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25C-177 (3)
86 PARSONS ST BP-2021-1174 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C- 177 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPAIR BUILDING PERMIT Permit# BP-2021-1174 Project# JS-2019-001846 Est. Cost:$2000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 4356.00 Owner: KINGSTON PATRICIA M Zoning: URC(100)/ Applicant: KINGSTON PATRICIA M AT: 86 PARSONS ST Applicant Address: Phone: Insurance: NORTHAMPTONMA01060 ISSUED ON:4/13/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE PORTION OF SIDING, REPAIRS TO SOFFIT 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. (• ' ,r , . Certificate of Occupancy Si2nature: � ) cj' FeeType: Date Paid: Amount: Building 4/13/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner n 1 E C--e--- D 1 APR 1 3 20 Tilt Commonwealth of Massachusetts FOR 21 'oar of Building Regulations and Standards if assa chusetts State Buildin: •.s e,780 CMR MUNICIPALITY F SuiLeiNc IrtsP r USE `- 1- ld��ing �£Ap#lication To Construct, 'epair, enovate Or Demolish a Revised Mar 2011 ----I One-or Two-Family I .,- ing ,,99 This Section For Official Use Only Building Pe it Number: J�W`�j ��7� Date Applied: �vir.1 ( ': ! 11-13-ZOZ‘ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Pr_o,perty Address: \\ 1.2 Assessors Ma &Parcel Numbers �'Co�`t-Sahs `.�(-.,NOrkhQw.��h 2, i "7 7 1.1 a Is this an accepted street?yes no \ Map Number Parcel Num er 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 Owner'of Record:'F Pv* .(per`� C'Rk L 1 P1 R►0 t S-t—p N lv �An0.tNr%9• Din -W 1 t O t 0 C.0 C Name(Print) City,State,ZIP 48(D ('&r S D r,S Si(. 413 32)1 o(D2.5 Kite.? i t•to N- &o 1. C.o-rn No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Owner-Occupied X Cepairs(s) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units 1 Other 0 Specify: Brief Description of Proposed Work2: 0 I d A s..A;n v0 vts e W'tntr"6 a.i f."r,rt-j tA)rl5 j &r+d © R,e e0.v► Ino I e-s %r% .5 o4 ►-t-• tWorrvt f2ef vk : .S11,ia4c ) NAIL..S) HoaSf� i MP, eo,.ts-rRjAce r1c; ► <,o(fk) SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Buildin PMc\e. )t $ 9 '71 . 00 1. Building Permit Fee: $ Indicate how fee is determined: \\ 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ It 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ IQ Total All Fees: 4 Suppression) 1—AD . * 4 a 0 _ 0 e Check No3)-19 Check Amount: Cash Amount: 6.Total Project Cost: $ 1, 379 #0 0 ❑Paid in Full ❑Outstanding Balance Due: 1 SECTION 5: CONSTRUCTION SERVICES N`g 04)14±�yy(�1r�w. 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,State,ZIP Telephone V SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))1�{.bj`‘` 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 .❑ 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. Print Owner's Name(Electronic Signature) Date SECTION 7b:C)"ER 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. iIQ I U JCS n-�C+�S�� q�1 U-0.-�' � •1 a •al.� Print Owner's or Authorized Agent's Name(El 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/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" f/t4�C1 c I A. K-to v CITY OF NORTHAMPTON ` - SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton 4µ,HAro S�5. ..s�C � Massachusetts k?`` - •ti<<G --4 w % ':."�.LL DEPARTMENT OF BUILDING INSPECTIONS �` it .. '` r .., 212 Main Street • Municipal Building yJi _. _." Northampton, MA 01060 �SM�y ;�0 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. IQt7 [1�r.vs ah ai'eA 45 We Are_ tkcv $• ti �irlrt--1-n an� a in9 Nc.(oc 50 ' ' ev-i eLt-S ,v b-e c ,.k5-el "cm& Ve ri-- A 5 n e� v-e.ci . �1-►'L�,r..-..,M&,L I.e 4=.- -t u er im-}'e ek is u.)I Ll b-e r eA'a ' � e_a, �,- -(-�-44- w- o, i,-e-e i.i-e.‘ "s tir'' re p&v,-S . The debris will be disposed of in: Location of Facility: _ The debris will be transported by: Name of Hauler: Signature of Applicant: �' �- �- - Date: `t-' 1 a- a- I see : }{n), n er5 ' E%�m t>� 0l3;bi.l�+� ,f ;dav►' The Commonwealth of Massachusetts =+; ifI Department of Industrial Accidents • _ 1; 1 Congress Street,Suite 100 41 * Boston,MA 02114-2017 / Q. • • •�'-�.�=�,,��` IVWw:maSS.gOvidiQ V.outer+'Compensation Insurance Affidas it:Builders'('avtractorsIEkctririansfPlumberti. II)Hi.FILED 1117If I DIE PER111I I IVGAIRH(1Rfi1. Applicant Information Plea+ne Print legibly Name IBustreessOrgattiratwm'Indtatelual): Address: City/State/Zip: __-- Phone#: Are too an empknrr'1 hock the appropriate loot: Type of project(required'- 1.❑I am a t-rnpkr}cr with cn4rlorrev(full and or part-tines I• 7. 0 New construction 20 I am a vok peoprxwr or punnerdiip and have no rrr4ato,rev ovrl,arir In on in g_ Q Remodeling may capacity.[No workcn'coup.i nturancx reyumd-j 9. ❑Demolition ;0 I am a ltomn+wrrrr doing all work.rnysclt`iNtu wuatms cone.imuraar required" 10 Cl Budding addition 40 I am a homeowner and will tot hiring antracton to conduct all u,"ak on my property- I will croon:that all oil aeon tither lave'Arnhem'competin haai m.waancx as are vole I I.IJ Electrical repairs or additions rnkns w ndr a+t alovcca+. s� "� 12.0 Plumbing repairs or additions •O l am a yen rad ce+ntraelin and 1 have ha al ahc auto-contractors is<i.J'.m the attached sheet. 1312 Roof repairs ihe,t sub-camtracwtahave/maploy'cca and have wurk.c&coaur +trouts 6' Wi ape a corporation aid an of is r.have rxcn'iscd tact right of to nrptu+n pci\t(+L u- 14. Other 1.J 152,I1(4),tad we have no cntpka}rev.I'°wmiera'wage_uuuruntc reyuirol.1 •Ain applicant Ildt checks Mon RI nor also fill out the unction below sruwin their wawkaa r7umpermwrun polio,information.. l losnovu a-rs who,innate tlus affidavit indicating trey arc doing all work and chore hire uwhade aaattractrns muss tubrtnt a new atfadav it infixamg much. (,antracior,dial crack aim box stunt attached an additional sheet Aron art tires/Mt of fire ahbtcaaernanra and,talc wlather at nut donor antite%late e'nrtate+tee's- It tire aura-centraetort hate en;alovt'e,,dart merit ptaaarde then wt+rh.en'comp.policy natter. I am an employer that is providing workers'compensation insurance for rely emplo)ees Below is the policy and job site in,/nrmation_ ii imancc t'otnpany Name: -- —._-- — I',+act =-or Self--its.Lie.#: Expiration Date: Job Site Address: City/StateiZip: Attach a copy of the workers'compensation Icy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,1i25A is a criminal violation punishable by a fine up to SI,500.00 andror 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 .overage verification. I do hereby certify under the pains and penalties of petrjug that the information provided above is true and correct Signature: Date Phone#: Official use only. Do not write in this area.to be completed by cite or town officiaL ( its or Town: Perntitllicense# Issuing Authority (circle one): I.Board of Health 2.Building Department 3.( ity town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ('ontact Person: Phone#:_ City of Northampton , Massachusetts ic ,- DEPARTMENT OF BUILDING INSPECTIONS b� 212 Main Street • Municipal BuildingO b.,o�" J . —. Northampton, MA 01060 �1 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT !D 7 (i t p1 I, 1 /k' (t U ,�C \L-1'�`,' (insert full legal name), born _ (insert month, day,year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this r- day of I f..1 L- ,20 '(Signature) �