11A-062 (4) BP-2022-0110
9 LEONARD ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
11A-062-001 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-2022-0110 PERMISSION IS HEREBY GRANTED TO:
Project# WTR DAMAGE Contractor: License:
Est.Cost: 18500 MARK SARAFIN 053434
Const.Class: Exp.Date:04/28/2023
Use Group: Owner: O'NEILL SUSAN F TRUSTEE
Lot Size (sq.ft.)
Zoning: URA Applicant: SARAFIN BUILDERS
Applicant Address Phone: Insurance:
85 RUSSELLVILLE RD 4135639256 WCC5005019027
SOUTHAMPTON, MA 01073
ISSUED ON:02/03/2022
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO BASEMENT DUE TO WATER DAMAGE
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: I Q/
• , ' A .
s� �(
Fees Paid: $123.50
•
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
r @EcEI vE
-- - •-,
S, The Commonwealth of Massachusetts F E B r 1 2022
UIBoard of Building Regulations and StandardsFOR
Massachusetts State Building Code, 780 CMR -- TONS_MUNICIPALITY
is' TIONS USE
Building Permit Application To Construct,Repair, Renovate Or Demolish an n-Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: PP "---- NO Date Applied:
, 3
Building Official(Print Name) Si8n ature -� a
SECTION 1: SITE INFORMATION
1.1 Property Addr s: 1.2 Assessors Map&Parcel Numbers
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(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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
u.,c,,,,. b nse• LeeA ii�M - o►&s3
Name(Print) City,State,21P
(3\ L.evla4 cc) S 4- 113 -f 3 -4-1-.?Lo
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) Alteration(s)A Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units ^ Other 0 Specify:
1i ef Description of r000sed Work2: Re t z c,,,1.)tvecY -1✓jSE-14,1 c•1 1 AU -fib L .L-S
G•\+^Cie e (\j'v o.k-e .21,\-e,t,o-2 wc.\iS NvoS\,►.,\\ , ..ew \c, 1nks c..
2J‘(--eS GISLVI-Li►iJc. 1\ 1uiU\\g tkik• Awll Cep\—�, %.J.K.�Q Vo Ct.�`2 . .- .
v\w.w Cl-.t\ry Lk`i1A4-.
SI&TION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ l 5 006 . - 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ CI Standard City/Town Application Fee
�'cOo. 0 Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ — List:
5.Mechanical (Fire $
Zil
Suppression) Total All Fees: $
19.
Check No.1O23 7�fCheck Amount:l?3'S ash Amount:
6. Total Project Cost: $ I p j00. - 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
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G� Massachusetts
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• DEPARTMENT OF BUILDING INSPECTIONS
r" 212 Main Street • Municipal Building
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,ate Northampton, MA 01060 ssdyti TON'‘
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW / private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
C5—o5343y LI a8—a3
V\A‘AvL\L S IA,2‘a-F\.-\ License Number Expiration Date
Name of CSL Holder
n List CSL Type(see below) U
85" Q,�,S-e t1,,, 11'e a o
No.and Street Type Description
� _i 1 �� (7 � OIG�-� U Unrestricted(Buildings up to 35,000 Cu.ft.)
� R Restricted 1&2 Family Dwelling
City/Town,T\••State,BP
M Masonry
RC Roofing Covering
WS Window and Siding
1 SF Solid Fuel Burning Appliances
4413--3 —9.9 5'6 S Q Q 'Pe,.l'e -I I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
.0��"4 ,`-+ HIC Registration Number Expiration Date
HI Comp Name Name or HIC Registrant Name I
No.and stye 5 V.4R vyc 9- CLa e�+etZ,vi ti
` e_ 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 Pc 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 V v\ JA-✓Z L S 1AvZ w -•••'''\.
to act on my behalf,in all matters relative to work authorized by this building permit application.
<;L d vl.e. l —a $ a s
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name be w, I hereby a test under the pains and penalties of perjury that all of the information
contain 'n ' pl. to true a accur a to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name( lectronic 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
The Commonwealth of Massachusetts
!e Department of Industrial Accidents
tt•slam
A 1 Congress Street,Suite 100
Boston, MA 02114-2017
WWW.mass.govfdia
1%urkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
it)BE FILED'4W'l`ID THE PERMITTING:AUTHORITY.
Applicant Information Please Print Leeibly
Name 1Bus tnc.;s Organization;individual): 'sv2%4' &..'-\ �5 \eQ.- —"Cs.
Address: p6_____(Z,,�5-t. I) �1.� 2�
, iii, cJ
,, _
City/statetz „„ (AAA- Q1 Phone#: L(l 3--5103
Are yogi an employer?Clack the appropriate boa.
Type of project(required):
1.011 am a employer with J employees(full and/or pan-time).* 7. 0 New construction
2171 1 am a sole proprietor or partnership and have nu employees wwrking for ran iri R. Remodeling
any motility_[No workers'comp.insurance required'
3�lam a homeowner doing all work myself.[No*mire's'emir_ivauram a required.]' t"� +lition
4.0 lam a lutmcowmrs tw and will be hiring contractors to nduct all work on my property. 1 will 10 Building addition
enaun that all cmnrraesnra either have workers'compensation inwuranm or are sole II°Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
lam a general contractor and I have hired the sub-contractors listed on the attached sheet a Roof repairs
'these sub-cr ennien rs have employers and have workers'camp.insurance.:
6.0 We are a corporation and its officers have ekercised their M right of exemption per GL c. 14. Other
co
152,E 1[4),and we hams no employees.[No workers'comp.insurance requital]
`Airy applicant that checks box n I must also fill out the section below show inn;their workers'compensation policy inforinatiun_
f Homeowners u hu submit thus atrtdahtt utdreatine Llrcy are doing all work and then hire outside contractors roust submit a nex aftidm it indicating such.
:Contractors that cheek this box must attacbed an additional sheet shun ing the name of the sub-contractors and state*holier or not those..rubes haws
employees. If the sub-cuniraetors etrrployees.they must provide their workers-comp.policy number_
I ant an employer that is providing workers"compensation insurance for my employees. Below is the polies and job site
information.
Insurance Company Name: 41
Policy#or Self-ins.Lic.#: I...-)CC— CaC7�-`sbl�6 ate-ate) r4- Expiration Date:: —7" )—
.lob Site Address: 1 Levi 04 COy -j d City/state/Zip: (V V4 O 1 a5 j
Attach a copy of the workers'compensation policy declaration page(showing the policy number anal expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51,500_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 of the DIA for insurance
coverage verification.
I do hereby certify r e pa an cities ry that the information provided above is true and correct.
Signature: / Date:
Phone#: 14/3— �(��-9o?SLP
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
p0.1-H�+AGMiro\ 5 "" S
Massachusetts 4�,/ °._ ��%
ali 16L 'i 14 DEPARTMENT OF BUILDING INSPECTIONS '.
a 212 Main Street • Municipal Building %.) ,t,
\ ):: Northampton, MA 01060 ss`. j1�
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: 1/ \u,2 a..r, ?1 a✓"
The debris will be transported by:
Name of Hauler: J�‘fZvak..,-1 ��\1eD•J z
Signature of Applicant: Date: f_e; g-077