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12C-011 (3) BP-2022-0003 5 NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 12C-011-001 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-2022-0003 PERMISSIONISHEREBYGRANTED TO: Project# ADD BATH Contractor: License: Est. Cost: 15000 MICHAEL DESORGHER 106004 Const.Class: Exp.Date:02/08/2022 Use Group: Owner: PELLETTIERI BETH F& SAMUEL M HUDZIK Lot Size (sq.ft.) Zoning: RI/WSP Applicant: MICHAEL DESORGHER Applicant Address Phone: Insurance: 448 BRIDGE RD (413)834-1499 UB-6R143470 FLORENCE, MA 01062 ISSUED ON:01/04/2022 TO PERFORM THE FOLLOWING WORK: ADD 1/2 BATH TO BASEMENT 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: CPI / 4. • >2 Fees Paid: $98.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ! RECEI `E e i f JAN - 3 202.2 7 I rTPT.OF RAI.DING IP1c:-DF 'Ticn;j g •r'L— - 22.2t4 r he Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR W 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 - Q U Q Date Applied: lCvil...) (Z5.5 l- 3 ZdzZ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 5- n/G.zrcy frru R-0. 12C l2( -Oil - Oo 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zo FF�` ng,Information: 1.4 Property Dimensions: nn chcc � 3 a:, /so '-- 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❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Rrt'tf PEU-ErT1+r11-1 /SAMVCL µV.4vt- /1,/V iatii4imP1N.1 /144 Ot O( 2. Name(Print) City,State,ZIP f/3 ,a,, q 5 nit/ fir`( .- 7§4M. S QY0 •Ss b •0Wq/ L�t^ta� 1eir J k"COM No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 'ify: /4r,P 0 Yi R AT tf 4("DM__ Brief Description of Proposd Work': . 1tp> Ir-e '/z< Iq't. p,,,,,, -Z g,-st ry,y t„t— 6'Fnt-('17-- - NElAi C'Nl ..„r— 41^-h ---i.o -v- iti 6it-Te ` &T'ICE:::' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ /UYii) 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 2 �� 0 Standard City/Town Application Fee / 0 Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ -5, 2,c' .7 2. Other Fees: $ 4r Mechanical (HVAC) $ List: 5.Mechanical (Fire $ (.il Suppression) Total All K Check N Check Amount: V? 6.Total Project Cost: $ l t 0 Paid in 1 ❑Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1 Q 6 0© %2 A/G 7 t cJ ' License Number Ex iration Date Name of CSLHolder 7 q�Q6 2i p t List CSL Type(see below) 12-0 No.and Street Type Description ti r Q U Unrestricted(Buildings up to 35,000 cu.ft.) a(LI T O i b(o 7' Restricted 1&2 Family Dwelling ZIP M Masonry RC Roofing Covering WS Window and Siding t n l SF Solid Fuel Burning Appliances q13-8�Y-r i J/�' ' )y1 ( pogo l eis,5r ii10.(d"\ I Insulation Telephone I "`�vv !Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) M Ct/tnt L Oc�Scv�c-r��^Y� I 78 73 02/PY/1a HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name Y(c 3/LI9C R0 iti f0 ( ('vr/kGvI ele5Ait 6(.40,(gikl No.and Street // Email adth•mi-� 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 Issuan a 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 A IC hoc Pe cof I e✓- to act on my behalf,in all matters relative to work authorized by this building perit application. � r Print caned s tine(Electronic Signature) I Irate 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. 4(c4fe l /��fer. 4f ,�� — I�2/zo�Z Print t er's or Authorized Agent&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 City of Northampton Massachusetts s j I 1° ?. 1:4 I l f1. jr� DEPARTMENT OF BUILDING INSPECTIONS �� "_s,' :' 212 Main Street • Municipal Building v le': Northampton, MA 01060 • 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: VA►li� L C (( ( A?i).v 7, /A Zi The debris will be transported by: Name of Hauler: A ict bf:so (to-AA_ _, .., Signature of Applicant: Z Date: 1/Z,2 Z ...aatataaN The Commonwealth of Allissachusetts .=Cir Department of Industrial.4ceidents 4 1 Congress Street.Suite 101) Boston. .11.4 02114-2017, www.ni aNS.gorldia IA or kers' ('oruperis. IuUI Insurance Affid t Bui1ders1'ontrAet ors/Ilectricians:Inuto s. I() Bk, I 11.1-.1)WITH I HI.PI.12‘11 I I LNG Al I ittuttrY.. .iinnlicant furor tit ii)11 Ple3se Print I eolith N arm: liostriestrriiatuiationitidividual Nrc_ Aft C-vJ (2.LA LE) (Yg ( it, zip r& ttu an t t htck 11ti appropnitit but:* I s pe of project in:Noires') 1.11111; 01100y0 With I eintsloyn.es(WI arator part.tinve 7. Li Nc w congtuetxm 271 tarn a is;proinietort nannerittits=31 hats no ernialoytaat working tor me in g.11,..ereling encracit%.tNo workers'emir.insurarox requinalx) 9. Ej Donobtion 30 I ant a hormowner doing all work myself.'No workers'eon*.thane-aux no:guitar 0[3 Building addition 4.0 I 4111 wno-arid w rh hebrnn noun-noon t4)trontinet all work on al!!property. I will ensure.that eontractors either hate%when° 11.0 Electrical repairs or additions proveleteva with no employees. 12_[:1 Plumbing repairs or additions it general COMfacun 410 1 ilaiet toted tht Usb-venttlettics ii1101 n tfre tUtstitaxt 414:CL 3{DRoof repairs thcse.sub-ceraraciors minty-yam acid have noihers'comp.trburance 6.0 we we a corporation and it+1.41ivers as C exereised then right ammonia per J5.2.§114 and we havt arpluycc$.[Nu wuttco'comp.Oen/ranee required. ° apptivant that t.:Inx-ks hos,zit meg also fill out the set.-'-6011 WO%alks4kitt5: u. s.;.: „ lau,xs, t:/Co',rizrsx who submit this affidavit inditaticat they-art doing WI work and 4 nen affidavit indicating was. I.on!!J,tot,•that eheek tin*box intig attached an additional sheet show tog the narrie tit the aub-4:orc,.c.ts,lara with.nate whether 001 ditrIEC Clititte.5 ha.xe 17 4,1,• CttrAtaatyt.,11,04,„ IS,IN !, mist pitr,We theft ro Outnbct I am in:employer that is providim:nor/kers'compensation insurance tor itty employees Below is the policy and job site information. InsulatKrt: ompany Name: ;LO Policy#or Self-ins.Lie. UP) 60,1 LI?, t-(-7 o Expiration Ilate. (05 20 2 2. Job sae Add, • .5" kuoarri F 'dJ O _ SlaTA.: tip 0 0 6 2 C-ff cpo 467(04) Attach a copy ut the out kur s. coni( ctisittion jruIi.s I 'itaration p.r,;choss rii the prrlks number and expiration date). Failure to secure coverage required under VIGL.c. 152.§25A ‘:rirninal son tttiniabahle by a tine up to$1.500.00 ander one-year impristniment,as well as civil perialties-in the form of a STOP WORK ORDER and a fine of up to$2.50.00 a day against the violator.A copy oi i;; ,sateinent may be fin Jilted to the Office of frivestigarl,ms of the DIA for in.surance co i erage serification. I du hereby certify sand e it s and penalties of perjury that the information provided above is true and correct. Stunature. //2/-2-2- y( -g31-1Y11 Dr, lust rate su(NA area.lobe ample-tell by city or 10Wit(06411 ( its or I own: Permit # Issuing kiithorit? leirele ;mei: I. Board of Health 2. Building Department 3.Cit:41Ttre, lerk 4. Eketrical Inspector 5. Plumbinit Inspector 6.Other 5 W oQ-rtt FARMS RD. oaXt rro I./ Ex 4ng Space Proposed space I Proposed work includes: IP asctrkal penal Removing drop ceiling l painted concrete foundation wall Installing wood ceiling 17'2" } Office Space — Remove carpeting. Exisdrg finished room 12'9" 5'6 1/2' Installing engineered wood flooring. Bathroom New bathroom:2x4 walls 5'3" sheetrock walls/ceilings tile flooring. Plreplsas Wall mounted PYeflsos Septic pump Unfinished basement Unfinished basement . Work / 'PI.^N ty: Ye()Nov.) 1)ts'6J 'Bv%Lb