36-314 (3) BP-2021-2346
177 CARDINAL WAY COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-314-001 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
Penn it # BP-2021-2346 PERMISSIONIS HEREBY GRANTED TO:
Project# BATH RENO Contractor: License:
GLAPOLLO RENOVATION
Est. Cost: 24500 CONTRACTOR 088071
Const.Class: Exp.Date: 12/06/2023
Use Group: Owner: COSTIN AMANDA TRUSTEE
Lot Size (sq.ft.)
Zoning: WSP Applicant: GLAPOLLO RENOVATION CONTRACTOR
Applicant Address Phone: Insurance:
189 BIRNAM RD (413)768-7277
NORTHFIELD, MA 01360
ISSUED ON:12/28/2021
TO PERFORM THE FOLLOWING WORK:
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 U PON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 1
1 0
Fees Paid: $159.25
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
': \L0
EC 28 2021 1\
The Commonwealth of irassachuc tt '� r N( WSPFCflONS
.����..,ti�„��;,rsao�oso .- -- FOR
W
Board of Building Regulatidnsand Standards-`--"— -�-�✓
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
Building Permit Number: 4p a 1"4 3ci Ce Date Applied:
►„ ; 1 i ,a,
BuildingOfficial(Print Name) Signature 3.)C1
-1�
gn
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
I GAT-41NN.. l,11-4 3lo-1,714 - 001
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dime sions: I
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
"t6'Water Supply: (M.G.L c.40,§54) 1'.1 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 yesD/
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner''of Recor¢
.„ 63 i
Name(Print) City,State,ZIPgi71
1/7- C/tAb INt&L, (A)Rs>9 91.4.4.rair4gazo 4twer444441.L.,b4
No.and Street Telephone Email Address ,/ cir-1
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 151, Repairs(s) 0 Alteration(s) Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': .bATt i R o 0 M R F..v 0 D P+C- • Iv ,,, -I-I L.. LJ X
11-.QAuA)( NA)Jir\) , taoW�t M LPG. I pA,"N . NUJ fock1n
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ Zp 100 0,Q Q 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ O • DO 0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ -5, $O 0. 6'0 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees:, -y ,.1,Check No. ,1 I Check Amount: rI I l
6.Total Project Cost: $ L 9 ) SO C,tIO 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-088071 12/06/23
License Number Expiration Date
Name of CSL Holder V
Gabriel Lapollo List CSL Type(see below)
No.and Street Type Description
189 Birnam Road U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Mason
ry
Northfield, Ma RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-768-7277 glapollo77@gmail.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 201250 03/19/2023
GLapollo Renovation Contractor HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
189 Birnam Road glapollo77@gmail.com
No.and Street Email address
Northfield. MA, 01360 413-768-7277
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 .dI
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the s ject prope ,hereby authorize Gabriel Lapollo
to act on my be fin all matt elative work authorized by this building permit application.
2,r 2/
Print Owner' ame(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.
Gabriel Lapollo
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,fmished 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 Op
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Department of industrial:Accidents
l I Congress Street,Suite 100
a ' Boston. MA 02114-2017
Kwww nlass.gnv/dia
)1 urkrrs'( ontpeusatioa Insurance,Atlidas it:Buidersi("ontractorsii:Iectricians/Ivlumbers.
10 BE FILED N•1111 1 ilE PElt.SII I'I ING Al UMW 11.
Applicant Information Please Print Leiibh
Name ttlusmcax:(Jrratttration Indio,id WI : GLapollo Renovation Contractor
Address: 189 Birnam Road
City/State Zip= Northfield, MA, 01360 Phone .4: 413-768-7277
Sr, you an cumin!,cr'(Tier.the.appropriate box
7''ypeelrptroleet(required):
DI see a ennpkeyet oath employ oes ttaell and ss psi•time 7. 0 New construction
am a irk immrietor err purtnershep and hate no cmplo.yI es oorlkrrt1' for MC nr X_ a Remodeling
any capacity..OM workers'cutup.uewrance required"
9_ El Demolition
ICJ I am.a la.nacruoaeci dump all esorle rnyselt.h ra%stoke:.'comp..anstiraaa.e recprunzl l"
10 Q Budding addition
tpl I am a iono Uo a and oil!tic honey cYMaracrltrs to conduct all 044 k 4nm trey morel el ty I se all
reason that all eorntrackrn either hate workers'eorrrpwtesatwma nourance Orr arc sole 1 ICI Electrical rq airs or additions
proprietors tsilh tdr►nnptuyeo,.. 12.0 Plumbing repairs or additions
auk a ism tal conteattor and I lease lured the sub-'.retractors listed Ora the attached sheet 13❑Roof repairs
tsar sub-erxntemnor.}mate c rrplk.yees and hate workers:reanp_nn..urune.
Other
6.0 we 414 ol ICIllern and its ollicen lease exenised tta:rr right of rtcntptnunn per MK(&L r. 14.[3
152,1I(44.and we hate no employees.(Thu wortiets'comp.rnsurauce rcqunre.d.l
*Any applies*that chocks box nI roust also till cart tltt xeteuaa bedew.lit+wane their%erkers'congsmsatr4n policy ent+rtnithen
t thmmet.wncn,shin submit this atlrrbsit indicating they are donee;all work and then hue outside ca«ktrreters roust subunit a nt'kk atldastt indicating such.
%("emu:ukvr.that clxek the%box must attactncd an side aenel shirt dress nor the moan of th..ul*-.e4adractors and state wtoettrcr Ors not thaw entities lute
employees. It the.uh-eeHrttaltkm%have employers.tiny must pro*Me their seenkcr. rtrnm peso%number
/am an employer that is providing worAers'compensation insurance far my employees. Below is the policy and job site
information.
Insurance Company Name__ _
policy#or Self-ins_Lic.d: Expiration Date.
Job Site Address: City:State/tp:
Attach a copy of 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 puniskabk by a tine up to S1.50t.00
and or one-year imprisonment,as well as civil penalties in the form era STOP WORK ORDER and a tine of up to S250.00 a
day against the violator.A copy'of this statement may be forwarded to the Ottice of Investigations of the DIA for insurance
cot era+e verification.
I do hereby certify under the/rains and penalties of perjury that the information provided above is true and correct.
Signature. Date: ` -• i Z 1
Pln•tte :,; 413-768-7277
O//ic'ial use only. Do nut write in this area.to he completed by city-or town official
t its or Town: Permitlicense dt
Issuing Authority(circle one):
I. Board of Ilealth 2.Building Department 3.('ityrrown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
('untact Person: Phone#:
City of Northampton
QY H A Mp,�.
?�" SAS 116,..0 ti
�•� Massachusetts �4.? y-- e
13 * c
DEPARTMENT OF BUILDING INSPECTIONS y e 4.
qi 212 Main Street • Municipal Building "p OD
w _y..f Northampton, MA 01060 sSNjy ar'3A"
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: Valley Recycling 234 Easthampton Rd, Northampton, Ma 01060
The debris will be transported by:
Name of Hauler: Gabriel Lapollo
44,vir_
Signature of Applicant: Date: 1Z) 2- 1 2.- 1
I-, 1.-..-.1
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JOB
GLX421 lk 0
- ,0t1 V pc--slo,.) co avvoN
SHEET NO. OF
CALCULATED BY DATE
TYN'T(A 'iCOetv\ . CHECKED BY DATE
SCALE
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