03-010 (12) 565 COLES MEADOW RD BP-2021-1290
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:03 -010 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2021-1290
Project# JS-2021-002137
Est.Cost: $10320.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRUCE TAUSCHER 087399
Lot Size(sq. ft.): 79976.16 Owner: ROTH BRUCE DYRE
Zoning: RR(100)/WSP(100)/ Applicant: BRUCE TAUSCHER
AT: 565 COLES MEADOW RD
Applicant Address: Phone: Insurance:
54 ADAMS RD (413) 268-3814 SOLE PROPRIETOR
HAYDENVI LLEMA01039 ISSUED ON:5/6/20210:00:00
TO PERFORM THE FOLLOWING WORK:NEW 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.
i • J i yC1 I
Certificate of Occupancy si;naturcI
FeeType: Date Paid: Amount:
Building 5/6/2021 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
��G The Commonwealth of Massachusetts
,s ,t 21 Board of Building Regulations and Standards FOR
a :z� a�'o� Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
‘ ��G\N f g Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
' ,,, ,,nor'' One-or Two Family Dwelling
- IPtAP T'` . .:i'': _ S z xj 2.r=qtP Tills: a tionT0I Ofci8,1'`Usc.Or1�Y: '_'Si_?n.; 'c_ ,4"r .` ...
C
ui1Q?ng, er N'wxnb '4 f:1 Date Applied
6:24
.*58447.3?ffici41(P: .11`Tamej S 1 t�?s — — D �it .
_r, : :. _. _ S1+,CTION 1`SI U JNFO.�RMATIO)Y.. -._.:,.,. ,.
1.1 PropertAddress: 1.2 Assessors Map&Parcel Numbers
5c5 Co L 4-3S 1t,Eiloocti ec Q (6
1.1a Is this an accepted street?yes )( no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required I Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
';:1•r - _.. : ., 0 ON ;=:PROPERTY O$V14gRSITYY'x
2.1 Owneri of Record: // •
B,w E 20711 A0/LT v-ed /14.' 0/06 )
Name(Print) City,State,ZIP
565. C64ES /yfrY`roow /Z ¢/3— S-90 zj
No.and Street Telephone P.mail Address
SECT1 O1 3; ES IP+" ''TIO T Off'PROPOSED WORE(c1 eekajl th-040.p
• New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) sil, Alteration(s) ❑ Addition 0
Demolition El Accessory Bldg.0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2: /(/E f J (r A ILA 6- Ii.00 F.
„•, 4,:`, .,.;- CT 9:1`,T,4 EST (MATED CONSTRUCTION-CASTS
Item Estimated Costs: _
'Official(Ise Onl.
(Labor and Materia s :, _. - _ :•
:,_ -
1
1.Building $ /U i 32 Q 1:BuiId n :Peiniit Fee $5 . India to how fee'is 0:*.iltec -.:
2.Electrical $ [7 Staudazd: cityrrown°Applieatipn Pei ''
'l4 btal ProjeetCost (Item 6)x iirltiplier,
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ :-List:: , _ . _
5.Mechanical (Fire ,
Suppression) $ Tofsl All•F'':. :.1`
-:CheckN. o, r. c:k•A?:4eua . ,-.:- Lash m;o n;6.Total Project Cost: $ IJi 320 ��..P idnFiill: c•�•,Otsk ari`di• ngBa1a -ceDu.eu
:..
� .. .. - .. ..-;SECTION?5i'�'CONSTR UCTION STR.�VTGES.; ..:- • ,.. :• , '. ... .. .. .. _ .
5.1 Construction Supervisor License(CSL) C,S -0 8 7 3 9 9 ?(c�/Zo z/
E)ru e e I�s e_L e,r- License Number ( Expiration Date
Name of CSL Holder Gl
Y AD i,Ms � List CSL Type(see below)
S �
No.and Street T Descngt on ;
144 Q V/L G t� p2 X d I b'39 B. Unrestricted(Buildings up to 35,000 Cu.ft.)
y B. Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
413_za' 38t J/ f T $G,,,,,re,6a 5..i..'46÷. SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 RegisteredHome Improvement Contractor(HIC) /3 78e 3 3-/6-2e -
,1j t't!C S G A o.r HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
5'1 4oiP%mfi f?-.. 1.-.'f44/ 4.1ie,o eeiliina s f. k e t
Nin4,.S,o,s+viaff ,ii4 6/03, 4/3-z6e- 3F'r Email address
City/Town,State,Lit' Telephone
SECTION 6.i'i -OR1 EERS'-COMPENSATION INSURANCE Amogsw(ICI G.T, c 1 2 §25€'(b))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes 6 No ❑
SECTION 7a 080iERAUTgOR1ZATIO' TORE C.+O1VotinED- •® l i
.ow.s R'S AGEg OR b NTRACTo AEPZIES BQi i*.or DING$ERNIIT _ .
I,as Owner of the subject property,hereby authorize am<< - d S4.,a'
•
to act on my behalf,in all matters relative to work authorized by this building permit application.
13coce iZ0'7tA 4 - «-ZI
Print Owner's Name(Electronic Signature) Date
n .... _
' SECTION1[i:'O .•�R OR'AUI'HO ED AGENT:X}ECLARATIO :.,: •:.-
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.
.S'Qa0Ls /Au s i-i YL 4-//--Z
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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,fmished 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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): J r'/( e 6 tea--
Address: ,SJ 1f ,4.s> �
a i rn s r'
City/State/Zip: Ih4y)/57"V1c 1 e o4 0/03`j Phone#: 4 13- 2 4<f ` 38/y
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.21 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp.insurance$
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3._ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself [No workers' comp_ right of exemption per MGL 12.(g Roof repairs
insurance required.]t c. 152,§1(4), and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
.I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: A_A... Date: 4 1 Z/
Phone#: 4)3— 2-6e- 38"Y
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Perniit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
L,,,,v., lir! .`5 x.. 9 w
ryr-4 �, Massachusetts ?S c'�`
w,
a ws ti
�l j DEPARTMENT OF BUILDING INSPECTIONS (
t); � v' 212 Main Street • Municipal Building J` a
Northampton, MA 01060 r �1'���
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: V ALE7 �ELcJCLI,-* ()—
The debris will be transported by:
Name of Hauler:
r
Signature of Applicant: �Gu� �Lrc,�,.-r — Date: 7 i' "z/
� e fo imo-wifica/4 g Gcr�o ;c. !,limit
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Individual
Registration: 137883
BRUCE TAUSHER 4 UC Expiration: 03/16/2022
5HAYDENVILLE,MA 01039
Update Address and Return Card.
SCA 1 0 20M-05/17
r6�e riir rniaruu///r/^/(nuaeAnte/7;
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE: Individual before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
137883 03/16/2022 1000 Washington Street -Suite 710
BRUCE TAUSHER Boston,MA 02118
BRUCE E.TAUSCHER ,
54 ADAMS RD. 0,n,Pef GL -'aG�s
HAYDENVILLE,MA 01039 Undersecretary Not valid without signature
4 Commonwealth of Masscchusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constr964AlS rvisor
f
CS-087399 Expires:09/09/2021
BRUCE E TAUSCHER
54 ADAMS RD
HAYDENVILLE MA 01039 ! a
Commission2r � c �