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37-101 (4) 63 ICEPOND DR COMMONWEALTH OF MASSACHUSETTS BP-2021-1920 Map:Block:Lot:37-101-001 Permit: Acc Structure CITY OF NORTHAMPTON PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1920 PERMISSION IS HEREBY GRANTED TO: Project# pool shed Contractor: License: Est. Cost: 37500 TIM SENEY CONTRACTING 061088 Const.Class: Exp.Date:09/22/2023 Use Group: Owner: KIRCHEN NICOLE T&JENNIFER A JURCSAK Lot Size (sq.ft.) Zoning: SR Applicant: TIM SENEY CONTRACTING Applicant Address Phone: Insurance: 371 PROSPECT ST 4136261797 2001X1846 NORTHAMPTON, MA 01060 ISSUED ON:09/23/2021 TO PERFORM THE FOLLOWING WORK: I2X16 POOL SHED 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' C',/ • Fees Paid: $30.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner c �— _,C1, The Commonwealth of Massachusetts-- � Board of Building Regulations and Star dart .n. [.J FOR ,/ Massachusetts State Building Code, 78U C kr 2 CIPALITY l Q USE DemobBuilding Permit Application To Construct, Repair, Or De a R ised Mar 2011 One-or Two-Family Dw v70°''nutlr)t�, ThiS Seetton For Official Use Orily�'..''jr �;7.PNrrio Building Permit Number: 13 P-011 - /0 2,0 l iplied: r Ct; p Building Official(Print Name) Signature to SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 1.la Is this an accepted street?yes x:L no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Er Private❑ Zone: Outside Flood Zo e? Munici Check if yes pa lZIOn site disposal system ❑ Si . -PROPER')f 2.1 Owner'of Record: (..,c ' ,c) r ,,ta. 44 R / Zec7 Oi-41?ri,J ``-44 ar 0 6 0 Name(Print) City,State,ZIP (J or_ e..n , (9 (/,3)306 rJ(,( t No.and Street Telephone Email Address SECTION 3:DESCRIPTION OP PROPOSED R ase that ap` . New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. Or Number of Units Other Cl Specify: Brief Description of Proposed Work': A3oi(.t) /.2. /(, a2cci iaa./$C Pit,1 n it-(G-i" L. PI-o r/ /l o viic. C.cl 7'0v T, SECTION 4:ESTIMATED C3NSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ S '') 1. Building'P tFee: $ Indicate how fee is determined: 2.Electrical $ < J 0 S�; own Application Fee ❑Total lit Cost'(Item 6)x multiplier x 3.Plumbing $ 7 5 c c 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All`ee * xj) Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 3j Sim 0 Paid in Full 0 ceding Balance Due: 'SE N,5i.1CONSTIOICTION SERVICES 5.1 Construction Supervisor License(CSL) OC, I n 35'a ,f p1/1-y License Number E Date Name of CSL Holder �j List CSL Type(see below) 12oSPrcc ,— No.and Street Type DescriPtion Unrestricted(Buildings up to 35,000 cu.ft.) a/c -Htlr,LP'w Restricted 1842 Family Dwelling City/Town,State,ZIP M Masonry RC Roofmg Covering WS Window and Siding SF Solid Fuel Burning Appliances 6d 6-/7?7 //✓-viSPr7eu/ 9 // CDig? I Insutation Telephone Email addfess D Demolition 5.2 s red Home Improvement Contractor(HIC) /9 5/id/ f/r✓� JL i4 Y sTt7c�7,✓�- ��J G HIC Registration Number Exp. .on Date HIC Company Name or HIC Registrant Name 3'7 r l�eO sPrc,,S� No.and Steet Email address )(6277frn-+o i�(9 6,16 /Tp r City/Town State ZIP Telephone SECTION 6t WORIaRr COMnNSATION INSURANCE ArifiDAVTI'1141. .1132.*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 13' No 0 EeriOli.'ltt OWNEROWttERAvtuoRridttioicitt BE'etThiPI;E' #T- N OWNERS A . 'OR.,CONTRA OR APPLIES.sex BUILDING PERMIT 3. `, . 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 A* OWNER'-OR AIJMORIZEI,ACCDECLA IIO By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained'' appli tion is true and accurate to the best of my knowledge and understanding. 7e0 Zf Print Owner's or Authorized Agent's Name(Electronic Signature) Date I S:' 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/4ps 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"maybe substituted for"Total Project Cost" City of Northampton 5 Massachusetts DEPAPTI.ENT OF BUILDING INSPECTIONS �° 212 Main Street • Municipal Building 4 Northampton, MA 01060 414 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: tcY �c�c�-,..a. The debris will be transported by: Name of Hauler: c_77..-�- Signature of Applicant: Date: 2 tz., �� s The Commonwealth of Mesachusetts e• .� _, went of Ind Accidents 'Feb -\44,, I Congress Street;Sadie 100 {, Boston,MA021142017 wwnt.moss.gowltia Workers*Compaisalino Nrrtrsace MathrvIt R del roc otr* to ntbers. TO>R FRIED WITH TIMI PERMITTING AUTHORITY. Applicant Information Please Print Legible' Add 5"7( fosa = S',:. . Vt r LJ ni I M!.la :11#. Phone#: �d 4, 4-az..:,7. �x..'.�`(.,��:',3'}.A'Y�'A��Y Are yea am eagiay�tsT m!m thi t�11�IMt lestYPt 1 t alma a etapkiysr lttth. �tlyMihela( maw par!•them)* 7rial‘wconstruction ICI tam■rode peapher.cor partamehiP,sit lime me employees+iIodun5 Cra me is 8.el Remodeling *ay -[No wears'Ceeltf,.iratmeme t 9 Demo 3 I fen a homeowner at myself.aif.[No wereke&crop.WiteWeoe tem rood.)` 0Lietn �� IS0 Buildingatddition I am a hemerro er and will be hike coatneors 10 oeaslrai ell work oft my property. 1 will '`""'imam that ell ceetredort either have workers"compereation insurance or we sole Ill 1:1Eleetrinal repairs or additions ptµ proprietors with too rrmpaa 1 'Meeting or additions V ma a a Me roll I have ad the asrb�limed on the> sheet. i rf - 7 Them eteramettemose km reesdi rye+ea sad have we><eehae►"comp.iasaeremo 3 d ifast 61:3We am e tweediest**atd het at5oem have exercised end their right otea coiptiar per Mehl,c. 14 '' . e`"< i ` 132,*1(Aj.sod we have no artplesyfea.[Pia workers'comp.interims ei red.l *Airy apptic m that cheek*has el nem sign Blom the meager Wee/sheltie.their nna!keees'eetopeautioe policy ieformettatt. s litiaseoweete who abed deie eintilvn iatimatimi they ate dohs all I va&aau then Mere mead/oaamm eters SOW submit a new affidavit indv iisis►gi suck leaestracti s Met tack die hot amen retarded as talked sheet ithewieithe mend et the etsbliestrectise and¢lame witrdeer er not those meta*have dlitsPittro. Nibs wab ultt eworrt have a setleyeee.they mot provide their ueaehan"comp.policy re mbar. I ear as copilot that is presidia':workers'cerapswaatkoa besarwiwe few aye employees. Beiew is the police andjab silt Insurance Company Name" ,2r--r .4,--,/e../ - Policy#or Sett-ins.Le+L tF: 0/W/X l,t/4 3/L6 /' Jab rife Addrelik,......' A 3.. ... =cat... .•f? : City/stale/Zip: . � m..,. J /f'1 aid o e Attack a espy 011ie worieere'ern peaty declaration page fibiawing the policy neseeber and espiratisa dale). Failure to secure coverage as required under MGL c. 152.1125A is at criminal violation punishable bye Sere i to$1,500.00 and/or one-year imprisoninent,es well as civil penalties in the form ofa STOP WORK ORDER and a Sneer up to .00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ter*sassier the potables ofperfrery thoj the information provided abort is slydcorrect Signa , ,r -r— Dote; p 4° Z/ Phone*: 4. 2 ° /7;7 "nii.- . v.. Official est D stet write IA+ +ate,Mire'sorapirted by city or sewn City or Tltitrteii .t�...c.. ng: , _ Per"mit/Licenset# looting Andre (drde eft): 1.Board sir1ks i 2.latiffing Ikpaltaneat 3.Cityirsomo Clerk 4.Electrical Inspector or 5.Plumbing Inspector Combed Poro n., Piltelee le: oNt CJAw S w,��,�r�- -t HX-05f-rWt- - OCAA - y 10 b 5-T,c-LLit$ /5."2_ C R/C. - ( J Cc co - S O Z cl q - ,20 Z 1 egRIG- /--lacrr,.,se‘v 72 cerr✓rtThi✓ s v - 65600 OckiO3 Ea i 1 f' fZ i ` to j Ns Cr— ,' 3 M Z ..... a A t i . ...,/ i142 ,. . 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