38B-117-002 BP-2021-2265
19A EAST ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-117-002 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-2021-2265 PERMISSION'S HEREBY GRANTED TO:
Project# KITCHEN REMODEL Contractor: License:
Est. Cost: 10000
Const.Class: Exp.Date:
Use Group: Owner: MCCARTHY,SEAN MARSHALL
Lot Size (sq.ft.)
Zoning: URB Applicant: MARSHALL MCCARTHY, SEAN
Applicant Address Phone: Insurance:
19A EAST ST
NORTHAMPTON, MA 01060
ISSUED ON:12/06/2021
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
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:
titTh..,
pia
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
I
The Commonwealth of Massachuse s -J�/
Board of Building Regulations and St dar
i Massachusetts State Building Code, 7 0 C R oFe . 6 US ITY
Building Permit Application To Construct,Repair,lien Demolish 1 R ised ar 2011
One-or Two-Family Dwelling\NORT nuiioi
This Se on For Official Use Onlyo . �SpF
Buildin Permit Number:���/ "'"A ��, Date Applied: u1 so"s
=1111./Z5 ,E 7' ~ 12-6-2ezi
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 AssssseessgFsMap& Parcel Numbers
A EnT GT. .1*. Ilrrtlit i .M'4'.0to r��
Li I a Is this an accepted street?yes ✓ no Map Number Parcel umber
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 ❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner'of Record:
5 `I M,aLAi'fj I'tivfli Awl P'T!frJ - NA. 01 D(c a
Name(Print) City,State,ZIP
11 E $T ST. -* (_co5)4-140-17.)t4 sakomt( g4Qc,r,alt..coiM
No.and Street Telephone Email Address
DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building Yi Owner-Occupied I Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 11-11'Wrt,' fil•FhftblIft
er I'ION 4:11111111111111111111111111111111111111111111111
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
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:
Check No.10t Check Amount: („.16
6.Total Project Cost: $10, 0 Paid in Full 0 Outstanding Balance Due:
4101/cr SFA4NMCCe a€Gnu1(..0 N•
City of Northampton
•�' t" Massachusetts
t /tDEPARTMENT OF BUILDING INSPECTIONS 9 x
212 Main Street • Municipal Building J6;
Northampton, MA 01060 rs�W 3 D\�\`C
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.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
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 0 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
'b: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.
sc r1N Aa iti I 1-19
Print Owner's or 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. 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"
s
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.= 1 Congress Street,Suite 100
-"''MM �' Boston, DNA 02114-2017
''•.- ' www.mass.gov/dia
11 inter.'('umpen%ation Insurance Affidavit:Bu1kIer%/(ontrartoniIElectrieians!Plumherv.
tO RI: 1.11.1.1)U 11.11 THE PIERMI'rI I (:At'1'HORI I'1'.
.‘I►I licant 111fornlatiaall Please I'rint I.ecilrk
Name 4 Hu,l ic,,,i lr-x;.ulnr ttt,IIL lttal%IJu:ll l: 5 C -k, ' l v`L<' Mc
Address: 1° E' 'S1- "T #11
CitylState,�•Zip: 1•1 ottirl1W'MQ1O0.I '. 010 46 E'Itcllli - (5o5) A-i 6 -oi 11'
Ate you as iMliIhlyer?('heck tier opp/vpnala•loos
I w 1K of project(required).
LO 1 atrt a eteg.l..}L'r*dill ert k..eo!.ttilll and.rt part-tune L' 7. ❑ New construction
10 1,ant a,atte teer.lrrk'kw tor puttner,hrp aril lam :rk1 engarr N dcil ilrknt` I4,1 nee en K. Q RCittods;lltlg
dun caraertr. [Nit,•lallrka:r.•.anti.. tanurart r requared.l L..J
9_ ❑ Ihniolitlon
t a huen.s.l,met a.ltnte all%far►inr.elt.INo u.tier..'compua,ucattce n.Nuerall..I'
!o❑ Building addition
a Ilk MUM thIlia and 14all K:hutting evnlrsetors,on c.mduet all%vale ma um 1eDpsYtt. I ayill
ut,uta:that all ea tIit:xtl.r,entree It:t1.e.4.4tken'eoateprrt,atlait ut,LYtance a.t:AMC,a.lc I I a Electrical repairs or additions
pnrpnetor,at€h no anpll.±,eres t
11❑Plumbingn pair. or addition,
I 50 AIRa genntaleauntsaata.r anal I lu4c hard the,ub-a:unlraeta.ts lacteal on the mltaclled,1x1t I 342:1Roof repairs
these wh-etmitirksts hiss ernpluvie,and hate+►urkcr.'camp.tn,uu;tnac.
6.0 we arc a c.ettnet•,Nua•n and It}atle[ahits
'r.he excrelxj then the nghl art evattptauvi per Sail c_
1.4_❑()thew
If?§I$it.iota]vs 4:lease tea.engrloyces.!Nu 46ur►er,'eaanp.insurance itquuexl.]
*Azov apptie3tt that chucks INA 1,1 MUM alxl till out flee,ecelartt 1*c Iwo,Ahua>,inoe their'barrkers eontpansatum p..dl.y uniL;K/tistio 1.
lla,,inco%ten%he stllemll t1us attall3aet ln(lalalltai their arcdr-Mnit all %a.tk and their hire.xatslak:•t:otirl..tc.c- auu,t,uhaltat a taco.atIttlal.It nwlrcrimg such.
.4.un[raetots that Cbia .tits kart must atta:teal.tn additions!,tx'et,lM"41nt•Ilse minx ol the vu1.-.+10114:t..r..and,talc .R 1u:Itxr a.It not ttk.x.titette,hallo
cnirItnea^.. It the.uh-codractots kaRe a7tllall.RCt,,Hier I11E1,1 pn.R1d.•their •µorkca,'.r.enp.poll:'ttutmllscr
I am an employer that is providing worAers'compensation insurance for say employees,. Below is the policy and job site
in/urnmtiun.
IIIsuiance l oil Tully Name. —
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: ('III StateLip:
Attach a copy of the workers'compensation polio declaration page(showing the policy number and expiration date).
Failure to secure coverage a'.required under NI61._c. 152.'25A is a criminal violation punishable by a tine up to S►I.500.I0
and-or one-year imprisonment.as well as cis it penalties in the form of a STOP WORK ORDER and a tine of up to S250.t 5 a
day against the violator. :A copy of this statement may be tiar►'arded to the(Hike of Intestigattons of the DIA tar insurance
coa%crate veriticatum.
l do hereby certify a the pains and penalties of perjury that the inlormatian provided above is true and correct
11-04
Nia,11c : 11''1`1-
(41h:ial use only. l)u nut write in t/ti►area, to he completed by cite•or town official_
('its or Town: I'ermitILicettlse h
Issuing Authority ]circle one):
I. Board of Ileilth 2. Building Department 3.('it'.Town('Irrk 4.Electrical Inspector S.Plumbing Inspector
b.Other
t untarl Person: Phone 1t:
City of Northampton
,S S!
¢ Massachusetts � cs,
DEPARTMENT OF BUILDING INSPECTIONS yJti D
212 Main Street • Municipal Building
Northampton, MA 01060 rsHW
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
c,I' 119 d4
1, erPriNS ' " 1 (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 3 day of OCCErn6ER. , 202.I .
( ture
—
mmili
City of Northampton
oa"N M
i �''1. , Massachusetts �;'^ x. 1
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,l DEPARTMENT OF BUILDING INSPECTIONS „��
�. 212 Main Street • Municipal Building OD
Northampton, MA 01060 �J'Nh. TO\'���
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: -13 VUY4STOZ 510 `' w1)`ro4^' I"- 5"111WinVcv. r 01615
The debris will be transported by:
Name of Hauler: t41 b bJ'N'q s P
Signature of Applicant: Date: 12 J3lzovi