16A-018 (10) BP-2021-2058
478 SPRING ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
16A-018-001 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-2021-2058 PERMISSIONISHEREBYGRANTED TO:
Project# windows/doors Contractor: License:
Est. Cost: 5600 EDWARD RICKEY &COMPANY 15084096159
Const.Class: Exp.Date:05/02/202207/13/2022
Use Group: Owner: BRIDGMAN JAMES E
Lot Size (sq.ft.)
Zoning: URA Applicant: EDWARD RICKEY&COMPANY
Applicant Address Phone: Insurance:
80 SOUTH ST (413)695-7059
CHESTERFIELD,MA 01012
ISSUED ON:10/26/2021
TO PERFORM THE FOLLO WING WORK:
replace windows and doors on garage
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of\Airing 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:
)2 CSjaiT
Fees Paid: $65.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
/41) s� Massachusetts State Building Code, 780 CMR MUNICIPALITY
_ USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
-) One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: 8 P-�1. .2-0S' ' Date Applied:
KL-U►•J S
.1Z<Z"-
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property ess: 1.2 Assessors Map&Parcel Numbers
y7Q )11244.1 'I
I.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 Owner'of Record:
it (trinttAmdrw City,State,Z
No.and Street f Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building t Owner-Occupied 0 Repairs(s) (ffi Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work': ey ym„r, Y artAa. LG N @ , .A.,, e /i*p c.. ,A,;.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 40 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 60� ❑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:$ Ct,
6.Total Project Cost: $ Check No.3(6� Check Amount`.�6u Cash Amount:
S 60G.00 0 Paid in Full 0 Outstanding Balance Due:
V
City of Northampton
Massachusetts +5 c'�
, `c
.0 0 I DEPARTMENT OF BTIILDING INSPECTIONS
- 212 Main Street • Municipal Building Jh cs
Northampton, MA 01060 �sb `.�
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.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
� CS-096/55' 7i3 zoso
License Number Ex ' on Date
Name of CS older
List CSL Type(see below) v
No.and Street Type Description
•
N O/O/2 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town, te,ZIP i M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
W 3-695-'1 os-7 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /S�$4lo
e��++ z
dge rI� et Co;-. HIC Registration Number E ' ion Date
MCom y N e or C Re 'strant Name
G
No.and Street Email address
CYa mil O/O/2 Y/3-C9.�-7a 7
City/To�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 ef/4644/ '
to act on my behalf,in all matters relative to work authorized ' bu 1 liidg permit application.
X x0(( 12ROal
Print er'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.
��/ � /2 202 z.
Prue Owner's o on 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
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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
,ir . Sys.. 'Flo
c
Massachusetts �4?r - •t�G
i. „ wi ;DEPARTMENT OF BUILDING INSPECTIONS i J �
, , ,f 212 Main Street •• Municipal Building p.,,. C
Northampton, MA 01060 fs.... `10
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: V, / ' 6-T-1-7
Location of Facility: Thatek...72ZA47 'fit 0/06 0
The debris will be transported by:
Name of Hauler: 42,9
Signature of Applicant: �cG� d Date: /�2 2cZZ
__ The Commonwealth of Massachusetts
=. Department of Industrial Accidents
1 Congress Street,Suite 100
''='•__ Boston,MA 02114-2017
3,;_ �_'_, www mass.goridia
- 11 ureters'Compensation Insurance:AfTidas it: BuildrrsK"eatractarstElectriciansTlumber..
10 11t.111.!_i)N III li 111E P1.R tI 11I! G A1rTHORITti".
Applicant Information Please Print Lerib1s
Name 111usinesslJrgantrauwrn lntltsteluali,' ‘sleacer4/1pLi
Address-. 0
City/State/Zip: a4ayd.gidi 7)171 0I GI Z Phone#: t//3/6 ss 70ss
Are Ins as employer.Clink tie apprnp late ties: ►
Type of project(required):
1.01 I an a employer with _ trnpha}ae.dull:indite part-time(.• 7_ ❑ Noh, construction
*'t•�/ Inn a ink muptx-ter or partner-41m and hate nu ouployetis%ott n i tit ern to - X. 51 Remodeling
mycatracrty.'Nu workers;etanp.nouratee rcq wrndi
30 Ism a hamiarwn►r Jong all meet myself.Into*when'coup.insurance required.l'
9. 0 lknotittton
10 0 Building addition
1.ri I ant a finnilYewncr and n Ill be hum!oontraeiors to conduct ail week on my property. I will
emote that all vie n:aeierrs either have nosier; taaiturt insurance or are sale 11.0 Electrical repairs or additions
ptupnettns u ith nu ernpduvices.
12.0 Plumbing repairs or additxms
t3 1 am a general cuntra cior and I hasc hued the subcontractors listed on the anache-J sheet.
These subcnu ns:Ion lust ctrquuyt.vs and hate wurktTrs'atanp.ristrrancer:' 13❑Root repairs
6.0 Vie are a e are and its uf6u:is have cxcreised then nehe of exemption 14.g Othei
oPt epiNtet per!yN�l.e.
152-i 14 41.and nit:have no ertyrlusets.Pin nutters'comp insurance required.[
*Amy wham dui clia:ks bus al must rho fill uut the ssxtion beton%bunrug their workers'etnepensautw policy information.
Botueowaets who submit tins attulat it intheatmg dies are'lunar all work and then hie uuhxde'contractors Naar aUIImIt a new atrrlas it indicating stw-h
kContracton that cheek they Mot must attached an ndiMiunal sheet shirking the name 44 the sub-e stiraetur i and sank'whether or nut three aattattes eta :
omplu:kers. It the sub-contractors have envie}vies.they must preside then votive&..imIIIIIIIII. p-pokey number.
I am an employer that is protiding.vorAers'compensation insurance for nil'employees. Below is the police'and job site
information.
Insurance Company Name: '
—
Policy s or Self-iris.Lie.#: Expiration Date:
Job Site Address: C11) State.Zip:
Attach a copy of the workers"compensation policy declaration page(showing the policy number and etpiratioa date).
Failure to secure coserggc as required under MGL c. 152.*25A is a criminal violation punishable by a line up to Sl.500.00
andior one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S►250.00 a
day against the%iolator.A copy of this statement may he forwarded to the Office of Investigations oldie DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjure that the information provided above rs true and correct-
*Aaiun:: ,�./ • O�Dale. , �ZGZZ
Phone 4.. %/3- 3" os9
Official rise only: Do not write in this area.to be completed by city or town official
( it or I oIs n: Permil'I.icense#
Issuing.tuthorits )circle one):
I. Board of Health 2.Building Department 3.(It yr boon Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
( untact Person: Phone#•
City of Northampton
st-
Massachusetts
G
d �c N
ae,1 • 4i t DEPARTMENT OF BUILDING INSPECTIONS y M
" 212 Main Street • Municipal Building
w Northampton, MA 01060 s' 301'
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
•
I, (insert full legal name), •. _ (insert month,
day,year),hereby depose d state the following:
1. I am seeking a buildin: permit pursuant to the homeowners' exemption to • permit requirements of the
Massachusetts State Buil<i.: Code, codified at 780 CMR 110.R5.1.3.1, in c• , • tion with a project or work on a
parcel of land to which I hol• ••:al title.
2. I am not engaged in, and the proje or work for which I am seeking j aforementioned homeowners'exemption,
does not involve the field erection of ufactured buildings cons dried in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's de' ition of"homeo• ner"as defined at 780 CMR 110.R5.1.2:
Person(s)who owns a parcel of land on w he/sh• esides or intends to reside,on which there is, or
is intended to be, a one-or two-family dwellin a r ched or detached structures accessory to such use
and/or farm structures. A person who constructs ore than one home in a two-year period shall not be
considered a home owner.
4. I do not hold a valid Massachusetts construc • supervision • se and, except to the extent that I qualify for
and will abide by the Massachusetts State Bu'ding Code's requi 0 • is for the supervision of the project or work
on my parcel, I am not engaged in cons •ction supervision in c. •nection with any project or work involving
construction, reconstruction, alteration repair, removal or demoliti• involving any activity regulated by any
provision of the Massachusetts State :uilding Code.
5. If I engage any other person o• persons for hire in connection with the a • "mentioned project or work on my
parcel,I acknowledge that I • required to and will act as the supervisor for sal, • oject or work.
Signed under the pains and •• ' ties of perjury on this day of , 20
(Signature)