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25C-040 (6) 212 NORTH ST BP-2021-1293 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C-040 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Porch Repair BUILDING PERMIT Permit# BP-2021-1293 Project# JS-2021-002139 Est.Cost: $17000.00 Fee: $110.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MATTHEW BEAUDRY 177679 Lot Size(sa.ft.): 6577.56 Owner: GOLD HOWARD J Zoning: URB(100)/ Applicant: MATTHEW BEAUDRY AT: 212 NORTH ST Applicant Address: Phone: Insurance: 117 FERRY ST (413) 320-1348 WC EASTAM PTO N MA01027 ISSUED ON:5/6/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:REBUILD FRONT PORCH 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 U ON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. . A-15/ Certificate of Occupancy Signatur : FeeType: Date Paid: Amount: Building 5/6/202I 0:00:00 $110.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusetts , %),, -k-op . Board of Building Regulations and Standards I FOR -,,• Massachusetts State Building Code, 780 CMR, 14AY _ IUNIFO ITY 2O2USE Building Permit Application To Construct, Repair, Renovate Or D coolish a Revised Map 2011" One-or Two-Family Dwelling LIP* of aui�)r --� _. ____ HAM...... MA 07060 WS i Q This Section For Official Use Only —._�, Building Permit Number: 644/44 * 3 D•i to Applied: grEthrJKZ 5 // - S-G-ZOzi Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 rgDrty y(d4 st 1.2 cress ap& Parcel Numbers /0 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 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❑ i SECTION 2: PROPERTY OWNERSHIP' /�/� �/ 2.1 O )LAI opd: r1C�1C� /VUr7/fJl �I� /r� 4�(l�lO Name(Priin�tt)) fir( l� City,State,ZIP SIX A/Or�}�{1 5 '. 413r 3)o-3 3? h 1 ok1f 0 s ' 1' 1, edu No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction X Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition X Accessory Bldg. 0 Number of Units Other ,lam Specify: Brief Description of Proposed Work': DCpi1O e,A,f c ,iii t- $ dYGh b u i/d q j w -from f OS 5 % , All OS4,,)%,r k) 4v,Yurt by,' vu SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ' .7i OW 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All FessAt ',I, , Check No.k i'/f/ Check Amo . \D Cash Amount: 6.Total Project Cost: $ PI 0( ' 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction``' Snppervisor License(CSL) 1010_0 c /� "` (4d Licensel NumberlJ Ex ration ate Name of CSL Holder �� List CSL Type(see below) kii No.and Street f Type Description Evs 1.0710, A/14- D !ra?7 U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town, tate, 1"r 1 �1� Vim" R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering _ WS Window and Siding 1413°f3;0'{�,�,/ ��� � SF Solid Fuel Burning Appliances I (� 51 @ ( tt'C V\ I Insulation Telephone Email addre s D Demolition 5.2 Agistered Home Improvement Contractor(HIC) 177 I_7 /1.2-3 2 ^_•-^', � lY �A l� �—�11�`/� J�Qi11 HIC Registration umber pira' n Date HIC�Im,Ban�N e or HIC Registrant Tjlame th i�/ 0 � c,^ No. !!tree -/}— S (I W ✓tr,5"YlfithiAki‘ NW f 3 /3 Email address , City/Town,State,AP 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 MQ .. &why to act on my behalf,in all matters relative to work authorized by this building permipplication. 140,,,,i fold s y ,zl 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. 44i- fraud s/y4L/ Print Owner's or Authorized Agent's Nam (Electronic Signature) ate NOTES: I. 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 0 aSHAM• `�. S 's 46 0' �S C •" i` Massachusetts f.F DEPARTMENT OF BUILDING INSPECTIONS `;t \ �"" " 212 Main Street • Municipal Building yeti a. ,. ,. + Northampton, MA 01060 SSN� ,��•\`'N 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: f& )t) Location of Facility: V&k1 VAty tC k,) 6/74- AhrAsieivn MA The debris will be transported by: Name of Hauler: 1i �r S 0 /�'i Signature of Applicant: Cq%!.t Date: � . The Commonwealth ealth of.11assaclrusetts I.= t. Department of Industrial Accidents =ani '" — ' - I Congress Street.Suite 100 t= Boston. MA 02114-2017 =t.t*' WWlt'.► ass.g►ov/deft U uilters'Compensation Insurance ABM atv it:BuildersiC'onIraitors!Electricians/Pivanhers. TO BF:FILED I)♦%t1"11 1 III:PEIt1I11-1'I1i:At 1•1101DIN. Annlicant Informatio. Please Priut Ltiibh Name IBusinews OftonirrtLtm I ad NI.kiwi): 41 L(d kl 81414 /Mile$t/Y t* - Address: 1(l R ____s -__..._ as hap), /A4A oi02-T.__ City,State/Zip:_. Phone #: y)3 3 ZU 13 t :arc taa an eanpin:ire!Check the ryytrtrprirre boa: Type of project(required): I. I ant a employ t with I ____employees and rw part-inn:t" 7. Q New construction ' I ant a talc pnTprkkw or IRYtatr1kIP and 1M9t'e MT cltittoy cc,.well Il till tree in 8. 0111 Remodeling any capacity.[Nio tta9Lcrs'camp.uetulanax townc-d.l 9. Demulttion 10 I aut a ItunictrINIU13 tk..unu all want intolf.l NO u«sal+.,a`contr.oti,at nc motto"d 4.0 I ant a Itpnol tnta anti ti ill Its hnntp a> ae lrttir%to conduct all 1,4,3 kon nit Iwtyi aty. I will 10© Building addition tmurt'that all ctwur:uliatrs other hat c 1tYTtkos"ctw111aitsaiwl nerulano:air at:s ok- 11.0 Eicctncal repairs or additions }Htitl+rtCtora Nrih no otiploycot. 12.0 Plumbing repairs or additions i0I ant a noteralcuntrxktraril I tuts htratl fire styi+-tt,rttrack'r%bigot On dic attached sheet 13 Roofthem:9Klb.conirada.Is lute. ri9lt.tec' and hate itukta caanp.nlsunaaca t /� 6 We a a taainal and IN ott-lcen lot c cveivisol their right of Cwito ttion per MCA.c. 14. OtheiIs f'�',k_ ? 1�� .Qre lrl9tw 1152,li 1(4),and tc ltata no onployce,.1 No it ticket t'vamp.insurance reaninaLI*Ant applicant Ikat deals Ii i »I Inuit alto till teat III.wctuwt IT-kV*:%homing their*mntai comp:motion policy intiTrrnaiiwt. +I lontt+Intucr%Who sarong this afttalat It trllhcau,tw tlii arc tlawny all Monk and then hut taat'amik contra eh.r➢nn,i ill-quit a men atiralat it uadi %tinny ouck tC otilrach.1%that chla.-1.Oita Inn mist att&Itc l an additional shirt shtwint fret:nano of ttu sulicontractors anal mac iltoltcr it rout Iht*sc 7trrtrt-s lieu C11491tT'tirs- II till-sult-Lctintradits lore onpkTsui's.rltl'y nand plum elkir norka'rs"cutup.pollcy'tnrui9er- 1 am as employer that is providing~hers'ers'compensation insurance for my employees. Below is the polity anti job site inflation. Insurance C'uanpany Name: 141r/ j* ic -,--4 _____— ._.. Policy 4 or Self-ms.Lie.:: lY S(OD t[I 62. r 3C4111?I Expiration Date: _ / Job Site Address: '-I) /V 0 eil51- l U City State l V I V im/`__ Attach a copy of the norltera'compensation policy declaration g Zip:- I e(skewing the policy number sad expiration date). Failure to secure coverage as required under 61(iL c. 152. w 25A is a criminal violation punishable by a line up to S1.500_00 and or one-year iniprixunta:tti.as well as civil peuahics in the limit of a STOP WORK ORDER and a fine of up to S250_10 a day against the violator_A copy of this statement may be tOrwarckd to the Office of Investigations of the DIA for insurance 4O crags i criticatitsn. I do herby certify under the pains and penalties ofpe►n err that the information provided echo t e is I ate and correct Signature: 1>atc_ —ife Phone it: yi3 - 3a0 -i3V 1 Official use only. 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