36-137 (3) B P-2 02 2-0491
20 LONGVIEW DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-137-001 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-2022-0491 PERMISSIONIS HEREBY GRANTED TO:
Project# BASEMENT RENO Contractor: License:
Est. Cost: 2000 ED JAZAB 050099
Const.Class: Exp.Date:04/02/2024
Use Group: Owner: DUFFY JAZAB, ED A. & PATRICIA A.
Lot Size (sq.ft.)
Zoning: URA/WSP Applicant: DUFFY JAZAB, ED A. &PATRICIA A.ED JAZAB
Applicant Address Phone: Insurance:
9 SHEPARDS HOLLOW
LEEDS, MA 01053
9 SHEAPARDS HOLLOW RD 413-222-4710
LEEDS, MA 01053
ISSUED ON:05/05/2022
TO PERFORM THE FOLLOWING WORK:
FRAME & INSULATE BASEMENT - PERIMETER WALL AROUND EXISITING PLUMBING TO CREATE BATHROM
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:
I •, I . )2 .� Ti .
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
.._________ji--- 1:1-8----- ---CEIVE
' r
,I &M y _ 5 f he C mmonwealth of Massachusetts OR
j*, 2022Boa d of uilding Regulations and Standards
MUNI IPALITY
�� Ma ach setts State Building Code, 780 CMR SE
' _ ___ NORF 6U
Bu��•�eft�rttlic tion To Construct,Repair,Renovate Or Demolish a Revise Mar 2011
`----A-01— ne-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: �OJ _)Yoe
Date Applied:
4.Z..5 I/�� - 5-5-262Z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
20 LONGv IL\AJR sizCTiCE
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 1a. Private 0 Zone: _ Outside Flood Zone? Municipal KOn site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:T —(' LD S N c7 I c7
a n53
e(Print) ' 1 City,State,ZIP (j /1M
'
IACP1- (Th,75 l'T O LA.0W ' /y3 9 cidvT'y3 0 A01, C
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Owner-Occupied 0 Repairs(s) 0 Alteration(s) % Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brie Description of Proposed Work': 'may M AND .\t4 SU L PATC TSPACrr C 1 T
c.)2st-fere2 tv44tzsr CrZert,'E L 'Sri 'k /3.4TH
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ \5 U, 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
SO'0 0 Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 0 2. Other Fees: $
4.Mechanical (HVAC) $ 0 List:
5.Mechanical (Fire $ /
Suppression) Total All Fees jf d�
Check No.�U v' Check Amount: Cash Amount:
6.Total Project Cost: $ 200 0 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
...src{
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y5555 Massachusetts �,,.° 'ryy
tad j''rFYCCRg DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building �-, 4.
— ' Northampton, MA 01060 jd'H •-•6"44
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. 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. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new / replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW / private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. 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)
d Csr� �- �� q� 2
OH �a2 �t �
,p an License Number Expiration Date
Name of CSL Holder
J S y're y S List CSL Type(see below) 1
\ a avu
No.and Street Type Description
� S 01053 U Unrestricted(Buildings up to 35,000 cu.ft.)
J R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1-2 ' 222-49 e�J .� 2,-a1) YAI o-tam I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 2.032e2., 41,,, 2,3
Zfrv4 HIC Registration Number Expiratibon Date
HIC Company Name or HIC Registrant Name
SprC
No.and Street Email address
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 tp 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 PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
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.) g(,'J (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count £
Number of fireplaces U Number of bedrooms '3
Number of bathrooms Number of half/baths 1/2-
Type of heating system t1.C:C'1 R C Number of decks/porches C)
Type of cooling system tv,oN C Enclosed _Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD '
r ,
,
FRONT SETBACK
FRONTAGE
City of Northampton
_,.5,-,r,T I ,, 51s �sir
Massachusetts wV .''._
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�
DEPARTMENT OF BUILDING INSPECTIONS e
x,0 .44
K 212 Main Street • Municipal Building �y ^r
Northampton, MA 01060 s111, 1,,.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:
The debris will be transported by:
Name of Hauler: 0 l!V Ni P
Signature of Applicant: q_c \ Date: J5 (0 \22'Z,
i
The Commonwealth of Massachusetts
;tfl Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
SVorkers'Compensation Insurance Affidavit: BuiklersiContractorsTlectriciansfl'Iumbers.
TO BE FILED WITH THE PERMITTING AUTHORITV.
Annlicant Information Please Print 1.egibli
Name tilusu1cs.6,10rgantzattort Indoldual):
Address:
CityiState Zip: Phone#:
Are'mu an empkrytt!Check the appropriate!pH,: Ty pe of project(required):
I atm a entployer with empioyem(hill=dor part-tinset " El New construction
491/ I*I asok proprietor or pannership tmd haw no employee%workrtsg for rut in S. 50 Remodeling
-0"an capacity,[No woriers'comp insurance required"
Demolition
AO I am a homeowner doing wort.mysr_lf.[No workeis'comp.insurance required.]
10 ] Building addition
4.0I am a horneownta and will he hart*contractors to conduct all weal.on my property.. I will
ensure that all contractors either lose workers-compoisation insurance or are sole 110 Electrical repairs or additions
propriruns,*ith no employem.
I 2.Ej Plumbing repairs or -additions
SOI am a general contractor and I hate hired the sub-contractors laded on the attached sheet
I 3.0 Roof repairs
Thew sub.cotaracturs Moe employees and bast wxwkers'warp.insurance
(la we are a corporation and us officer,have exercised their nglit of exemplum per iL 14.00ther
152,§14411.and we hate rut employers.rsk,vourker;comp.insurance nanicreril
*Any applicant that Litecia lox al must also fill out the section below howinr Eh=W Clti.Cr• ,:orapcnsation puhiçs inlormatiord.
notneowners who submit this affidasit 13/411.021V the)are deans all work and dim hire outside contractors aunt submit a new affidavit indicating suck
1Conttactoii,[hal diced.the,bi mutt Id an additional,beet shooing the mune ol the and sate ithethc:or not thoNe c
LIIII1I. II 11.1 Lt ltql0:w 4:Cs.the) roio.i pros-ide thew worker;‘unir r nuttlivE
I ant an employer that is providing worAers"compensation insurance fur my employees, Belo IC is the polity and lob.%ite
inform Wiwi.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: CityStatelZip:
Attach a copy of the lekurkers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required wafer NIGL c. 152,*25A is a criminal violation punishable by a fine up to S1.500.00
andor 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 'nay be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify us ler the pains and penalties of perjury that the infannadon provided above is true and cr,rrei.t.
Signature: Date: r.) 7 1 20 22.
Phonc .5 8 I `--/ 1
Official use orgy. Do not write in this area,to he 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.Eketrical Inspector 5.Plumbing Inspector
G.Other
Contact Person: Phone#:
City of Northampton
/op 4e,
Massachusetts x. •14 ` " t
m40'
,, DEPARTMENT OF BUILDING INSPECTIONS ?`
212 Main Street • Municipal Building
Northampton, MA 01060 t r a,;j1,�8
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born _ (insert month,
day, year),hereby depose and state the following:
1. I 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:
Persons) 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, except to 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)