31B-183 (3) 104 STATE ST BP-2022-0134
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B- 183 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Permit# BP-2022-0134
Project# JS-2022-000239
Est.Cost: $6325.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BAYSTATE EXTERIOR RESTORATION INC 190659
Lot Size(sq. ft.): 8319.96 Owner: BARRON JEFFREY M
Zoning: URC(100)/ Applicant: BAYSTATE EXTERIOR RESTORATION INC
AT: 104 STATE ST
Applicant Address: Phone: Insurance:
87 SHATTUCK RD (413) 549-6824 WC
HADLEYMA01035 ISSUED ON:8/4/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
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. to • iti >2 T'i . 0
Certificate of Occupancy Signatur
i
FeeTvpe: Date Paid: Amount:
Building 8/4/20210:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
' v
/44:QG..../1/" ..6
ga The Commonwealth of Ma achu etts
Board of Building Regulations and S. rds `3 <9049/ /OR
Massachusetts State Building Co�2IPALITY
aa,,ti4,i niyr, SE
Building Permit Application To Construct,Repair,Renov ' a Mar 2011
One-or Two-Family Dwelling ,q 07oeooNs
T is S ction For Official Use Only
Buildin Permit Number: &/2a "/?'I Date Applied:
it, IeD /47 6-Y-ZIOZI
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property A¢drless: cd 1.2 As so Map&Parcel Numbers
1.1a Is this an accepted street?yes no Map Number Parcel NIL er
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'
2.1pO r'o cord: \ O V I al)�1
Name(Print) Citx,Slate,
(,v V.‘,Ce.-St, ( 117 Y6 --Sao r
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupiecepairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. Number of Units Other—ecify: IARAiki.
Brief Description Proposed Work2: h
P c tj cos v , caa£ An, (A— .17
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ (3 "h 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fee $� �
.—ue) Check No.7 Check Amount: Cash Amount:
l5
6.Total Project Cost: $ `)as 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 t�.truction S pe visor License(CSL) 29(N' 3/sly-
a(A.A.Ac?'O LJ License umber ExpirDate
Name of L Holder
.3 'SSA eic- + List CSL Type(see below)_ LA
No. r beet Type Description
1,, 1 ��3( _ U Unrestricted(Buildings up to 35,000 Cu.ft.)
Restricted 1&2 Family Dwelling
City/Town,State,ZIP trvl R
tyM Masonry
RC Roofing Covering
WS Window and Siding
5)37_ :1i1 ' ( "`_)�C T SF Solid Fuel Burning Appliances —
C/Y' �"``', I Insulation
Telephone Email address D Demolition
5 Registered Home prove t Contractor,(HIC) l ` ' ( a—���>A16,,; n 1t/2441 y4� HIC Registration Number xpi tion Date
HIC Company Namear 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 Issue ce of the building permit.
Signed Affidavit Attached? Yes No .0
SECTION 7a:OWNER AUTHORIZATION T, :E COMPLETED WHEN
OWNER'S AGENT OR CONTRA R APP 1 '' t R BUILDING PERMIT
I,as Owner of the subject property,hereby authorize I
to act on m behalf,in all matters relative to work authorized by this but ding permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my ,:..i a below,I hereby attest under the pains and penalties of perjury that all of the information
c. ' ed in th i ation is true and accurate to the best of my knowledge and understanding.
f
a innk 3
Pr •., er's or Authorized Agent's Name(Electronic Signature) D to
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
r-> j Massachusetts �w�. S. <
DEPARTMENT OF BUILDING INSPECTIONS ;I .,
��7' 212 Main Street • Municipal Building w�• �.0
N. ---�! Northampton, MA 01060 frki
4--)N,
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: ( t .1
ti..L. 0 _
The debris will be transported by:
r
k
Name of Hauler: SC>12,4, _ ,
I
0
Signature of Applicant: - Date: IM
.ii,.. The Commonwealth of Massachusetts
Department of Industrial Accidents
12
=*- 1 Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.goWilia
ti.tc-
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE I:I El)WITH TIE' ERNIMLYG AUTHORITY.
Annlicatit information .,.--1 Please Print Legibls
Name(BusincsR:organmationitnalviduair. C1(.._., . V\Ai - 1'\-0
Address: aleirL P
City/State/Zip:_ _Mil—6103-'s Phone#: 1 ...0
Ar,)U11 an employer,Cheek the apprup a box: Type of project(required):
I.Clain a employer with°I-- employees abll ileaVor part-time).• 7. 0 New construction
.)n I 4111 a sole proprietor or partnership and have no employees working for me in
geEf Remodeling
any capacity.[Nu workers'com required.) -
insurance requir .)
. [j Demolition
31:]I am a Itunicowner doing all work myself.[No workers cump.irasurance required.]'
100 Building addition
4.0 lam a homeowner arid will he hiring omuratiors to conduct an work on my property. I will
ensure that all contractors either have smorkers*compensation insurruice or are sole l 1.0 Electrical repairs or additions
proprietors with no empluyeini.
12.0 Plumbing repairs or additions
50 1 ant a'paw-rat contractor and I have hired the sub-contractors listed un the attached sheet
I.30 Roof repairs C
These sub-contracturs have employees and have%writers'comp.insuntnce.;
6.0 We are a ourporatsun and Its oftkers have esemised their csght of exemption per ARIL e. 14. 9thericLi._...
152,.§1(4),and we have nu cruplu.i.ces.[No workers'comp.insurance required.)
'Any applicant that checks box 0 1 inust also till out the section below show ing their workers'compensation policy information.
t Iltnnuowners who submit this affidavit indicating they arc doing all work and then hoc outside contractors must submit a new affidavit mdieaimcj such.
Cuntractun,that check the,box must attached an adslitiunal sheet shutting the name of the sub-:van-actors and sate whether or nut thuse taititic,..have
employees. If the sub-contractors have employees they must pro+ide their workers'Oaalp policy ninnber,
I am an employer that ls providin workers'comp iltion insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ---
,..
Policy#or Self-ins.Lie.#: Ce 6-1-u_8- 68 D-(_33?- Expiration Date:
(
Job Site Address: loq 7.1- ,.. (S-f2 City/State/Zip:_A.) krt-1/1/1-61040
Attach a copy of the workers'compensation policy declaration page(showing the policy number and piration date).
Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a tine up to S1,500.00
and/or one- ', itri,risonment ,' veil as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against ,e vi 'i A c•.y of '-statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage ye, fic on.
I do hereby e ify on , .0 e 1,,, a penalties of perjury that the inprogotion provided ab is tr and correct.
/ 1 / 3 d/
Signature: two Date:
Phone :
Official use only. Do not write In this area,to be completed by city or town official_
City or Tort II: Permit/License#
I ss u i rig Authority(circle one):
I. Board of Health 2.Building Department 3.CftyiTown Clerk 4.Electrical Inspector 5. Plumbing Inspector
G.(hlier
Contact Person: Phone#:
_ .