23D-117 (4) 196 FEDERAL ST BP-2021-1018
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D- 117• CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:window replaced BUILDING PERMIT
Permit# BP-2021-1018
Project# JS-2021-001741
Est.Cost:$3490.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BAYSTATE EXTERIOR RESTORATION INC CS-089485
Lot Size(sq. ft.): 10628.64 Owner: GULLA PAUL E
Zoning: URB(100)/ Applicant: BAYSTATE EXTERIOR RESTORATION INC
AT: 196 FEDERAL ST
Applicant Address: Phone: Insurance:
87 SHATTUCK RD (413) 549-6824 WC
HADLEYMA01035 ISSUED ON:3/17/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 2 REPLACEMENT WINDOWS & 10
STORM WINDOWS
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 Signature I
FeeType: Date Paid: Amount:
Building 3/17/2021 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED
MAR 1 7 2021
The Commonwealth of Massachusetts
' Board of Building Regttlations jic i<{'_n„cho Ns OR
MUNICIPALITY
PALITY
Massachusetts State Building-Cod6,— /30- R - '
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
/� i tion For Official Use Only
Q lid'
Building Permit Number: 2/,! f�1 Date Applied:
Z-00._)(Z5 '3-/7-2cz/
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro rty Ad ss 1.2 Assessors ap& Parcel Num�
1.1a 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❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Recor(raAJ( /(
q �� �olbezA-
0 /66�
Name(mot
Pri t) City, State,ZIP
194 1; ( s,4 &015371-erg
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. rj Number of Units Othei Specify: 41 �k,,l
of Description of Proposed W kz: I Le_. /e� S teru.L t-
'rp ✓�4 S ,,.�, plat �, - / jti W 1 d�./ `,,0
. 3O (A'✓QLA., LJr . 1
/" SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ NCO 1. Building Permit Fee: $ Indicate how fee is determined:
1 ' ❑Standard City/Town Application Fee
2.Electrical $ ❑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 NoTl/)heck AmountTLJ 4Cash Amount:
6.Total Project Cost: $ 31 f°(a 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5. 1 Or Etruction Supervi or icense(CSL) C f �
I e 4 ^,`t`to-�,v icense Number Expira ion ate
Na of CSL Ho der
7 5(„V_ pot ,
List CSL Type(see below)
No. • d treet � '_ Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
a, 44 I j 0 t O 3S R Restricted 1&2 Family Dwelling
City • ,State, M Masonry
RC Roofing Covering
WS Window and Siding
L _ r SF Solid Fuel Burning Appliances
( 13) fii R S C-4 /"ir I Insulation
Telephone Email address D Demolition
.2 Re lsg tared Home
_,I,mproove nt Contractor(HIC) r I(10�<9 4911 3/a�
(icI(K�EX- 9CC .Le HIC RegistrationNumber Expirationl Date
HIC ompany Name or HIC Registrant Name
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
SECTION 7a:OWNER AUTHORIZATION TO : COMPLETED WHEN
OWNER'S AGENT OR CONTRACTO APPLIEgi BUILDING PERMIT
I,as Owner of the subject property,hereby authorizek. a riv
to act on my behalf,in all matters relative to work authorized by this building permit application.
¶(ttealN �l vl -3/1I �o/2 )
Print Owner's e(Electr is Signature) ate
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name �w, I hereby attest under the pains and penalties of perjury that all of the information
co a' e ' is appli i true and accurate to the best of my knowledge and understanding.
Ck_ k, -,/v 3 /1(4,/a (
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.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"
The Contntonwealth of Massachusetts
J :nes Department of Industrial Accidents
• [_- a'I I Congress Street,Suite 100
z zt 6 � Boston, MA 02114-2017
,. _ , ,' www ntass.govldia
11 a,t kers' Compensation Insurance Affidavit:Builders.(`untractors/EleciriciansfPlumhers.
"1'()BE FIELD V.1 III TIIP:PERM 11 I (;AUTHORITY.
tHOt ITY.
Annlicant Information ( Please Print Leeihlr
Name(13usincss•'Organixafutu lndtv'dual); __ � ' n C..
Address: 7
City/State/Zip:, Phone#:
Are stir an eattplover?('heck the appropriate box:
"type of project(required):
I. ant a employer with C" employtae's(felt and'or pare-time).• 7. 0 New construction
'.01 in a sole pruprieto in partnership and have nu employers working for roe in 8. t_) Remodeling
any capacity'_[Nu workers'comp.insurance rxs.[iored.)
9. ❑ Demolition
30 I am a homeowner doing all work myself.[No woakrns"cane.instininee required.]'
10❑ Building addition
4.E3 1 am a homeowner and will be hiring cmtraeiura to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions
prupnetoas..with no u7nployee^s..
12.0 Plumbing repairs or add ttttmti
501 am a geanerral contractor and I(sas a hired the sorb-contractors hated un the attached sheet.
13.❑Roof repairs
These sub-cuntractors halo employees and base workers'comp.insurance.:hi:We are a corporation and its officers have exercised their right of exemption per Ai ii c. 14')this ((-44 S
152.,11,4).and we hate.no employees.[Nu workers'comp.insurance required.]
'Any applicant that chtwks box al rust also fill out the sector below showing their workers'compensation policy information.
'I lonneowncrs who submit this affidasit undaeataae they are doing all work and then hire outside contractors must aubnut a new affulas it indicating such.
:(ontructors that check this but must attached an additional sheet show ing the name of the sutr-euntractors and state wtether or not those entities pane
▪nnplor.ce>. lithe sub-contractors base employees.they must pits idc their .Marken'comp.policy number.
I um an employer that is providing workers'co ensatiun insurance for my employees. Below is the policy and Job.site
information. t
Insurance Company Name: - '' C,(Y'� S
—
Policy#or Self-ins.Lie.#: (o 14 .tg —(0 c_. 2-(33 /q
'`1 Expiration Date:
Job Site Address: l ` c 0349/21.aC'p S City/State'Zip:ij 4u? AAA- ()r o w_
Attach a copy of the workers'eg re atiotf polky declaration page(showing the policy number anh espiraiion date).
Failure to secure coverage as required under N4GL c. 152,§25A is a criminal violation punishable by a tine up to$1,500.00
andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against iolator. • t, • of this statement may be forwarded to the Office of investigations of the DIA for insurance
coverage v: Ilion.
I do kertb ' • r , ,e ns kind penalties ofperjury that the information provided above true d correct.
Signature: ittiti
�1% / Dale.
i641
Phone#: ( I) 3 7 �6' /
£Delhi rest'only. Do not mirth'in this area.to be completed b1 cite or town tr ficiaL
( its or 1 ossn: Permit.License#
Issuing Authuritt !circle one):
I. Board of health 2. Building Department 3.('ityiTossn Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone*:
City of Northampton
?oar Mp,oti .,5 s
? - Massachusetts 4? ..._ .'1
* cG
�I DEPARTMENT OF BUILDING INSPECTIONS 11 4
a 212 •Main Street • Municipal Building SJ ra'
Northampton, MA 01060 j'sah, 3;:5.$
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:
i
Location of Facility: Q W i ef, . _ %,,�,
1111
The debris will be transported by:
6Name of Hauler: S �S IbP ?7c.( —
c
Si nature of Applicant: � A.
Pp g At! U------ Date: c5
I ta/d-I