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39A-065 (7)
10 HAMPTON TER BP-2021-1440 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A-065 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&BATH RENO BUILDING PERMIT Permit# BP-2021-1440 Project# JS-2021-002396 Est. Cost: $70000.00 Fee: $455.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DOUGLAS THAYER 107699 Lot Size(sq. ft.): 58806.00 Owner: SARINGLANIDES SOPHIA Zoning: URB(51)/SC(49)/ Applicant: D O U G LAS THAYER AT: 10 HAMPTON TER Applicant Address: Phone: Insurance: P 0 BOX 60322 (413) 530-4785 () FLORENCEMA01062 ISSUED ON:6/7/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCHEN RENO & 2ND FLOOR BATH 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. 53- Certificate of Occupancy Signatul : • v' . ytJ • ),I FeeType: Date Paid: Amount: Building 6/7/2021 0:00:00 $455.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusettg s. b Board of Building Regulations and Sta dard ✓(J R /�I, Massachusetts State Building Code, 7 0 C N <2. SE`LITY J• A Building Permit Application To Construct,Repair, Ren ,- olish a Rev' ed M 2011 One-or Two-Family Dwelling Ttig41,5e4t,(1 Thissection For Official Use Only o SQFe2.. Building Permit Number: )I 2/r /�O Date Applied: '�°o°tis L`AL) IZ t4Z r 6-7-ZZ1 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION l.l,Property Aa p � 1.2 Assessors ap06 Parcel Numbers ©6" 5 1 [LTI CVO- 7 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 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: SO OP Set v(A !ittife es Nat Q.►/(J 6{ ,_.4___ Name(Print LL City,State,ZIP 1 No.an Street / Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s)K Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': tch#k• Ofimii fi Pll ,icn+ Q/,a( Piasv fk.l( & (190u4 k Jells rid or 11 Renedei SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ (O COO 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ElStandard City/Town Application Fee 1 U CY.tO 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ SO COO 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:/MV r Check No. IQ IA Check Amount: �r✓ Cash Amount: 6.Total Project Cost: $ -a-1d 006 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS lo7G2q as �Q(� l q S 1'j�11 a {( License Number Expiration ate Name of CSL Holy PC) 61/4 h 60 30 a List CSL Type(see below) No.and Street Type Description r �k A'� e �� Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP G a( R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding 1 SF Solid Fuel Burning Appliances Dok I t5 7 la�i,c y1�lg,l.cod — I Insulation Telephone U Email address S I) Demolition 5.2 Registered Home Improvement Contractor(HIC) 1pou 1us Tha`e. ! g� OSS HIC Re Registration Number x iration Date HIC Company'Name or HIC Registrant Name ! � P 201 Gormsl 5' lh�k�45-fit A/ �, frua:L cam' No.and Street I EAR addrekti cfreit 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 Ui attic S Mitlo to act on my behalf,in all matters relative to work authorized by this building pern t application. SOf 41A Sw&tkof hQ w/A'21 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. (SD 12+t1A- S 2i c toKi 5lig/zl 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 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REA' ARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton l}�sr+K r Massachusetts j G • DEPARTMENT OF BUILDING INSPECTIONS \ • ; ": 212 Main Street • Municipal Building 6 a Northampton, MA 01060 ro N�4 -117 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: \fa 1�� Qec 1 W The debris will be transported by: Name of Hauler: 0.)(rici4GC 5 (..W • '� Signature of Applicant: Date: � �/\ . . The Commonwealth of Alassachusetts Department of Industrial Accidents I Congress Street,Suite 100 1111 time Boston, MA 02114-2017 ,.., www.mass.goridia 11 orkers t'ompensation Insurance Affidavit:BuBdersiContractorsfElectricirins/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITE. Anollaint Information Please Print Lemiblv Name(HusineasiOranszation,Individual): t)etti!it&5 T)164.1r V Address: 6)C Q1,-.;..,L. 6C 1,2 ?, nells,,, City/State/Zip: cict ..) Phone#: . Are yea an employee Cheek the appropriate NOV Type of project(required): a employer with ,,,, .3 svierioyeei/MI sadist parr-tisrict* 7. 0 New construction 2.0 t am a sok proprietor'or partnership and have no employers working for roe in I. aRemodeling any capacity [No workers'comp.insurance it-quires:LI 9. El Demolition Acj I am a hosescovincr doing all wink rriyarlf[No workers'comp.irAUfal roe required.)' 10 0 Building addition 4.C3 lam a homeowner and will t hiring costractors so conduct all week on my properly I will ensure ttuu all coraniciors either have workers'compensation insurance or are sole 1 10 Electrical repairs or additions proprietors with no employees, 12.0 Plumbing repairs or additions CO I am a general contractor and I have hired the sub-contraicion listed on the attached sheet I 30 Roof repairs ihtm:sub-cormactors,have employee's and have workers'comp.rnsiurance.: 14.00thet 613 we.are a ono/sermon and its officers have-exercised their right of caertiption per Alta c. . 152.,f lt,t),and V.0 11.111W no employees.[No workers'COITIrl,thiLitailee required] 'Aty applicant that chocks boa al must also fill out the wettow below show ing their workers'compensation policy information. t Homeowners who submit this affidavit ruilicating they arc doing all work and then hire outside contractues must submit a rteW affislav a indicating such, :Contractors that check this box must attached an additional sheet Mow-in the same of the sutscontraetors and sere whether or nut avow..mtsties hair ciriployeet lithe sub-contractors have rropleyees.they merit provide their workers'comp,policy number. I am an employer that it providing workers"compensation insarance for my employees. Below is the policy and job site information. Insurance Company Name: 0 /1;?.. ( _ ' Policy ti or Self-ins.Lie,#: 6 If(Ai'? q__F -7 9 ie 617Expiratioe Date: 01 ,2 ( Job Site,Address: I_C_ 144, e ).,„ le,04. ,e City/StateZip: plik_ Attach a copy or the workers'comiktisation policy declaration page(showing the policy number and e piration date) Failure to secure coverage as required under MGC. c. 152, §25A is a criminal violation punishable by a line up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator.A copy of this statement may be lOrwarded to the Office of Investigations of the DIA for insurance coverage verification, _ I do hereby certify under the pains a nalties of perjury that the information provided above is true and correct. Signatun,.. —c*---iP Date-. —' Phone 4: V11- C1C V7if- S • Wildal use only. Do not write in this area,to be completed by city or town official. City or Town:___ Permit/License# , . . Issuing Authority(circle one): I. Board of Health 2. Building Department 3.Cityrtown Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone a: t r1 ,) s , ( . . 1 ' ,.._......_..... 9 .,__. d r t" a, r 4t. qd V t 1 ��-S pp k t a w W m ct S i • e_. o a