17B-016 (11) BP-2022-0191
419 BRIDGE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
I7B-016-001 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-2022-0191 PERMISSION IS HEREBY GRANTED TO:
Project# RENOVATION Contractor: License:
Est. Cost: 160000 DANIEL DACRI 105989
Const.Class: Exp.Date:05/07/2022
Use Group: Owner: SINGH RANJIT
Lot Size (sq.ft.)
Zoning: URB Applicant: DANIEL DACRI
Applicant Address Phone: Insurance:
247 RIVERSIDE DR (617)543-2843 R2WC 121938
FLORENCE, MA 01062
ISSUED ON:03/02/2022
TO PERFORM THE FOLLOWING WORK:
INTERIOR RENO -RENO 2 BATHS AND ADD 3RD MASTER BATH, 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: ,
,Qy CSIADV
Fees Paid: $1,040.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
l�
1148 1 ''
The Commonwealth of Massachusetts �0 22
Board of BuildingRegulations and StandardsoF'` FOR
•vi,
Massachusetts State Building Code, 780 CMR'TF t4°''k3 r -, MUNICIPALITY
-�anl "o.� E , . ,v� USE
Building Permit Application To Construct,Repair, Renovate Or Demol Sh-a`.' Pevised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: ( `.a›-~ 1 R ( Date Applied:
r / -I-ZOZ Z
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1. r er8 Address: 1.2 Ass or Map& Parcel N hers
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:
Zone: _ Outside Flood Zone?
Public Private❑ Check if yesf�' Municipal �On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2 ei &,rl f `nc ilb teat) /fl 4 0134)
Name(Print) c City,State,ZIP
Li 19 Ritr>d6-. 9/3-'5&-6907. ,___
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 1211 Owner-Occupied 0 Repairs(s) le Alteration(s) 121 Addition 0
Demolition d Accessory Bldg. ❑ Number of Units Other 0 Specify:
BrigDescpiption of Pr posed Work': It -'!`�! f vi0:11.1i:�i-. �C k t.- r ew,i"C y In a �b-,�/;,JjM4
CS 3�`'1 Ale''7�-F'' h , Q0'. k/�c '-/eMbst pr�i/)t i h/a/ii 41)eiLh 4/11<ln.✓ ?In 4,r
c 0 „/ .J
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ I oao1 oiJO 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application
2. Electrical $ Fee
d'�) 7OO 0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ ao JoO _ 2. Other Fees: $
4. Mechanical (HVAC) $ ✓ List:
5. Mechanical (Fire $ -----
Suppression) Total All Fee : / 4ash
Check No.1 �p1 Check Amount: 1)V Amount:
6.Total Project Cost: $ 16 a 0 00 0 Paid in Full 0 Outstanding Balance Due:
i
City of Northampton
S1sorcrir �S •si
Massachusetts ��''��A. . . '�r`
t A.! 1
DEPARTMENT OF BUILDING INSPECTIONS . �4
s" ` 212 Main Street • Municipal Building yJ� Az'It
C'-•'� Northampton, MA 01060 .yam ---•'�
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.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
51 Const ction Supervisor License(CSL) /°5—CM of
q,►�DaC{) License Number it on Date
Name of CSL Holder
�p '44(C) /, �T1/ List CSL Type(see below)
No.and Street} U.�- �/1 Type Description
PO f£'w/ MA OP b� U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Townt,,�S^tate ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
Q SF Solid Fuel Burning Appliances
617-sy3 a '/3 d cicr)e icii/,C.4�, I Insulation
Telephone Email addrdss D Demolition
Reg' red H9me Improvement Contractor(HIC) /Cam �3
0
HIC Registration Number xp ion Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be pleted 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 .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIIESS,F,FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize TLQ"l, `"�L 0
to act on my behalf;in all matters relative to work authorized by this building permit application.
'CIO';\)c. S1 3 )- & —
Print Ow ttkt'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
c reed' application is true and accurate to the best of my knowledge and understanding.
\A"` 1 0161 a ).- �Z
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 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 lanned,provide the information below:
Total floor area(sq.ft.) 33 5 0 (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) aa yp Habitable room count /0
Number of fireplaces t Number of bedrooms 5'
Number of bathrooms 1 2 Number of half/baths /
Type of heating system 645 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
C�tiTd�'rrl�' S SI
Massachusetts
1 �'� DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building yvs
Northampton, MA 01060
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 1/(7\1)(7
Facility: �-
The debris will be transported by:
Name of Hauler: J0w-N
7.]::::;) (1111:12—
Signature of Applicant: Date:
16" _ The Commonwealth of Massachusetts
.1 j(;� Department of Industrial Accidents
1 Congress Street,Suite 100
`., Boston,MA 02114-2017
:7 -- www.mass.gov/dia
Ii ut kers'Compensation Insurance Affidavit:Builders/Coatractors/ElectridansIPlumbers.
II)RE RILED Wit II THE PERMITTING AUTHORITY`.
Applicant Information Please Print Leeibiv
Name(Business/Organization'Individual):j)4\A c.f l
Address:? Wer5 a AO/
City/StateJZip: 4 0 NA 02, to A O10 6d- Phone#: C l 5-e a-FY 3
Are yes 1r employer'?Cheek re appropriate hot
Type of project(required):
1.0 I am a employer with 0employees(full again part-tiny)• 7. 0 New construction
2.1 am a sole prupricwr or parmmril p ad Yoe no employee%working for nor in S. 9-Remodeling
am capacity_[No workers'croup-loosebox n q ared.1
30 I am a homeowner doing all wort myself-[No workers'comp.insurance n-yuired-1` 9. ❑Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property- I yid! 10 O Building addition
homeowner
en ore that all a oranrtors either have workers'compensation misname or are sole 110 Electrical repairs or additions
proprietors with or employees.
12.0 Plumbing repairs or additions
StErraM a general ewntractoi r and I have hired the sub•auntractan hstcd on the attached shut_
These sab.a-wrtracton or have emptoyem and have workers'comp.ignorance_• 13.0 Roof repairs
14_(l Other
6.0 We area corporation and its officers have exercised then night of exemption per MC&C. --
152.¢I(4),and war have no employers.[bite workers'coup.insurance required.]
'Any applicant that checks bus oil own also fill out the section bekaw showing thew wakeen'oomperWrert policy infarttWiaw_
t fiessowass who mien this affidavit iodising%they are doing all work and then hire is uala oorttatasra air submit a new indent idiessies nil
:C:settaetos abet check Ibis Ix.t must_ichd as additional sheet showing the name of the esb-esoradors sad sane wheher or not those notifies have
employees. If the rtb•contrackrrs haw egeployaim they must lino aac then workers"o 1 unp policy samba.
I am an employer that is providing workers'compensation insurance for my employees: Below is the policy and job site
information. D y�
Insurance l'ratt}rany Name: eVa( In 3 CD
Policy#or Sclt-ins-Lic.d: k V C_ 5\ Expiration Date: /0/8l a"/--
lob Site Address:`1/c 8(k) gGL City/State.1p:WoC'4(I, 414 01064.
Attach a copy of the workers'6aspessation policy declaradou 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$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.,'-•statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage writ-I do hereb fy a . pa' . and penalties of perjury that the information provided a is a and correct
Signature: . Date: .)-)" y)-•
Phone#:6i 1 -51/3_E- 3
Official use only Do not write in this area,to be completed by city or town ofjiciat
city or Town: Permit/License q
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.('itylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
, 6.Other
' Contact Person: Phone a:
rt
\;,100)r _) .igiokt, 1
. _
1 - I
i1 i
1 I
n
\ / 1 I , 1 I
i ___
\j J) CU {fi-3r. \!
'N.,JCIN ,,,,,, rev,
1
A _, , 1 _ ,
C). 1 , 1
V Ii+
opv\ ki)vv{j,/ ajvuh2s 6/3--513 Ai3
(a) w
11-
*f r/� €5 e53 (tom
t
-
1111- i
pli. � ill • Jy�J4'C(c �fil
I(3) 1?„ LVL. J
Note:This drawing is an artistic Designed: 7/22/2021
interpretation of the general Printed: 7/22/2021
appearance of an design.It 2020 w g
notot meant to be e exact rendition.
Dacri- Singh 2.kit All Drawing#: 1
PDF created with pdfFactury Pro trialy- sion www.ptlffeulurv.corri
F,,„
r5 _ ec) I 911
1/4‘