16C-033 (2) BP-2022-0457
402 SPRING ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
16C-033-001 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-2022-0457 PERMISSIONIS HEREBY GRANTED TO:
Project# FIREPLACE Contractor: License:
Est. Cost: 6450 CHESTER MITCHELL 67026
Const.Class: Exp. Date:03/23/2024
Use Group: Owner: W GOLEC CHESTER C& DONNA
Lot Size (sq.ft.)
Zoning: URA/WSP Applicant: CHET MITCHELL RENOVATIONS
Applicant Address Phone: Insurance:
2 PATTEN HILL RD 4135357457
COLRAIN, MA 01340
ISSUED ON:04/29/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE GAS FIREPLACE
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:
52 CP 1
Fees Paid: $65.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
l
2 , The Commonwealth of Massachus tts
Board of Building Regulations and St darns F R
Massachusetts State Building Code, 7 CMR APR 8 2022 IU E LITY
Building Permit Application To Construct, Repair,R nov tie Or Demolish a 1? ised ar 2011
One-or Two-Family Dwellin DEPt sUILDiNC INSPPcT'O S
D p This Section For Official UseY3iity-►�rJOF RrhaurT°N MA 01060
Building Permit NumberG' ' A 2 " 4/5_47 Date Applied:
jetUu ) es //2 y-7q-2ozz.
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1�� rtAdd�ess 1.2 Assessors Map & Parcel a �Pry zi ctr�T � Numbers33
1.1 a Is this an accepted street?yes V 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' Private❑
Check if ye
Zone: _ Outside Flood Zone? Municipal 0 On site disposal system
1 s
egP
SECTION 2: PROPERTY WNERSHIP'
1 Owner'of Record: Q
'DM (,GoLe-C �d CZ�Yl c• _ I�O` 0 )0 6'--
Name(Print) City,State,ZIP
Ltoa -nxrn3 Si_ w3-309O-1/67 ciao tec siolVaSi.kit
No.and Street 4 Telephone U Email-Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied F9 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
Replace. Nctfvc0-1 a.5 r;reclacP uvidf a I.,,4'+1 Ntw (AA --
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 6 i gon 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa (Item 6)x multiplier x
3.Plumbing $ 856 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees: $ �.
Check No.13T heck Amount: �-'
6.Total Project Cost: $ CoY6-6 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts
* ,
DEPARTMENT OF BUILDING INSPECTIONS
Eti 212 Main Street • Municipal Building C) •
►
—�� Northampton, MA 01060 *44, ^s,4
•PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
1. 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. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new/replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code —all new construction(Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) cS 067ca, 312 3/Zp 2i-I
CIwsliec C Ref- 11 License Number Expiration Date
Name of CSL Holder
P& etA I' 24k List CSL Type(see below) U
No.and Street Type Description
COL ra N Y't 0 I—WO Unrestricted(Buildings up to 35,000 Cu. ft)
�_( Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
\ ( SF Solid Fuel Burning Appliances
13J y.' clQ�j�+q�'�G'i-1 I LIv7iC V(,,I�1to,C1 Insulation
elephone Email address / D Demolition
5.2 Registered Home Improvement Contractor(HIC) f n I /
1tT -iI b fau. P2,lnnva. rrxt 5 D �� Z/off ��
Cke9tii
/ HI Registration Number Expiration Date
HIC Company Name or HIC egistrant Name
V
4-1,,11 I,kL l) z/a( gyp,Cowl
No an StreetEmail address'
COS .LA Na 013(1 a 013)6-35-7y57
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 No . 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIIT
I,as Owner of the subject property,hereby authorize L.hes\ec 1] , `, 1v\c.j. Q \
to act on my behalf,in all matters relative to work authorized by this building permit application.
`14.31-‘fa 63 .Go\cc, tOst,ag-,
Print Owner's Name(Electronic 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.
ti rc—i G c CiPs0..
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.) (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"
..... .
it\1 zakh....
_----, The Commonwealth of Massachusetts
‘,1‘.7„.. .,..7„/-
1 .,40,1 Department of Industrial Accidents
I Congress Street,Suite 100
Boston, ,11A 02114-2017
www.ntass.gov/dia
%Yorkers' Compensation Insurance Affidas it: BuildersiContractorstElectricians(Plumbers.
'It)HE FILED WITH THE PER:141171NC AUTHORITY.
Applicant Information Please Print 1.e2itil%
Name 1 liusiness.:Org.inization;Individual): C 4 :-tr. s- D, 1146-00-t( / 1)/i3P4- cikritot.4102-4 'alto trea-ov-t- 9
Address: Pcki--(e,v ii,tt
City/State Zip: C 0 I ra L V\ Ng 00116 Phone 4:411(3 1 V _L 1 )
.7
Axe you an ruiptio:k ir:t:Yeek die appropriate box: :
or project(required):
la lani a ettaphryer with einip&yets(Nil and.ne part-tinv).* 7. 0 New CUrIStilik:Ilell
2. I am a sole propnetor or partnership and have 00 employem working tor me in K. c] Remodeling
any capacity plo wartett.camp.insUranct mourn].)
.30 lam a homeowner doing all work myself.[No workers'conp.insurance requiredt 9. El Demolition
l 0 0 Building addition
4.0 I am a homeowner and will be hiring contractors to ixinduct all work on ray property. 1 will
c1161.1re Itlai all contractors either have workers'conspensaistai insuranix or me sole ' 1 i.0 Electrical repairs or addition:,
proprietors with no emplow .
12.E]!numbing repairs or Additions
sr:3 1 am a general contractor and I have hired the sub-contractors listed on the attached theet_
110 Roof repairs
Th...-ve sub-curnmetors have employees and have workers'comp.insurance.:
0 kte 11.9
6.0 We are a von:oration and its offaceri have exercised the ri ir ght o 1 4 4 Other pela
f exemption per NIGL c.
152.§hat,and lfee have no employees.[No workers'comp.insurance renuireill fl:cre--1 tC le
'Any applicant that cheeks but 41 mho also fill out the section below meow ing their workers'compensation policy info
*Homeowners who submit this affidavit indicating the!,are doing all work and then hire outside contractors mita submit a new atTribv it indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the .sub.....untrah:roc.and.tate.,,,,hartitcr in not those,muttes have
employees lithe sub-conhactors brie...-mplo!.eel.the!,must provide their workers comp.policv ilLitilver.
mw.
torn an employer that is providing worAers'compensation insurance for my employees,. Below is the policy and job site
information.
Insurance Company Name: —
Policy#or Self-ins.Lie.4: Expiration Date:
Job Site Address: City/StateeZip: ... __.
Attach a copy of the workers' compensation polic declaration page(shelving the policy number and espiration date).
Failure to secure coverage as required under MGL c. 152. §25A LI,a criminal violation punishable by a fine up to S1,500.00
anti or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a
day against the violator.A copy of this statement may be forwardeti to the Office of investigations of the DIA for insurance
coverage verification.
/ ,/\
I eh) hereby c, 'ill atraer e .,' -i. r p iv hies of perjury that the inprmation provided abov is true and correct.
Signature: i - Date: LliZA 22
Phone#: tit5 53.5- `-/(( (3 )
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):
I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: P hone#:
City of Northampton
GYM
-. ''' Massachusetts ." e'er
# .m DEPARTMENT OF BUILDING INSPECTIONS I E ,xs
w / 212 Main Street • Municipal Building ,�+�,_ `�
P Northampton, MA 01060 s4'/ ,,.)t'1`�
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�OS \\n0.SINA)k �ik'('\n E5--- 5 Ot C 1
The debris will be transported by:
Name of Hauler: \1 C1 lo\c�" � .3\- `
Signature of Appli 0 c Date: V a2
Donna W.Golec
Owner,
Kendrick Property Management
City of Northampton
r ; Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS ai
212 Main Street • Municipal Building tr
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_ (insert
month, day, year), hereby depose and state the following:
1. 1 am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one-or two-family dwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in
a two-year period shall not be considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, exceptgto the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of 20 .
(Signature)