38B-154 (2) 176SOUTH ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1889
Map:Block:Lot:38B-154-
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-2021-1889 PERMISSIONIS HEREBY GRANTED TO:
Project# INTERIOR RENO TO WALL Contractor: License:
Est. Cost: 1700
Const.Class: Exp.Date:
Use Group: Owner: WOLF ALAN C&MEGAN L MURPHY
Lot Size (sq.ft.)
Zoning: URB Applicant: MURPHY WOLF ALAN C&MEGAN L
Applicant Address Phone: Insurance:
176 SOUTH ST
NORTHAMPTON, MA 01060
ISSUED ON:09/16/2021
TO PERFORM THE FOLLOWING WORK:
INTERIOR RENO TO WALL
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:
Ili • >2 • T''1 •
Fees Paid: $65.00
2l2Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
/ 711-3—
E./
The Commonwealth of Missac uset P j 6
Board of Building Regulatio an Standards cue/ FOR
Massachusetts State Buildi Coep R CIPALITY
Nor? nuitoi •
USE
Building Permit Application To Construct,Repair, peet3 • a Revised Mar 2011
One-or Two-Family Dwelling Mq otps 0MS
This Section For Official Use Only
Building Permit Number:r&e.-i"/27/9 Date Applied:
Piia 9/6/al
B ildin Name) V� UV p
Building Official(Print / Signature
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
I`)(o S(k.YC\� 5 i
1.1a Is this an accepted street?yes Pl. 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 Zone9 Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
A2.1 ,pwner'of Record:
1 C N021-N4 et,p ' 6 Di O
Name(Print) City,State,ZIP
11(o So S r" 703 60C ¢s zs— /4LA/Jcw0 F-Q G,#I I 4.coo,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': CliAuf £ 01Al1 wA K,-fick _e
SlN✓` _ 2X%STvJ(, WAS A G(d€5Y SPRric.L6 A(4:M4 SOPS /w¢t,"er Ta
'-0(11.‹ L i>/{ SfiV C co• c.. C j 0 p!-A to DR'( WAt-L f}^!O RQ I6Cst�-L
u Lo c1)LP_ Q X(S -w Pou1e✓ o f t ' 3
SE?TION 4:ESTIMATED CONSTRUCTION COSTS
Item +estimated Co Official Use Only
(Libor and Mat
1.Building $ ` 2_00,oa 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
S�� 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Oe
Suppression) Total All Fees: $ ( .
Check No.6D1l Check Amount:
6.Total Project Cost: $ ( '") , 6 0 ❑Paid in Full ❑Outstanding Balance Due:
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building lj
"� Northampton, MA 01060 �,ti
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 specification 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. Homeowner's License Exemption Form(if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction(Gut/Rehab)requires an HERS Rater Affidavit.
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 D 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 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
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:OWNERS 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.
AL40 C W0(—� J2-i
'rint Owner's or Authorized me`. .tic Signature) ate
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.Qov/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"
„., The Consmonwealth of Massachusetts
r-
Department of industrial Accidents
44/ I Congress Street,Suite 100
Boston,MA 02114-2017
wwwmass.gov/tha
Winters Compensation Insurance Affidavit;Builders'Contnict, sI luctricians;Plumbers.
TO BE FILED WITH Ili rtitmi r psc, ,1 1 I 'RII
Atiolitant Information Please Print Legiblv
Name iliosicess,OrganizationindividualE ALA)4 14)31-i7:
Address:
City/State/Zip: Phone#: •
tee yen all ettaplineer?eta,k IILUpprrprialt lanz: -1. PC of project(required):
7 1 arn employer with cturaenrees(full and,'cat part-tinary. 7. 0 New construction
i.ole proprietor Or gormiaship and cnoemployamt walking forme in ,! 8 0 Remodeling
ivorters‘`comp.insurance. required]
! 9. Demolition
1411111111t a boritixewnei doing all work myself. No wit *'comp. imurance requirod.3
10 E..]Building addition
hunulOWner and IIbchurinrw1ruuiiacmidud.dI wurk on my property, I will
r.-11:1.1IC that all coatraciors either he Wolter;cAnnpt.trE,ntiocri nnAsranLX iste I if:j Electrical repairs or additions
proprietors with AO ettaplea,...
12.0 Plumbing repairs or additions
am a ipailhal contractor and I have lured the sub-contractors listed on the awaited sheet
Roofrepairs
Them:illb-C.Onnatlors Movie Onnluyees and have ivurkirry Ctenp.untitzux:c)
14.1nOthei
6.C3 Vie are a corporation and es officers have exercised then right of-exemption per c.
152, and su no csopinytes.[No Virattcri'ettnip equisetil
Any niaplitand that checks boxatmum also till out the section trelow sbots ing thee workers'catripeavon ion polity information.
t Hiatnecowtsers who submit this affidavit midst:Ain they art doing all work and then hire outside tAnaractors mast submit a new affidavit indicating such_
leerntractors that check this box mast anatived an taidational sheet showing the name of the s,trb,contractors and state a hemei or not those entities haw
employ ct, tithe arz t ha,e cmplo,oa.thc musi pro'Eck thci a arkri. tnrip. xthc rmatribzr
um on etnplo)-er that is providing ovorikers'compensation insurtznce,for my emplocees. Below is the policv and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/StatelZip:
Attach a cups 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 fine up to$1,500.00
andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 cerd.o,under the pailisk tend penalties ofpetiory at the information provided above Is true and correct
1111.1111W- 111111011 116 1
Phone#:
Official use only. Do not write In this area.to be completed tr city or flown offieiaL
City or Town: Perinkt/License
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.('it)Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone it:
, ,
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
,,� g, 212 Main Street • Municipal Building
Northampton, MA 01060 bey
(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 ALLt
The debris will be transported by:
Name of Hauler: `}118 �tc-Qr(� — tAtki,d. G..l
Of2„br,
Signature of Applicant: C Date: / J2-1
City of Northampton
Massachusetts h ' f�f
ct 0 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 1f :,°
4 F Northampton, MA 01060 4`t ,.\y_
ot
illi bq 6 e
I, Ai-4.).1 C. wo LF (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 I(P day of �Pk'7'\. , 20 J
C �
(Signature) ),__ _