,6 S b y 03/0 9/z 2
l l [d)1'5 bW1{L I J 0 (EIV' � "� C HIC Registration Number Expiration Date
HIC Co pany N4arie or HIC `strant Name \-,)el
I Sa leCO h UY lad
�
400 • C► iiN 5 s x p rYf� 7n o /vZ 7 Email
City/Town,State,ZIP- , L/13- ',Z 7slii�
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 f 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 authorizer0e, I ( S 0AI) (/3u k' /
to act on my behalf,in all m•tters relative to work authorized by this building permit application.
Ssinerc& f da i:
avrl 05 3// / i
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under i • ,• 4 . and penalties of perjury that all of the information
contained in this applicati c• 's true and accurate 4 i r., • t o ,, knowledge and understanding.
1 - «vLA) u ' f A 3/ / s/ 2021
Print Owner's or Authorized Agent's Name onic 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/dns
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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
The Comntunrvealth of Massachusetts
1.-� )�I I1. Department of industrial Acc idents
ii __..1= I Congress Street,Suite 1011
«;=1:1=, # Boston, MA 02114-2017
,,. _ ww .mass.g►ov/dia
11 urkers'('ontpensation Insurance.►ffidasit: Builders!('ontractort/Electricians/Plumbers.
To BE FILED%%I I II Ina. 14.10ll art c; ti 1 110141 11.
At1 nt Information Please Print Ixi ilnh
aI� Q9 6- c
Name I, t„t 4.Irl �,fat :tt.lr C�YJ
Address: 31 Cxefcr ( 0 1
Nl ii
City/State/Zip: g(,�Sltj:) h 8'n"J l f Phone Y: �(3 2_-2_2 —1-
.'rr you an employer?Cheek the appropriat last: h of project(required):
yaw p j [req 1
LD I:on a employer with emnp1u ee.Ifull aub'or past-hintc1.' 7. D New construction
'Biagio a sole pnrpricior or partnership and have no employees wurkeng fur the in S. O Remodeling
au4 capacity.(Nu mongers'comp.insurance ncyoired.(
9. ❑ Demolition
L❑t am a Irtnncxuwter doing all%oak mu' lt.(No wallas"emir.insurance required.]'
10 fl Building addition
.10 I am a l.cnteuwter and*ill he fining eouMractoratu conduct all walk on my property. I will
emus that all contractors either have workena euomensauon mbotant ur are sole 1 1 a Electrical repairs or additions
proprietors with no employees.
12.0 PI01 thing repairs or additions
5r:i 1 an a general contractor anal I have him-tithe sub-contractors listed on the attached)slte►t. 13 out`repairs;
'these soh-crattractuts have employees and have workers'comp.ur urutee.t
14.❑O[11er
6.❑We are a corporation and its officer.s have ccerrised their right of CAL-minima per MeiL c.152.3i 1(41,and we lave nu employees.(Nu*osiers'comp.insurance requited.j
*Any applicant that clucks box 01 must also fill out the section below shuts mg their wotkcrs'compensation policy information.
*homeowners whit subnnt this affidavit indicating they are doing all work and then line outside contractors must submit a new affidavit indicating such.
'Crnuraduts that check this box must attached an additional sheet shuwttty the name of the sub-eunhrjctors and state whether ut out those entities have
employees. II the sub-euntractuts hate employees.the!.:must prosaic then worker.'comp.pttlrcy number.
I am an employer that is providing trorkers'compensation insurance for my employees. Below is the polie).and job site
information.
Insurance Company Nanne:_ —
Policy#or Self-ins.Lie.fit. Expiration Date:
Job Site Address: City:State'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. ;z 251A is a criminal violation punishable by a tine up to S 1,500:00
and/or one-year inlpris mot as well as ei4il penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator c y of this statement may be forwarded to the Office of Ins esttgations of the DIA for insurance
coverage vcrilicatmr
i do hereby certl rider he pains and penalties of perjury that the information prorided above is true and correct.
Signature: Date: 3 // 5 2 /
Phone#: Li/3 " 2.- 2 2 ^ `f/z.
Oficial use unit. Du not write in this urea.to he cuml.r/rte•d by city or town official.
City Of Tuev n: l'erntitliicense#
Issuing Authority (circle toile I:
I.Board of Ilcalth 2. Building Department 3.Citytrunn(perk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Penton_ Phone#:
City of Northampton
% . Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street Municipal Building
� � go Northampton, MA 01060 5
1-1 \`
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: t/C (le/ p G tin ,'
The debris will be transported by:
Name of Hauler: 'i7w' r 5 Cpy�ij JL� ) / CJ
Signature of Applicant: Date: 3/I s / 2`� z
OILII
r t.v lion of VI a Licensure
a Office of Consumer Affairs&Business Regulation
Division of Professional Licens
Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR
Construction Supervisor TYPE:Individual
Registration Expiration
3-100030 ~=: ,: Expires: 10/23/2021 165619 03/09/2022
BELISARIO BURI BELISARIO BURI
31 EXETER ST D/B/A BURPS GENERATION HI&GC
it
EASTHAMPTON MA 01027
BELISARIO BURI
31 EXTETER ST �i.T = '2!��
EASTHAMPTON,MA 01027 Undersecretary
Commissioner 1„r14••%f/ —-