16C-037 (4) BP-2022-0205
378 SPRING ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
16C-037-001 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-2022-0205 PERMISSIONISHEREBYGRANTED TO:
Project# BATH RENO Contractor: License:
Est. Cost: 11000 JOHN SACKREY 079384
Const.Class: Exp.Date: 10/14/2022
Use Group: Owner: DECARO LOUIS J&JAIME L
Lot Size (sq.ft.)
Zoning: URA/WSP Applicant: SACKREY CONSTRUCTION
Applicant Address Phone: Insurance:
83 SOUTH MAIN ST (413)563-6639 0 WMZ-800-800-5793
SUNDERLAND, MA 01375
ISSUED ON:03/02/2022
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 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 • ›,9 • 1 •
Fees Paid: $72.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts �'
W
Board of Building Regulations and Standards ! MAR ,FOR
Massachusetts State Building Code, 780 CMR.- ��1LIUN FOR ITY
T' USE
Building Permit Application To Construct, Repair,Renovate Orif0liaiih [ -Reviled Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Builit Number:(3P- A 62.0 67
7Date Applied:
/�j�
l / 3-2-2022
,� ` h055
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Asses ors Map&Parcel Numbers
318 ,S e Kl.4 r S i, TI-41tiuL o _ I (IC Q37
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 Ow er'of Rec?fd• n
Name(Print) City,State,ZIP
-J Telephone Email,address
No.and Street P
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) le Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
RrthAll)E.L &vli-sr bet-cdl-Koa1-1 : C, c,l� -Cot --co s -1 1.11E(A) 1 AAttl,
('4u.i -CIc.6_ (. -.c R21 Ha u.t Tot 1 i 0A-/t-4Ttt-(Li
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1 5.00 00 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 1 66 6 6° Cl Total Project Cost3 (Item 6)x multiplier x
3. Plumbing $ 2 5-6-0 UO 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ Total All Fees: $
Suppression)
Check No.OD 1r\Check Amount: -.1 Amount:
6. Total Project Cost: $ I I 1 6 6 0 , (.51) 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) d -1 a 3 S \1p 1 0 / r y ,Z,Z
/ -
o `A- r S A(.,� I License Number Expird'/t'on bate
Name of CSL Holder
a ` , List CSL Type(see below) Li
No.and Street Type Description
6 U i> 1 L4411 p A- a 137 ) U Unrestricted(Buildings up to 35,000 cu.ft.)
R _ Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS _ Window and Siding
SF Solid Fuel Burning Appliances
4 Sb3 64,31 g c 4 (Crec t . Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) -�y p1 I 30 22.
.S�1 1 j2 dre 1.-L� HIC Registration Number E irati n Date
HIC Company Name or C Registrant Name
No.and Street ,' I n,�- v Email address
.0 A) L4#-I.p 113 '5 bl -a 3rl
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 ........ ❑ 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 )/(7.1, .r y�
to act on my behalf,in R matters relative to work aujl>!o ' ec14 y t 's building permit application. p
,,,, c l e .en 2.......„ z
Print Owner's Name(Electronic Signature) z_..
D e
SECTION 7b:OWNER'OR AU ORIZED 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 i -true and accurate to the best of my knowledge and understanding.
-__ 61141..k iiiri kc, ,rz 3 ii 2,-2--
Print Owner's or Authorized Agent's Name(Electr_Qpic 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
/oa .5..._"":.. ..
� : ' f. Massachusetts °t5 . •.c
',.
4 • - ,A. ;it t.,7/ ig t
4 DEPARTMENT OF BUILDING INSPECTIONS :
*y c 212 Main Street • Municipal Building .Cab
:=4- Northampton, MA 01060 jSNi;'.. ...
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:
J0
l��tf-
Location of Facility: X r CL (-7--
The debris will be transported by:
Name of Hauler: S (-0,1-SqiiLL)Cre-ertS
Signature of Applicant: Date: ,3 ) ( 2- Z---
The Commonwealth of Massachusetts
t =: / Department of Industrial Accidents
1 Congress Street,Suite 100
4i- Boston, ,AMA 02114-2017
=4,f www mass.gov/din
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
/lnnikant Information Please Print Leeibiv
Name(Business!'ganizationtlndividuall: SACv4k&c Crt-AS1'• •
Address: 3 S S . •
City/State/Zip: �� c440•L.f •1) - Phone #: L L 3 (0 3• (4,4. 3 T
Are yarn an employe!?Check the appropriate box: Type of project(required):
I.ciam a employer with employees(full anikor part-time1.• 7. D New construction
20 I am a sole proprietor or palloenhip and have no employers working for me in K. 0 Remodeling
any capacity.[No wormers'carp.insurance require.'"
30 I am a homeowner doing all work myself.[No armies'comp.innura ar required"' 9. ❑ Demolition
4.0 I am a homeowner and will be hiring ooatracto to modulo work on my property. I will 10 Q Building addition
rs
COMM that all contractors either have workers'compensation insurance or an sole 11 a Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
SC3I am a general contractor and I have hired the sub-contractors listed on the anadred sheet
These subcontractors have employees and have workers'comp.insurance.: 13 a Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. l4. Other
I S2.11141.and we have no employees.[No workers'comp.insurance required.!
'Any applicant that checks boa a 1 Hurst also fill out the section below showing their workers compensation policy information.
*Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mint submit a new affidavit indianting suck
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and cute whether or not those entities have
employees_ Vibe sub-contractors have employees.they must provide their workers'ramp.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: r/‘ —
Policy#or Self-ins.Lie.#: iu'`'v " � 6UO 1:13 " 2b2 Expiration Date: -2-1 -a/2. Z-3
Job Site Address: 31 S Q L ST. cL e-fro-L(,k'z- City/State1Zip: (D b Z
Attach a copy of the workers'compensation polky declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S 1.500.00
andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verifi
I do hereby c tinder their- allies of perjuty that the information provided above is true and correct
Si mature: 1
Date: "2Z
Phone#: {(J ''Sb. ' (dF 3`f
Official use only. Do not write in this area,to be completed by dq'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#:
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Sackrey Construction Co, LLC it etfAs, -a t 7-o z 2,
83 South Main St ,
Sunderland,MA oi875 ,r "