23A-193 BP-2022-0126
29 BEACON ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-193-001 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-2022-0126 PERMISSIONISHEREBYGRANTED TO:
Project# BATH RENO Contractor: License:
Est. Cost: 15000 KUEL MCQUAID 051394
Const.Class: Exp.Date: 12/11/2022
Use Group: Owner: AULT JAMES M JR
Lot Size (sq.ft.)
Zoning: URB Applicant: KUEL MCQUAID
Applicant Address Phone: Insurance:
131 FERRY ST 41335375063
EASTHAMPTON, MA 01027
ISSUED ON:02/10/2022
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department [MI e«a} Final: Fireplace/Chimne':
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:
it• y2 . (RI1
Fees Paid: $98.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
; .7 -8-----C-----------
-=_.yj
i, The Commonwealth of Massachusetts FEB
Board of Building Regulations and Standards; B 20`
W Massachusetts State Building Code, 780 CMI&_ FCIPO FO ITY
_,T n..n r US
Building Permit Application To Construct,Repair,Renovate tlegi rasa seas ar 2011
One-or Two-Family Dwelling A o oso
This Section For Official Use Only
Building Penult Number: iS P— '�' 1 Z(P i Date Applied:
!iiv it i 2. /,)v/ '�
Building Official(Print Name) I Signature lldte
SECTION 1:SITE INFORMATION
1.1 Prop rty Address• 1.2 Assessors (G Map&Parcel Numb,'"
�1 r5 eke" T. FI.o,Rr Uc.E NA d'0(Z 3,4
1.la 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❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 OTCr""� rtt:.oa s A Record:f
J � -t�,1 Ft-o r2e N c,G. M +°t D I O G Z
Name(Print) City,State,ZIP
7g Reekcoa S1, x' 413 1('-,,90 jo eS.41.l?Uwlta)jWAi) .Co
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 2,t( C(0p.< QAMh ,Ce..W.0 d e
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ es p D 1. Building Pennit Fee: $ Indicate how fee is determined:
2.Electrical $ .S 000 Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 6000 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees $
Check NoAlI Check Amount. 66 Cash Amount:
6.Total Project Cost: `(7 0 0 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
..."Z. s,/c
t •�" Massachusetts e
DEPARTMENT OF BUILDING INSPECTIONS �. x
212 Main Street • Municipal Building Jti CDM
Northampton, MA 01060 ssfN, at)\-\`
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
'3. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted wim permit
application before issuance of permit.
4 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 Li se(CSL)
/� ` ' CS-OS/3 94t /0(/Zozz
L.( /'` t . QJ License Number Expiration Date
Name of CSL Holder
/3 ' �G< C �j List CSL Type(see below) V
No.and Street Type Description
C S,�[�A \
0.A.0(N � (` 6 co(o t7 U Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,State,ZIPR M Restricted I6L2 Family Dwelling
RC Roofing Covering,
WS Window and Siding
�S37-So63 SF Solid Fuel Burning Appliances
4�3
�V(,Qo�,.0c• l�ut.l '� kka. ,CO w\ I Insulation
Telephone Email addreC I) Demolition
5.2 Registered Home Improvement Contractor(HIC)
KEG( �� Q��� �0�700
HIC Registration Number Expriration Date
HIC Company Name or Registrant Name
131 ru c j 5"' m cQ ,dQ .k .I .Cowl
N and Street 1 , NA O 1o27 �3-S37 -S06 5 Email address
City/Town,State,(`ZIP r 7 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 of the building permit.
Signed Affidavit Attached? Yes No ❑
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 K el MC a v a► 4
to act on my behalf,in all matters lative o work orized by this building permit application.
'TWA(E 5 M, fl-u c.i 2.6 2 2-
Print Owner's Name(Electronic Si l 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.
Aw( MC Qut44 21gr?el 2
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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. 142k 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.govydvs
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 systcm Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OI' NOKI'HAMPTOl'
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
The Commonwealth of ifassachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston. MA 02114-2017
-,:,....e40, mew mass.gov'/dia
's1 rakers'Compensation Insurance Affidavit:Buildersl('ontractorsJl:kctriciansil lumbers.
f(1 HE HEED W41111 I HE PEKNI 1.LING Al 11101(1 IS
Applicant Information Please Print Letibls
Name(llusinesseO ganizataon.'tarlividual l: Ku e-( /t 1 u1 C u&W Gl
Address: / ( f;c "-
CitylStatefLip: - A65,_ /4/t 0(o27 p1li,n, if l3 . 37-S063
Ant yaw an earpltn rr'."t bolt the apprvltrriitr lM(t: 1
Type of project(required)_
Irl 1 mu a er lob e7 meth cu'�r cos{till allot Iimincl-'
7. D \,i.vv construction
_r: :uirt a,.ik impactor or l 11111rihip and haw no employee,working kir me in
ennxlclmg
any capacity I%.'moiler,'comp.urwraner mimed' 9. El lki iolltlon
ICJ I a111 a IMHIr141V1m1 thong all wnd myself..!No 1,polkas'comp 11r411alnee required"
4.0 I am uv a lion .wnet and mod I.c hump contractor,traetor,to conduct all work run my property. I wad10El Budding addition
ensure that all unllractorr either hie worker,'cr.ngietn,:ition ue urance t r are rule 1 LEI l:Ik'ttracal repairs or additions
proprietor,with nr,e711pitl e'e's.
12.0 Plumbing repairs or additions
50 I ant a gcmtal eoiUaetor and I have hired the,td.,rontiack.rs hrteJ..in the attached dseid 13("1 Root-repairs
These sib-conttackln ha,e employee,and hart*urger,'comp.uesurauce. "L J
60�' 14.0 Othe
Wt an:a cr.giuratiun and its utlrctr, erci,d their ngIii of exenrptini per 11t(iL C. —131. It41.and we have nu atgrlowc,.l *oiler.'comp.insurance rcquueal.l
'Any applicant that chucks bus xl inusi aim fill out the section 1i,hwn shamans their w.irLer,'cv.inpealgtaapolicy iskentrum_
t Ikanev.waci whim submit slur atlidastt indicating the!,arc dr.in1 all work and there lute r.utsidc committees nowt submit a nc4v atilda%it itnlicaim1 such.
:Contractor,that check ter l.o%,nua1 attached an additional shout shim rng the mane r.t the sulk-euiiin,ctr.r+and,talc ns hrthe-r on not tlr.sc imtita-s leave
c-inplot,cr,.. It the tuts-contrackns bare cal(rlo...s:..they must pia.tidc their worker,'comp.policy number_
I am an employer that is providing workers"compensation insurance for stay employees. Below is the policy and job site
information.
Insurance Company Nance;:
Policy a or Self-ins.Lie.lt: Expiration Date:
lob Site Address: CitviState Lip:
-
Attach a copy of the workers'coinprnsatlon polio'declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,*25A is a criminal +,iulatim punishable by a line up to SI.5O0.t0l
auk or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250110 a
day against the violator.A copy ofihis statement troy be forwarded to the()eke of Inv estigations of the DID(or insurance
cos erage verification.
I do hereby certijj•un er the pains and realties of-perjurr that the information provided above is true and correct
Signature: 14Q. � �'�%�v Datc: 4 202..Z
2
Phone*: 163 - S37-6663
1t .1
I Official use only. Do not write in this area.to be completed bycitl'or town official 11
1
Cif!, or"Cows: I'ermitiil icense* I
issuing Authority(circle one):
I.Board or Ilealth 2.Building Department 3.City/Town('krk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone*:
City of Northampton
atH4Mt.T
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47 ' .
Massachusetts �� x_ .
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� � t• • DEPARTMENT OF BUILDING INSPECTIONS �. s, x
4..,�,"a_ clig,' 212 •Main Street • Municipal Building y`)ti b4
\� ��a� Northampton, MA 01060 �'rMW .O<��C
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 e
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
•
The debris will be disposed of in:
Location of Facility: Uo,_kle ce Gf e ifoc-1-{trA ti 1-0(/‘ MA
The debris will be transported by:
Name of Hauler: Xle-( Qv r►. . J
Signature of Applicant: Date: Z 2 f2Z_