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31B-146 (2)
BP-2021-2071 1IOKING ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 B-146-001 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-2021-2071 PERMISSIONIS HEREBY GRANTED TO: Project# REPAIRS-TO RAMP Contractor: License: Est. Cost: 9500 CHRISTOPHER FONTAINE 075432 Const.Class: Exp.Date: 1 1/04/2022 MELNIK PATRICK J JR &ZOE B ZEICHNER Use Group: Owner: TRUSTEES &OTHERS Lot Size (sq.ft.) Zoning: CB Applicant: LALIBERTE BUILDERS INC Applicant Address Phone: Insurance: 296 AMES RD (413)335-5131 LAWC290283 HAMDEN, MA 01036 ISSUED ON:02/22/2022 TO PERFORM THE FOLLOWING WORK: REPAIRS TO HANDICAP RAMP 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: cs-1� . 1 • lirFees Paid: $100.00 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED OCT 2 1 go' d i-�07/ 202 I he Commonwealth of Massachusetts ' Office of Public Safety and Inspections PT.OF BUILDING INSPECTIONS Massachusetts State Building Code(780 CMR) r NORTHA = I I 1 t l o _ Permit A; t lication for any Building other than a One-or Two-Family Dwelling (Thie C'nr•finn For Official T Ten()nhr\ Building Permit Number BA 11.-Art d Date Applied: Building Official SECTION 1:LOCATION No.and Street /T Zip C de Name f Bui1din (if applicable) 110 14-1 S� City ' vp�d� C7 Cobb re-4ti.i It Assessors Mal p# Block#and/or Lot # SF('TION 2 PROPOSFD WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building ElI Repair Alteration ❑ Addition 0 Demolition ❑ (Please fill out and submit Appendix 2) Chance of Use 0 Chance of Occupancy ❑ I Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 Noalit Is an Independent Structural Engineering Peer Review requ' ? I l Yes 0 No,t Brief Descrip ' n of Proposed Work r'et)i17,1",e, P ,1 CA.t/L r�grt l lrS cs►& ln.oLyka:cic, r ckyv,P 1 SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): I Proposed Use Group(s): I SECTION 4:BUILDING HEIGHT AND AREA uulg I Proposed No.of Floors/4tnries(include basement levels)k Area Per Floor(so ft) I I Total Area(sq.ft.)and Total Height(ft.) I I SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business E: Educational 0 F: Factory F-1 0 F2❑ I H: High Hazard H-1 CIH-2 0 H-3 0 H-4 0 H-5 0 1: Tngtitiltinnal T-1 CI TO 1-3 I-4 M: Mercantile❑ I R7 Residential R-10 R-7❑ R-3❑ R-4❑ S: Storage S-1❑ S-2 0 U: Utility 0 Special Use❑and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA CI IB0 IIIA0 IIB0 I mA0 IIIB0 I IV0 IVAD VB0 CTlTTI T A.OTTT!TI.TTl/1i11 rL TT/l1T I--t......L-nun 0.,TL III+ne n t..-.l-f....1_ L IL__.\ O&M..l 1V1\ I.JAI L.L A 1V1�LVL'1 111/1•k1CLCL LV IOU UV11%LW.J amUCLAl1A or.caLll Amin) ITrench Permit: Debris Removal: Water Supply: Flood Zone Information: I Sewage Disposal: I i Public 0 Check if outside Flood Zone 0 Indicate municipal CI A trench will not be Licensed Disposal Site❑ reuired Pri�rafwo f I or in.4o ihfrr 7nnu• I "I'nn cifn eve*nm I_I ❑Or trench I Or specify: I I V I permit is enclosed❑ Railroad right-of-way: I Hazards to Air Navigation: I MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? I Is their review completed? or Consent to Build enclosed CI1 Yes 0 or No 0 Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY L I-1UVll V1 t.VUC. Ttise Group(s): _ __ Type of Vnstruc.LV1L Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: 1 SECTION 9: PROPERTY OWNER AUTHORIZATION NRepnd Address of Property Owner Name(Print) No.and Street 4 City/Town Zip Prmerty Owner Contact Information: 4 //sr`/ Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here I/ Otherwise provide gonstruction control Corms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address I Registration Number Street Address City/Town State Zip I Discipline Expiration Date 10.2 General Contractor 0 c. Company Name Cri CS — CY7siiv C5L II ,)_)- Name of Person Responsible for Construction License No. and Type if Applicable a.9 C, A ' S eiN.&, Ha.,, d,ex., t 0/03 6 Street Address City/Town State Zip Kra-G1r 3;-75 H/3 -513I /�.liter'10 igI ualtssC c,A ,c. tvi Telephone No.(business) Telephone No.(cell) e-mail address v SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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 Is a signed Affidavit submitted with this application? Yes I] No ❑ SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 4115©C) 1.Building $ 9/5 OQ Building Permit Fee=Total Construction Cost x 7 (Insert here 2.Linuitai :v appropnate municipal factor)=$ LIr. 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ /00 (contact municipality) LJ.ivas .auL kVLLLC1/ Enclose check payable to 6.Total Cost $ `1/ c U Q I (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By u.tuai g m` r-"le..x:low,I hereby iaaaiaat under he pains and uaiuw of perjury that all of the information contained ai.this application is true and accurate to the best my knowl and understanding. 1 1 je. A."a Pie6)oteYA La. S sWp--,71 PleasPlease print..«.1 sign«.ing T:41 Tele—-......No. rl..IC e suss and sign a.raaa tc a♦ a cac a. a a vv. ac j i r3 bw St .4�x. AL We N o1d-7 5 ` ' Street Address City/Town Stare Zip Email Ad ��Me I+it/\ P Municipal Inspector to fill out this section upon application approval: ly air\A R., .1 3I t , :2.4D. ._ $Naino Date The Commonwealth of Ivfassacnuseits it7,- .I, Department of Industrial Accidents ;;�,1= 1 Congress Street, Suite 100 LVJLVIL,1I1/1 0I+11-I-S FA I =t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): LC,l,lN,Ak eJ bp,' \atcs Address: ' ` eyZrklibv SA ` City/State/Zip: lAceitio2 ) MA C)IO`7S Phone#: -/ 13 03 -js� IAre you an employer!Check the appropriate✓✓ box: I I Type of project(required): Izu.am a employer with LI employees(tun and/or part-time).• 7. U New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 53Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.f Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. ROOF repairs These sub-contractors have employees and have workers'comp.insurance.t ❑ p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] /ply Upputitu I Will VlIL.II.WA M 1 L11LL11 a/aU 1111 VLLL UPI. •ylitiUl/11 I/L.1V W J111/ •W11%Llilill W VlALila LIVllll/Lilla4UUU puuVy 11110111141.1011. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: Vaii Ci fX 1 s U l;A vex /49 V Policy#or Self-ins.Lic.#: L-Cki43 C. a, l3 3 Expiration Date: 5—a,Cfra,a Job Site Address: J l Q K I'Ar\c Si City/State/Zip:iljUY 1`nA,IM9-fd h,iiT[ O( , Attach a copy of the workers'compeu ation policy declaration page(showing the policy number and exp ation dhte). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perfury that the information provided above is true and correct i IC) L-�t Signature: if/1/1/L.t-� Date: Phone#: 1 l �� 5-3 5 7 V Official use only. Do not write in this area,to be completed by city or town official �.IIy Vl IVI/II. A GI WIVLIbGLLAG/T Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: City of Northampton (MAM •, / 4 Massachusetts +Ss x- sc• 41� • � _ DEPARTh]E1VT OF BUILDING INSPECTIONS41-0 y t .f Northampton, MAy 01060 j4JV a,��° CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40. S54. a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: The debris will be transported by: Name of Hauler: 4- cAv)k („3d\A % Jlblla lulG v r-NNnbai �. _ - Date: 67...0v�`••''L 2/22/22, 10:34 AM City of Northampton Mail-110 king st ---------- --------- 4-4 / .. -- i / a —7-4r--- 4 4'77— 1;-\ 4— —m- ._-_ 4 -- _. ' - ,--y' t tJ" '' , t t 3 C 7 Ne m 1 4 t 6 �. ---$.„ -(st_..±,37,7,---c'!'j..cA,__.'t ,,Y_____7_,----'1 , _-____t„,,' , -,t,..- Q 1 1 d j ..'...-. 6 i 0 • A 4 _ https://mail.google.com/mail/u/1/?ik=e5d 1685713&view=pt&search=all&permthid=thread-f%3A1725385235104522678&simpl=msg-f°/o3A1725385235... 2/8 2/22/22, 10:36 AM City of Northampton Mail-110 king st µ' n .. ,......:.-7._. ..•'+� ,,rr..,, , "', sa .1„„;�,,, ;>"', °a"=„, '�'." ..;,..:;° 'fsa,';r' ✓fit,- =-•"�: .. nr %` ` Arai. ';'., r-.c.-r''� .,. .'tom+,.-r. • , tt • “�:> .-. ,;.:.3, �;"ssz\ r,= .. _". ,� ,• ,;.: ::4 �.3`�y '.a C•"a's �a'. 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