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25C-068 (9) BP-2022-0301 26 DAY AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-068-001 CITY OF NORTHAMPTON Permit: Ails Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0301 PERMISSIONIS HEREBY GRANTED TO: Project# RENOVATION Contractor: License: Est.Cost: 58300 MICHAEL HARRINGTON CSL102948 Const.Class: Exp.Date:02/05/2023 Use Group: Owner: WIND HORSE INTEGRATIVE MENTAL HEALTH Lot Size(sq.ft.) Zoning: URB Applicant: MICHAEL HARRINGTON Applicant Address one: Insurance: 64 NORTH ST (413)275-0335 NORTHAMPTON, MA 01060 ISSUED ON:03/29/2022 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATIONS, SIDING 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 jr Fees Paid: $377.00 212Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachus is 0 �9 "Wit ''l Board of Building Regulations and S ndar,s �aq9 'FOR LITY Massachusetts State Building Code 80 s�k R For� c)S aa,,,, US r Building Permit Application To Construct,Repair,Re D emoligif R ised, ar 2011 One- or Two-Family Dwelling Tti9.t oiti„ This Section For Official Use Only T°4' s.° _ q Building Permit Number: �"d b 0! Date Applied: o%GA'S / k V►0 /ss 17� 3-z9-�ZZ Building Official(Print Name) ignature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers ; (o �.y 4ve/lve PSG- o145- 0o1 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: LH 301 iz.e5icjence. iSt12 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 fBr Private❑ Zone: _ Outside Flood Zone? Municipal Er On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Wi4 IAA vse :CA fejt- fie Movk1 ((eoiidl NOr+dtx.r�!%6n pi o1,i Name(Print) City,State,Z I ell1 /ror{'x 5 ct fl3-5$4-o.o7 rdeli5le0w14kore,Mt . 0tJ No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction el Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition H Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of ProposedWork2: Te.mol,t%on of Okret non•l(WI be" , walls; Lon3♦ruc-.en of Ide IAM-II.5 ana 5uvpor+ be.n: ;►i'fa4lLfion of w� V;n/ l I Si / Y d �ing ; in 5tA/tailon of 5eVi1 r Vinyl fepI,toer1t w:naow p r Q. r 5� 0.1,4c2.-50 13e ^olil-ion lar,in4 of - wo ,nferier Win w5 Jo , Frn„„,,,1 or . x-tcuor WiARo,o Frame 1we dooA✓. r, cy.5; Fi�7►i,i9 Two Glz�i5. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ f 2,p 9 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 00 0 Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ )5;300 2. Other Fees: $ 4. Mechanical (HVAC) $ VI $00 List: 5.Mechanical (Fire Suppression) $ ti Total All Fees: Check No625J6 heck Amount: 3'1 1 6. Total Project Cost: $ 51/ 300 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1y�1Cons ruction Supervisor License(CSL) �/0 Xc1/5 2/�/.-3 /I` ( i G lit P-1 f ✓I)`1-1"6 4 License Number Expiration Date Name of CSL Holder l 1 I A/0(4 4iYVe List CSL Type(see below) V No.and Street 'l Type Description N0 I-,L n i'll A 0 I 0 6 p U Unrestricted(Buildings up to 35,000 cu. ft.) City/Town,State,Z /' R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 913-,/75'0 335- Pi( C A A e / A 0 2 oS 0 3,'a:I.Go" I Insulation Telephone Email address D Demolition 5.2 Registeredtr`Home Improvement Contractor(HIC) ) t1 5-3 l c 0///a ✓L e n ae I a`'�'�1 n 9 fo A HIC Registration Number Ex iration Date HIC Comp Name or HIC Registrant Name p fDy f 0CA S.trltef ltAiLkae,\ h 0a.05©Srn,O.Com No.and Street Email address Street. 1{-0A AA 01010 yl3- z7.0335 City/Town,State,ZIP t 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 0 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 to act on my behalf,in 11 matters relative to work authorized by this building permit application. .-6114,2ibdrs 3 25 ?2- 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 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.) I$Y (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) t 7 0 a.. Habitable room count 57 A i4C Number of fireplaces r of e. Number of bedrooms -th tee Number of bathrooms fiw o Number of half/baths aillre.a. 0 n e Type of heating system fl i A i-50;is Number of decks/porches On e Type of cooling system 01 i►1 i .S el i i'S Enclosed Open V 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton /atHAM}y•,, ,a.. ,��, r'�'�2,. Massachusetts 4?> 1. "!, * G - .4 r w/ Y c. � • p`l �,,{c DEPARTMENT OF BUILDING INSPECTIONS ol }� `.+r „ " 212 Main Street • Municipal Building �Oj. Ca • ,"roarSot �,�ra� Northampton, MA 01060 r� .... CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: i-' �� lea+ 'a (S e" l 'e c yc ('n� 1 13$ P.I e( Ave West 5f'^,W / / \)eytoklon ; W �Ivt 1i M �elnlo on Corp +o Ca”v-I(`a 5 65S6 Ilavn 5r- Holyoke i i oto4P) The debris will be transported by: Name of Hauler: q i 3 .b u rap 5fe-r- 3 5 2z Signature of Applicant: be/7`t Date: 2 Lii bay 4v 0 ( 11 11a- 1 , 0 SketchUp .�� " 1 t t 1 7"6" i c i mod D_ L be'`( A ve 4S etch p 3' Stairs 6" I P 14' 1 7,6„ � � �r \( Ave . . .„ SketchUp 14' 14' to 5-A. 5'6" 7' 4'6" ,---- 5' 12' 1 f,' 4 19" 2cD -ba1 Ave AI - +bo r15 " _ �. f ke c U p 1, 14' �� 14' 1 p' 1 1{-----------STA.1 R:s ._ . . _ T1 T 1Z'6" _ " G' 1 1 I 4' i 11` 19' , '., I.- � ��� . a: .�, �. .tea_ ..' a a _ The Commonwealth of Massachusetts I . Department of Industrial Accidents 3 * = , 1 Congress Street, Suite 100 ik ... ` Boston,MA 02114-2017 4, 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): Al iCAae I Na4 Kg its for) Address: 1,y Not 5 e(- City/State/Zip: Na✓ r{-a1 MO Phone#: gi 3 Are you an employer?Check the appropriate box: Type of project(required): l.O I am a employer with employees(full and/or part-time).* 7. El New construction 2.II am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. 0 Demolition 10 0 Building addition 4.01 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.©Electrical repairs or additions proprietors with no employees. 12.2 Plumbing repairs or additions 5.0 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 6.0 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.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy 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$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 ceerrn:ftunder the pains and penalties of perjury that the information provided above is true and correct. Signature: Aida / /6`( ^ Date: 3/ 5/a Z Phone#: 'I 13 Official use only. Do not write in this area,to be completed by city 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#: