31A-005 BP-2022-0406
11 MASSASOIT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31 A-005-001 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-2022-0406 PERMISSIONIS HEREBY GRANTED TO:
Project# 2022 RENO Contractor: License:
Est. Cost: 9000 DEAN COUTURE 072541
Const.Class: Exp.Date: 12/07/2023
Use Group: Owner: LLC. 11 MASSASOIT,
Lot Size (sq.ft.)
Zoning: URB Applicant: DEAN COUTURE
Applicant Address Phone: Insurance:
PO BOX 95 (413)575-4941
H UNTI NGTON, MA 01050
ISSUED ON:04/25/2022
TO PERFORM THE FOLLOWING WORK:
DEMO PANTRY AND CONVERT TO BATHROOM
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
r )2 • cgAny
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
si eo Pt_tIOS ' ifs `
T,4131.-ii0 D Vogt 1 r'"'" .04--/4
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14 The Commonwealth of Massachusetts �P� 19 FOR
Board of Building Regulations and Standards 20(92
w
Massachusetts State Building Code, 780 C MUNICIPALITY
r USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One- or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: 4P` ?1-• 'FOCI Date Applied:
u,,-) 70055 j4f/ 11-25-20ZZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.11P14 ,45 (
property�ddress� 1.2 Assessors Map&Parcel Numbers
�5
ff 1 `f S V
1.1a 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 OWNERSHIP1
2.1 Owner14 Record: ff'� y74-
14.04 _1 4/to Ic"-I Art.
Name(Print) City, State,ZIP /
7 ALAI.5ci t- 931X�E.'7,4f IQJoi,+t)34,( C.C(M-
No.and Street Telephone Email Address J
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 W rk2:
1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 4 V(,
1. Building Permit Fee: $ Indicate how fee is determined:
�_ 0 Standard City/Town Application Fee
2.Electrical $
00 J 0 Total Project Cost' (Item 6)x multiplier x
3.Plumbing $ li W v 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $ Total All Fees: $
Suppression) ,f
Check Noi("11 Check Amours Cash Amount:
6.Total Project Cost: $ 9 0 0 0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL) () �. L `/t/
ot:N� Lo -W-2.,.,. License Number Expiratioft Date
Name of CSL Holder
t .01 ix x, CI, C List CSL Type(see below)
No.and Street Type Description
f_T' v l i M ,/� U Unrestricted(Buildings up to 35,000 Cu.ft.)
�1/Ct-- R Restricted 1&2 Family Dwelling
City/Town,Stat IP / M Masonry •
01 RC Roofing Covering
WS Window and Siding
Via, C ti�if::t'�C .i riv—kit e i t e�' L"k 1 SF Solid Fuel Burning Appliances
41 / / tr Grp t/'' � C'et t L d:� I Insulation
Telephone Enid'al less b Demolition
5.,2/y Registered Ho a Improvement Contractor(HIC) /Ij 4 ) 4/5_____ // 7/ v
Det,n6Z' �"'�"` HICIRegistration Number iration Date
FIX Com •ny Nigneoerr HIC Registrant Name
err v ?IA t'.^' 4i,J�'.
No.and !Lc
e It,AC
address'
City/Town,State,ZIP Telephone (.4%\ eC Le.)
3"
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
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES
w PLIES FOR� lBUUILDING PERMIT
I,as Owner of the subject property,hereby authorize 4- i/L V..Q
Ki
Q
to act on my behalf, in allmatters relative to work authorized by this building permit application.
t -›1
.... .,... Li - ici - -2_ --e—
Print • '`,PV e(El onic Signature) Date
SECTION 7b:OWNER1 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 impirtatQlformation 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
O,_ MP TO\
)1•''' 1 Massachusetts ,.- . _ 5,��`
�. `
c.
`-;lt R4 m� DEPARTMENT OF BUILDING INSPECTIONS a. r
r 212 Main Street • Municipal Building w`. �e�
, '-1 Northampton, MA 01060 `assIV b
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: VCR //-e7 )G7 l C r61
Location of Facility: Ain 4U\1 41111--
The debris will be transported by:
Name of Hauler: ak ii t
Signature of Applicant: 1 ci,,,, Date:
ate.\
—.-..—..,... The Commonwealth of Massachusetts
s cw1 !i Department of Industrial.Accidents
�~ _ I Congress Street,Suite 100
1,
Boston, :VA 02114-2017
='.' rti•rt•)o:mass.got/odic
11uhkers'Compensation Insurance Affidavit:Builderr'tfContraetorsJEketriciansfPlumhers.
1'O EW FILED N 1111 1"11F:PERMITTING Al1TNOR1T1'.
Applicant information Please Print I.e ibly
r
Name($usittess<(.kganixati+x>llndivishlttl): 4i 4___60.44 _... ___
Address: P.0.g e x 9 .s
City/State/Zip: 4 ��510 Phone#: 1 5 '� — 4�j4 y
Art Son an elnptayet?Cheek the appropriate WE
Type of project(required):
t.Q 1 am a employer with employers(futt firth*partdimtt-' 7. a New construction
l silt a sole proprietor ut partnership and has no employers wotI.ucs fur erne in •.s seling
any capacity.(,Vo n
worker'.'comp.msurae required.)
30 lam a homeowner torn all work myself. g. ■ Demolition
yse [No workers'comp.raiuramr r quired.I'
Ini am a homeowner and will be bring corstractoen to conduct all work on my property- I will lop Budding addition
armtar,that all contractors either have workers'oompensatiun insurance or are sole i i p Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
30 l am a sesend cvetraclor and l have hired the snb.runttaclun listed on the attached sheet_
These Seib coneracton last employees and have workers'comp.insuratace. 13.a Roof repairs
6.0 We e a corporation and officers have ezerei ed their ngle of exemption per Mal.c. 14.C)other at
152.*1(*),and we have no employees.[No worker'comp.insurance requited.)
'Any applicant that cheeks barn a1 must alma fill out the section below showing their workers'(oratiennation pubes information.
Homeowners who submit this affidavit indicating;they are doing all work and then hire outside contractors moss submit a new affidavit indicating such.
:Contractors that cheek this bus must attached an ackhtomal sheet shoo,my the name of the sun-sxrntractrws and state whether or nut those ermines have
employees. If the sub-contractors have employees..they must pros ids their workers'camp policy ntnrtber.
I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and jot site
information.
Insurance Company Name:
Policy#or Self its.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,§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 'tatcrnent may be forwarded to the Office of Investigations of the DIA for insurartei
coverage verification.
I do hereby a fy under the s d penalties of perjury that the information provided above i.c true and correct.
.._Signature: �-�' (laic 7/0'2—
Phone#: 4/`) c - 4 94/
Official use only. Du not write in this areee,to he completed by city or town official
( it or Town:n: Permit/Llcease#
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3.I'ihflown(jerk 4.Electrical Inspector S. Plumbing Inspector i
6.Other
('untact Person: Phone#:
.4
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