25C-121 (4) BP-2021-2161
15 ELIZABETH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-121-001 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-2021-2161 PERMISSIONIS HEREBY GRANTED TO:
Project# WALLS Contractor: License:
JASON SEXTON CONSTRUCTION &
Est. Cost: 500 DESIGN 106263
Const.Class: Exp.Date: 1 1/28/2021
Use Group: Owner: BILLIEUX ROBERT J SR
Lot Size (sq.ft.)
Zoning: URB Applicant: JASON SEXTON CONSTRUCTION &DESIGN
Applicant Address Phone: Insurance:
49 EDWARD DR 4132101778
HOLYOKE, MA 01040
ISSUED ON:11/09/2021
TO PERFORM THE FOLLOWING WORK:
REMOVE WALL FOR PLUMBING WORK
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:
4 • 46' • • 5r.
•
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachuse
Board of Building Regulations and Standards N OR
WMassachusetts State Building Code, 78)C Nov
8 kDn
1 USECIP ITY
Building Permit Application To Construct,Repair,Rnov 1 :- o olish a Revi.ed M r 2011
One-or Two-Family Dwelling ,.".' rHgMn N�in,c
This Section For Official Use Only ro,y.MAors o Ns
Building ermit Number: 6P— a I e a.1 (41 Date Applied:
ge W t.) 5 ,147- lI 9 20z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
/S PLJZAP T+I Sr
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 Private 0 Zone: _ Outside Flood Zone? Municipal pi On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
elkbiE fizZPEKTitS / LLC SWATH A+APTOP ., MA bIo13
Name(Print) L1 City,State,ZIP
30 fia- /.i L2 1413-2/Dwi779 ,12,4501•'@13IA-ONeP► reEkTIES.(.Om
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) 0 Alteration(s) 0 Addition 0
Demolition (8 Accessory Bldg. 0 Number of Units Other HI Specify: 64►. Bohan
Brief Description of Proposed Work': 'REr+ovc t_ocq-r, J Op I STIN G 1JRJI WALL lb
ALLOW FO I^)Stla 1L1cT10--) ()F pLunet NC-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ (,S Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $ 6$
Check No.9
6. Total Project Cost: $ 500Check Amount:
0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
lot 263 /(z /2/
J ASO n) a)k' YA/ License Number E piraDate
Name of CSL Holder
AQ_A List CSL Type(see below) L.
No.and Street Type Description
/� , /( U Unrestricted(Buildings up to 35,000 Cu.ft.)
fJo`tE) 1�IA OI D\1 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
ti)3 210 11-79 oFFJcE 3SEK-I'Dk,CE..(DP\ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 18156� $' 2 23
J. Ste^' CAA 'ItoC11t i 670 HIC Registration Number E p. Lion Date
HIC Company Name or HIC Registrant Name
ql ECG,c It p - of/C )J sfxrty c.h.(DK
No.andstreet Email address
Moz y ou.E J yrr 210 /779
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 ldl. No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
J
I,as Owner of the subject property,hereby authorize ASO r'J x'ra,)
to act on my behalf,in all matters relative to work authorized by this building permit application
IS(tot€ RLOPErri Et skcc_ JASON' // 2 2
Print Owner's Name(Electronic ignature) Date
SECTION 7b:OWNER1 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 ap•lication is true and accurate to the best of my knowledge and understanding.
,/50 /
Print 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
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.fL) 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 Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, MA 02114-2017
belle»:mass. ov/dia
%Vol-kers'Compensation Insurance Affidavit:BuildersiContractors/Electriciansil'lurntiers.
TO BE FILED WITH THE PERM'CI"IN(:AUTHORITY.
Applicant Information Pleitse Print I rtihls
Name(Business ur anrrationlnd[titluall J. �EXTVrJ Cok) T'R.UCTI 1 .1EStEcN / 1,6 C-
Address: y 9 tbt-oR ,p
City/State/Zip: Not.vbIcE) 14 0)04° Phone#: 4/3 2 to /7 ?
krt.sou an employer?Check the appropriate Wool: Type of project(required). _.
10 I am a employer with employees(full and or part-limcl• 7. New construction
am a sole rnopri•ctee ur lvflnrrship and have ter rtrrph) CC)w irking for me en 8. Remodeling
any capacity.[Now urkeT&'comp.unuranix reipursa.[
9. ❑Demolition
3FJ 1 am a homeowner doing all work myself.[Nu workers'cutter.insurance nyuml-)
i 0 Q Building addition
4 l am a homeowner n-r and will be luring tamaractors to conduct all wink on my property. I will
insure that all contractors either base workers'eonnprna tion insurance or are sole 1 i.Q Electrical repairs or additions
ptupnc Wn w i[h no crnpVuyr cs. 12.0 Plumbing repairs or additions
5 1 am a vem-ral contractor and I hove hired the sub-contractors listed on the attached sheet. i 3 Q RW f repairs
These sub-cuntraetors base employees and has c workers'cunrp.insurance.:
60 We arc a corporation and its offerers Peas a e:xen:ised their right of exemption is r?skit c. 1 .0 0[I1L'r
152,*It4l.and we have no employees.[No workers'comp.inseaance requited.]
'Any applicant that eheeks hos a l meal abo fill out the section below showing their w urkLT,'compensation policy information.
Ft+nneuwncrs who submit this atlidasit indicating they are doing all work and then hue outside contractors must submit a new atiie as it intliu"-itrng so-la
:Contractors that check this bus must attached an aldrtiunal sheet show mg the name of the sub-contractors and state whether or not those entities hasc
ctnpioy ees. lithe sub-contractors base employees.they must pen ILL:their woken'comp.peolt..!.nurnh.r
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy or 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
andtbr 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 certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature! Dale ///2 2
Phone- ly/3 2/0 /77i
Official icial use only. Do not write in this area.to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone 0:
City of Northampton
r
,„c�'1„r J' Scs SIC
- Massachusetts
��? !cam* GC: ,j DEPARTMENT OF BUILDING INSPECTIONS S
Ill 4'
4!i'�-e• 212 Main Street • Municipal Building %) Cb
Northampton, MA 01060 'r'S11, 1,.
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: \/ALLE`/ lEGN CCr
The debris will be transported by:
Name of Hauler: 3. g5Kro ��TRVCT)D/.l i
N
Signature of Applicant: Date: Il 2I