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38D-030 (9)
BP-2022-0357 292 SOUTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38D-030-001 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-2022-0357 PERMISSION IS HEREBY GRANTED TO: Project# KITCH RENO Contractor: License: Est. Cost: 16000 JOHAN LIVINGSTONE 098571 Const.Class: Exp. Date:04/15/2023 Use Group: Owner: LIVING ROOM LLC Lot Size (sq.ft.) Zoning: URB Applicant: LIVINGSTONE CARPENTRY Applicant Address Phone: Insurance: PO BOX 586 (413)475-0771 BERNARDSTON, MA 01337 ISSUED ON:04/08/2022 TO PERFORM THE FOLLOWING WORK: KITCHEN 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. 51-1 (� Signature: . • '�� yJ Fees Paid: $104.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner • 4`\. The Commonwealth of Massachusetts qp �`d� :',,`, R W Board of Building Regulations and Standards 9C ITY Massachusetts State Building Code 780 Clot C ._ .1,;of'i <20 Building Permit Application To Construct,Repair,Renovatiiolish isedlar 2011 One-or Two-Family Dwelling , .7,,mi %`` f/ This Section For Official Use Only �• qo, o(1ti9 9. Buildi40-) g Permit Number:P,J"• 1 ;--,0-. .5-.'`7 Date Applied: �,� 4255 .// ii'8 ZOZ2 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 seoy�Map&Parcel Numbers a AI Sr70 'i !// 1.1 a Is this an accepted street?yes Vc 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 pply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage D' posal System: Public Private 0 Zone: _ Outside Flood Zone? Municipal don site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Qwne Record; (�r,r 1 tom,.n e. /�'ak a tA aleSC ‘0 wkh>a" �-}S,r, �N� 0 I.©G 0Name(Print) City,State,ZIP '2.R2 SavAiN 9 - qI3 l0gs-0`17P' ccA40.Adlcssm c_creetc istd No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Fiie Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work': Ki Tnielk../ ,e>-re1 c.ic tZ.. , Ne".► CA Ric 5 j -Rai-Awe/ , for CueN6 TILES , 12E-P -M s 77--Arc K D 'P'ktNTfkk. Giq•CCS Am) -in '�, SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ J)I. 0•00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ a �0-- ❑ Standard City/Town Application Fee _ 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 3,croO 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fes Suppression) ) • Check No.I Check Am unto l 6.Total Project Cost: $ l 6r d 0 Paid in Full 0 Outs • ue: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0414216?I 446 /Z3 J*1AN LI V/&) icv ,� License Number Expiration`Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description TiteNAicasioN MA f-,S- 9 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 �7 SF Solid Fuel Burning Appliances �j&'7 ' 475-tM id( vt n( ovrne5€ 1 AfL I Insulation Telephone mail address �J D Demolition 5.2 Registered Home Improvement Contractor(HIC) 178 1188 ,8 VAl/Z3 Li V 1‘)G6S7z•i C(F0J772-7 HIC Registration Number Expiration Date HI Company Name or HIC Registrant Name Wo. ?c�c 58c idhVitbs--ht .,en lLi 67147 N d Street Email addresY ft/A- 01339 (¢3-1195-077) 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 IV- 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 - -03#-t✓ Crri2veK)Try to act on my behalf;in all matters relative to work authorized by this building permit application./ Co it nnt, C,Atk vviit ss� 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 contain•• in this application is true and accurate to the best of my knowledge and understanding. D. y Owner's or Alit r. d 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.) (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" """� The Commonwealth of Massachusetts t Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 �' www mass.go►Vdia %%urkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. `10 HE: FILE )WITH THE PtRMI riIMC At I HORI`l i. Applicant Information Please Print Legibly Name(BusinessOrgantzationtlndividuaI : L.jviI )( Srbj'J C c la %JVD2 Address: �r O. t( 68,c City/State/Zip: f 2Nt\e5i-bt-i 91359 Phone#: 1'//3 - V75 0 t?9i Are yule an employer?Cheek the appropriate box: Type of project(required): 1.❑I an a employer with.-. employees(full anitor part-time).• 7. El New construction 2 y5 f am a sole proprietor or partnership and have nu ernpliyn-a working for inc in 8.Wemodeling any capacity.(No workers'comp.insurance mquirad.j 9. 301 am a homeowner doing all work myself.[No wnd�ers'comp.insurance requital"' 0 Demolition 10 Q Building addition 4.01 am a homeowner and will be hiring contractors to conduct all work on my properly. I will t� ensure that all contractors either b:aN a workers'comp.-n.s:rtnm insurance or are suit II.0 Electrical repairs or additions pruprietomi with no employers. I2.❑Plumbing repairs or additions 5 jJ I am a general contractor and I have hired the rub-contractors listed on the attacrad sheet 130 Roof repairs These sub-contractors have employees and have workers'camp.insurance.; (LE]We are a corporation and its officers have oxen:iced their right of exemption per ME c. 14.0 Other 132,§1(4),and we have no employees.(No workers'comp.insurance required" *Any appliratt that chocks box 41 mint also till out the section below showing their workers'compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidaa it indicating such. `Contractors that cheek this box must attached an additional sheet showing the name of the sub-currtrtcto rs and state whether or nut those entities has: employees. If the sub-cuntracuxs have -a.luyees.they must pros ide 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.Lie.#: 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. 152,1)25A is a criminal violation punishable by a tine 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 verification. I do hereby certif. der the pains :nd pen aides of perjury..that the information provided above is true and correct ' ./ Sig ture: ` Date: Phone#: V/3— '/%" r 0 7 / 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.CityrTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone*: City of Northampton ,... a ?ti, SAS SzC Massachusetts ��?' - 'e .s * c t 4 s'# ,, DEPARTMENT OF BUILDING INSPECTIONS S: nx, =�r .-' 212 Main Street • Municipal Building J�;. ca +✓�" ' a'" Northampton, MA 01060 ss��_.. �10 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: 41 4 The debris will be transported by: Name of Hauler: AiA 4 Signature of Applicant: Date: 6D.,