18C-062 157 PROSPECT AVE BP-2021-1039
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C-062 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Bath reno BUILDING PERMIT
Permit# BP-2021-1039
Project# JS-2021-001770
Est.Cost:$6600.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: TODD D PEASE 101384
Lot Size(sq.ft.): 10672.20 Owner: CAHILLANE MICHAEL T
Zoning: URB(100)/ Applicant: TODD D PEASE
AT: 157 PROSPECT AVE
Applicant Address: Phone: Insurance:
4 STILL WATER RD (413) 210-1476 WC
SOUTH DEERFIELDMA01373ISSUED ON:3/23/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:BARH RENO
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 NO 'THA PTON PO iOLATION OF
ANY OF ITS RULES AND REGULATIONS. I , �, ,
l
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 3/23/2021 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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The Commonwealth of Massacjuse ///
F Board of Building Regulations and Standards44i9 e FOR
it: I PALITY
Massachusetts State Building Code, 704 ,r R a(9? E
Building Permit Application To Construct, Repair,Rena emolika Revi•-d Mar 2011
One-or Two-Family Dwelling -<"/ ''''_,
. 0,�, N.00
This Section For Official Use Only .. o, rinb f
Building Permit Number:OP o7� I6L [/ Date Applied: s
I,; 1 itIkv J. T ., • OYa Building Official(Print Name) ( Signature
ECTION 1: SITE INFORMATION
1.1 i operty Address: 1.2 Asse Map&Parcel Numbers 0si frostpcQ� S r rtirrivivk i 4
1.la Is this an accepted stree 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 if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Recor
,r at c';h11 11.,c nocttA e r* as c
Name(Print) City, State,ZIP
1gl rXOSP T y7K y/3-alp•EvCA to_cahille."4caneItnc4
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other l4'Specify: a, rep-tolie.
Brief Description of Proposed Work': (V.W 'rob /Shc,06 e( /?o i I C p— /'j'iJ C / r&11.5 T>p
-cider lie•-p
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 3$0o. ‘,.v 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 $ 31C°'GO 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
G Check No?� l Check Amount: 64 Cash Amount:
6.Total Project Cost: $ 6600 U ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) ,G) ,� //d•1
TaV Pe-4 7Q License Number Expiration ate
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
50/fr41 u-
JLkC I /M A C 13-7-5 U ✓ Unrestricted(Buildings up to 35,000 cu.ft.)
'/' Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
_ SF Solid Fuel Burning Appliances
yrj— �'/L -P/76 pAAtc4430.&_ Insulation
Insulation
Telephone Email address D Demolition
5.2 Registered'PAA / Home Improvement Contractor(HIC) fea7D 7 7/15
1'LS SL HIC Registration Number Expiration Date
HIC Company Name or HIC Re strant Name
y st,I LA'4l r P 3 a t,n,4"
No.and Str t Email address
Srh t tt,4 OICSs CM)3
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 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.
m� cah „ t 3/1e/c)6P1
rint Owner's Name(Electronic Signat e) 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 accurate to the best of my knowledge and understanding.
O1 at 141 3/le Jovd/
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"
City of Northampton
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? "` Massachusetts mow, x_ 'e�
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x_ , DEPARTMENT OF BUILDING INSPECTIONS y
�` 212 Main Street • Municipal Building J/- C.
'" Northampton, MA 01060 s7 v r"""
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 resuiting 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: vAlki QCc,ct iv, 41
The debris will be transported by:
Qt un (L rn1 ,l 1. /
Name of Hauler: -raii PoiSe ( 1
�1
Signature of Applicant: ' � Date: /1 / 1"? 1
.``'
The Commonwealth of Massachusetts
'> + -7' if; Department of Industrial Accidents
1:; ` I congress Street, Suite 100
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—ii- Boston, ,11:a 02114-01
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Ia ww.mass.gortdia
II us kers' Compensation Insurance.Affidas it: Buitdcrs.+(contractors;Electricians:Plumbers.
I(> RE FILED 11 Mr ll lilt.PERM!"CfIMG At I llt)R1 IN.
Applicant Information I'�'��� Please Print e:tilits
Name tt3usrncsc t)rganixation individual): !iai4 Pei," }t
Address: y ,s. i i wc4't` Q.A
City State:'Zip: &'' h Jul-Pt.Jul-Pt.CIA Ma..vr Phone #: Y/3 -c,?/G -/V7
krt.you an etuphoer'.'t'heck the appropriate Nis: Type of project(required):
I.,tn a cntpIo t wrikt 6 tend dt•}stet,tluil and`w hart-tirtw•t.f 2. J New construction
20 i ant a sock proprietor en partnership and have nu etiµaloyees working for me to tl. aiRemodeting.
any capacity.[No workers'comp.ttsunmce requinal..l LJJ
9. ❑ Demolition
0 I ant a homeowner all work myself.[No workers`camp_xr'suranee mono,',l'
10 Q Building addition
ha 4.0 I ant a nsxternet and will be home ctkittratturs to conduct all work on my property I s ill
ensure that all caeanrr`aaurscitlsrrhatcworkers'erM1xnsattonut*suranc or an soli i I1 Electrical repairs fJradditions
proprietors w ith no crnplOyet-s #
12_[J Plumptmtt repairs or additions
SO I ant a i Cricra cunuaatot and I LA%c tnrcd the sub-contractors ltsttd on tdx attached sheet.
13,1 Roof repairs
Cher sub-contractors Ira+t•tnttpl.os v s s and loe wurkcrs'comp_utaurantt. i
14.0 Other
6.01k'e are a corporation and its officers have exercised then right of exert/piton per VIOL C. —-
152.f 1(4 and we haw no enspluscrs.[No workers'comp,insurance required]
*Any applicant that mks box Pi moat also rill out OW s i.tion tabu,howtrt thttlt worker,•connpcu,aton policy nnfrocutatton.
*HrtaittOVVItias rrtho ituboin tin,attidattt tntdstattnc ths-t at t aeon; all w otk and tdxn hoe outside,.ontra,t.n,trust subuut a ttcu rkiati it srrds.atn:e sort:
;Contractors that cheek this Ix,s it att:z:b,rd an,addtitona]shcct sows i.tlw name art the suds etvttra.tor,and,bate i.lhethcr of nni Idstt,t canine,hs,c
cntpioyccs, lithe sub.contraa,aa has.employ ces.they roust parr nic th Cif wut4. rm.`comp.pi1tc}number.
i am an employer that is providing warmers'compensation insurance for my employees. Be/ow is the policy and job site
information.
Insurance Company Name: oF,tr-Yk. got(t.,,AI tr ____ —
Policy or Self-ins. Lie. #: �00 i weee�-1 Expiration Date: /60-4
l�G�� M
lob Site Address: i PCv��C}' i tt' StateiZip: {�OC'1�Y. aterV //14-
Attach a copy of the workers'compensation police declaration page(shos%ing the policy number and expiration date).
Failure to scenic cos erase as required under MGL c. 152. 25:1 is a criminal violation punishable by a fine up to S I.5(x)_()t)
and or one-year imprisonment.as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to S250.00 a
day against the v tolator. A copy of this statement may be tot i arded to the Office of In'.esligations of the DIA for insurance
co'.wage s eritication.
do hereby certify under the pains and penalties of perjury that the infurnimion pro t ided above is true and correct.
' mature: t _Ae's 12-tom--- (Bate: 31 le' "a)1
Phone in/3 - :a?t c -fY'71
Official isse only. Do not write in this area. to he completed by city or town official.
('its or bow n: Permit/License k
issuing:Authority (circle one):
I. Board of health 2. Building Department 3.('ity[Fossil Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
r
Massachusetts � c,
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W *.yinx T ' DEPARTMENT OF BUILDING INSPECTIONS I �-
. Y 212 Main Street • Municipal Building of ca
Northampton, MA 01060 rfl, TO°�
Fee Calculator for New Residential Construction ONLY
Location : i,, j M ,,_, (S PCoSir cG/' 97?t (bt'T -,�r
i
Square Footage Amount
Basement @ .20
1ST Floor @ .50
2nd Floor @ .50 4 b$, G
1/2 Floors, Finish Attic, Garage @ .20
Deck / Porches @ .20
Total : 4 c, Go
NOTICE NOTICE
TO TO
M wr wrt
ern tw __
EMPLOYEES • rr` EMPLOYEES
1,4 s,4b
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017
617-727-4900- http://www.state.ma.us/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice
that I (we)have provided for payment to our injured employees under the above-mentioned chapter by
insuring with:
Farm Family Casualty Ins. Co.
NAME OF INSURANCE COMPANY
P.O. Box 656,Albany, New York 12201-0656
ADDRESS OF INSURANCE COMPANY
2001 W6829 03-26-2021
POLICY NUMBER EFFECTIVE DATES
TIMOTHY F VILES 4A SUGARLOAF ST, S DEERFIELD MA, 01373-1119 413-665-8200
' NAME OF INSURANCE AGENT ADDRESS PHONE#
TODD PEASE 4 STILLWATER ROAD, DEERFIELD, MA 01342
EMPLOYER ADDRESS
EMPLOYERS WORKERS' COMPENSATION OFFICER (IF ANY) DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the ser-
vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and
reasonably connected to the work related injury. In cases requiring hospital attention, employees are
hereby notified that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
2001 W6829