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12C-087 (9)
28 RICK DR BP-2021-1358 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I2C-087 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2021-1358 Project# JS-2021-002233 Est.Cost: $2650.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JASON CASAGRANDE 086138 Lot Size(sq. ft.): 10018.80 Owner: SCOON MAXWELL&DEBRA Zoning: RI(100)/URA(100)/WSP(100)/ Applicant: JASON CASAGRANDE AT: 28 RICK DR Applicant Address: Phone: Insurance: 45 SOUTH VALLEY RD (413) 253-0479 SOLE PROPRIETOR PELHAMMA01002 ISSUED ON:5/24/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:SHEETROCK AND INSULATION , CHANGE LOCATION OF FRONT DOOR 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 Fircplace/Ch in iwv: 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. 1. ,2 5.1-1• '1 • Certificate of Occupancy signature: l 10 FeeType: Date Paid: Amount: Building 5/24/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ,i\ 1/4y � . �, $1J, The Commonwealth of Massachusett OR r ' Board of Building Regulations and Statlda d ?0�J pi1�L1NIF PALITY �� Massachusetts State Building Code, 780 CaM1o,,y� USE p in, Building Permit Application To Construct, Repair, Renovate Or I Revised Mar 2011 One-or Two-Family Dwelling �'�°.,bo_ This Section For Official Use Only Building Permit Number: _l/- / ..x'.e Date Applied: al al Building Official(Print Name) Signature v' e SECTION 1:SITE INFORMATION 1.1 Property Address: 0/0‘ 9, 1.2 Assessors Map& Parcel Numbers '14 R'elc to R t V k- R c-J<& 1M. , c o g 7 1.1 a Is this an accepted street?yes f. no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: _t1N p` I o'13r`'C- /O, o0O • /00 Lonii. imstrict Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 0 al 1 s Xt)-.,Li/ a-o -3"/ 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public El. Private 0 Check ifyes❑ Municipal ly On site disposal system ID SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: At /liN E w f 06.5045, 5 CD o W 2C-1-lk*w r)A- Di o b'. Name(Print) 1 City,State,ZIP 4 3 S. Vai t,c6t j• N13-131'cbl$ dr DI-4-6. COON ID (Mal. No.and Street Telephone Email Address tom SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) - Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': t,g&—M o VE /' 76iGl o IC g A et io eh_ pw-!L /I1-5vIRir"4 0. 3 6 eci ro AS -Foa..4 k AS J Sth 3.c" R2s Me hoc L) ✓1'W - fe-11 t7 - ©a t_ 7O ,Fn, lei_ S✓►t k t L &d rD ow% w r1 wi 11 6.4_ _A-K q wet y , SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ a to� 1. Building Permit Fee: $ Indicate how fee is determined: I. 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fee Check No. I 11 Check Amoun't11:io6 Cash Amount: 6.Total Project Cost: $ a 1 CIPaid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) _O g o 3$ J/4$c))-) Q/4-j jq G-ft-kn.)b E License Number Expiration Date Name of CSL Holder List CSL Type(see below) LI 5evrl* vh-L-LE y td No.and Street T e Description U Unrestricted(Buildings up to 35,000 cu.ft.) P&L A-A-nA /'VIA O 1 DO Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 6167 ' L/ 4-145oN5t4o"nc R.EPAci�V I Insulation Telephone Email address '440.c z IN D Demolition 5.2 Registered Home Improvement Contractor(HIC) A-5 o to .2�4-S A t4�D G 6/ f 7/?-11�z HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 4?j ''DU T1a v frt.l -' t'4 - •-- Tit'S p P5 l°MSC gc,P A-t R ® /A%Iop:f otW No.litd Street Email address ,w, o ►o 0-- '413-6137 -a191/ 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........... ❑ 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. VA I a t-L ScooN 51/s 1 ZaZ 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. S'c-oo>N) _ 5�L4' Print Owner's or Authorized 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 L_3. "Total Project Square Footage"may be substituted for"Total Project Cost" .siteigsg s -----, The Commonwealth of Massachusetts rr, *) Department of Industrial Accidents • I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.govidia %-orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO Bi:FILED WITH I1IE PERISIMINC:AUTHORITV. . Applicant Information Please Print Leeihis Name(BusinessiOrganizationlIndividual): ..7/4-51,A) 044 A 6 trniv TIC-- . . . Address: 115" City/State/Zip: PG-1,44...4•41 il/A- eta 3., Phone#: V/3-667-Aa_4-if , Are yeti en eteettelyer,Cheek the appreprEete bar Type of project(required): 1.0 taia a employer with employees MR anit'os part-tins:i_. 7. Ei New construction .:.,igfi I ant a auk proprietor or partnership and have to employees,writhing for rtht in 8. El Remodeling any vapseity_[Nu'workers'et:imp.instiramV within:Ail 9. 0 Demolition I arn a hornoottenn.doing all work myself.[No workers'on iristiminee reetitired_]. I 0 0 Building addition 4.01 ant a homeowner and will be hiring otriMbetura tt)exmdbet all iiii ink on my property I will ensure that all onto-actors either hake SihMattil.etempenialion insutlatiO!M an WIC I I a Electrical repairs or additions • proprietors with no employes*. I 2.0 Plumbing topairs or additions . . ...... .. , . Sri 1 ain a Ltennal tOstrilcan and 1 Mgt hired the sub-enutraeturs hated Ian die anaehed sheet I 3.C1 Roof repairs • These sob-contragetors have employees and have gentian'comp.insurance.; .En Other . a evaporation and ita off?ing haytexiinjaed theirnsit o.f iixems/Ition.per MG ,e,, . •. .i e i ..,., ,:. ' 151 triliti:til'Alye/1;..ti tin'grigi.liiives:No:gtiatn' .eitEtp.inilleMr;t7e*regatta] . ; *Any applicant that ehetia._big pi mu ui 31...1 fill aut.theanetion ban*showing their worters'cornpensatiorrpoticy intbortation. $Hoirinownerg ighii Submit this affidavit indicating they are doing all wurk and iher3 itir, Ot.atitde cal1:11410m matt subnut a new affidavit indicating such, 'iConiraetors that cheek alb kui).must attnebed an additional sheet show in i thi,•Ming:of the sub-contractor,and state whether or nut those nuitin have amployen. If the sub-euritraetmt.MiVe empluyees.they must provide their Workers*ouirip.policy mitribet. I am an employer that is providing workers'compensation iitSiirattee for my employees Below is the policy and job site information. Insurance Company Name: . — Policy#or Self-ins.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 ciAci.kgc as roquioed under MU.,c. 152, *25A is a criminal violation punishable by a tine 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 tine of up to$25000 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 certify under the pains and penalties of pedlar),that the information provided above is true and correct Date: 57//5/C) I Phone#: „ .... „. .... . .... .. . . .... .. „ , Official use only. Do not write in this area,to be completed by city or Iowa official. City or Town: Permit/License# Issuing Authority(circle-one): • I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector.5. Plumbing inspector • 6.Other .. . . ., i Contact Person: ' Phone 4: ... _ ... ........____ , ........„,____,, City of Northampton °aT N _A\ �5" S�C Massachusetts 4� A, 1.1 a (1 � DEPARTMENT OF BUILDING INSPECTIONS S a , 212 Main Street • Municipal Building Northampton, MA 01060 `10 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, MA-x ►u FLU- SGoON y / 3/it-I ' (insert full legal name), born (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. 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 day of �"/ , 20 011 („,0 (Signature) City of Northampton QY Nr.MI J/�,�� os wv,..,Sic ie•*�' Massachusetts I • DEPARTMENT OF BUILDING INSPECTIONS r 212 Main Street • Municipal Building vb Northampton, MA 01060 '' oks 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: gECc(C ,i N Cr k}51 f lAi P r7))%1 per Ina vrpfrivt The debris will be transported by: Name of Hauler: Mkiltv6a, S L00N ( / 6- IJ Signature of Applicant: a.,ate �CrJ''`- Date:171 1-1/ y 2024 RICK DRIVE a� a+ a,. a1. a. a. __ ,. ...— . .. 1—" a. la. a. al. a. a1.le.ano:o°P�1P // 1 I x. o. :ro xw r' ---- a0m' 6-PC r0•COVER �Q"}7 /1 r I 5V) l I I 07� i I L „ 2Z.' 037 ; H L — j. .. i/ • 1 �321' 3 ) �]1—— , , D , N I .6.M'xKBY•. - co,. J�. Q 2 N YORCX dJd N6]6\ ..• 1 4246.6.' E1.2118.10• 1 Q f ,1; 2.1rir I I oR.E , I I I a6s I I I I . WAIL I 1 STORY x MCP OR.O O�SE OD I Ii._ - - — 1� a.5' IU g 8. I.. �"o I 1 I I 24 I / s X Ro0u 8 ` XEM b]lt• I .� I ,F-2.a05' I 1/4. 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