23B-023 (6) 29 HATFIELD ST BP-2021-1023
GIS#: ; COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-023 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-2021-1023
Project# JS-2021-001745
Est.Cost: $9036.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOHN LANDRY 093450
Lot Size(sq.ft.): 16596.36 Owner: MCCORMICK THOMAS J
Zoning:URB(100)/ Applicant: JOHN LANDRY
AT: 29 HATFIELD ST
Applicant Address: Phone: Insurance:
104 NORTH ELM ST (413) 204-9880
NORTHAMPTONMA01060 ISSUED ON:3/18/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 13 REPLACEMENT 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. iicf3-1,1 •
Certificate of Occupancy Signature( I 0
FeeType: Date Paid: Amount:
Building 3/18/2021 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
The Commonwealth of Massachusetts
= r1j1 Board of Building Regulations and Standards FOR
�, r MUNICIPALITY
Massachusetts State Building Code, 780 CMR USE
c —Q Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
3 a ' m One-or Two-Family Dwelling
z C This Section For Official Use Only
Dz ra' Buil •_ ermit Number: P)Q• �/— (0 Z3 Date Applied:
om _.
S 8 0 Eth 1..) as
/72 3-18-zzi
co Building fficial(Print Name) Signature Date
_------ ----t ---- SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Asses rs Map&Parcel Numbers 1
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
/6596 •36
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 Owner'of Record:
77i6 s Mc_Cori..0-k %hi- r, / 6/1760
Name(Print) City,State,ZIP
99 /3ld 54— y/3 —/787 -><a,ccorst c4 0//13e5 iska.,,,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTI N OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building I ' Owner-Occupied 0 Repairs(s) L4"/Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: L,Q/C,f,,, 13 tu>'..dlA(-)S Inc:4. N., :.4 I r; -*-
Pc-l-ervr 4-r ....., U Ti-Cl/3f •ZS
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ .83,',N 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ CIStandard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) Total All Fees: $
ti
6. Total Project Cost: $ 9p3�n o� Check No. Il Check Amount: �Q Cash Amount:
0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
� (5 o93yso r3 a9A7o.
/[ ti J/ v License Number Ex 'ra on Date
Name of CSL Holder
gay Newt( List CSL Type(see below) U
No.and Street Type Description
,1�� ] / U Unrestricted(Buildings up to 35,000 cu.ft.)
N )40%- "s ! 0S<'6 R Restricted 1&2 Family Dwelling
City/Town,S e,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
[� /�1 SF Solid Fuel Burning Appliances
//3-A,y-mi JO�� g b des,(ti , 1,roM I Insulation
Telephone mail address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
&At 9 PeS., /�� HIC/Registtration Number xp' ion Date
HIC Company Name or HIC Registrant Name
/4 Nilrg Caw 54 1 1, 1b4?d , ,4,7 .1..—
No.and Street �f Email ad
Nat . NA QM& re�Y.9g.810
City/Town,Stat'e,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 Issuan of the building permit.
Signed Affidavit Attached? Yes 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 Lk/ h L
to act on my . ; ,in all matters relative to work authorized by this buildin permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: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.
iA �Print Owner's or Authorized gent'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 Commonwealth of Massachusetts
-films` Department of Industrial Accidents
s w I Congress Street,Suite 100
W: Iiitamr h Boston, MA 02114 2017
www.ntass.gov/din
flusters'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
11)BE FILED t1 fIIH THE PERMITIFit:AUi'HORITY.
Annlicatnt Information Please Print Leeaibly
th Name(iusiness'' ganirationlndividuai): 4_vi C.._�c q A4ict- yvild' /vtl,
Address: /i lk A j1 1/t.�, �,� `'
y/ (
City/State/Zip: Nor ILI 4 ///1- 0/0(4 Phone#: O/j"ap111fsso
Are yea an employer?Check the appropriate box:
Type of project(required):
1.0 I ant a empkryer with M__empiuyeea(tali motor part-tart/• 7. O New construction
41 I am a suit praprrttm or ponwerridp and hate inn employers minting forme in S. n Remodeling
ur any pacay.[Novrork t1 ers" istaootr anprannij +�
9.
3.I I am a h niowacr doing all wurk myself.[No worker.'comp.insurerrue amoral` ❑D molition
t
4.0 I am a homeowner and win be hiring a ntracaurs to conduct all work on my property. 1 will 10 Q Building addition
ensure that all sti.etra:turs either have workers'r+arrrjn^nsai tin inourtmer or are sole 1 I a Electrical repairs or additions
pnrprittom with nu rmpluycry"
12-0 Plumbing repairs or additions
50 I am a general contractor and I have bust/the wb-cuntracturs listed on the attached Aloft.
'[hears 3r213-euntrxtur4 have employers and have workers'cam.insurance.; 13.o Roof repairs/ ',
*ile_Ae.,_
6. `e are a txlapurauun and R.s officers have exercised there right of exemption per hint c. 14. }1eT— �/I�lorGr✓
142_,*1(4 and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks boat al must alsu fill out the section bcluw showing their wurkers'compensation policy information.
f Hutncuwners who submit this affidavit indicating they an:doing all work and then biro outside contactors must submit a new affrdat it indicating suck
:Contractors that check this box must attached an additional sheet showing the name of the sub-ctmuactu s road sale whether or nut those monies have
employees. if the sub-cunlracturs have cn,luytrs.they must prus idc their workers-comp.policy number.
am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: 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,§25A is a criminal violation punishable by a fine up to S1,500.00
anit or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 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 certify u der a pains and penalties of pe perjury that the information provided above is true and correct.
Signature: // Date: i3/4/-20a/
Phone#: ��3-0�7 7dge
Official use only. Do not write in this area,to be completed by city or town Vidal.
City or Town: Permit/License# f
Issuing Authority(circle one): f
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: `
City of Northampton
c.
r _
Massachusetts +'
4 DEPARTMENT OF BUILDING INSPECTIONS
ti
"r, 212 Main Street • Municipal Building vti a�
xl , Northampton, MA 01060 W `^a0
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: U //ti y rij
The debris will be transported by:
Name of Hauler: r1v. La-,.r/
Signature of Applicant: A/ Date: 3��/ a/