25C-047 (5) BP-2022-0025
218NORTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-047-001 CITY OF NORTHAMPTON
Pennit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
• BUILDING PERMIT
Pennit# BP-2022-0025 PERMISSIONIS HEREBY GRANTED TO:
Project# 2022 RENOVATION Contractor: License:
Est. Cost: 20000
Const.Class: Exp. Date;
MENDELOWITZ EIITAN GI LAD & ELANIT
Use Group: Owner: WEI SBAUM
Lot Size (sq.ft.)
MENDELOWITZ EITAN GILAD&ELANIT
Zoning: URB Applicant: WEISBAUM
Applicant Address Phone: Insurance:
218 NORTH ST
NORTHAMPTON, MA 01060
ISSUED ON:01/12/2022
•
TO PERFORM THE FOLLO WING WORK:
CONVERT ATTTIC TO BATHROOM
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:
Gas: Final: Final: Rough Frame:
•
Rough: Fire Department Driveway Final:. Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: '
r, . 0A,,L, >2 .
Fees Paid: $130.00
•
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner .
RECEIVED
J A N 6 2022 The Commonwealth of Massachusetts
4 Bcard o Building Regulations and Standards FOR
E °T OF BUILDING JN$PEC-rk §sachusetts State Building Code, 780 CMR MUNIU�CIPALITY
,.. NORTHAMPTON,MA 01060 I
Butltffi1g PerinitApIication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two Family Dwelling
This Section For Official Use Only
Building Permit Number:( t 7 a• 44 Date Applied:
1��uti,u /vs5 IZ f.- 12-2OZZ
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
14 Pro�ja ddre ss:viiii 1.2 Assessors Map&Parcel Numbers
Wall
1.la Is this an accepted street?yes V no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
I
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards 1 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 CI Private El Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SKOTIOSIMPRORERWO.WNERSHIP
2.1 Ownert of Record: '/
6.1-c., �
,7 MF ,Aid, Nci'-I ti c-Nro-ILuh ) MA 0/0 a
Name(Print) City,State,ZIP
2_/ 8 fih r'r 4 S-f. 3 1-3 rc'-yyr Y el t c,..,42 M«; 1. r.-o ti+
No.and Street Telephone tail Address
EC«rT ON 3:D_ES_ORIPAION O PROFIOSE WOORk'3(check all t at apply
New Construction❑ Existing Building 0 Owner-Occupied 5( Repairs(s) 0 Alteration(s) `l I Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:_ _ -
Brief Description of Proposed Work': • _ e 1/ -i
4 Ali i/ 64Ah ci)6 44 r 3 ad ,'/o,w jc '
SE,onossuSiuVIATEDZCoNSTRUmC1NrCOSTSI ,
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1.Building $ 000,Off; 1. Building Permit Fee: $ Indicate how fee is determined:$ 0 Standard City/Town Application Fee
2.Electrical
j, ddO`v0 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 7) D OO. OP 2. Other Fees: $ [
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fee : $ ,
Check No.ID b Check Amount I/"! Cash Amount:
6.Total Project Cost: $ AO/
(71)Do DO 0 Paid in Full 0 Outstanding Balance Due:
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.)
M Masonry
1&2 Family Dwelling
City/Town,State,ZIP
.
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 .......... ❑ No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLES 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
lS'ECITII')l�fiir7,b ONVNER,1O.RTAUTH:ORIZEaDIKGENTIDEWARrA`.TION
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.
47.
Pant Owner's or Authorized Agent's Name(Electronic Signature) I 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 ate 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
S1ETB 410110/4
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
1/41
SIDE YARD SIDE YARD
/ v A
FRONT SETBACK
FRONTAGE
G
City of Northampton
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CT �, Massachusetts � 5S� S�rc
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' a `, DEPARTMENT OF BUILDING INSPECTIONS y: f
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:, 212 Main Street • Municipal Buildingvd C�
J Northampton, MA 01060 �--1,9 W-'
" ITSTRI CCIOWE-13RISRFF DAVIT
(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:
i)
Location of Facility: V4.46 (i , oZ W lAier lrneed
P
The debris will be transported by:
Name of Hauler: Hov'tecwkel
" I
Si nature offinwlcea t: Date: I/6/2 L-
- The COMMOnlweatalth of l assarach nsetts
i .Dgiarh1ient•ofibrinstria1Ac dents
"' _= 1 C�ongr ess Street,
.Suite 100
=94.— Boston,_i1L4 0. 114?017
•;_ irrr rannaossgaifaaarn
' lV uelrers'Compensation Insurance?iidazato Buildersito+ntractorgEleritricaan iPlumbers,
TOBE FILED'tal'ITmnTEPERNITITINGAUmORII=
Applicant Information
PleasePai�a€ Leg b1a
N' siOrmm-ationt7uciiai 'Eitty StatetZi_N_c rT\(-1 p 4o ► m Oi9 ba 1 phone g! 3-1-. _ Si(' y V r el
-11
rireNom ae employer"Check the appropriate be= re of project(required):
1.0I as a asmploJrsrlfirl 1Qmployaa:(fall=diergarr-time).+! 7 NEW COIis17111C i011
2.Nna.Ella Foy/data•crgsnnar3ipaad'Ezra anemploy=/raffia:foram in S. Remodeling
any capacity.P.Te r eriker comp.in:m nca rwl"nsns l
, ► 9_ I Nihon.
g®3 a . h. e�ac 7.4en a10irpr1_ el.r —a lrreketi e n*ss at-aa r i
+career-urz txal44341 carom ct,rce$ c }pa ,i.szt7 kng'ai'lt
i Ill. Electrical repairs or additions
12.4Plumbingaepairs oraddilions
5.0 3 atre a puma contractor madams huamtha sub-ceat:actor li.md onrIsa=whad,la:Y Ili_❑Roofr s_^
These sam-ccnaactar:har:ee lease:st€hrroworke:camp.larrmaace.". r- ---
6.0We area=pont:ion aad its officer:lava exercised theirng3't ofraemptien aerMGL c. 1 -[]Cbther
11512„S 441 and we ha.eao amptoyes:.role worker:cep.imorancaa sill
*day applicant that chinks b:er=T roust abo fin,nut the sectiontelarr shariag theirscertl-er'cca pansationp+olicsrimaol:madam.
IRemacunes Talc submit di:aYfids+sat inlicatinztlhe are dcmg all worlsaadthea]i onni3arcontractea cant sa%mistaacaraTaia itie3ictir. :u&
enttavo:a:that char&ttli:tcs must annhad ma aiMitioaal Omit shaaittg the aa=of the s iircentr..ctar:and:ma whether ergot time entitle:haw
crple se:. lithe.ubzzats:.don hare employee:.they=apmtida tram:rsorke.—"romp.pelicy at titer. j
Iamon employer that isproruruarworkers'compensation insnranceforIncerrlployees Below as the policv conljobsi¢e
i
acurance C'ompanyName 1
{-- — — ---- - —
---_�-- - -----1
Polite or aelf .F.c =�' I E��aiiatiolt iI ' •
Attach a copy ofthe'workers compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coveraQ"e as sequiredunderNIGL c.152_§25A is a raimin11liolatioanp> .hb1ehy aline up to S1511 .110
au 'croi -i,ear inprisotnnent as well as dui gemakies intim form ofa.STOP WORK.ORDE Ranch fuse ofto to 5251100 a
day againagairotthelio'latcr_A copy of this scat miitma+rbeforwardedtothe°likeof%are✓-ti ation:oftheDLL£orinsmamce
coverage-verification
Tdo herein califs,tinder the pains aand,pa naltaes ofperjthy that the ipforanationproritledair alas trite and dearer,,
Official ane only. Do not mite in&is area,to he completed by clop Or town official
City or Town: _ Permittl icense 4. I
Issuing Authority(circle one):
L Board of H_a ltth .•BuildingDepartment 3.Cit Town Clerk 4.11estrical Impeder a.Paaaa�bingInspector
6.Other T a-.. _ -
Contact Per:cn:I Phone Ft -
1
City of Northampton
f.• ojr' Massachusetts Q}Srs... '..si�!`�
S_ J , tom iG
'" '� DEPARTMENT OF BUILDING INSPECTIONS \yJV. a
212 Main Street • Municipal Building d.. .c
C . " Northampton, MA 01060 J5l.,,V5, .;0
D EOWSTEIN ENEMTIO EMIBIP WER 4Vl
I, L.'t4.il M a li Wa1v+4z— (insert full legal name), born �� -7/72- (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.
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 /a day of uti 20�'-
/-------- .._
(Signature) 1
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