24A-029 (5) 84 RIDGEWOOD TERR COMMONWEALTH OF MASSACHUSETTS BP-2021-1917
Map:Block:Lot:24A-029-
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-2021-1917 PERMISSIONIS HEREBY GRANTED TO:
Project# bath reno Contractor: License:
JOHN LEBHAR BUILDING &
Est. Cost: 15000 RENOVATION 075531
Const.Class: Exp.Date:07/10/2023
Use Group: Owner: JAMES JOANNA IRENE&JOANNE E SALUS
Lot Size (sq.ft.)
Zoning: URA Applicant: JOHN LEBHAR BUILDING &RENOVATION
Applicant Address Phone: Insurance:
68 SCHOOL ST
HATFIELD, MA 01038
ISSUED ON:09/23/2021
TO PERFORM THE FOL LO WING WORK:
BATH RENO
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:
• 1 I )2 Ts, •
li
Fees Paid: $98.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
CEI V E-
The Commonwealth of Massachusetts SEP
/ ' Board of Building Regulations and Standards / 2 1 OR
Massachusetts State Building Code, 780 CMR IP. ITY
I ,a_T, USE
Building Permit Application To Construct,Repair,Renovate L frays ' d Mir 2011
One-or Two-Family Dwelling ` =°" r.14 FZ o°NS
p This Section For Official Use Only
Buildin Permit Number:.jp'a I•/'/7 Date Applied:
Build!,
Nit-1 es i(4/7 !"ZZ-ZOZ)
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property.Address: 1.2 Assessors Map&Parcel Numbers
gf goti-£woo0 T AC-i-
1.1a 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 It) 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:
Zone: _ Check if yes❑
Outside Flood Zone?
Public Private 0
Municipal On site disposal system El
SECTION 2: PROPERTY OWNERSHIP'
2. caner'of ecprd: • —�' V h14 H M fl j 0(o 0
QdtKN♦ .50.1.14S • �QKK0. u�2s / �(4-4 tt Q
Name(Print City,State,ZIP
gti ,.,• glycwoa rYac.e ti13 50 , 2334 •aauue • Sulut@
No.and Street v Telephone Email Address 5044i tt a'n
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) trt. Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': the-eft t 1... `�4101('--
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ / / , 56.) 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ C l Standard City/Town Application Fee
2eyu
/ � 0 Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 1 CD 2. Other Fees: $
4.Mechanical (IlVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Ff; $
Check No.UTI Check Amount: Cash Amount:
6.Total Project Cost: $ /S QTj 0 CI Paid in Full 0 Outstanding Balance Due:
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
- / / �l 0�Ss-•3/ 7- 10 ' icvz3
N D(� C, i— /5 t '� 4 'Z License Number Expiration Date
Name of CSL Holder
6 6, _Se
$(�D 4 C r' List CSL Type(see below)
No.and Street J Type f Description
/I/1--r--/ Gia /011- 0/ 0 313 0 Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
n M Masonry
RC Roofing Covering
WS Window and Siding
id_u; 1
SF Solid Fuel Burning Appliances
�l3 221-� �I) �o �(M f.Ca`"L I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvemeent Contractor(HIC) ` 0 $ ( •'(t0/20 2_3
:To e , L£614 HIC Registration Number Expiration Date
H Company
Name or HIC Mtn t-- S rgistrant Name . 1� AA4)
yC vqaI , Co
No.and Street J Email address
N4^rPt 6(4( M � 01() 6 (1[3-LZ(- (jl
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 .❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property •-• -g .uthorize �"' 0�`� ,"Le- a r
to act on my behalf,in all matte .ret authorized by this building permit application.
4
041kk a Wt2i
Print Owner's Name(Electronic i
Date
SECTI tWNER'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 understandin .
.3—a C , i-I- 2( I 26Z1
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
Information on the Construction Supervisor License can be found at
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) • • g 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"
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CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
Jv630
.P-1711)
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
/ Massachusetts ��
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DEPARTMENT OF BUILDING INSPECTIONS - U .,.
w �, y 212 Main Street • Municipal Building
--: Northampton, MA 01060 -r3,,ty ,i\"
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: 1,1/4‘ e' £ /2- '67/C Z-/")
The debris will be transported by:
Name of Hauler: //VI/5 G 7T6 If& tf61-1-4-1- )
Signature of Applicant: 6' Date: VZSO 2-/
g pp
The Commonwealth of Massachusetts
1`r Department of Industrial Accidents
it, I Congress Street,Suite 100
Boston, MA 02114-2017
www mass.govidia
'Buskers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH 11W PERMITTING AUTRORI 'ti.
innlicant Information l ,? 1 Please Print Leeibh
Name(Business Organization lndtvtsiitat?: ��0/1/4•+ (— t L_21 Y 1-1
Address: 6_8 56 "C'L- 66
citystatezip: Ad- °1° r #: I1 i3 -Z z-I - I i 13
Art you as employer?Cheek tilt appropriate tot: Type at proles(required):
10 I am a employ with .__ employees(full and'tx part•timel.• 7. O New construction
2pI am a sok prupriette or partnership and have no employees working for me m K. ' Remodeling
any capacity.[No workers'comp.uwwrance required �--
y�1 am a hvrntwwru'r dun ,]g all work myself.[No workers'cutup insurance required • t r litlOfi
4.0 I am a homeowner and wnH be hiring contr-acicm to conduit all work on my property. l wen
10 CI Building addition
eo
emur that all c ntra-tur5 either has workers'compensation insurance or arc bole 11 a Electrical repairs or additions
p upnetut%with nu cmplovco
12.0 Plumbing repairs or additions
50 I am a general cuniraowr and I have hired the soh contractor fisted on the atta led sleet
These sub-contractors hest employee%and have workers'comp.insurance. 1 o Root r pairs
6.0 ik`e are a corporation and as utficer%have exercised thou nPSht of exeanptwn per MCA. 14. Othet
152,-§114I,and we hale nu unploy'ces.[Nu workers'cutnp.insurance required.]
"Any applicant that checks box al Musa 9110 fill out the section below showing their workers'compensation policy information
`Homeowners who submit this atTidas it indicating they are doing all work and then hire outside contractors must subnut a new affdtas it indicating such
Contractors that check this tax must attached an additional sheet show mg the name of the sub-contractors anti state whether or nut those entities ha se
cnrldu}cc, If the tub-cuntractext bate cmplu,cis.they mutt Inv,hie their worker'..+imp.policy number
I um an entplorer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance C.mipan. \fans_
Policy;or Silt-ins. Lis:.#: Expiration Date:
Job Site Address: 97 , /F 4--1/V'c 7 /2I t 4 City/State/Zip:N6ok..ft,‘,0 TCi r" viM.
Attach a copy of the workers'compensation police declaration page(showing the policy aaarber and expiration date).
Failure to secure coverage as required under N(UL c. 152,1125A is a criminal violation punishable by a fine up to S I.500.00
and or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 t rtifr er the pains a penalties of perjury that the information provided abov is true/ nd correct.
Signature: C Date 2/ 2
Phone#: j (-23 '` 2 2 t — Iqt
Official use only. Do not write in this area.to be completed by city or town official
('its or Town: Permit/License#
Issuing.tuthorits (circle one):
I. Board of Health 2.Building Department 3.('ity(1'own('Jerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
('ontact Person: Phone#: