17A-129 (8) BP-2021-2324
8 FOX FARMS RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17A-129-001 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-2021-2324 PERMISSIONIS HEREBY GRANTED TO:
Project# BATH RENO Contractor: License:
Est. Cost: 22000 SONDE CONSTRUCTION 67758
Const.Class: Exp.Date:01/02/2022
Use Group: Owner: LIPKIN-MOORE,ZACHARY M &SURBHI G
Lot Size (sq.ft.)
Zoning: URA Applicant: BONDE CONSTRUCTION
Applicant Address Phone: Insurance:
205 PARK ST 413-529-2176 UB4K05380A
EASTHAMPTON, MA 01027
ISSUED ON:12/20/2021
TO PERFORM THE FOLLOWING WORK:
1ST FLOOR BATH 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:
C+ .I •
Fees Paid: $143.00
212 Main Street,Phone(413)587-1240,Fax:,(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts `C
z2 j ;� FOR
Board of Building Regulations and Standards MUNICIPALITY
Massachusetts State Building Code, 780 C14'1> ,rt
_ n ny USE
Building Permit Application To Construct, Repair, Renovate Or beano t lFa 1Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 13P-d)"a '± i-y Date Applied:
,i-vig..s < 1<0}5 // )2-Z0-Zo2.k
Building Oficial(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pr a ty Address: 1.2 AssessorAs Map& Parcel Numbers
1-o:k 1 7. /29
1.1 a Is this an accepted street?yes 17 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:
Zone: Outside Flood Zone?
Public ETY Private 0 Check ifyes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
tea'. +-‘gi thl -NIcx>2r 1r1-O2C=N LF , A C)1Uld
Name(Print) City, State,ZIP
rLA-0,S TZr1 , G03 56i, 7299 SCi-opA EG-HAIt-.GOH
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) t-IL'Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: lat- pv,L_
T►.j L L- N emu 1-1(r1--1 Tt ►v fr, 17C-utk-A 3 l RJ Cr-i F LC( 12__4- 'A I Or,
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 9 000 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ / 0 ❑ Standard City/Town Application Fee
L 0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ )0. MO 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $ °°
heckNo`Ii'r7 Check Amount: Cash Amount:
6.Total Project Cost: $ �7 /
�Zj 006 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
5--OL,7i c Er I -2..- ZZ
M A-.\c `► C.) .i c t: License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
0705
?Mz , 1 No.and Street Type Description
OAP
.
Unrestricted(Buildings up to 35,000 cu. fi.)
�cST�1 Aohl PTCDO OA A 0102;7 R Restricted lea Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
4 t 3 52.`i- 2,11 ioM S- Z E C-1-hate.-V2,I.l T I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) _1_z 3
�.►t?E ic,N` i C..1 V)IJ HIC Registration Number Expiration Date
HIC Company Nape or HIC Registrant Name
No.and Street Email address
E µP`TbiJ, oivz7 91363/ zi7G
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 [lam 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
S..42,91-I1 pKitit^t fvF 1 Z-2U- Z.
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.
.mayjrn.t 1 2-?z) z
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"
-
City of Northampton
��
Sg SC
Massachusetts
t A
DEPARTMENT OF BUILDING INSPECTIONS
,0y 212 Main Street •• Municipal Building of- cs
C_ Northampton, MA 01060 3:rNh, 3,DN'N.
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: �y��z,—�t,�n�p��►v , V�.u � � c
The debris will be transported by:
Name of Hauler: c>►.it'c (t? -:te-vet 10►..s
Signature of Applicant: '-1/4 Date: 1 Z-Zv I
The Commonwealth of Massachusetts
►' Department of Industrial Accidents
yLIE 1 Congress Street.Suite 100
Boston. .tt-102114-2017
wls'n:ntass.go►•/dia
))uckers'('ompiensation Insurance.VTtdasit: BuildrrsiContractorsrElectriciansiPlumbert_
I u Mt.111.11)Vs 1111 1 111_rEat.0 rl IM(::tt I lIOlttr%.
Applicant In fill-mafiosiPlease Print Lrttibh
Name lliu„ra sa t Ir anr/.ItI.mn /'ludo. l 1J�(_ l rsiS 116U �teli._1_
Address: 00 S VAr ik.
City/State/Zip:_ ' 14 iH P►-- ��1 ZS1.�� i�-�l� � rhonc#: t-1.l 3 52.--9-7-1 Z
-ire%on an.rnpknrr'I bra the appngrnalt lira:
Ty(ir Of project(required):
i.arrattaempkna urth cmplm,ccslullandurpart-tun.I.• 7. ❑Ness construction
201 am a sank prulsw-taa in partnership and lust:no mirk"w-s%intinp: kar nn in 8. 9-1temodeIing
:ms capacity.(\u iurcomp.trs.cop.nnuran u cc requcnl.l
9_ Demolition
lam a hnwvun-n akwip all nsmrk inasd1.I\u n ti kc7. cslnitp_nn t:Ince htpWttll.l
4.0 tam a k ns nor r and n i l In: un brt c�"rdraciun it'conduct all st is k on im pnyrtrts_ 1 wall
10 0 Budding addition
snare that all c-anir'aciurs rnllnr lust aanken:compcmasautmn nnur'ancr OS arc sine 11.0 Electrical repairs or additions
pruprn'Gmrs w tilt n+carrplaryct�_
12.0 Plumbing repairs or additions
'11 ant a general camntra.tin and I lusc hired the sub ctnuacttrs h.tcd an the anil-hcd slaty. 13 Roof repairs
sub
umnuatis'rs Iosc cnpkmoccs and loot utmrken comp_uuuramY_:
14.DOthei
r..LJ N t arc a tt+rpa...Amu and ut t pin cm has c cu.-cowed ilea nprlal vt cacnu"ucn per Mt
1}2.;1141.and ne has.:no cnrp•lusct..(Nis wt rkcn.camp.mwarnc rcaluinJ.( I
•An%applicant that chczls ht..a=1 rnua atsu loll smut th►acciNKtlrk:M shagrnic their uankcn. ca+nipcnatun padnc-s mlarrnalr n.
+tkmrucs.sanms Au".uhmtl this attisi'nnit uulnatm:Clay arc damps all wank and then!Inc.mutsitk cam m.:t.t.must subnut a tnst atri da%d mituaiiigsmk.
t.-anuack•rs that chcc-1.thu ln.a must altar an ad.huunal shod Shan nip that:mama and the.uh-:aedracts*s and stale n lrcther an no!those aninu:s haw
cauplir cis. It tln sub canlraciar.lase cmrrio:.ccs,t!r-} taus prams salt ilitu snarlers'cianp. manbcr.
I am an employer that is providing waorAers'compensation insurance for tar employees. Below is the policy and job site
information.
Insurance Company Name:_,_ _ V 1 r:z
Policy =or Self-ins.Lie.a:_-SJ 4 KO53..A i Z ". _ lL puatutn Datc: 3
lob Site Address: ' t 11- 5 • City State,Lip:_'L,Oe (`j /A/ir C)((y3
Attach a copy of the workers"compensation policy declaration page(showing the policy number and expiration date).
Failure to secure cuserage as requited under\1(iL c. 152.*25A is a cnnunal violation punishabk by a tine up to Sl 00.00
and or one-year imprisonment.as%sell as mil penalties in the Corm of a STOP WORK ORDER and a line of up to S250.00 a
day against the s miaow.A copy of this statement may be forwarded to the Office of Ins estigations of the DIA for insurance
cos erage s crnliealion.
I do hereby certify under the pains utrd p enuhies o/perjure that the in/armution provided above is true and furred.
.
Pbr,nc - 4Y.3 �a-�1-Z\ 7C3
Official use only. Do not write in this area,to be completed by city or town official
('its or [ossn: Permit/License b
issuing.tuthurity (circle one):
I. Board of Ileaith 2.Building Department 3.City(1twin(jerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('unitact Person: Phone a: