29-063 (3) 39 GILRAIN TER BP-2021-1475
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-063 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-2021-1475
Project# JS-2021-002451
Est.Cost: $17000.00
Fee: $110.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RICK LIGHT 056457
Lot Size(sq.ft.): 17685.36 Owner: CABRERA MIGUEL
Zoning: Applicant: RICK LIGHT
AT: 39 GILRAIN TER
Applicant Address: Phone: Insurance:
25 BOYDEN RD (413) 253-9492
PELHAMMA01002 ISSUED ON:6/10/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN 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. I
i � A
Certificate of Occupancy Signature 1 • , ' I
FeeTvpe: Date Paid: Amount:
[3uildin� 6/10/2021 0:00:00 $110.50
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
1
7, '�y
�. The Commonwealth of Massachusetts o o ',
Board of Building Regulations and Standards FO �' \�MUNICIP Y
Massachusetts State Building Code, 780 CMR USE a ' (�
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Ma 01 ` )
One- or Two-Family Dwelling _ C
This Section For Official Use Only o
Buildin Permit Number: 0-2)'/q Date Applied: c
ev�,� ass 1// 6-JO-2UZ.1
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prop lty Address: r4 1.2 Assessors Map&Parcel Numbers
-Amtk
A
1.1 a Is this an accepted street?yes no Map Numtr 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❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ow of Record• �a 11.404,v
Tin (Qiqk 0I06 ZName(Print) c City,State,C, ZIP L►d.J• /j.�
3(, ( c,Q1 vt I _cp 14(372736y� � 'n -
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building}p( Owner-Occupied p Repairs(s) 0 Alteration(s) 0 Addition 0 ,
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Q..F,,. c ..45.frv'. V ciSdict., Carkisitifri5 i Get.,,,
ttr 44:e
e vi)41., ; le:3,1 t A'4, 114'VJ C446i i e•-e i SS
v 1--Q.4,440
4(
r 0,44L,Ast ...e�, , .� et '��,�� tVe
SECTION 4: ESTIMATED ChNSTRUCIKION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ f-7 d • to 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 1 ❑Standard City/Town Application Fee
0 Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $ 1 0
',�1 Check No.,fl1(heck Amount: Ilb. Cash Amount:
6.Total Project Cost: $ C7( OW v uV 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Q AV_
(ice, -r License Number
Name of CSL Holder
Oeythe^', List CSL Type(see below)
ill
No.and Streef Type Description
P-4/ f ,�J �� U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,Stag,ZIP /T R Restricted 1&2 Family Dwelling
tY M Masonry
RC Roofing Covering
WS Window and Siding
/ / t- SF Solid Fuel Burning Appliances
107-�j)-t& ( L4 G. �f( t� d yywr( I Insulation
Telephone Eritail address D Demolition
5.2 Registered Home Improvement Contractor(HIC) p ���]
L� ti 1' - M HIC Registration Number Exp. ti Date
HIC Company',Lame or C Registrant Name ay .
No an S et Email address
�- -, 0.$11 ptdov. `tt3 -3l
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 cL- LUG t-
to act on my behalf, in all matters relative to work authorized by this building permit application.
I- b0E L C-A 6 P- 2� 20a
Print Owner's Name(Electronic Signature) , ate
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.
Print Owner's s r Name( le r onic Signatur; {1(7Dite
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
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
I t SS SC
��� ,R Massachusetts ,it *;1- '/e! ,
F DEPARTMENT OF BUILDING INSPECTIONS ta• n
, _ 212 Main Street • Municipal Building s�. /♦1
If * Northampton, MA 01060 fs ���
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: t4 PCtieil Cia, f'
Location of Facility: )..37 G.61 f 744-, iLe 1 offia- (/1
The debris will be transported by:
Name of Hauler: pt_,L, L.r,
r / !-
Signature of Applicant: , af`Vi ,21-144---
Date: (0 2f
The Commonwealth of Massachusetts
Department of Industrial Accidents
_ rr�-- 1 Congress Street,Smite 100
,; Boston.MA 02114-2017
'`•, sJ www mass.gor/dia
%%inkers' Compensation Insurance:%I iidasit: Buiklrrs/Contractors,Fleet ricians.Plumbers.
10 HI. I lt.l.t)N1 i tH'1 HF PEK%IITI'I.NG AtiTHOlu U.
Applicant Information Please Print I.l••_iti
Name lkiusnic s&)r.nur`n�rn ltidis'dual l- ge L
Address: 2-5— �
5— Yd^__.
P
City'State'Zip• ( olap� `f Phone#: 2-53 — 9.
%re you an employer?Check tlk appropriate but:
Type of project(required):
I 0 1 am a.mpkryer with employees(full and or part-tines 1• 7. 0 New construction
_[I1..m a uk pnstxtr[ca Of pmtncrship and lisle nu employers a,,fi,u g fat nix in 8. al Remodeling
an)eapawity-[No*Midas'comp.insurance retpanaij
9. wli Dent t tun
0 I inn a liornrowner doing all aunt myself.'Nu workers'comp sr,untrite n oted i'
I 0 0 Building addition
a.Q I am a hurtxvwner and*III to hiring contracture to conduct all,,.oak on my propt-m I%ill
assure that all cs}rona:turs enter base worker'4:,mpensatstn insurance Of an isle I I.o Electrical repairs or additions
proprietors with no cmplovecs.
12.0 Plumbing repairs or additions
T:j 1 am a general contract a and I Isar c hired the sups-cantrtatun tested on the attached street
Chest sub-c.mrr tctory hay.employees and(tote workers'comp.insurance.: 13.0 Roof repairs
6.0 we are a euginratiun and its officers hate ca.cn iscd their nKtir of exemption per t ttiL c. I$.El Other
I32,.1(4).and a c base no Imployecs.[No workers'comp.insurance requital
•:fin,.applies**that cheeks but a I must also fill uut the section below stowing their workers'curnpernatiun r ilie4 information
'Ilorruroancrs who submit this atrial%it uuhcatasyt they are doing all a ork and then hue outside ctmtrackes must subnui a new afti.lal it irxliutirr si J.
:(unttactors that[:heck thu hot must attatscd an addstiunal sheet shoe rig tlse name of the sub-contractors and state a hctber in not Itit,se canine,n. _
esplutcc, It Ow sub-c.ntrsct,r,tvtic eniplusces.they must pn,side 1M rr %(Deters comp polies number
l am an employer that is providing worLers'compensation insurance for my employees. feloN is the polity and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City'Statt.,Zip:_ __�._._._____ _-.
Attack a cope of the workers'compensation policy declaration page(showing;the polity number and expiration date).
Failure to secure coverage as required under M(iL c. 15_. §25A is a criminal violation punishable by a fine up to SI.500.00
atittOr one-year itnpnsonmcnt,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a
day against the s iolatl,r. \ copy of this statement may be forwarded to the Office of Investigations of the DIA fur insurance
i UsCrjeC♦ellilCatlt,tl.
I do hereby certify under the pains and peaalties of perjury that the in/ormation provided abase is true and correct.
S13nature: -1/Ybc-0 I- Dal.: lipi
Phl,nt ": !` Yl3 ,1S3 -1 66
iOfficial use only. Do not write in this area.to he completed by city or town official
( its or-limn: Permit/License#
Issuing.luthorits Icirclr one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
G.Other
Contact Person: Phone ii: