24D-046 BP-2022-0340
22 STODDARD ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-046-001 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-2022-0340 PERMISSIONISHEREBYGRANTED TO:
Project# FIRE SEPERATION Contractor: License:
Est. Cost: 21200 BRIAN FRANK 102740
Const.Class: Exp.Date:08/03/2022
Use Group: Owner: M. PARKER, JEFFREY
Lot Size (sq.ft.)
Zoning: URB Applicant: BRIAN FRANK
Applicant Address Phone: Insurance:
43 RIDGE RD (413)512-0822 V9WC032786
ERVING, MA 01344
ISSUED ON:04/06/2022
TO PERFORM THE FOLLOWING WORK:
REWORK FIRE SEPERATION BETWEEN FLOORS
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:
(' . . , Q . 9?-).,
I
Fees Paid: $276.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildine Commissioner
RECEI - ,
The Commonwealth of Massachuse4s APR — 5 2022
Board of Building Regulations and Standards — FORM T
Vti Massachusetts State Building Code, 780 C --- — ;11Q1I1 CIPt+LTI'Y
DEFT.OF Bull WING INS ECTlON`.iJSE t
t,',t.,Ino
Building Permit Application To Construct,Repair,Ren vate Q .so. end Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: SP. . .- 3410 Date Applied:
K uIiJ 7Z-,; /Z�/l LI-G-Z612
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
as s+Od�k.r-C' 54- .0 HD ()41{6—al1
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
1.��.'� 11-e vx, l ?011 (Q 6
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, Private 0 Zone: _ Outside Fi ? Municipal'On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Re►(cor .t- /►� /�
Je,k r-� a 1' \C.Nr \`-cam T-\o —e rk C t I `k U ' V�t
Name(Print) / ` )1 City,State,ZIP ( '
CS l--c X',�'u /1 v..< G)6 -7)I-( C-I J,S�rc.(Q,rnrA..,,,—15-e M�a��.G or t
No.and Street Telephone Email Address Cl
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: /Z.tjo�rl k - i n-e 5 P -c-Tag) bP e.t-n c,c, gc
rock j Rrc Fa WI �'1 4r -1.1 — er Co m0,0 A at(�,+ C (I t I�ccC t+ j
/'2 h 1.i e..<CAA t" pa..�irk 4- ares.cs tt ohere. 578 9 i s v1 c .1 blc - Soto a c `+.•
fa( code
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ Q 0 Q 1. Building Permit Fee: $ Indicate how fee is determined:
l
2.Electrical $ � 1 0 Standard City/Town Application Fee
1 0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ C' r (55 U 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fee): $noii
Check No.(1ti 17Check Amount: #370Cash Amount:
6.Total Project Cost: $09j1 a(57) 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /62 10 431 IN
15?
i/'(a n Vt 14_ License Number Expire on Date
Name of CSL Holder (..A-
I 2 , List CSL Type(see below)
No.and S"""`�"u'/��--=', � Type Description
fr vl //A" n) g q U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1842 Family Dwelling
State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
y/3-572-0ba� b.4,4 c v s4' 1,..x) i.c'o'- I Insulation
Telephone Email address (� D Demolition
5.2 Registered Ho,..sw Improvement Contractor(HIC) /
6rl a rx rI7 VI �FRC Registration Number xp' ' Date
HIC Comp y Name or WC Registrant Name
and S t Email address j
f,- 4— 01341 tils--SIL-a itZ
Ci /T ,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 .❑
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 e,t_/(n/ 623 17 f
to act on my behalf,in all matters relative to work authorized by this building permit application.
Jew' P4rke r y 2z
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
con • • 's pplication is true and accurate to the best of my knowledge and understanding.
erieVh-' /1/1444---- S J-__.
P . er's r Authorized Agent's Name(Electronic Signature) ate
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
tH AMf'l6,
/�• Massachusetts ? !t�
` . .�. i DEPARTMENT OF BUILDING INSPECTIONS S %fic
d
t.�. ,ry >r `•' 212 Main Street • Municipal Building v+
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 Facility: V61hif'
41-7c-
The debris will be transported by:
Name of Hauler: rA }1 )1�
Signature of Applicant. Date: L(/
The Commonwealth of ilassachuseits
do • Department of Industrial Accidents
; I Congress Street,Suite 100
Boston, ,tIA 02114-2017
w► w.nrass.g►ov/din
114tkers' ( t►rnpensatiun Insurance:t fWasit:Builders/Contractors!'ElectricitniJPlumhers.
it BE FILED •11W PERMITTING AIJTNO1t1l .
ADDlkaot deformation Please Print Letil►Ia
Name(Business'OrFa uzuioa individual): 6 • c
Address: V 3 !LLG�y, e /1—eI
cit<<`State/Zip: 1I'll ltir /4 k v13Ytt Phone#: //3' .57 2- 6g
tr uu an d uphill'!Clinch arppropriatr hoe: Type of project(required):
•C1.im a rmpluyu with 5 cuiplu►ces(full and ur part-time►.• 7. 0 New construction
lam a suk ptuprietur or purta.Tshrp and hats nu cnt}+ho ee s working fur me in 8. a Remodeling
any capacity.[No»u►cn'comp.insurance required..]
30 I am a lionverouner Jung all'work myself.(!1u autos'comp_insurance reynr►tl.t'
9. DI Demolition
10 Q Building addition
J.a I am a humeouneo and»ill be hiring metra:on to conduct all work on my property. I will
enwn that all contractors either lute:workers'conpensatrun wormer:or are sole 11.0 Electrical repairs or additions
p[upnrtunwith no employ 12.0 Plumbing repairs or additions
SO 1 am a n-isu al contractor and I hats hired the rarb-contractors listed in,the attached)sheaf 1��Reef repairs
These suht kite s untractu n te employees and hat stokers cusp.insurance.:
hi:we. re a a eurpuu atm and its utlaeeTs ha►s exercised their right of sxsnaptxm par%k.L c. 14.0 Odu`t
I S_'.ti 11 It.and wa has:nu onpluyers.(No wukcn'sun ,.insurance rcyuucd.(
'Any applicant that cheeks bor.al runt also fill out the section below%dal»ing their workers'compensation policy uduranauon.
I1kMMVs den who submit this attid rile rudaeatana they arc doing all:work and then hoc outside contractors most submit a rout affidas It indicating suah-
:C"untraclon that cho.k thus hula must attached an additional sheet showing the o:une of die sub-cuulra.tus and seats wlathcr or nut those mimes liras
employee... If the sub—contractors leans rinpluyec's•they must prosaic their suurkeis•comp.puley ntanhe-r
I am an employer that is providing worllets'compensation insurance for my employees. Below is the policy and job site
information. >>
Insurance Company Name: P f)t? L.l et b i // 147
Policy#or Self-ins.Lie-#: 1/ '1 C O 301 )6I!/ Expiration Date: 51 ��3�
lob Site Address � lids%S ( S� City State Zip: 111 '``�ie4+- G iOt
Attach a copy of the workers'compensation policy declaration page(showing the policy number a expiration date).
Failure to secure coverage as required under MGL c. 152,*25A is a criminal s iolation punishable by a tine up to S1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a
day against the s iolator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification. /
I do hereby rfrd the pains and penalties of perjury that the information prori a ve is true and correct_
s, 2 2�-
Signature: Dale:
Phone#: LP?—6 7a- -"O -
Official use only. Do not write in this area,to be completed by city or town official
City or Town: l'rrntitli.icense Si
Issuing Authority (circle one):
I. Board of Ilealth 2.Building Department 3.('ity[fuwn Clerk 4. Ekctrical Inspector 5.Plumbing Inspector
6.Other
(contact Person: Phony b: