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17C-120 (8) 34 SHEFFIELD LN BP-2021-1308 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 120 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit# BP-2021-1308 Project# JS-2021-002166 Est.Cost: $20000.00 Fee: $130.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOHN C LEBHAR 75531 Lot Size(sq.ft.): 38115.00 Owner: BENNETT JANET Zoning: URB(100)/ Applicant: JOHN C LEBHAR AT: 34 SHEFFIELD LN Applicant Address: Phone: Insurance: 68 SCHOOL ST (413)247-5107 O SOLE PROPRIETOR HATFI ELDMA01038 ISSUED ON:5/10/20210:00:00 TO PERFORM THE FOLLOWING WORK:KITCH RENO 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. 55-/ Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 5/10/2021 0:00:00 $130.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner f The Commonwealth of Massachusetts / y� ��✓ W Board of Building Regulations and Standards/ ,ff4r , MUi CIOPALITY Massachusetts State Building Code, 780 CM,R 0 20 / USE Building Permit Application To Construct, Repair, Renovate inn 1t.13,olish a Revised Mar 2011 One- or Two-Family Dwelling -1 t u,,^,1 �._. This Shption For Official Use Only --nl Or;(! NS Building Permit Number: '-,„2`'/' Date Applied: 41_)%Z, /�/ //:a 5-lb-zoz, Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assesso s Map& Parcel Numbers 3 Set�Ffi k-LP A-N I C/ I 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 tk Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal IA On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of ecord: P77cti>,e I-- iynrtel 3k �e ie Li -eA.�,► Dio�z Name (Print) City, State,ZIP 34 gtie ; 11 Lo1/4.1,-e_ zj 13 . -s-4 . 1LjL L, S -1mc. awevpe� , (0. C��.. No.and Street Telephone Email Ad s SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building II Owner-Occupied a Repairs(s) 0 Alteration(s) ' Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: /Z 14C 2 Jr,te/te"i 61-6i.41 z rS //1,24, 1-ti t-►IP -Ldv£1.v 4- C''/s-iN Jr L-f 77 7 w -- / I" 3S o S f A- /ff f c'i✓ �//,-1/✓`-Cr- /' -E._ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) _ I. Building $ f,7 62,7? 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ f STD , 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ / 562) 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:J Check No. 11 IS/Check Amount: ` Cash Amount: 6. Total Project Cost: $ 2 0 J Ob 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction � f Supervisor License(CSL) p/2 b f�f'NJ C . —E 'r+>� LicenseNExpiration j C,._ Date Name of CSL Holder U 6,6 �C�-D T List CSL Type(see below) No. and Street Type Description All p l4' 3 6- 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 11 �Q SF Solid Fuel Burning Appliances €1/9 2-2-11 et J GI P U� °1� ,,1 a,l.tdtv, I Insulation Telephone Email address D Demolition l 5.2 Registered Home Improvement Contractor(HIC) 1 76 d�� 7/0 /2 3 1#* C ' L. F 1514 HIC Registration N mber Expirationt Date HIC bCo pany Nam IC Regi anntt_Name t , ,ae No.and StrFtt f I O v D 3 e I9?Z( _ 1�1 Emai 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. i A" ta .I>t 5-'SJ '- Print Owner's Name(Electronic S'14 atur:l to SECTIO •• •WNER' 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. :m/fJ C . LE8H*0 -- Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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.) 3 5 0 (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" Jc+‘,.., "" The (ommon►i'ealth of Massachusetts --- '_-' Department of Industrial Accidents °" '- '`-,, I Congress Street,Suite 100 -.' Boston. MA 0 2114-201 7 :-y. ,, '"' wwwn:mass.gor/dia It ut kers' Compensation Insurance Affidavit:Builders/('ontractorsfElectricians1Plumbcis. fU BE FILED WITH 1 HE PERSIITl IM;Al'THOKI I"l. kpplieani Inforrttalion Please Print I t•i.ihly Name iliusixs ,s th gam/anon India'dual i: Si) +,J 4 r L.h6 14-4 f Address: ri $ 6L /1D 1.— S7- City/State/Zip: I-14n=/ ! M4 Phone#: (1/13) '22 I , 1 1 3 Arc sou an employer'!Cheek the appropriate ben: Type of project(required): I 0 1 aIn a cntptuyer with entplosees(full and'or pandimc 1• 7. CI New construction -` am a sole prof/Mingur puflnershtp and hair no employees working tot ntr m cI 1 . Remodeling m eapaccomp.y.INo workers'comp.tnsutan uu er nyal) 9. 1011 Demolition tC:1 I ant a hums:via net doing all wurk myself.(No wtrrkos'comp insurance required.]• wil l 1 0 DI Building addition 4.0 I am a hernuawnet and will be hiring omit-actors to conduct nduct all wink on my property. I will cnsun that all contractun either hate awaken'conipm anion insurance Of Olt WIC I I.o Electrical repairs or additions proprietors with nu ernpluyee . 12.©Plumbing repairs or additions 5C:1 I am a general contractor and I base hued the sub-contractors listed un the studied sheet. These sub-contractors have employees and has a*torten'comp.tinurmCe.' 13.0 Roof repairs 6.0 M'c an:a corpurra tun and its officers have exercised thou right ut c tertq+tnn per M(iL c. 14.Q Othrt ___ Vr _-. __. _ 152.31141,and we base no employees.[No workers'comp.insurance required.] •Any applicant that checks fox•I must also fill out the sesctaon below show mg their workers'compensation pubs:, utlurmanun $ H.nnet'w Caen who submit this atludas it uidacaung they are&Jong all work and then hire outside contractors must subnut a new affidas it maw: ng suit :€untractors that chct►this hos must attxhed an additional sheet show in_the name of the sub•co:tractors artd state whether in nut those citifies base cutplunccs It the subcontractors has.:cn{,luyeis.they must pro%tie th.r ..urkers'stnnp pult.s numb-i l 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-Ms.Lie.#: 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 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 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 coverage verification. I do hereby certi/• nder the pains a d i Ides of perjury that the information provided abo•e is err r and correct. Signature: ( - Dale: c�(0 1 2 0 •� e Phone#: MI •3 ) 'Z2 i — 11 I ) r OJJlcial use only. Do not write in this area,to be completed by city or town official City or I oss n: frrmitil_icrnse h Issuing Authorith (circle one): I. Board ofIlealth 2. Building Department 3.(•itsr1ossnClerk 4. Electrical Inspector 5. Plumbing Inspccior h.Other ( untact Person: Phone b: _ . - ,.._a - — ... a ... . .. City of Northampton 4:so 14/ 4. SAS •SI •�'" Massachusetts �� �• �'� 1If . y o$ DEPARTMENT OF BUILDING INSPECTIONS y f +•'d yr�. "' 212 Main Street • Municipal Building '— O�`°t°� b Northampton, MA 01060 �SNh 3+DN^`' 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: ii-A-Gt-g7 ZG � L//V 4-- The debris will be transported by: Name of Hauler: -vl'1-U" 1-2. 6 (Z-- (a 2 � i Signature of Applicant: Date: I 1 .- ,,//I, /27 /6;.,.rr/s 4.) Office of Consumer Affairs&13usineseltegssisliiam HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 176081 07/10/2021 JOHN C.LEBHAR JOHN C.LEBHAR t 68 SCHOOL ST � "'^ / HATFIELD,MA 01038 Undersecretary i +s Commonwealth of Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards Construction'Supervisor CS-075531 Expires:07/10/2021 JOHN CHRISTOPHER LEBHAR 68 SCHOOL STREET HATFIELD MA 01038 ' Commissioner 4,Fa,uL_y"� -