38B-171 (11) 17 MADISON AVE COMMONWEALTH OF MASSACHUSETTS BP-2021-1906
Map:Block:Lot:38B-171-
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-2021-1906 PERMISSION IS HEREBY GRANTED TO:
Project# 2021 BATHROOM RENOVATION Contractor: License:
Est. Cost: 10000
Const.Class: Exp.Date:
Use Group: Owner: BARNHART CLARA E
Lot Size (sq.ft.)
Zoning: URB Applicant: E BARNHART CLARA
Applicant Address Phone: Insurance:
17 MADISON AVE
NORTHAMPTON, MA 01060
ISSUED ON:09/21/2021
TO PERFORM THE FOLLOWING WORK:
RETILE EXISTING SHOWER FLOOR & WALLS, RETILE BATHROOM FLOOR, ADD RADIANT FLOOR HEATING
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: t
� v O Tii •
Fees Paid: $65.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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a The Commonwealth of Massachusetts
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Board of Buildin Re lations and StandardsFOR
rn g MUNICIPALITY
a Massachusetts State Building Code,780 CMR USE
LC. u., =1 .ilding Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
v z One-or Two-Family Dwelling
M9
___ __ . _____ _ - This Section For Official Use Only
y'Butl4ing Pe if Number:3P ZOiI-1'1D coDate Applied: oci ZG ZOLJ
- CV1�J' l�o�� q-ZQ-707I
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.2 Assessors Map&Parcel Numbers
Ii .nitA s ,iAje . 3E13- 171 -60t
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
U R 13 .zqS A>-1-e s
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) r.
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'of Rec rd:
CIttvA lgAvnI.iav-r✓ A/i✓mati„phr7 , NtA- C5Ia4,b
Name(Print) City,State,ZIP
11 /V1 a/Ji 'i AV MV( 3/y- y!L- gb70 ba���p✓-i;cl avpt@ �w'..4, uwi
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building IU/ Owner-Occupied Gil Repairs(s) lrAlteration(s) liyrAddition 0 _
Demolition L "Accessory Bldg. 0 Number of Units Other El/Specify: r (Ault t -7 ary '.44 i i4--.
Brief Description of Proposed Work': Y.e._ ---'(.fa. -r k.- 5 Pi w-.r -6 pee- 4.- (N4115
L X shatir
VC- -hL. - b4vMva. ?lirr. qy)r) r v'4M- f1.',,- ,
yt,¢ ys__
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ Lib — Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (IIVAC) $ List
5.Mechanical (Fire $ o a
Suppression) Total All Fees:$ — ��
Check No2539 Check Amount: („S:-
6.Total Project Cost: $ j 0,, 600 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
' ' Massachusetts
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1SF , a;:. ,
, y ! ) DEPARTMENT OF BUILDING INSPECTIONS * ?
4 ;:-Y, 212 Main Street • Municipal Building L, .'
N.r-r 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:
l'i
Location of Facility: �� V I' / IMA _
0
The debris will be transported by:
Name of Hauler:
C glio l'IA
Signature of Applicant: Date:
City of Northampton
r-•�` Massachusetts
L•
,L ` T DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 fSNjq x\‘1
HOMEOWNERS'E,XEM TTONELIGIBILITYAFFIIIAVIT i 0/2-7/-7
I, l al/ Iii'i 14^ (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'S�% ,20�.�
(Signatu
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
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.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address II 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 ❑ No .❑
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.
C l a/VA 13anoIZta g/Zaz �
Print Owner's or Authorized Agent's Name(Electronic Signature) lI 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 ofhalf/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"
, The Commonwealth of Massachusetts
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Policy w an Self-ins.Lk_::. Expiration Date:
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Official use only. Do not write in this area.to be completed by car or town official
('ih or 1 oon: Perrnitlicrn%e
Issuing.tuthorits Icirdr one):
I.Hoard of Stealth 2.Building Department 3.('ih I ton('kill 4.Electrical Inspector S.Plumbing Inspector
6.Other -- —
Contact Person: Phony#: