25C-065 (6) 280 BRIDGE ST BP-2021-1162
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-065 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ALTERATION BUILDING PERMIT
Permit# BP-2021-1162
Project# JS-2021-001952
Est.Cost: $8000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 10715.76 Owner: CHEN KUNG HUAN
Zoning: URB(100)/ Applicant: CHEN KUNG HUAN
AT: 280 BRIDGE ST
Applicant Address: Phone: Insurance:
280 BRIDGE ST (413) 582-1888 ()
NORTHAMPTONMA01060 ISSUED ON:4/23/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE GARAGE ROOF
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.
9 Ti
Certificate of Occupancy Signature: j I 0
FeeType: Date Paid: Amount:
Building 4/23/2021 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
-le u D pt,,3,,3 . RECEIVED I
ttl,4ic.eY> y -l3-Z1 I
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APR
9 2021 i
1
The Commonwealth of MassachusettsBoard of Building Regulations and Stiffd ' r:un_einc�NSPECT)oN_ FOR
H414Finh �IA01060 CIPALITY
ILill
Massachusetts State Building Code, 780-CMR-------- USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 6 P— -) — 1 (C_D Z Date Ap lied:
.0 I Tip I, _,V9T 1-1/?*)'I
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1.1 a 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 El Private❑ Zone- Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record; rr��
i4{,trc L.,k \ El v..,'\ /�oti�lnav'igtsVI M � o 6 o
Name(Print) City, State,ZIP
Zgc 2 g2. BV,Gt./' St 1W 1 MCCWZvnsmav` .eeilintfVih16 I. (own
No.and Street Telephone Emai Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction 0 Existing Building 13/ Owner-Occupied 0 Repairs(s) il Alteration(s) 0 Addition 0
Demolition 0 Acceswillnit.u Number of Uni Other 0 Specify:
Brief Description of Proposed Work2: IPj._) etwelk a r a t n i
1o+ dj St-
-' , ® 4:ESTIMATEDGOKSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ ?000 — 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ .51)00 ❑Standard City/Town Application Fee
`� ❑Total Project Cost' (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $tt'' /
Check No.ILI4ICheck Amoun . (,1' Cash Amount:
6.Total Project Cost: $ a000_' 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
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
1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
H1C Registration Number Expiration Date
HIC Company 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 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: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.
Print Owner's or A&horized 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
Massachusetts ,,
DEPARTMENT OF BUILDING INSPECTIONS s `
212 Main Street • Municipal Building yA`..
Northampton, MA 01060 4.°;-""''`a
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:
c`5t- St . C esSdA vg VI" M u ( o l
Location of Facility: � /
The debris will be transported by:
Name of Hauler: NcAbv\(s Ko O
, - -..'
Signature of Applicant: Z Date:
l ''
0 (Oci 6.(
The Commonwealth ofMassarhusetts
r 4111111MM=1"re
Department of Industrial Accidents
1 Congress Street, Suite 100
B05 ton,314 02114-2017
W111aSS,g0iViiiti
,..o.ters' Compensation Ins UF3flC Affidatit:Builder':'Coniractors'Electricians.Plumbem
TO BE FILED WITH THE PEILNETTPIG AUTHORITY
Applicant Information Please Print Leehly
Name (Bminesi.Orpmmtionhichvidual): ktAAti iA6
Address: z- - 22 y t-ckykf.
CityiStatelZip: I1/44 1-Nk Ph ,one 4-0 I
Are 3,1avu as emplaryve Check the appropna:r TYPe of project(required):
1.E3 I am a atophozyso with amploraes(full awl or parr-rum)$ 7 11....;e17:construction
2.01 am a sole proprietor or parcawahip ia avaao iiElpirraeN work* far ma in S El Remodeling
rapacity (No workon'comp insurance retrain<
ElDemolition
\I ans honeontair damp all work myself.[No workers'comp,saamance nacpurat.1
o El Building addition
4.01am a hanacrwmar mai win he kniag contractors to conduct an work cm gri property E
ensure Mat an contractorsarthi.s have workers`r uaicainasU12101 or are acts; 11.0 Electrical repairs c additions
pmprierms with no onsployeee.
12.El Plumbing mignis or additions
!..El Iinta panaral contractor and I hava hand tha sab-cout mottos Ilsoad cr,the attached Mae t.
.ri Roof repairs
These sub-contracton hams mapkryaos and workon'comp masuramoo
14. .-
Co We are corpontost wad officers Inn exercised thaw of atarn on po par 151GL z 0 oth
152, 441 and we hasn scropla7ses.[No workers'masc.mamma 7411.1.1=resi.:
*Any applicant that clacks hoz al most also fill aut tha sedum below ahowio Man worken comp:a.111 Informatics..
flomoonman who submit this alfridavn indicating they an doing all work and than ham=tido contactors roust 1..m1=1 a rmact affidavit inditztimit:rich
:Contracton that chock this box mast attached am airlitanal shomx showilan±a=ea of Me sub-c antra:was and sum whaihar or diOt.41 ont64,1,k274
naplosnes. If tha sub-contractors have amployeas,thwr omit provode their weaken'coop policy=Mar
I am cm employer that is providing.workei s'compensation insurance for Ittl'employees. Below is the policy and job site
information
Indusinze Company Name.
Policy ix c Self-ins.Lc.g: ENisiratian Date:
Job Site Address:, CitYYStateZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy laronher and expiration date),.
Failure to secure coverage as required under MGL c.152,§25A is a ciiinnial violation p .intrishable by a fine up to$1,500.00
and:or one-year unpnamment,as well as ciiil penalties in the form of a STOP WORK ORDER and a fine of up to$250_00 a
day it the'violator.A copy of this statement may be 6:irwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby ceotify under tkepains and penalties ofpnrjary that the information pros above is true and correct
Sivatwe: ' Date: 0 67
'Avow* 4/5 901/6
Officio,use orOy. Do not:Erne in this arm,to be conpleted by city or town official
City or Town: Permit license
Issuing Authority circle one
1,Board of Heahla 2.Btuldirg Depat nnent 3 C iry Town Clerk 4,Electrical Inspector :5.Plumbing Ini.-pector
6,Other
C ontmt Person; Phone al
City of Northampton
Massachusetts ,
w"
.
;s DEPARTMENT OF BUILDING INSPECTIONS
•
212 Main Street • Municipal Building , tr
Northampton, MA 01060
ROMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT f I / Q
I, kVA) 611A (IA \ (insert full legal name), born 0(1/l`I-( ( I it assert
month, day, ye?1r),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 D I day ofrz , 20L4.
(St n.a re
J�ti City of Northampton
fl, s
f r, _ • " gy Massachusetts 's �.e
3 `, p, ,, * f,:
DEPARTMENT OF BUILDING INSPECTIONS S€ ;
212 Main Street • Municipal Building ua�
u +° 1/4‘
i Northampton, MA 01060 S�, w• �1
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING,ADDITIONS, POOLS,DECKS,ACCESSORY STRUCTURES,
FENCES,GROUND MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specification of proposed work(digital and hard copy).
9
g Site Plan with location of proposed structure(s)and setbacks.
® Construction Debris Affidavit filled out and signed by applicant.
(5) Worker's Compensation Insurance Affidavit filled out and signed by applicant.
g<I Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
A Energy Conservation Compliance Certificate (new/replacement windows).
S. Home Owner's License Exemption Form filled out and signed by homeowner(if applicable).
9. Note any Conservation and/or Special Permit requirements (if applicable).
10. Driveway Permit(if applicable).
11. Proof of Water and Sewer entry fees paid(if applicable).
12. Trench Permit-public land by DPW/Private land by Building Dept.
13. Stretch Energy Code—all new construction will require a HERS Rater Affidavit to be submitted with
permit application before issuance of permit.