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36-310 (5)
133 CARDINAL WAY BP-2021-1277 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-310 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Above ground pool BUILDING PERMIT Permit# BP-2021-1277 Project# JS-2021-002111 Est.Cost:$6000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): 18164.52 Owner: PELIS ANDREW S Zoning: Applicant: PELIS ANDREW S AT: 133 CARDINAL WAY Applicant Address: Phone: Insurance: 21 FERRY AVE NORTHAMPTONMA01 060 ISSUED ON:5/3/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:above ground pool 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. Certificate of Occupancy Signature: ' r ' - TAIT FeeType: Date Paid: Amount: Building 5/3/2021 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner . .1.9 -° _,, Z --.31 1‘ / �� The Commonwealth of Massa6hus ttss r / o Board of Building Regulations . andards+ 3 (1/21 /IUNI IPALITY Massachusetts State Building Code:1,78% 04,E :[n�Nr �' USE Building Permit Application To Construct, Repair, Reno ' a Revised Mar 2011 One-or Two-Family Dwelling A%so�NS This Section For Official Use Only y---i Building Permit Number: g/..4i /Z 7 7 Date Applied: l �� 1. ; %' . It.,.: a( Building Official(Print Name) , Signature �, ate SECTION 1: SITE INFORMATION 1.1 P erty Adress: '`J�� 1.2 Assessors Map&Parcel Numbers Ci 1.1a Is this an accepted street?yes no Map Num er Parcel Nh1 el 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❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 i Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 puler' Record: : c C a7� k-c 4., L,ss' t :yc, 0/° e Z Name(Print) City, StatE;Z /3? 4.—v+/H,'/1.r.6 <,i ‘1 ''i ,4,, AZ Ste+�,e,G.,/, ro-'. 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) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ©_ Specify: J>'o Brief Description of Proposed Work2: / I� A.,'TfI7. //T'� Z 1 ' A90ve �L,+J /c,. / /i1/ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 9, .4.e + 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ Z./ e 0 ❑ Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All F U 1 f Check No. Check Amount: _ � ` Cash Amount: 6.Total Project Cost: $ 6, D 0 ❑Paid in Full 0 Outstanding Balance Due: City of Northampton fir. Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ` ti 212 Main Street • Municipal Building Northampton, MA 01060 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). 3. Site Plan with location of proposed structure(s)and setbacks. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new/replacement windows). 8. 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. r 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 I&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 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 . 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 i nd accurate to the best of my kno e and understanding. *AA" 4/ Print Owner's or uthorized 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 12 1 / ZS Dew SIDE YARD fld V SIDE YARD FRONT SETBACK FRONTAGE 4. City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building -'""•,,, Northampton, MA 01060 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 -� �� �� ilibr/ .,,�/ate The debris will be transported by: Name of Hauler: L — Signature of Applican Date: y 3 /zi The Commonwealth of Massachusetts Department of Imiustrial Accidents I Congress Street,Suite 100 Boston,AfA 02114-2017 www.mass.gor/dia - others'Compensation Insurance Affidavit:Builders,Centrsetor.•Electricians:Plumbers. It)Bit FILED NI 1111 THF PitRMi I'[INC AirrnoR I fl. 2...p2licant Information Please Print 1, ibh Name illusinessAkgainzationlindixiduall: e-1/"..e*eso /r Address: /3..? / City/State/Zip:"-- p-rei eie6 i__ Phii 7..r. '7 V 2 c• An yule gm employer"Cheek me appropriate bors; T)pc of project(required t. 1.3 t am a empleyer*Ith employees trod unifor paryumet,' 7_ New construction 20I am a sole proprietor or pumas/up and have no empinytes working for Me WI 8. 0 Remodeling any..apacity No*miters'comp.insurance required.] red] 9. Demolition tili*.inn homemsner doing all*ark irtielf.No workers'intim itnitrance enqui ' 10 CI Building addition 4.C3 am a homeowner and*ill be holm t..vistractiars;so conduct ail work 1:31t thy psuperty I will ensure that all ciintrots either hate*tickers'cempintsaition mairan 11.0 Electrical repairs or additions propnetori with no eirqAoyers.. 12.0 Plumbing repairs or additions 30I am a er-ns-ral Lontractor and I hai hired the sub-contractors Listed un the attached shod_ These sub-contractors Keit C1211111.AVEN and hose*takers'comp.insurance.: 13E3 Root repairs 1.4:ELOther 6.0 vi'e air a ci.:Tp012130.713 and its officers have extrend their right of exemption per mu_c. I 4L and*c iocrnrloces. o.urn•,:unip. EMU':nice requieed.] 'Any applisant that chocks box gi nuta also fill mat the settion below.ilifirt MS their workers'compensation pule information_ ftimneow nem who submit this affisknit intik:mine they=doing all work and then hoe osnk canlnaaiora must*tikinut a itina affistm inedimting such. ;Contractors that check this box mutt urinated un Additional sheer stunting the name of the miti-coritractors and suite.whether c no those entities haw emplo:,ei.,. It the Alb-contracwrs 11,4 .• th, Lc.rLs" r;.mkt I am an employer that is providing worAers'compensation insurance fur rn employees. Be lA the polio and job site infOrnottion. Insuran,:c ConiNrr., Name: Policy or Self-ins.Lic. Expiration Date: Job Site Address: CityiStatelZip: Attach a cop, of the workers'compensation policv declaration page(showing the policy number and expiration date). Failure to secure coy cruge as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the fonn of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverag,e.verification. 1 du herebyrtify a r the pain ond penalties of •• s•that r in lOrmation provided above is Re an d 'tirreCr. Signature: Date: 9 e 8/ Phone#: Official use only. Do not write in this area to be completed by city or town official City or Town. PermitiLicense Issuing.XuthoritN (circle one,: I. Board of Health 2. Buildilq;Department 3.Ckyrfawn Clerk 4.Electrical Inspector 5. Plumbing.Inspector 6.Other Contact Person: Phone . _ City of Northampton Massachusetts v- r� tat DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ,_ 7 Northampton, MA 01060 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT �f.4 prl. J / I, (insert full legal name), born `�/z7/7;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. 1 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 paid penalties of erjury on this 2 7day of Pry , 20 2.j Signature)