11-003 (4) 79 COUNTRY WAY COMMONWEALTH OF MASSACHUSETTS BP-2021-1931
Map:Block:Lot: 11-003-001
Permit: Exterior Res CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Penn it# BP-2021-1931 PERMISSION'S HEREBY GRANTED TO:
Project# WINDOWS Contractor: License:
Est. Cost: 11000 KUEL MCQUAID 051394
Const.Class: Exp.Date: 12/1 1/2022
Use Group: Owner: GRIFFITH MARGARET &NINA SHRAYER
Lot Size (sq.ft.)
Zoning: WSP Applicant: KUEL MCQUAID
Applicant Address Phone: Insurance:
131 FERRY ST 41335375063
EASTHAMPTON, MA 01027
ISSUED ON:09/24/2021
TO PERFORM THE FOLLOWING WORK:
10 REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Undergro mid: 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:
.y2 . PI •
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
•
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The Commonwealth of Massac use IF
FOR
14 ) Board of Building Regulations an S S . I• (SEP + CIPALITY
Massachusetts State Building Cod , 781 CMR 2 3 2021 '
USE
Building Permit Application To Construct,Rep r, ' —.1 '. .: 4 1 emolish a R' sed Mar 2011
One-or Two-Family Dw Nogr,AM DIN('INs�Eoso
"s Section For Official Use Only
Building ermit Number: v".I [" Vt Date Applied:
Ev►aZ /KV Cl-23 az
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro erty Address: 1.2 Assessors Map& Parcel Numbers
(1 � •1 wey HortncLiMgo(0a ii oD3
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❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Ql1 wek G,.-Gfi' pa,r.,,tiz_ P4- 0/0("2_
Name ) City,State,ZIP t
q5 G„„hn w.u, 6/?-gs7-e2 cis- le-,.0.,..,) e3 ;1.
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) CSC Alteration(s) X Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: R. (c v, /O \Ai► '►%e4 O tAIS
N/o v. s-kru C- �04 , e V i
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ,1/ 000 1. Building Permit Fee: $ Indicate how fee is determined:l
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:Ai
Check No.AIW Check Amount: Cash Amount:
6. Total Project Cost: $ /i 1 00 0 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
�erIc- Massachusetts ��'
! ti DEPARTMENT OF BUILDING INSPECTIONS
�r ,`•.!'ram' 212 Main Street • Municipal Building Jti QD
Northampton, MA 01060 sftW WO°�
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 &2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. 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. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW/ private land by Building Dept. •
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass gorldia
)1 Jokers'Compensation Insurance Affidavit:Builders'('ontractorx/ElectriciansFPlumbers.
tY)HE 1"11.Ia)ttl'1'll"I HE PERN17TIM(.
Applicant Information Please Print Ixtilrls
Name h.Husirrett,Organiiattt'u tndrtrdtrall: / `ti L'_( 4"1 L &u
Address: I re f
City.State/Zi : 5 0.v MAW'(3 5S aC�
p- __ Phone s 7 - 3
Are you an enrployyr''('heck the appropriate hut:
o1CL?
Type of project(required):
I.�!am a employer with .mn]aloytes Bide and ur parr-tiraeh.' 7. 0 New construction
2111 I am a sok pn/pewloi 11Ung1i7•"Mitt and,tlatit rMl empl yet. works* krr art in S. 0 Remodeling
any rapacity.INo worker,'etmnp.rmur:utet remairttl l
9. D Demolition
(am a hortinot n e Join!!all mitt myself. NO it mint`comp..inturane ruyuir d.I"
10❑ Building addition
•t.Q I am a lump t wrw•t and will he huuhg ctmtlradurs to conduct all work on nay property.. I swill
ensure that all contractor, lane wwken'tvminanatitur insurance to an sole 11.13 Electrical repairs or additions
proprs tuts with no tit rloyoot..
12.0 Plumbing repairs or additions
N:=I I am a r carat contractor and I have hind thai malrenntraehita wood na the attached sheet
13 Roof repairs
thc.c sula.r:untractors hate errrployer.-and workers'camp.insurance.
14. Other__A e w I v dQ W
6.0 vv.:area commotion and its of6ccrs hate evened them Milt titesempivar per Wit_c.
1 y'. MIA).and we have aro corplo r es.INo wtMicr.'camp.insurance n:gum:J.1
°Any apphcant that clocks hot.41 roust also till out die sic-chain n helot*showing their rimier' campentation pokey information_
t 1 k.iucm nen who submit flat athulaw it mnticatinr diey are doing all omit and then hire smirk etiuNanatort must submit a new alildar it indicating such.
k'car[ttackan that cheek this hot mud attached an adrtitrtional sheet sidltiagilit Want ot'the tul.evurtra.-turs and state Nhither or not thorax airitics haws
anploscea".. It tot sub-viral/aches lose a nplovva:s.t ev mast provide their workers'cutup.polio number..
I am an employer that is providing worbers'compensation insurance for air employees. Below is the policy and job site
information.
Insurance Company Name:
Policy i.'or Self-ms.Lie.#: E:xpiration Date:
Job Site Address ("it}'•'StalcI_ip: _-
Attach a copy of the workers"compensation policy declaration page(_showing the police number and expiration date).
Failure to secure coverage as required under 61(iL e. 152.y25A is a criminal violation punishable by a tine up to SI,500.00
andbr one-year imprisonment.as well as civil penalties in the torn of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator_A copy of this statement tiety be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
t do hereby certify'ender the pains and penalties of pe rjnry that the information rmation provided above is true and correct_
�7 c -7
Signature: l��G7C. . � � Date_ '//Z/Gm'
Phone#: � 3 3 /- 5663
fi/rc'ia1 use only_ Do not write in this area.to be completed by city or town official
Pitt or Ton it: Pcrntitf'Licen`e
Issuing Authority(circle one':
I.Board of health 2.Building Uepartrnent 3.City/Lunn Clerk 4.Electrical Inspector 5.Plumbing Inspector
6,Other
Contact Person: Phone#:
City of Northampton
Baas N�MpTo
`S
Massachusetts A�
a DEPARTMENT OF BUILDING INSPECTIONS s ,„
1 d' 212 Main Street • Municipal Building
Northampton, MA 01060 '�sbh, `�J
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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: 116( 11AO�
P
The debris will be transported by:
Name of Hauler: /� �e— i{ C (f up. ,
Signature of Applicant: l; , Date: V22/3.1 g pp � G� (� �� 24
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS _o b l 39 L+ ,2/1( 2G 2
kv e-( Mc QV A\(Q License Number Expiration D
Name of CSL Holder
I e [1 List CSL Type(see below) U
No.and Street J"T Type Description
C i 0-o,�� A, 0• :7 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
3 _ �37� /,� n SF Solid Fuel Burning Appliances
it' /vt f)vai c,1 1/4(1 AllMq,(. I Insulation
Telephone Email address C2s.+1 D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Y.�e.l /�'l c C2� .�1 I o 6�o0 7 23 2o22
HIC Co Name or HIC Registrant Name HIC Registration Number Exp. on Date
13 ezcand Street �� -7 r� /Ke-Q✓Qi d.Kt/el ® x�'►^4t(. �1^'k
k.S 0.GW p vk /l A Q (0 2/ 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 R V e- ,L Oa c t
to act on my behalf,in all matters relative to work authorized by this building permit application.
9/Z242oZ1
Print Owner's ame(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.
iPit �u °/ Z2/20 24
Print Owner' or Authorized Agent's Name(Electronic Signature) 1 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/dns
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"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE