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23A-131 (3)
54 MIDDLE ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1850 Map:Block:Lot:23A-131- 001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1850 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 7500 RICHARD LABOMBARD 055340 Const.Class: Exp.Date: 10/20/2022 Use Group: Owner: TIBONI ELAINE K Lot Size (sq.ft.) Zoning: URB Applicant: RICHARD LABOMBARD Applicant Address Phone: Insurance: 102 CLARK ST (413)537-6139 EASTHAMPTON, MA 01027 ISSUED ON:09/13/2021 TO PERFORM THE FOLLOWING WORK: REPLACE 1 WINDOW 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: (� • �� S , C''1 • Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 111/ C =-5_ The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR ITY, Massachusetts State Building Code, 780 CMR IUEMUNCIP`� n Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 z One-or Two-Family Dwelling —' This Section For Official Use Only ~ m i -_ 1 Building Permit Number:AP"A. I I"8TO Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.la 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 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'ofRecord: • �9; T/&A)/ FigeN' 0/04), Name(Print) a City,State,ZIP 5 V n/D h15 5771e7 e1l3- 37 /0 fl' No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Desc ption of Proposed Work2: A4- � GN1 G ,Dau4LB C 5i 7iJ o ,9,v0 — SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 75;00, at, 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fep Check No. b-r Check Amount: 40 6.Total Project Cost: $ 15Zv• °° 0 Paid in Full 0 Outstanding Balance Due: City of Northampton Massachusetts !r . k! •e. Vi 34'. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC. 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work(Digital and hard copy). 3. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new /replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements (if applicable). 9. Energy Code—all new construction(Gut/Rehab) requires a HERS Rater Affidavit 10. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Constriction Supervisor License(CSL) O 5.53 ub 10/at/ -)- /?' CJ A b F1ar License Numbeer Expiration Date Name ofCSL Holder v /0 C 1. i „� �_ List CSL Type(see below) No.and Street %�'� Type Description TgA)/ /7 O/0�', U Unrestricted(Buildings up to 35,000 cu.ft.) fJ /" d Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances y/3-3-37 -6/39J 7R/)/L19W 7 6414.(901 I Insulation Telephone Email address D Demolition 5.2 Re 's/tereedd Ho a Improv ,(ent Clj ntrrayct (HIC) /,°p !� Rl a-hp1e �4'"" ^'4. 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 COY No . 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOREBUILDING PERMIT I,as Owner of the subject property,hereby authorize /(C.V?I 14 to act on my behalf,in all matters relative to work authorized by this building permit application. Elgin T bin cibe,t ' �a-1 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 contain in this alplicati is true and accurate to the best of my knowledge and understanding. L Print Owner's or Aut ized 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" our 111 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Radon, ,$1,4 02114-201 wwov.mass.goildia 1Vorkers'Compensation Insurance Affida‘it:Builders/ConirsetoesiEleetricians/Plumbers. Br.MEI)NN I Ill I111.. AUTII0R11V. Applicant Information Please Print Leteiblv Name (Itlustnio,s,Organization I _ Acdplie, Address: JO e-z-n/e-e 57- Ate yor as eenclrytr?t'heck the appropriate box: pe of project(required): 1.0I AM a entpkryer unth ereiployees tfull and,-or !:!4,..t• 7. 0 New construction s sole propriekir or partnership and haveIiao noemployee**orking fur me us 8. c3 Remodeling trn y *nrkerr.comp.inauraner regtures1,1 9. Demolition 3.0 Lm a horaeowrier doing all work myself.No workers'comp.insurance;tam:in:ill* 100 Building addition a hunrowner and will be[Mktg contractors to maiduct all*mk on no peoperty. I will ensure that all contractors either hove titOtitera'compenialion uttltratiLV tat ate‘'tale 1 fj Electrical repairs or additions propiietels with no entployees. 12.0 Plumbing.repairs or additions 5 I am a general contractor and I have hired the allb-Cclatractotat listed on tbe mauled sheet. 13.C]Ro©f repairs mb-contractors bare employees and have workers'comp.insurane.e) 14.0 Other (4.0 culpornoun and its Lacers have exert:6rd their right of elcmptiikk per MGL 152, Ii 41,and we have nn employees.No workers comp.insurance moor:real *Any applicant that cheeks bus 41 must also rill out the section brio*showing their wor,n.:,' ilia policy inicirmation *Homeowners who submit this affiskssit indicating they are&MI;alt irk and than Par,.AltAltk I.Ubrilit 3 tkett• tit'd 1.C.:,:tntraeturs that check this bus matt attached an additional sheet showing the name of the subeuntractsr*and stale whether or.not those • Itivv erstrikree...., ltthc altb-eutatractiva 1131,e titipluyeca.the!!rawal pittikh:tner comp. I am an employer that is providing workers'compensation insurance for my employees. Below i the polity and fob.lie information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City State Zip: Attach a ropy 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 purushable by a tine up to S1,500.00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to V50,00 a day against the violator,A copy of this statement may be Forwarded to the Office of Investigations of the DIA for insurance coverage r I do hereby cert totft 9 t1 in nil al of-perjury that the information provided ah "ve i true and correct. P*maim: Datc, hone#: C3? &/.3 /use only. Du not write in this area.to be completed by city or town official. City or Town: Permit/Licrnse Issuing Authority(circle one): I.Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone*: „.__ — City of Northampton Massachusetts k' *� DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building , ? 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: 55° /0/ LF)/ The debris will be transported by: Name of Hauler: /AM-57X— /44,0,66.71/C1(51— Signature of Applicant: Date: b t1 City of Northampton Massachusetts 4 + c. 4. 11 DEPARTMENT OF BUILDING INSPECTIONS IfoAte 212 Main Street • Municipal Building Northampton, MA 01060 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born_ (insert 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 day of , 20_. (Signature)