24D-038 11 WINTER ST BP-2021-1545
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-038 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:demolition BUILDING PERMIT
Permit# BP-2021-1545
Project# JS-2021-002567
Est.Cost: $5000.00
Fee: $30.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RAYMOND GRAY/HARRIS & GRAY EXCAVATING 024991
Lot Size(sq.ft.): 8058.60 Owner: DAVIDSON PAMELA R
Zoning: URB(100)/ Applicant: RAYMOND GRAY/HARRIS & GRAY EXCAVATING
AT: 11 WINTER ST
Applicant Address: Phone: Insurance:
P O BOX 300 (413) 628-4774 WC
ASHFIELDMA01330 ISSUED ON:
TO PERFORM THE FOLLOWING WORK:DEMO BARN
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 N I RTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. ( i I
Certificate of Occupancy Signatur:'
FeeType: Date Paid: Amount:
Building $30.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
r-
JUN 2 /
The Commonwealth of Massachusetts 4 2/
Board of Building Regulations and Standar 2� FOR
�r of MU ICIPA�LITY
VY� Massachusetts State Building Code, 78�0 CMRn�oRTHq�Lo'^�G Inlsp US
Building Permit Application To Construct,Repair,Renovate Or De Mo i " oro�' ed Near 2011
One-or Two-Family Dwelling _
This Section For Official Use Only
Building Permit Number: Jr,"- I y Date Applied:
A:u/N 5) 6 Z5-2ozi
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
// 4.1/4vrE2 rc7 I-r a 41' ►' a 317
1.1a 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(II)
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,ErOn site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
1ThinEL►fq `>AUi DSc rd /V0A7/7/ 9mPy i) , ,. CIO'
Name(Print) City,State,ZIP
. xr_ET
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work': u /1 11 �1
rn0l„cn'TZCnr a 'wlova-d' di) rip cci.Nett bclr'r�
$r 1S face
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Onl
1. Building $ 1. Building Permit Fee: $ ndicate how fee is determined:
2. Electrical $ CI Standard C' wn Application Fee
0 oject Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) Total All FeFfAti
Check No.]>71VICheck Amount ' Cash Amount:
6. Total Project Cost: $ ✓'�2VV.' 0 Paid in Full 0 Outstanding Balance Due:
1
r )
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-a-21'Q9/ 9 y c2./
C _ I 14_L 1mO24ci G ra.A License Number Expiration ate
Name of CSL Holder 3
�7L) Ct C >ox SGa List CSL Type(see below) Unre3JlrJef�
_21 /Y)Q in
No.and Street Type Description
A� f /� e/_/f {)'7 ` Q 433 3 Q !� Unrestricted(Buildings up to 35,000 Cu.ft.)
Ci]`� CX / / V R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-62 —477( ra cter r-aqi€VerI zoo. I Insulation
Telephone `4Efhail address flei D Demolition
5.2 Registered Homenn Improvement Contractor(HIC) �E_(�3Y890 .Z ez/
[�fj‘on c GrQ4 HIC Registration Number Expi tion Date
HIC Cortany Name or HIC Registrant Name
AI nnocn sf , — Z6_TGX 3o6 ro q�--Qy1CVer 0/).ne7'
No. d ee / Email address
O ielek , Mom. 0 I33 G -113-62 2r-477 i
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 N No .0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
rfD I,as Owner of the subject property,hereby authorize I<el y'st\c-r Ctt-1-1 s el �'+'r'a..t.i
/ to act on my behalf,in all matters relative to work authorized by this building pe t application. J
N Cija,Ve\C- 0 0 I(19 on ,
..2.2,
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
c • this application is true and accurate to the best of my knowledge and understanding.
mo'ri� 01/ 2)/-2-0 ( - _i e / D Print err +uthonzed Agent's me(E�n c Signature)
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"
The Coostotweakk of Messachtts x
iy t of loodivstrial Areidesits
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err,M 4 fl2114-.2#17
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TO Of.vitiownli THE Pi:RSt1 t i rst. %Vito IVY
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tx'Nitritei ?trtsntt�r�'`lncfsr=�xltcratt: TY�o,vl 9 a,,t_C�
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r tionicowtant4 who wit t ,affidavit ofirmhuly they atte 4****vank arad test hue amok contractors.aF tors maa aukstat a new s:rdoiit Ups 4
!coletr'ut tu*beuo chit*stet Nut mot anwhatt t awn Amen the num Odle aittreatat art**Ardi*cure a tte#ter at not thaw asaule*tarot
093140yOtt If the autatoutuatuuaact ptaair a diva annuzx'tamp pokey tt r
1 arst tor ear *dB pawls/kg 'jai net lases t frr Myenglit re*. /WOW is the policy m i ake
information.
'ate*or Seit.ins.tic.Irk ✓ Expiration Bate:
lob Site C� ip-
Ati*dl'd copy tf the hers'compe patty iterlaratiati pope( the polity umber turd expiration
Fibre to secure coverage as required under MGL e.152 t25A is a criminal violation punishable by a feats up to S 1.500.0
*nd/or -yam imartxtetntmnt.as well Civilpenakies to the horn Ta STOP WORE ORDER and a fine otup to S250 00 a
day against the%iolator.A copy of tftiaa oatmeal may be forwarded to the Office of ins ewttgeatunts otthe m fiat ttusuranix
wets a vefificaetton
A .ar r .,N.'1-•4' _._. _ -- .-V , .r' l+awarA.--
I du . :y .Y naa r the pains am idp n antes eperJurx t at air information piteltfrO M*It*Tit
' i ( .oec
Phone# 913-6 2 ,7 l
(1(cial so oats, Do not write in thA area,to be t:omptettd by thy iar totes Orin/
City or T€►wn. pt�ttntt tt'
Ito Authority C ouc)
I.Board of Health 1 Building Department 3.Clyne**Cheat 4.Etc tuspe.tor :t. Mantillas h
6.Other
Contact Penen Phone
City of Northampton
F AM
Massachusetts . tc,'�{.
t
ft `t DEPARTMENT OF BUILDING INSPECTIONS ,
!aF
212 Main Street • Municipal Building
wed°V-4 ' Northampton, MA 01060 Fjq, 1�,
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: r
The debris will be transported by:
Name of Hauler: /9/'7) 4eA.4, �.iu,c/� un.t,
Signature of Applicant: Date: DL_ l Zcz