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23D-142 108 HINCKLEY ST BP-2021-1456 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D- 142 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ADD BATH BUILDING PERMIT Permit# BP-2021-1456 Project# JS-2021-002417 Est.Cost: $14350.00 Fee: $93.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WILLIAM ROCK 050081 Lot Size(sq. ft.): 3310.56 Owner: PATRICIA A RYAN Zoning: URB(100)/ Applicant: WILLIAM ROCK AT: 108 HINCKLEY ST Applicant Address: Phone: Insurance: 23 Amherst Rd (413) 256-4930 SOLE PROPRIETOR PELHAMMA01002 ISSUED ON:6/9/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:ADD 3/4 BATHROOM ON 1ST FLOOR 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. 14 • v . .).2 7-) Certificate of Occupancy Signature: , • ,..43%, FeeType: Date Paid: Amount: Building 6/9/2021 0:00:00 $93.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 1, The Commonwealth of Massachu f0, ; FOR 1l Board of Building Regulations and Starida; 1)1' r Massachusetts State Building Code, 780 c1 , ,�� _NICIPALITY _,, o/4, Te1SE Building Permit Application To Construct, Repair, Renovat&CSkb lish a Revised Mar 2011 One-or Two-Family Dwelling 'o�„T This Section For Official Use Only �eO ors Building P it Number: OP-- I 1 /4-/6-C, Date Applied: c—v�,� 55 /g// 6- 9-zozi Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Num ers .,, f0 H10C.kt_.EY STREET- a3� ) 1.1 a 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 Private CI Municipal Outside Flood Zone? Municipal, On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 71 Owner'of Record: YA— g IQ 1 A A . i- r-o.1 Ft_Ot2C Nee— NIA a (O a_ Name(Print) City,State,ZIP (O.814 ►wo,KU-q 5 iJT Ifr3ao_-Lrg_ 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) 0 Alteration(s) fa( Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': AcA A q 4/4 1oq'A coo..A. 0vc.Le _. rs`- -cisoa' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1. Building $" al Sb 0 01 1. Building Permit Fee: S. Indicate how fee is determined: 2. Electrical $ .23 p 0 0 0 Standard City/Town Application Fee 0 0 ❑Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 58t 2. Other Fees: S 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: S Od Check No1-11 7 Check Amo :q Cash Amount: 6.Total Project Cost: $ d ��35 0 Paid in Full 0 Outstanding Balance Due: City of Northampton ••' Massachusetts �4i' ".c� w '1 . DEPARTMENT OF BUILDING INSPECTIONS yt 6 4.A ' 212 Main Street • Municipal Building Northampton, MA 01060 ......•''��O PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s) and set backs. 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. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Sbbe I 8 IS .2A-. i.j am License Number Ex rati Date Name of CSL Holder 1 ' List CSL Type(see below) A4w‘1'.e,rs-�- rc No.and Street Type Description �1 M O I CG U Unrestricted(Buildings up to 35,000 cu.ft.) ' `al R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering — WS Window and Siding SF Solid Fuel Burning Appliances yr3 5i5 (/307 -E„tlrack 5-.Ce,nn C a . I Insulation Telephone Email address D Demolition 5.2 Registered Home Improveement Contractor(HIC) /67 S7C /0 / hil.0 JWoc a i9tA 'rlP�^s 'c- 'o� LL HIC Registration Number Ex irat'on Date HIC Company Name or HIeRegkstrant Name S3 ems '1-6,Acock 5' c.e ►3): vn + No.an trees Email address e‘Vnavv\. IAA. ©too 8 T/3 575 1/307 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 °14n4 �)<Q C.k' to on my behalf,in all matters relative to work authorized by this building permit application. . oc .v3a Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 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. 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,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" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE The Commonwealth of Massachusetts ►",_: I__ Department of Industrial Accidents ii =I:Mi= A, 1 Congress Street,Suite 100 71- T E=,f' Boston, MA 01114-1017 ''•;, i,,s- www.mass.gov/dia - '%utkeii' t ontpensation Insurance Affidavit:Builders/ContractorsfEkctricians/Plumbers. ID BE FILED WITH THE PERMITTING AUU'1'HOR1'fl. Applicant information Please_ Print Leeibh ':Auld'I Husiness,Organiantion lndn � s_11e ldual): -I' 1/) 0OA 1 5� �o�S—Vt,e3 4 ciA L-t- Address: a3 A-I,yn t e rs* Y'ci' ---- _ _ City/State/Zip: IL.t.^ { 0)60 P Phone#: y/3 575 /3 7 .trr you an employer?(leek the Appreprlatr Ion: t 1 1 Type of project(required): 1.C]I am a employer with employees(full w d'or purl-time I." 7. 0 New construction - I am u sole proprietor or partnership and have nu employees working for me in K. El Remodeling any capacity.[No workers'comp.insurance regwnvlA 9. 0 Demolition .S.0 I am a homeowner doing all wink myself.[No workers'comp.insurance required.]' 10 Q Building addition 4.n I am a homeowner and will be hiringcorunsa.urs to conduct all work on my property. I will h�ensure that all meanie:tors either have workers'comperasataon assurance or are rule 114:1 Electrical repairs or additions proprietors with nu employees. 12.D Plumbing repairs or addition] S0 I am a general contractor and I have hired the sub-contractors listed on the suactred sheet 13❑Roof repairs These sub-contractors base employees and have workers'comp.rnsunrneer 6.0 We are u eorpuraliun and its taken have exercised their right of exemption per MGL c. 14. Other_ I5.2,*llal.and we lase nu employees.[No workers'comp.insurance required.] "Any applicant that checks bus DI mutt also till out the section below showing their workers'compensation policy information. ' llotneownen who submit this affidavit indicating they arc doing all work and then hire outside contractors mint submit a new affidavit indicating such. `('intrusion that check this box must att:rc:bcd an additional sheet show ing the name of the sub-contractors and state whetter or nut those entities leas,: :mph,:,,,:c, If the sub-cuttracturs lease c,ryrluyees.they must pro•,ide their workers',norm.]n,11c.number. I ant an employer that is providing workers'compensation insurance,for nty employees. Below is the policy and job.site information. Insur.mce 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 coverage as required under MCUL c. 1 S2,*y25A is a criminal violation punishable by a fine up to 51,500_(Kl aril:or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 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 certify under the pains and pe allies of perjury that the information provided above is true and correct. Signature: y/.l t ,v-s 1�� Date. C/3/9-) Phone#: y(3 575 1307 Official use only: Do not write in this area,to be completed by city or town official ('it} or'I"own; Permit/license ti i Issuing Authority (circle one): I. Board of Health 2.Building Department 3.Cit!;Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 'j 6.Other _ i ., i f' ('uutttct Person: Phone#; City of Northampton .."...,s� .% 4T Massachusetts • DEPARTMENT OF BUILDING INSPECTIONS Dl :jq 010 212 Main Street • Municipal Building Northampton, MA 01060 "'• y,00 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: PAav-�Jc vre-vV The debris will be transported by: Name of Hauler: 1A)Qs-Ve J)gtnay' ein� Signature of Applicant: y,✓b'k_ Date: 6).5) )v�i 316 115 54 34 - 115 DN (NI cz• LIVING AREA 11'5 43e-'8;ci ft 11'5 3-6 Affou)Woo i'vv,oy� 31'6 11'5 - 8'8- 11'5 I � � .DN M n LIVING AREA I� 11'5 438'8>q ft — 11'5— — 1 h jc� 5l' ►�� 6/4/2021 Patty Ryan OS Ninc ARROWWOOD t k�ey st 23 AMHERST RD PELHAM MA 01002 n orence Ma 413 256.4030 3/4 bath frame two interior walls with 2x4 1 6"QC Drywall interior of new room completely with 1/2 drywall plumb 3/4 bath to code install vent fan and lighting and outlets to code one fan/light ducted out,two recessed lights,vanity light and gfi outlet Tile shower walls and base,tile bathroom floor new 6 panel pine door exterior of new walls drywalled with 1/2" drywall and finished bath ceiling finished with 1/2" drywall all painting included and debris removal bill Kock