22D-031 (9) BP-2022-0203
128 RYAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22D-031-001 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-2022-0203 PERMISSIONISHEREBYGRANTED TO:
Project# MUDROOM Contractor: License:
Est. Cost: 1500 THOMAS MALONE 055236
Const.Class: Exp.Date:01/18/2024
Use Group: Owner: MALONE THOMAS P& PETER A CABANIOL
Lot Size (sq.ft.)
Zoning: WSP Applicant: RHI CONSTRUCTION INC
Applicant Address Phone: Insurance:
128 RYAN RD (413)885-9038 7PJUB 1 K060384
FLORENCE, MA 01062
ISSUED ON:03/01/2022
TO PERFORM THE FOLLOWING WORK:
CONVERT PORCH TO MUDROOM
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: f
I. , . �'1 .
I ' l
Fees Paid: $70.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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' Co , ' The Commonwealth of Massachusetts
N Board of Building Regulations and Standards FOR
COi Massachusetts State Building Code, 780 CMR MUNICIPA L.TY
�' t w USE
&Aiding Permit Application To Construct,Repair,Renovate Or Demolish a Revised Ma•201i
It"" One-or Two-Family Dwelling
r This Section For Official Use Only _—_
Building Permit Number: O/'" -J.-, aU Date Applied: -- _
K v i►J /�1/os' - ,C 3 1 ZOZZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Addres • 1.2 Assessors Map&Parcel Numbers
\ate �. � - - � 10 03j
1.1a Is this an accepted street?yes no Map Number Parcel Number _____
1.3 Zoning Information: 1.4 Property Dimensions: I
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) -i
1.5 Building Setbacks(ft) ___.
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provide I •^
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;
`—Cti cr i ')makc,t /p (AS 4t w l e-c. -- CCU t. Z
Name(Print) City,State,Z1P
\a.g- (L (L>. - ay- A-�‘r\Lrt,rz✓.,(rek-•-
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) fill Addit on C_
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work'-:
u.,C---- L t z—E,. 5t,rr,r-,n cVl " VA---6C r xc2-4Y•
SECTION 4:ESTIMATED CONSTRUCTION COSTS _
Item Estimated Costs: Official Use Only
(Labor and Materials) _
1.Building $ 1. Building Permit Fee:$ Indicate how fee is deter line(
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$ 3S,
Suppression) Check No.3 (-4 egheck Amount: t:_-
6.Total Project Cost: $ I ca)-Uv 0 Paid in Full 0 Outstanding Balance Due: . ..
reto I-vTh5 /1.60
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) —
� rs- ass�3� -- (
-1 r_^ s % License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
?' c 1 U Unrestricted(Buildingks up to 35,000 cu.ft;
Lk t L R Restricted 1&2 Family Dwelling -�
City/Town,State,ZIP M Masonry _ .-
RC Roofing Covering
WS Window and Siding _
hem�C- � SF Solid Fuel Burning Appliances
`
�i��4��4 �� � I Insulation --_-_-_-
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) -
Cr. \iclA isn
C l b~i
HIC C any Name or HIC Registrant Name HIC Registration Number Expiration Da e
(Z.,✓1t - I ,Pe
No.��and_StreetCs �CJY�
C "^�lL t o O t b ti Z y� �-c.0 p Email address
City/Town,State,ZIP Telephone 0
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 WREN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize ' i\QlY\s«S
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) 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.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered covtracto?
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitratior
program or guaranty fund under M.G.L.c. 142k Other important information on the HIC Program can be f.and:i t
:w v w.mass.f2;o 'oca Information on the Construction Supervisor License can be found at wv,.%,,.mass.<izo\
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or por;:h)
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
J
Massachusetts 's. ° I
( t )pfm,'4 :,:': II '-:;
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DEPARTMENT OF BUILDING INSPECTIONS
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212 Main Street o Municipal Building ".
4� North ton, MA 01060 'rr 'l
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 di:;post d if 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: \lc k J
The debris will be transported by:
Name of Hauler: \J\LAne\-c S V-"(--
pp
Signature of A licant ��� Date:
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" '_ The Commonwealth of Massachusetts
- -- Department of Industrial Accidents
--~?i 1 Congress Street,Suite 100
. Boston,MA 02114-2017
w . _:4_� wwww:mass.gor/dia
11"t kers'Compensation Insurance Affidavit:Builders(.ontractorsJElectrician tPlutn(ter-..
TO Ilk:FILED Wirt!THE PERMITTING AUTHORITY.
Atltilieant Ittfort:tii_ ciii Please Print ,,-i_itlt y
Naive dirt, •:a:trganizatt ani I ndtv idea:): Q —% C,sjVZt ,., >•.c (—
Address: \rZi'tr`( z.N.. N
_ _ .._ •
CityIStatetZip: \— 1--U1Uio Phone-#: L►\�'g$3 go ) __
Are putt an evapiuyer:'Cluck the upp;utrriair bin: Type of project(req. iced �'
1.r0- J ant a im ct plav tt ith_...__.- p':en Jyecti d j
(dial an it part-tixr:t.* 7. 7 r New cl Shasta Jig
2.i_J 1 Ant a wse proprietor or paint-dip anti have no cinpleye a W urking for cr.:in 8. 3 Remodeling
any t-sp:teit_Y.LNu Nurki:n.comp.WLnintai rccpinial.,
30 1 sift a hunx ttner doing a4 m'hurls i ads.INC.w arkus came+.inauruur rtyuircil. .
9. 0 Demolition
It)0 Building addii:i::i
+.r1 i:urn a hon:count-7 and-4J1 de hiring Lvntructurs to tvndemi all ti.ark on my praxrty. I will
rnsen:that all tY ntractun.%i.h r ltast-Nari.crs."ccnipiniaa::ni invia:mM'i:ec are aLk I 10 rep_Electrical re :_,'- ::K.:ions
41
pruprinlan s ith nu cinpluycca.
12.0 Plumbu repot :s_rr i dd*ns
aria a ccaerai cunira`tur and 1 La:a hired the pub uniraaixa limai tin ti:•_a:'aeitcd,':ices. 134 Raul repairs
Thcae aubti-cprtracton hate cmphry ea.and ha t v iiitem conc.iflat.rr -
tAke ()Gen
(..Q t4'c:in a eti rstia�pat:its otYieua hat t Cliertiseal ttk'U right art c.teir.Lim i - Other
-;:.: :. �'- per ti.(iL r.
1 t2 i I14l.and ttc have nu tanplu}ica.[Nu+Nutkers'Lamp.in trance minima.]
•
'Any applk.ort'that chLL-ka bat.ul!nz t alw lilt Uli the rc'Ciknl:iiuw'show ink their Nurkta-s'coiYipcnoiiuri i.e,licy inle;nriatien •.�
i inmeuwnen who at:Knui th:a affidavit indicaiin_,they arc drier mil»ink and thin:tvrc i:utai&ianiracisra rut Sabra:[a new at_1.i,.1 it in a...::1 .t,:
tCuntracton.that check this b:.x,tru:a3 atta heel an adaitiurral ahent alma[in th•name cf the i.u.^-:ontni`tura and Stets V.hater or nut thuuC r:-..s:c, ;. -
e7npluycca. if the pub-eurtraetime hate ern kr per..they carat rut ide their worker-a'ecnip.pulicy ntanhn.
I rpm an employer that is providing tvorl er.•'compensation insurance for my employees. Below is the policy i,nrl ja i i 4i
information.
Insurance Company Name:
Policy#or Self-its.Lie.#: Expiration Date: /��
Job Site Address: `' 1lr ,ram,4' CityiStateJZip (I,n,-t/(.� f `---_QW
Attach a copy of the workers'compensation policy declaration page(showing the policy number and exp'ratio I d*L e).
Failure to secure coverage as required under MSGL c. 152.;25 A is a criminal violation punishable by a line up :. t:.(.l
andror one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of a ::- '- :5 ',!r a
day against the violator-A copy of this statement may be forwarded to the Office of Investigations of the DIA 1 ::_.,
c:r. rat.!verification.
1 der hereby certify under the pains and penalties of era that the information provided above is true and c.irreci
ci_nacti*c: ."7 Date: �� `r _. —
PI:orie i� 4 S4
1 Official use only. Do not write in this area,to he completed by city or town official �!
City or Town: Permit/License;4
` Issuing Authority(circle one):
I.Board of!health 2.Building Department 3.Cit4:+Town Clerk 4.Electrical Inspector 5.Plumbing nspe; or
6.Other
Contact Person: Phone#: 1
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