29-346 BP-2022-0144
80 AUSTIN CIR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-346-001 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-2022-0144 PERMISSION IS HEREBY GRANTED TO:
Project# BP-2021-1710 Contractor: License:
Est. Cost: 44200 VAL SHEVETZ CSL087690
Const.Class: Exp.Date:07/08/2023
Use Group: Owner: DUVAL JENNA E
Lot Size (sq.ft.)
E DUVAL JENNAOAK RIDGE CUSTOM HOME
Zoning: WSP Applicant: BUILDERS
Applicant Address Phone: Insurance:
80 AUSTIN CIR
FLORENCE, MA 01062
PO BOX 63 (413)374-9236 WCS-315-384694-037
EAST LONGMEADOW, MA 01028
ISSUED ON:02/16/2022
TO PERFORM THE FOLLOWING WORK:
BASEMENT 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 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:
1. yQ - 'NT
Fees Paid: $286.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
1 ry ---.O....._.
1 '.7•:-. ..
�e \1-
1.1J
The Commonw•rtlth of Massachusetts T of
'1�r,,�r q FOR%ri~ Board of Buildinz.g,Rez*ttlatians and Standards -:
Massachusetts State Building,Code,780 CMR �. ? ' k-`1 2I TY
Building Permit Application To Construct. Repair,Renovate Or Demolish a Rot is`?d Mar 2011
One-or Tito-Family Dwelling
This Section For Official Use Only
Building Permit Number: (6 P -._/._c/_y Date Ap ied: _....._._. ...-
..! , . i , T,Cui-e( /6X-d.
Building Official(Print Name) 1 Signature 4V
Da
SECTION 1:SITE INFORMATION
1.1 ProutertmAd, ds: 1.2 Assessors Map&Parcel Numbers
8 St.N G_°%Y._..-. ____-__.
1_la Is this an accepted street?yes__ no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage t fu
115 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.tU.c.40.§.54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Floxxl Zone?
Public 0 Private 0 Check if yesD Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of ecord:
C i1 -._. f V 1—. __,_. . . 2i CQ- __.._ v[�
.......
Name(Print) City_State.LIP
gV(Print.4)
_. 41133711 8760
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) D I Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units_____ Other Specify:__...
Brief Description of Pro osed Work :_......._13fe ._ f
.... 00---3-ED-g0t) li .
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only
1. Building S 1. Building Permit Fee: S ___.,.. Indicate how fee is determined:
2. Electrical S 5fe)00"" D Standard City Town Application licaticm Fee
`� 0 Total Project Cast'(Item 6)x multiplier x
3. Plumbing S 1000 ` 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire
Suppression) S Total All Fi,e4f5 00
Check No. Check Amount:._....0........__Cash Amount:
6.Total Project Cost: S f 0 Paid in Full 0 Outstanding Balance Due;
V / c2OV
SECTION 5: CONST.RUCTION SERVICES
5.1 Construction Supervisor License t CSL) �'^ s776s0 �7/
`� G/G? ram' L _t.�x iritt
1.3
1/14 Ii• 1 Z� License Number I.
Name of CSI._Holder
List C:5L Type(see below)._.__ _.'_.
pVl� f ..__-- —... _._.__._..._____._ --_-_._ Tv Description
No.and Suce
_E C 1 r, // 1 , 1. l� tare+tricted t C3tuldin up to 3S.tkX)en It.)
—. -_ R Restricted Iik2 Emil Dw ding
Cit''Town.State.ZIP '4 Masonry
RC Roofing Covering
__.__.......... _ ..__�. WS Window and Siding
�j
_ SF Solid Fuel BurningAppliances
�!/ 7 f9023b L 7 ylotli 1 Insulation
Telephone Email address D 1 Demolition
5.2 R 'st red flotne Im ovement Contractor(HIC) i
i el .
�_j _ ,511��= /sera96 9 .
IIIC.Registration Number Expirat on Date
IHHC "ow_nn 's:amc or fir Registrant Name
No.aael-Streeti Email aiddress
. - _ .-..:.1°4-eodo&- /..337'yg2
4
CityTowlt,State ZIP / alga' Telephone i
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)1
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 buildings permit.
Signed Affidavit Attached? Yes . .......34 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 1441 .5 leive a,....
to act on my behalf.in all matters relative to work authorized by this building permit application. .
cg."41114 14 DUO-I 4 ot J a.
Print Owner-s Name(Electronic Signature) ate
SECTION 7h: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.vial E,
i PrinttT __..._ �1� .4-z.• _ ..w_- /ic) ."3'
.2,
Owner's or Authorized gents Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do hisher own work.or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor tHIC)Program) will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the H1C Program can be found at
Infitrmation on the Construction Supervisor License can be found at
2. When substantial work is plume ,provide the information below:
Total floor area(sq.ft.)_— (including garage.finished basement attics.decks or porch)
Gross living area(sq. II.) • 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- 1
The Commonwealth of Massachusetts
Department of Industrial Accidents
f I Congress Street,Suite 100
Boston, MA 62114-2017
www.ntass.gorMia
otkers Compensntion Insurance it:Builders/ContractortiElectticionallumbers.
To BE Ell_ED S%I Fit Tilt:PERNITI-IING.41-1110RITI
A.riplicant Information Please Print Lettiblr
Name,z131./.sInts.s 11)fgantzatiou Inetzv'due t.
r")
Addr -ss'‘ --.„
CitylState:Zip'.
11- -
F
Art..tota aiactnpiT.en2t.htttit thr proprizie hoz: l'ype of project tre4uiredy
th a,Turtaycl 4.1th / anz-nt„t ):1,aza. 1'10 arid os 7. t3Nty.0>ftsfruLlaun
20 am a wiz'Itturniam rantacr,ia4p arn::tnivcincnirkytv,WorkIng Ayr Err I X. Remodeling.
any capfc.31y.[No wttricr,,. sump.lasa.ut3n
9. Demolition
ans a 144,111rAN,M41,1C11,141irly all ni..64.rnad1.fS4.4'1401.k4171°,' SM'XXIMI1XX4 MX1141101:
, 134.33kt:tag addit,03,
/ana hortklaWnei 111ii 11C i111111y11.4M41/44-10Y1 ramadiat XXX1444:1141in ppoptatl), I wall
tIttital!tut cnattainora cither have W4.414:t1S4 i."14/11X111111/4/11 Innuranix. wait 11 a LIN:Aril:al rt..Tasrsur
pnprr ith tu,enttivytzta,.
32.0 Pluiribmg m-pairs or additions
.ant. ,eznicsalivauttcwf aati I iter,•.e hard the ut, itEractorNliited untbe air.atatiVI slax
I
r ]Roof repairs
htv.v cdtplo,,,ce.,and Inn c 1,,,yrkerh'emnp.insurdne.e.,
14_nOlitel
t:.rj trx. rerttttratom taut th ttitirttrs hake-exereis'od thett right-of cm:thrum rta Mot c,
k;1141.arn ha ttr etrg5bsves, No%wrier's' irnp.ien,ierance equited.1
*AfIX 41111111CM14 1h4t uus.the m:efion tv1,14 Nitt"ting thee;140,1144.,/x,'&MtnIpts41,3/Ionttheitlenti:4/1,,4/1
flonicowa.zts Ahn tuhne iIi affida‘ii thin.-autts they atedoin;all and then hue •,,,,a6rart a new aiti4a*t. such
4:untrue. that duck"ihtt ktt.tritAt anaduttianatsidttitmtal Nheet shriikivie the name et thc adth-coattniattr,.and Alec hcillaz-1.4T atttt thttat:t_ttlittirtine
ft the?;1;,b,ciantt. -ter%tutt.e‘-ftgAir41.%i.the fmnit en;,LVnrip... nnerztlef
fiat on employer that is providing worAers*cotnpensation insurance fOr my employees. Below i the polity imd job site
inforstation.
Company Name:
Policy-4 ot Se1Iim. L . /PCS-- t217 Expirauon
Job Six Adtiz,:.-:,s:01.2,4151/9/1:;i0' it7121----e/Ate figiWStitic ai4.2.
Attach a copy of the 441 orkers'compensation policy declaration page lshoriiiig the policy number and expiration date,.
Failure to'wean:covera,4c as required under NIGI.v. 152..:,*'25A o.a criminal violation punishable by a line tq to Si.500_00
and.in one-year itoprisonimmt..as 0.ell at,civil penalties sn the fonit tila STOP WORK ORDER and a in ufiip it,S250.00 a
the violator, A.i.opy oithistatement"nay be forwarded to the Oilier Invesligabous of the DIA for insurance
VertitC-itt11.
1 do he-eby certify er pal mritiry that the iniortnation provideti obove is true andrarreet
•
) 110.1;.-
sivitatti
Phonv 9/-3 3 7 41:2...3P
Official tte oak Do not write in thi.t area,to be completed by city or town official
F
City or Town.: Permit/License#
Issuing Authority(circle oat):
I. Board of Health 2.Bonding Deportment 3.CitylTioati Clerk 4.Electrical Inspector 3.Plumbing Inspector
6.Other
Contact Person: Phone 4:
City of Northampton
;0744
�V,`
ff
•�,� Massachusetts
+• — 74 1 _
t'k<., j'p DEPARTMENT OF BUILDING INSPECTIONS f
i5= a, 212 Main Street • Municipal Building y ��
tip` Northampton, MA 01Q60
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$iq A Au I La4o(Sc4- c 1
The debris will be transported by:
Name of Hauler: LV$p i l alai
....„
Signature of App • nt: • ••) . Date: ..,.3 /U .2