25C-121 (6) i • BP-2021-2270
15 ELIZABETH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot: ,
25C-121-001 CITY OF NORTHAIVIPTON •
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
1
r.
BUILDING. PERMIT •
Permit# BP-2021-2270 PERMISSIONISHEREBYGRANTED TO:
Project# EXTERIOR RENO Contractor: License: •
JASON SEXTON CONSTRUCT ION &
Est. Cost: 25350 DESIGN 106263
Const.Class: Exp.Date: 1 r/28/2023
Use Group: Owner: _ BIRDIE PROPERTIES, LLC
Lot Size (sq.ft.) ,
Zoning: URB Applicant: JASON SEXTON ONSTRUCTION & DESIGN
Applicant Address) / Phone: Insurance:
49 EDWARD DR 4132101778
HOLYOKE, MA 01040 r
ISSUED ON:12/07/2021
)
TO PERFORM THE FOLLOWING WORK: .
' NEW ROOF,.WINDOWS, DOORS, SIDING, REPALCE FRONT & SIDE ENTRY STAIRS
" r
•
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#
1 Foindation:
Driveway Final: Final: Final:._ Rough Frame:
Gas: Fire Department Figeplace/Chimney: r
r
Rough: Oil: • Insulation:
Final: Smoke: Final: o
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. - '
•Signature•. •
I, ) .: h fr .• T/ ( 1
Fees Paid: $165.00 •
, 212 Maui Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner I -
/ r-- --C'4 g`i 1
The Commonwealth of Massachlusett -��y 1 •
c, Board of Building Regulations and/Stan rd VEC 7 OR
E. UTSPBALITY
��ii Massachusetts State Building Code 780`CMR2021
Building Permit Application To Construct,Repair,Rena oqa lish a Revised Mar 2011
One-or Two-Family Dwelling g AMnaN jn,^oFG�o s i
This Section For'Official Use Only ; ' ------ ._.� i
Building ermit Number: &�-. ..a�.°7 0 " Date A plied: f
EU►i` �O55 . /2-7-ZDZi
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
I $ ELlz&&ETtl cT. 25t_ 1 /Z/
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(It)
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 El Municipal_ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
i31&tic lab?CarIE5 t 1(c_ Sowcwiq P7b-40 /}IA 01D-73
Name(Print) City,State,ZIP
10 HEZEiv D( , q 2b-1779 ,JAScn( t12bitPxott-045.C6r'1
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Owner-Occupied 0 Repairs(s)91f lAlteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg.0 Number of Units _ Other 0 Specify:
Brief Description of Proposed Work': STALL ►JEw Roos I S,.JSTALI ,JE.W RCPLALEMEiur
10 i to m-4-'3 6 b*Ot..S ..n,s rn t . 0 E.w Sib 1 N 1-i REPLA( EXIST IA,cr 'RR 0 Nil-
e S 1 0 t E'nrra H STAi D S Ooor I wr ro 8s nn 1iatrkti ri F:kicTIu�)
U-Fflc1bf�L ,3O
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs: •
Item Official Use Only .
(Labor and Materials) f
1.Building $ 25 3 5 0,Oil 1. Building Permit Fee: $ I Indicate how fee is determined:
1 0 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:
Check No.0 ` Check Amoun
6.Total Project Cost: $ 2 p
'g135 ,l� 0 Paid in Full ❑Outstanding Balance Due:
silT s
P, lb5.uu
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
/ob2-C'3 <1/2r�27�
J fa S p►- SE)(,T()p License Number Expirati n Date
Name of CSL Holder List CSL Type(see below)
y 1 tiowql1 6 bR—.
No.and Street Type Description
/�OZyaIC� A ("1R 01D�O U Unrestricted(Buildings up to 35,000 Cu.ft.)
J7 I R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
'// ZIO Qr1i 3StA mpCb.Co/t I Insulation
Telephone Email address D Demolition __
5.2 Registered Home Improvement Contractor(HIC) ,g/ 6
.�_ cSEXT0/J GNs-TrLuc,T)DN b I i p L LC HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
U lbw 4 M D/L. OFF/c fe.(SE)(TO lAn.ca rl
No.and Street Email address
Alooyo)c6 M Ol oN o in3.2/0-/778
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 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 J. sfCta Irt)
to act on my behalf,in all matters relative to work authorized by this building permit application.
�ASor StrwN // 2 3/2 l
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.
o // 23/Z
Print Owner's or Authorized Agent's N (Ele oni 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.) ' Sb (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) -1 o S Habitable room count 5
Number of fireplaces O Number of bedrooms 2
Number of bathrooms / Number of half/baths 0
Type of heating system GA fax Ito fxttm c6lpb7 Ain Number of decks/porches (-
Type of cooling system Enclosed Open X
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
.
_ .�.. The Commonwealth of Massachusetts
"'�i tl} Department of IntlustrialAccidents
•" 1 ca 1 Congress Street,Suite 100
"'N: - Boston,MA 02114--2017
4.
V., n',vw mass goy/diet
Workers'Compensation Insurance Affidavit:Builders!Contractors/E1ectriciansfPlumbers.
TO 8E FILED WITH TILE t'Elirrtl i I'ING AtITHOItITY.I
Applicant Information I Please Print Legibly
Name(IlusinessfOrganizatioW1ndiv idual): `.:.�• :.SEK;ro'.1. • c0n�S1Ttt cX.flrJ;• ' . IIr.N LL'.L '.
Address.: 4-7 I&, t D t..L ; . _ ... .
City/StatefZip: . lc E - f lA'- ,OI0i10 PI>one#:. '/i- V O-/778".
Are you an employer?Che k.the appropriate box: Type of project(required):
1.01 ant a employ x with employees(full a.nd/or pact-aline)! 7. Q New Construction
2 Jam a sole proprietor or partnership and have no employees working for ore in R. LI Remodeling
any capacity.[No workers,'comp.insurance n.Nuindi.]
3 f]J am a lwenotrwner doing all work myself.[No workers'comp.insurance required.]y
9. El Demolition
I 0 p'''Building addition
A.®I am a hone rwaer and will be hiring contractors to conduct all work on my property.l will
ensure that all Contractors either have workers'cornper cation insurance or are sole 1 1.0 Electrical repairs or additions
proprietors with no onpluveks. 12.0 Plumbing repairs or additions
S4 I ten a general contractor and I have hind die soh-contractors fisted on the attached sheet. 13 Roof repairs
These sub-contactors have employees and have workers'comp..insurance.
6.0 we are a corporation and its officers have erereised their right of exemption.per MU e. 14.❑Other '
1{2,§1(4),and we I1.9ve no employce's.[No workers'camp.insmarieerequi.red-1
I
*Any applieattthat checks box PI must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hireoutsideeDnirletora runt submit a new affidavit indicating such.
(Contractors that cheep this box roust attached an additional sheet showing else name of the sulr-e oar-actors and state whether or not these entitid have
employees. If the sub-contractors have employees.they mast provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and fob site
information. -
Insurance Company Name: . - • ' . : : .
Policy#or Self-ins.Lie.#: • - - . Expiration Date:
Job Site Address: - -_ -- - - - City/State/Zip :
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 e. 152,§25A is a criminal violation puni4able by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance
coverage verification.
I do hereby eerily),under the pains and penalties of perjury that 11rr information provided above Is true and correct
Siunature: --� Date: i!/Z�Zi
9
Phone4: - 5/l3-210-/77 - 1
Official use only. Do not write in this area,to he completed by city or town official
City or Town:..' Permit/License#;-►► ' • :
Issuing Authority(circle one): .
I.Board of HIealth 2..Building Department '3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other . .•
-
Contact Person: ` Phone#:. i'
City of Northampton
�� � S�$.. =sic
Massachusetts ��?r'' : `•.f
3 tl ,s 3 DEPARTMENT OF BUILDING INSPECTIONS i C} i(',
212 Main Street •• Municipal Building '3,.. {.fib
Northampton, MA 01060 "'shy,^^ ,,�0
F
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: VALCEI1 P�G`fCLe
The debris will be transported by:
Name of Hauler: J aX.-roN GAzrfLuGT)DJJ \S 1 G-rJ
Signature of Applicant: Date: V20/
.
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MORTGAGE INSPECTION PLAN
To: - ,_ 't hereby report that I have examined the premises end that
this inspection plan shows the premises described,that the
� �. buildings are entirely within the property lines and that there
are no encroachments upon the premises described by
buildings of any adjoining premises,except as Indicated.
' I further report that to the best of my knowledge,there are
no easements of record affecting the tract shown hereon,
except as noted;and that this property
is 614TaT'located in an established flood
Property Address: ,. .� (Zone A))one of 0-100 years frequency o,!�OH:
K._,l-�L 17 szri# Qom! corms .1.
4 Na 35417
, ird� 44141
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Ofejiff offE 11'1 STC:FEdwit I f-157)
iyfocsoA)
18027.C12 1.3
pE 4
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moo . ON
Ail 407- 3
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19,-)EAsr Q,„,„p ity‹.. . _ 13:::),.."., 11. ' L'Z-:-1-23/0
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- _ • ' ST7-:,er ----i
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Deed Ref:Book 8077 Page i3/- Plan Ref: Book 472. Page Z.70
j ="Z4' 2.50/6v7 boo z,#'
' Please Note:This plan is for mortgage purposes only and is slot a complete•property survey.It is compiled from deed
` dimensions,existing plans and other sources of information,This plan is not to be used to establish property lines to erect
' fences or hedges,etc.,and Is subject to change as a more accurate survey may disclose.
John K.Somers /•
Professional-Land Surveyor
180 Great Plains Road • P.O.Box 1093 Date:
West Springfield,MA 01090-1093 j,`/.1
(413)739-1451 • FAX(413)739-J539 �jfft r4� ,,
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jsomerspls@comcestnet t{t .