23D-011 (7) 20 NONOTUCK ST BP-2021-1519
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D-011 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Porch Repair BUILDING PERMIT
Permit# BP-2021-1519
Project# JS-2021-002532
Est.Cost: $4000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 10585.08 Owner: ELDREDGE STEPHEN S&LAURIE F WOJTUSIK
Zoning:URB(100)/ Applicant: ELDREDGE STEPHEN S & LAURIE F WOJTUSIK
AT: 20 NONOTUCK ST
Applicant Address: Phone: Insurance:
20 NONOTUCK ST
FLORENCEMA01 062 ISSUED ON:6/22/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE WINDOW & SIDING ON FRONT
PORCH
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. (• ' if. ' •
Certificate of Occupancy Signature: 1 I 0
FeeTvpe: Date Paid: Amount:
Building 6/22/2021 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
ji
J
The Commonwealth of Massachusetts
• Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
`u
USE
s Bµi1 ng Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
r
This Section For Official Use Only
Building Perm fNj tuber: 2021- /5"19 Date Applied: 0 24(202I
,-; ?mvait s t A L, ,. . „Y1 as
Building Official(1-rint Name) Signature ti / Da e
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Number l
20 NoHoi t4 51- -Po Deuce( MA 0k062- '2-3ID
I.1 a Is this an accepted street?yes no Map Number Parcel Number
v�Zoo3ning Information:U�a 1.4 P opertty Dime ions: 6�s.` 0) ,
_ � � Lt5•cf
Zoning District Proposed Use Lot Area(sq II) Frontage(It)
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 0 Zone: _ Outside Flood Zone?
Check ifyes❑ Municipal On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 caner'of,I�ec roer`sil Pik g I� 1 ( Po
� / IA 0(O6 Z
Nam (Print) City,State,ZIP
Zo )J0 VOW< 5f—. Li t3 .33S•77( 9 .vel e4.ee-SVAC J-Cr,,n
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied X Repairs(s) V Alteration(s)X Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of ProM Work': ( c)1 lit to l(..u.. , 5; Zip re!) taviAeh Q v.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ L' 000 _oo 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ I ❑ Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire Suppression) $ Total All Fees: $ _°-
Check No.32143 Check (043,.(22-no Cash Amount:
6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Famiy Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email 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.
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'ilci
this application is true and accurate to the best of my knowledge and understanding.
s. EQw'rt cl0
Print Owner' �
s or Authorized Agent's Name(E ronic 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.govidps
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"
r
' \ The Commonwealth of Massachusetts
=* --- 1. Department of Industrial Accidents
s = 1 Congress Street,Suite 100
4..4•=_ t" Boston,MA 02114-2017
1/4 � ., s'* www mass.gov/dia
me-
Vs or kers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information � G.
Please Print Legibly
Name (Business/Organization/Individual):
Address: )00 VO+() l' 5-f--
�
City/State/Zip:t,oc- Ai Q1 �" QtO62. Phone#: 4l ; 35 11 ) c)
Are you an employer?Check the appropriate box: Type of project(required):
1.E1 I am a employer with employees(full and/or part-time).* 7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8.Remodeling
any capacity.[No workers'comp.insurance required.]
3. am a homeowner doingall work myself. t 9. El Demolition
y [No workers'comp.insurance required.]
10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
6. We are a corporation and its officers have exercised their right of exemption 14.❑Other
❑ rP g p per MGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I 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-ins.Lic.#: 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$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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:f and r the pains a 1,Ides of perjury that the information provided a ove is ue and correct.
/„
Signature: Y Date: 6. I O . `
Phone#: 4 5 —33 S ` --?-7 9
Official 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):
1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
1
City of Northampton
/°e Massachusetts A.
ti
t , DEPARTMENT OF BUILDING INSPECTIONS V it
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212 Main street • Municipal Building O '.iiiy Northampton, MA 01060 ill i'''
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT O / 19
ill
57(10
I, -k Q,1" rf E S r-V` e_ (insert full legal name), born (insert month,
day, year),he br de ose and s52e
te the oll�in :
J P f g
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 pains and penalties of perjury on this I day of TuNQ_ 20.
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(Signs re