25C-153 CO/UTIGA' C.TV C 4 4(.1 -6---
11 ORCHARD ST COMMONWEALTH OF MASSACHUSETTS BP-2020-1137
Map:Block:Lot:25C-153-
001 CITY OF NORTHAMPTON
Permit: ADDITION
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2020-1137 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2020-001907 Contractor: License:
Est. Cost: 96000.00 THOMAS QUINLAN 011289
Const.Class: Exp.Date:02/27/2022
Use Group: Owner: 11 ORCHARD ST LLC
Lot Size(sq.ft.)
Zoning: URB Applicant: THOMAS QUINLAN
Applicant Address Phone: Insurance:
94 HUNTINGTON RD (433)477-8361
HADLEY, MA 01035
ISSUED ON:09/16/2021
TO PERFORM THE FOLLO WING WORK:
ADD 2ND FLOOR
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:
• V • >2 ' cg6T
Fees Paid: $689.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
* l-%t✓C-O 140 Diuie,..,A` 4136 i
"fl))L-.Q HI✓t Ilw'. PROP OFF CHtfric-
_ to
14 The Commonwealth of Massachusetts o
Board of Building Regulations and Standards F W
II Massachusetts State Building Code, 780 CMR M ITY M i'
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised�bftzr 2011 tt0 Z(Di
One-or Two-Family Dwelling w( , `" °m
This Section For Official Use Only o.. m<
Building Permit Number: t, "ii )7 Date Applied: tht (6 Z
is t
4ou.)1Z5) c'-/ o21 ,°
Building Official(Print Name) Signature Tate
SECTION 1:SITE INFORMATION
1.1 Property Ad��Cr Ote ofS1�. 1.2 Assessors Map&Parcel Numbers
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❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSIiIP1
2.1 Owner'of Record:
11 G'cGi d SF-rect- /IC 017 Ivo. tietpit sf-.
Name(Print) City,State,ZIP
KCLa ey /A /k 0 (03S -y/3- Y4/-6466 Q, 1e 4MTelXS...
No.and Street f Telephone Email/Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: --
Brief Description of Proposed Work': ` ei�CS� oy r /fe Co., y�ry c i vd ,-,‘,0/
-rawttl Flcc.. c — Co ltYE 5iik tet=., r'4 Ira—Ive- di'o )
A- kb t" a � ,sq f
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ (� wQ a 1. Building Permit Fee: $ Indicate how tee is determined:
�� n 0 Standard City/Town Application Fee
2.Electrical $ ,.ti ` 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ Orti k.. 2. Other Fees: $
4.Mechanical (HVAC) $ ik,10 List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ l,S. 00 ❑Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
�es- bit �(3'� /27f 30 �-
T46 4• Q-5 vz 4 (4 License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
)�J r( U Unrestricted(Buildings up to 35,000 Cu.ft.)
4 t �G U( d 3 S R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
T Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /D/ ?A 7 `�6.
/2 cos
1,t(� 'G.-, I lIC Registration Number Expiration Date
HTC Co Q
pany Name or HJC egistrant Name
Co
Al n f-1 h'f-a" /1 vG
No.and Street Email address
.1� vpila5 (IA- v/V3S if/3-3dY 7703
City/Town, State,ZfP 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 —T-C?f`^ 6)ul'Ate..L/" fir.
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic ignature) Date
SECTION 7b: OWNER1 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 er's or Authori d 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:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
o%I A 5 ..' ' S
4V.." \ Massachusetts �{S, /c'c�
I . i DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building yv a C`wallea'
Northampton, MA 01060 j‘Stit
.10e
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: V Q(( ly Ae C G( ,,
y e)
The debris will be transported by:
Name of Hauler: Sc 'F
Signature of Applicant: (AA,A,,,`, ). Date: q - ! - J d
•
The Commonwealth of Massachusetts
Department of Industrial Accidents
=_� 0 ; 1 Congress Street,Suite 100
Boston, MA 02114-2017
www mass gov/dia
1l twkers' ('ompensation Insurance Affidavit:Buiiders/Contrartora/EIectricians I'lutnhrrs.
TO BE FILED WITH THE PERMItHNC Ali1HC)WT1'.
Annlieant Information Please Print I riiblx
Name(Business(h.;.inc..ttion Indirtdual! -7"- ....m v/,7
Address: "i I )'l Vet FiN 1"6/1‘ Pet C'f
City/State/Zip: i4afit L/Y a It4 A Ol 0-3 S Phone#:_j! 3"3 6`1 -7 7 673
ArtArs yea as eatplolret?Cheek toe appropriate twat: Type of project(required):
Ia 1 ants employer with employee*(full sent=or part•titae).' 7. 0 New construction
240 t Jut a sole proprietor or partnership and have no ernptWera working for mr to 8. ❑Remodeling
any capacrt).t'a workers'comp.martinet [tlgtutCd_)
9. ❑Demolition
1 ant a homeowner doing all work myyetf.No workers'eon".ntwraace remora)'
t.❑1 am a tionieow net and a ill be hiring oontractura its coated all work on ray proems. wtil 10❑Building addition
cumin:that all contractors either have workers*compensation gmauranee or are sole I la Electrical repairs or additions
prvtutttuts with einployccs.
12.0 Plumbing repairs or additions
, 1 alit a au m tat cuntrtr:toc.out 1 have hired the sub-contractors listed on the attached sheet 1313 Roof repairs
Ise se sub-contracton rase employees and have workers'comp.aasurince.t
6.0 We air:a corporation and its officers hair exrni ird their right of exciaptxm per httiL e.
14.D Other
152.S*11.d1.and we lucre no c apluvt t a.[No workers'cat.insurance rryttur&l
•
'Any applicant that check►box II roust also fill out the section bebw showing their workers'compensation policy information.
t Homeowners who seta at ores altf,la+,71 indicating they are doing all woek and then hue outside ccetractem mtest submit a new at'tidati It indication inck
teontrad on.that check this box must at t.s,had an:xldtttunal..hcrt ahuu int.;the name of the subcontractors and state whether of not those entities have
ngrlusce' It tls_ .L sot:actors ha,e cngrlv*,cc..fits} must I+s, t 3s :h is ,4,nk.r-. ;,rent (vncct,nurnhcr.
I am an employer er that is providing woroters'compensation insurance for my employees. Below is the policy and job site
in f arnt shun_
Insurance Company Name: _
Policy#or Self-ins.Lie.#: 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 tine up to S 1.5(30.00
and'or one-year imprisonment.as well as civil penalties in the Perin of a STOP WORK ORDER and a fine of up to 5250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DR for insurance
coverage verification.
I do hereby certify under the pains and penalties of-perjury that the information provided above is true and correct.
Signature:
I).ttt / , / l`?/
Phone
Offtcia/use only. Do not write in flux area. to be completed by city or town offielaL 1
City or"t own: I'ermiliLicense r'r
Issuing. uthority (circle one):
1.Board of Health 2.Building Department 3.CkyiTown Clerk 4. Electrical inspector 5. Plumbing Inspector
6.Other
( ontact Person: Phone#: