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25C-183 (4)
2 HIGHLAND AVE BP-2021-1099 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C- 183 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN&BATH RENO BUILDING PERMIT Permit# BP-2021-1099 Project# JS-2021-001769 Est.Cost: $12000.00 Fee:$78.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SPAETH PROPERTY SERVICE 103632 Lot Size(sq.ft.): 6577.56 Owner: MARKET ST RENTALS LLC Zoning: URC(99)/ Applicant: SPAETH PROPERTY SERVICE AT: 2 HIGHLAND AVE Applicant Address: Phone: Insurance: 117 NORMAN ST (413) 781-8683 WC WEST SPRINGFIELDMA01089 ISSUED ON:4/2/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:RENO KITCH AND BATH 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 NORTHAMPTO UP N VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I i Certificate of Occupancy Signature I I 0 FeeType: Date Paid: Amount: Building 4/2/2021 0:00:00 $78.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner , ,:„.„8._:,.._ f �V APR _ , „_. 7 r The Common �� th of Massachusetts E Office of P b1a�e,`, 'fit vegtions, 'Massachusetts State Building o r(7 I CMR) Building Permit Application for any Building other train a One-or Two-Family Dwelling �j q (This Section For Official Use Only) Building Permit Number/r,r' l I /t,l Date Applied: Building Official: SECTION 1:LOCATION 14 )-41 h1Zr}d S'. P.)4 p AM Q/O( i) No.a /g City/Town Zip Code Name of Building(if applicable) 4f Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State ode used If New Construction check here 0 or check all that apply in the two rows below Existing Building Repair 0 Alteration ® Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0 Is an Independent Structural Engineerin Peer Review req fired? ( ` Yes 0 No 0 Brie`�gscription,pf Proposed Cee-� rOC�\r\ WCl.,ls, (emote' kt kc nen Cas �� (uc c N4IJG, ' `f0 F POO SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) CI Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 3 Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational ❑ F: Factory F-1 0 F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA El VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Trench Permit Debris Removal: Water Supp : Flood Zone Information: Sewage Disposal: / Licensed Disposal Site 0 Public Check if outside Flood Zone 0 Indicate municipal i�' A trench will pot be P Private 0 or indentify Zone: or on site system 0 re permit ied r trench or specify: is enclosed 0 Railroad right-of-way:/ Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable Gi Is Structure within airport appro ch area? Is their review compl/e�ed? � or Consent to Build enclosed 0 Yes 0 or No Yes 0 No I�' SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Na e and Address of Property Owner rnY4-S I go (2Am)l M- i4CC. J . roll vl 035 Name(Print) �? S U.C. No.and Street City/Town Zip Property r Contact Informatio P6-ej2 (A2I l.►r.S LI I%g14 7 35.3 - . Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here I7. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) r� (-I 13- I - &08-3 IA ,s hon ri ame(Re ' an /Lend ,Teleplaonlo., e ail address t C Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor C^ 0.o h P . A-1-v £ew(ce; �'r\C- Company Name C Cs- 1 c)3 b3� 16/z`��zli Name of Responsible for Construction License No. and Type if Applicable YP PP 11 id()Cri41) S1-reQ tA). Sp C 14 (YTS ci Street Address g Cit'/Town State Zip Telephone No.(business) Telephone No.(cell) ..(.15:)' e-mail addrjss J SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ J C9C/O --'�. � Building Permit Fee=Total Constructio ost x (I there 2.Electrical $ appropriate municipal facto =$7.5ssi 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable toCi-I-4 ,Oc t'. ,� 6.Total Cost $ id) (contact municipality)and write cl e k number here C SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest un er the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of knowledge and understanding. � Pn 413_7BI _ aS.3 3f a-I Please print a si name Title Telephone No. Date Street Address Ci /Town State Zip - Email Addr ss c..41 Municipal Inspector to fill out this section upon application approval: I� % -421Mi s'3 - ' ' 11 C7 1 Name //Date The Commonwealth of Afitssachusetis r1• € f Department of Industrial Accidents �. _01 I Congress Street,Suite 100 . = Boston, MA 02114-2017 , � " w►�'n:ntass.gov/dire )linkers'Compensation Insurance,tffidas it: Builders.+('ontractorsfElectriciansfl'Iwnhers. 10 Bk. k11.k.1)N O H"1 11E PEK.1II 1-f1M;Al 1.110R111. Ann scant Information _ Please Print Leg�ihls Name tBusincss Organization Individual): Pr . JL� S{�-r � l Address: \1 ) t\./Di m.o., SITU& Qo ' t J City/State/Zip: \A . p Id a 1\14) 01 Phone#: 4I3- i i- (p(Cj'3 Are yen an employer?('heck the appropriate box. Type of project(required): l.©I ant a enmptoyer with 13- employees(full andUot part-tire I.' 7. 0 w construction 2.0 I ant a sole proprietor or purtru-r sup and have no employ to working fame in S. Remodeling any capacity.[No workers'comp.insurance minim-J.) 9. 0 Demolition 3.01 ant a humnwwnir doing all work myself.[No worksrs'comp.insurance rennin:d 10 0 Building addition 40 lam a hunroowtier and well be hiring c ontnislurs to conduct all work un my property. I will ensure that all contractors either have workers'compensation insurance in are sole 11.Q Electrical repairs or additions proprietors w ith no employees. 12.0 Plumbing repairs or additions 50 I ant a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 J Roof repairs These sub-contractors Isere employers and base workers'comp.insurance.; 6.0 Nye arc a cumin-anon and its ufrcers have exercised(haeu right of exemption per 5461.c. 14. Other 152,*10),and we 11as,no employees.[No workers'comp.insurance required.) 'Any applicant that dirks lose n I must also till out the section beluw showing their workers'compensation policy infurmrtron. Homeowners Abu submit thus atlida%it undicatintt,they are doing all work and then hue outside contractors must submit a tics affidavit indicating mole. 1Cunuacturs that check this hos must attached an additional sheet showing the name of the sulreuttractur and state whether or nut those cnhiucs have employees. If the sub-contractors louse employees.they must pros idc their wurkecs-comp.policy nunmbcr. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 1 p C \Ve it-'I- / _ Policy#or Self-ins.Lie.#: \I -La((,f)-S rV J("): J /-Ti L )Expiration Date: (f�-•dil-d-Lf Job Site Address: L4� 4 I \tV\�c� i. 5*r�3, CityiState.�Zip: 1\iOr OCi (t 1 ,ri i C11� O Attach a copy of the workersompensation policy declaration page(showing the policy number and e�piratic n 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 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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. 1 do hereby certif ;der the pain and pen !ties of perjury that the information provided ubavc is true and correct. Signature: F ` llalr: )' 1`i-' ), ' .. ?....--- ... Phone 4: Official use only. Do not write in this area,to he completed hp city or toter:official_ ('its sir Town: I'erniiULicense a Issuing Authoril} (circle one): I. Board of Health 2. Building Department 3.City Town('Icrk 4. Electrical Inspector 5. Plumbing Inspector 6.Other ('onlact Person: Phone#: City of Northampton Massachusetts ��? e, t * < G 11. 40 1 DEPARTMENT OF BUILDING INSPECTIONS �. 212 Main Street • Municipal Building �Vy �4` y s* s Northampton, MA 01060 sNy/ ��`� 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: / / , 'c- y C/ o The debris will be transported by: Name of Hauler: ,/idf�er s &be Signature of Applicant: ''! Date: ah'p .a