31A-087 (9) 18 VERNON ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1740
Map:Block:Lot:31 A-087-
001 CITY OF NORTHAMPTON
Permit: Temp Structure
(Tents)
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2021-1740 PERMISSION IS HEREBY GRANTED TO:
Project# Contractor: License:
Est. Cost: 800
Const.Class: Exp.Date:
Use Group: Owner: ROBERT BARBER
Lot Size(sq.ft.)
Zoning: URB Applicant: ROBERT BARBER
Applicant Address Phone: Insurance:.
16 VERNON ST
NORTHAMPTON, MA 01060
ISSUED ON:08/18/2021
TO PERFORM THE FOLLOWING WORK:
TEMP HANDICAP RAMP
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.
Signature: I` ' cp()l .
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
/
The Commonwealth of Massachusett o<� 9l C / /�
Board of Building Regulations and Standard 'N0,,G e �I�' LI
,*\k4k)
Massachusetts State Building Code, 780 CMR </
�.?„-i,.., 7 ISE
Building Permit Application To Construct, Repair, Renovate Or 6erkot t• , Rev..ed Mar 011
One-or Two-Family Dwelling ,der.
,,Z2 This Section For Official Use Only o�'s
BuildingPermit Number:'e P-�1 - I (40 Date Applied.
/41 i 0 I lk,. .X
Building Official(Print Name) Signature to
SECTION 1:SITE INFORMATION
1.1 Prope ty Address: 1.2 Assessors Map& Parcel Numbers
g(# f3 1.toN sT�' 3(A --06T -6O1
1.1a Is is an accepted street?yes V no Map Number Parcel Number
1.3 Zoning Information: 1�Property Dimensions: t
51Tire. C� .50
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) .3icm.1- c.d,H,t_in.:a-, 5 I d_o_ y*.V GL.
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
a
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 Flooyes yne? Municipal ia"Di On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Roe,gc-v E isPrg.SER. 4 c -c - E-O.-Ls-r r,NI N 2Thtom 'TIN)
Name(Print) City,State,ZIP t.&P 0 1 dG 0
1 p/18 Je et4 Sr 4Lg-585 - �53 O v v�4•. ctoa+trlocv 47- e
No. and treet Telephone Email Address j.4A. .j 42• CON
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) (j/
New Construction 0 Existing Building 2/ Owner-Occupied 11 Repairs(s) 0 Alteration(s) 0 Addition t❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: -f-e,4A r)2 r 'Y
Brief Description of Proposed Work':
t.1Perr i-Y h term D t<-Pt-t Pd A.P j ALTHh st 0 E--
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor an Materials)
1. Building $ @ 800 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ /
Suppression) Total All Fees: ("e
Check No.2(0 Check Amount
6.Total Project Cost: $ e0 0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
l V() _^ 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.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
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 0 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 in this application is true and accurate to the best of my knowledge and understanding.
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.) 1¢5 51. f{' . (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count O
Number of fireplaces Number of bedrooms
Number of bathrooms / :j Number of half/baths 6
Type of heating system / `� Number of decks/porches I
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
tra
Boston, MA 02114-2017
unizicer
www.ntass.govidia
Workers'Compensation insurance Affidavit:Builders/ContractorsiEfortriciatistPluntbers.
TO RE FILED WITH THE PERMMTNE;AUTHORITY,
AopliettnI Information Please Print Lend*
Name alustmessithpahmationilridividual tR1)6E,(4...r
Address: I cat _,V ei2-N„6 GYZ--n--t k-lieuuto
City/State/Zip:, Mik. 0.10ca,CS Phone#: •
Arr sea an emptiryte Cheek the appropriate host Type of project(required):
OM a employer with eivatioyetts OUR andirat partaimek,* 7. 0 New construction
20 1 am a Lc3 Remodeling
any capacity,[No workers'comp insurance matineell
9. D Demolition
lam a hottaimaner doing all work myself(No workers*COO*,trormaince required"
" Building addition
&Zion a homeowner and will he hiring wattmeters to conduct tilt work on my poverty. I will
02140.ite*di a coat either have workers*coropeassidion rusurinee ur are sole 11.0 Electrical repairs or additions
promoters with no employees
12,0 Plumbing repairs or addiftons
;SO lam a general contractor and 1 have Wired the subatimitactors Wed on the antelied sheet
13 Roof repairs
Them oah.contracten base einployeet and hose workers*comp.eatitionce21
14.to Other 1ZA-AA
.0 We are a cementation and in officers have exercised thou nen et"treerivtion per kfiGh c,
152,§lid),and we have eas employees_Psi°workers'omits insurance improodl
'"Aity enplaned that criateks boa#1 mint also rtu out the toilettite.below sans omit workers compensation policy information,
*Homeowners who submit this affidavit indicating they are ikons all work and then hire amide contrackes Mani submit a new affidavit loilicaming sack.
1Contractora that check this boa moat attachred an additional sheet showing the name ot the suhrentractors and owe whether or not thew entition have
employees. If the subscorarectors haat employocis they mon provide their smothers*omop.policy number.
I am an employer that is providing worhers'compensation insurance for my employees. Below Ls the policy anti job site
information.
Insurance Cotnpny Name: *
Policy#or Self-inc Lie.tt: Expiration Date:
Job Site Address: City/StatetZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requited under)461.e, 152,§25A is a criminal violation punishable by a fine up to SI,500.00
andior 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 forwarded to the Office of Investigations of the DIA for insurance
coverage verification,
I de hereby certify-under the pains and penaltio of perjury that the information provided iiriove is true and correct
Signature: [21*-114-k Date: EV I
phone#: 4SO
Official use only. Do not make in this urea,to be completed try city or town official
City or"itiori: Permit/License
Issuing Authority(circle one)
1.Board of Health, 2.Building Department 3,Cityrfown Clerk 4,Electrical Inspector 5. Plumbing litsrwoor
6„Other
Contact Person: Phone*:
City of Northampton
{j4 t Massachusetts �}z'° !�
tq
DEPARTMENT OF BUILDING INSPECTIONS
-'; e 4 212 Main Street • Municipal Buildingolfritoeloif
U. �.
Northampton, MA 01060
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: Vik 2 . LL.0
(p 23Y.. EA5Tec 1711•.1 1ZP
(SY&Tlf-t P (u
The debris will be transported by:
Name of Hauler: () W` 4 lJl_
Signature of Applicant: ' J Date:(j ( t I
/2-
City of Northampton
,.�' PY YEA�IYY ..•e.
•
Massachusetts
�t Qz « DEPARTMENT OF BUILDING INSPECTIONS1.
212 Main Street • Municipal Building 7
Northampton, MA 01060 �y 4+ ��
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT /
I, '` R iZr g'iz4t nsert full legal name), bor�i2 /14
seer }
month,day,year), hereby depose and state the following:
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 the pains and penalties of perjury on this 1 ( day of AiKer4.40. 'f' , 20 2 4
(Signature)
Borrower: Robert Barber File No.: 13761492
Property Address:16 Vernon Street Case No.:030912-01
City: Northampton State: MA Zip:01060-2862
Lender:LS-To Bank NA-Mount Laurel
DOC: s8C0uar6 0R 085ngS8 142
EXHIBIT "A"
The land with the buildings thereon situate on the corner of
Vernon and Jewett Streets in Northampton, bounded as follows:
Beginning at an iron pin at the corner of _Vernon Street and
Jewett Street; thence North 533 10' East Fifty (50) feet along said
Vernon Street to stake; thence South 410 26' East One Hundred (100)
feet to stake; thence South 53D 10' West Fifty (50) feet to stake
on Jewett Street; thence North 410 26' West One Hundred (100) feet
along said Jewett Street to the place of beginning; containing Five
Thousand (5.000.00) square feet. more or less.
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