24C-028 (3) 98NORTH ELM ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1947
Map:Block:Lot:24C-028-
001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1947 PERMISSIONIS HEREBY GRANTED TO:
Project# WINDOWS Contractor: License:
Est. Cost: 3000 GUIEL CONSTRUCTION 054248
Const.Class: Exp.Date:04/12/2022
Use Group: Owner: CRAND JOHN D& SUSAN SULLIVAN
Lot Size (sq.ft.)
Zoning: URB Applicant: GUIEL CONSTRUCTION
Applicant Address Phone: Insurance:
63 CHESTERFIELD RD 656OUB-9F66069-2-21
WILLIAMSBURG, MA 01096
ISSUED ON:09/27/2021
TO PERFORM THE FOLLOWING WORK:
6 REPLACEMENT WINDOWS
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 .
I � � r •
Fees Paid: $65.00
212Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
19
Ci
The Commonwealth of Massay uset , sFI- 2 ��
W Board of Building Regulations acid St.u,;r. .s �D�r UNI• PALITY
Massachusetts State Building Codes:NO •'
T�fq�j<O SE
Building Permit Application To Construct, Repair, Renova - 16', e p. a Revi•ed Mar 2011
One-or Two-Family Dwelling 4''1076-C7i0
This Section For Official Use Only
Building ermit Number: gIQ'"1/'/9477 Date Applied:
d-As j7' 27-aiz 1
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property�Address 1.2 Assessors & Parcel Number�,�
G�j �f(o - e�, U
1.1 a 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owl' f Record: ✓ ,A O ��
.l Q(�inC�ec ,�. .J V v v..,9 -1-.D,., NAM- a(0 t 0
`•"' N e(Print) , City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) _" \
New Construction 0 Existing Building' Owner-OccupiedW Repairs(s) A Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units / Other 0 Specify:
Brief Description of Proposed Work':
S))( tt 14 1•- r 1ti)G1, F 20 -1 o 4-uu
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $ #06
Check No�,�-0) Check Amount: J Cash Amount:
6.Total Project Cost: $ r - 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervi r License(CSL) 60(9(,1 u. /2 , �2
01/1 �ii( - License Number4 Expiration Date
Name f CSL Holder ' tj Iw z"'1
e List CSL Type(see below)
No.an treet ' Type Description
\ 1 11\41'. , ,r\Ou,�' Nit) 0/01 .4.,) Unrestricted(Buildings up to 35,000 cu.ft.)
�J Wly•J l tiD R Restricted 1&2 Family Dwelling
City/Town,State.ZIP M Masonry
RC Roofing Covering
WS Window and Siding
cps /6-17/ all-ehQ O`v iel, w SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Re i tereed Home Improvement Contractor(HIC) /0 L st I qg ) . 13 - as
P'/"t�'I Civ)"e I HIC Registration Number Expiration Date
HIC,ompany,Nam or HIS Registyrit Nine n a II O Uj ( ��
to e* �ipf l {C�/ Ql •
Street Email address
A Szw\s\pvc'9 14if alo / 344 5y5
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 O11Qy GU
to act on my behalf,in all matters relative to woli c authorized by this building pe it application.
9 (z __12 (
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.
4/f.etji 61),..Q.I 9 as a
Print Owner's or Authorized Agent's Name(Electronic 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.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 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
en?�i t
[r '' Massachusetts
rr" t. " OVI
DEPARTMENT OF BUILDING INSPECTIONS. "` 212 Main Street • Municipal Building
—'�F 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:
Location of Facility: /h.-11' V-fC4C\1 � ��'r7i - ' l'��✓ Vi/
‘ cD1
'. P fH4---
The debris will be transported by:
Name of Hauler: 6)i-el C,,v(c>LAuv----
Signature of Applicant: ♦ Date: /1111
The Commonwealth of Massachusetts
�" l Deportment of Industrial Accidents
_�;,7,111== a 1 Congress Street,Suite 100
Boston,MA 02114 2017
• www.mass.gm'/din
11eukers'(•unrpcnsatiun Insurance Affidavit:Builderui(antracton/ElectricMs*IP1uiiil►ers.
10 BE FILED ikFill TIDE PERMI1TING AIITI1011.1TY.
%unlieant Information )Ip1n I Please Print Legibly
Name ltstrtrk
rr (t, ,.11141Jt1.{,r, i�;al,.11: !/.Q4 C g 4QL.Z,.. G C)
Address: C i P� f'J
City/Staterzip. 1�"�11 D!O77 Phone#: 7�� 3 `�Q 9P/cc/
Are pun am a elite:r!Clink tie appos trisile
Type of project(required):
I.�a n a employer wrt4 / lerpiurees MU anti ur pat-umr)' 7. CI New Ac_unstrucliun
2n lain a sok peopriclur uI pttruc,thip and Iota i kJ& noticing scut arc in 8. 0 Remodeling
any capacity.[No vrotteot'cutup.utturanot rL-gi n dap
9. ❑Demolition
3O L am a Irateuwncr doing all unit my dL(No wurketn.comp_rtttunnttc requirciLl'
4.0 I ant a hins:onvi`t and w ill be hiring iouO vomit 1u conduct all t. on nay pi city. I will
111 Q Building addition
cnwn that all 1:1tur:tc1crrx cider lour mans'cunt in+atnir uc.urancr or an sole 11.0 Electrical r.pairs or additions
prtptretnrs wtill Ix+cmpiuyee.A.
12.0 Plumbing rep anti tw aiktittotis
t{::1 I ant a 1..clura1 cuntraclvr and I lose hired tlrc%ul-cuntractun titled on the attached shed_
Diem:e, suh-contracters lose employ es and lost:notion;comp.ntsurance. 13.a Roof repairs
t.. W c are a cutptnaeiun and its uflu er xn hate c ii%cd their n :L iht ofcm:opti o per M( c_ 14.
(y�Otlat't M C*.*
I s ,It•I1.and we hate no enptluycr:..(No wtskcls'compin5,rraaee r.:yueted.I ``//'
•:vtty applicant that chocks htos''=1 mini also tell that the section below shunting threw%takers'ct.tttpcutattun putts'.uttt,rmantas..
`Iknneu.wtert w ho tI i uIl des aft'rttatit imheatttn they are ihnrti all work and den kin outside contractors slut tuhvaul a sew atlidat tt Itnitramv suet.
:(untaactor tint check ihtt boat must attached an addrtaun:/l tlxxt shuns ine the name of the snM-contracluas and stale s heihct to not thou:ovules hate
cntrloyccs.. if the sub-contractors late employ ocs.tire-.mutt tide their worker'saault.polo•y number_
l am an employer that is providing workers'compensation insurance for army employees. Below is the police'and job site
information.
Insurance Company Name: ` 2—4rrc —
Policy tt or Self-ins.Lic. =: p77(p(V 6- 9 r (04 O c7 't• f l I.xpiratiun Date: y' a') • t�a
Job Site Address: p. ELIA Citw'State;'Zip:aDr41Aew OI D(pO
Attach a copy of the worker compensation policy declaration page h bossing;the policy number and en ration date).
Failure to secure co%erage as required under MGL c. 152,*25A is a criminal violation punlsltahk:hw a line up to$1,500.00
and?ur one-year iniprisunrnent,as well as civil penalties in the forth of a STOP WORK ORDER and a line of up to$250.00 a
day against the violator.A copy of this statement nay be forwarded to the()t iim of InvcNtigatutrtt of the DIA for insurance
co%crape t,eroticalnon.
l do hereby • ande%% pains an alters a/perjrrrr that the in/umration provided above is true and correct.
Signature: 1>atc..
•
Pltun� Lit ?(i qt5(/
Official use only_ Do not write in this urea.to be completed by city or town official
tits or l ow n: Permit/License tt
Issuing.lutlturily 4circle one):
I. Board of I lealth 2.Building Department 3.Cityli'own Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone if:
0.2(3 l`I.25