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31B-126 (3) BP-2022-0493 18 BARRETT PL COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-126-001 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-2022-0493 • PERMISSION IS HEREBY GRANTED TO: Project# mudroom Contractor: License: Est. Cost: 15400 JEFFREY GOUGEON 075029 Const.Class: Exp.Date:09/06/2022 HAYWARD D GEOFFREY (AKA JEFF) & ETKIN Use Group: Owner: MADELINE Lot Size (sq.ft.) Zoning: URC Applicant: GOUGEON BUILDERS Applicant Address Phone: Insurance: 1261 HAWLEY RD 4136259337 WCC50050141042020 ASHFIELD, MA 01330 ISSUED ON:05/06/2022 TO PERFORM THE FOLLO WING WORK: EXTEND MUDROOM INTO GARAGE 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: '3- 1 •L Fees Paid: . 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner a `� s���laa�oad►nl y n3utP'td aat3) t a�W' 1t ortyaadO �� tto►utN u!Pu' sin0 4 �auJ t l°3 (yin ntd't t eg z y dp au!q no�ud use�� ��` - rillp I �5 i i aaafo�d 1 °� 0 N�tj iluWeEk x C9°'ails pis°)�i�� peep iS up �o�l�`S �a!td!ilnW ddd u1no3J outpt!, •t �sie!aaleW aiti'�u!is3 as Uuo!it !t _ :aa'a i«uiad _silo P 1 3 __ _ - s�aa3 Not{alea!p 13��: Not �O a n►OD IsfJ - t :pau!�uaa P ► p11���1SI`t-- ---- d----f 3 sisd� _ _ yiOsodoad J°u°ti t o�uaQ _ uo!i� �2 {aos$3,ad Q no 1 0 h aft _ __GNP \ upli� . _--- ,unN st3 ��o�aq tnS aun �' 2s� —" svun 3 �,u!pl. 5 , , £ lid-04 1 n aagi0 a!dn:,�O`3aw,nO s�Q' O ��� �M -., laad5 Cl p t�ty�12IO ��� � 'J �,t� t�as�!ta n s����� o 1� ,, x.Ica a t t Pd ls�uo!le a V��aAa)}igpM 1. ,t., au�`v 0 uo 1.P (�ldde i ' �,}, ;paoa 21 t ����pP�+p�t�t _- ��/ 0 „^'0 IA/' __ ' -- ,ie.�ad V" �y 0�d �z��1� ©): lddn5 ►aaeM9 1 »1 x okV`p au"pQO �tunW f ailtto t ° u1 Pap�no�d tpdt,. :uoue��a 3 003.11 aps uO © pzr. it'aa.� 1 1 �ods,p MaS 8 paau�t��Z1u!Plm9 uta�s�~t' ale sVgg1a'`-, In ads�Q a�s� ► ,,t00.a {13) iarxis!Cluu° W p-i ,plc; spit',N. s_�dt_1kl 1 asfls tu�uQ`Z, i u1 iap�,.tud ,uo!aejO3 st t i't 1111),aea21 io'i dame up s!qi _ t tit 1n1 r,. - saC�iaads Pai cry l 1 1 - " L -"-- 77\ i rt,aiadoad -- (u)��ehtc�a 1 _-'-' U�ado.�d _' _ ssaaPP`d sao+sua !v t �lun'ty d W _ 1 �untilaa�d ..�-- deW s.�ossass`�' �'1 �:1 �01ya�5 t„ �S c o � ., (`+tO�71 s� gW°�laaaed'���1J���0 �1 - a!waadu!pt!nfl a aip(� _ " 7s O`_ ut? aad`�u��ltnS ZZ���' �- :tu0 as(1 te! �l�u�n.4'o"k O . -duo i!W 6"--,..„bi, ...ce:yfe, _ -'" t�i�1�aQ` .laniasua� A. �essel�`l �`- oso�. rvc ia4rrf,it n �?1`a!uda� ai�15 411°sn o pico43 � �.dsr�ii�N,c���� '��Ut ? .�P°��u!pt��a��u!pl!n9} auk 61 �'`. i.�a2i 'sp peels Put suo t°Ltal ��uau► 'Luz' 'AO ��� 5 _ ��� 1 $113sn�1°tSseW- �'dt INCI i . SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) W-073-bect eeh License Number Expiration Date Name of CST-ITo 1 ( l � T is1 CSI. 1}pe(sec lk lo++1 ------_.__ i Type Description No.and Street ,[��((��q�' II 61,4 Unrestricted(Buildings up to 35.000 cu. It.) 32'tYtZ � ' ��33� Restricted 1&.2 Family U++elling Cit);i(naii. State./I ' Masora) RC Rooting Covering WS Window and Siding Solid Fuel Burning Appliances 1 insulation Telephone Email address I) 1 Demolition 5.2 Registered Home Improvement Contractor(H IC) / Q qq ('/ d )- .y ac1-S HIC ant Name ( / (?� .etw c-7 e— v c t,y u, s .0 AshCwU ,n , o(33 d — — City/Town, State. 'telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 2566)) 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 l" 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 S -te a' 7Gfoon___— to act on my behalf, in all matters relative to work authorized by this building pAnit application. Jet Print Owner's Name(Electron c Signature) hate SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below. 1 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 Auth rized Agent'IINIame(Electronic Signature) I)atc NOTES: 1. An Owner who obtains a building permit to do higher 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 progr car guara: fund under M.G.L.c. 142A.Other important information on the HIC Program can he found at www.mass.gov/oca nformation on the Construction Supervisor License can be found at www.mass.gov/dps 2. v\ o rk 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 n mom,a N`= Department of Industrial Accidents ii a;a 5 I Congress Street,Suite 100 ;. -_:(j Boston, Mi 02114-2017 t. tom mass.gov/dia 11 urkers'Compensation Insurance.\fftdas it: Builders Contractors.Electricians.Plumbers. 141 at:hlt.hD XS 1111 1 IlI. 1'I.RstI f l IN(;Al I HORI I%. Apltlic:ant Iotturtnatiun Please Print lxeibls Name i Fiu:,ta:r.,i.9t:;a11'.:`1lt.10.i:tti.i i.;uWap: r.UVb U!101015, Address: 1 -6( ( A... ley City?StateiZip:_ GVdf 1114 013'30 Phone P: 44(3 5-(9 9C7 ( Are}uu an csnphtyrr'(heck lbr Af.propraaic tsar.: Type of project(required): I I am a enrFr.y i et*Litt empdu:cc,Oil and or part tune i D New construction 2 I are.a wk pr.rprretut or p.:na.rshrp and have n errq+tu.as wurk r fur inc in S. i2nRemodeling an}....quell} [Nu*viler.'carp utsuran.e rewind.] 30 I am a klItiCIA4ner duiIA all wail myself.pio workers`comp.unuratree ntparo l J' 9. ❑Demolition 1i0 0 Building addition i.❑I am a Fwnxvwnee and%ill be lirintsntr dura to.induct all wurk',rimy pmpctty- I volt ensure tins all contractor.either have n rotten'c.rnpen.a.Lunt:r.,uran.e car are auk 11.O Electrical repairs or additions pr .rpncttm.with nu employe s. 12.0 Plumbing repairs or additions 5CI l:an a genrnl cuntractur anal I has c hand the cab-.Knua.tun listed an to stanched skeet The,rarb-.untra.turs Fuse cmplu}..,and ha e w Kcompkera'comp :muranut.: 1 Roof repairs 6.0 si a are a cuiprur item and eta officer.has a cacnued[Neu nrht of c.enipticat per 11t(&L 1�_❑Othc I S:.*11:J1.and we Fuse no employee. [Nu vvarrkcn'cutup.in.urarne i guava' •Arrs applicant that.heck%I+us AI must atw till out al.:section belns shun their svarrk..ra'eompcmauun jtrin.y ulfuri iatne'n 'Ila°axt,wners**nu sul'nrt this attiri.avit man:along the}arc doing;all wok and then hue cataide cuntractura*moat:alum a ncrti attiiIav it indieatin=such. Cunttaetun that.h..k tin,.but must attached an artdatiunal sheet shuuinrr the nain of the sots-contract. ..and.state v.h..ita.r in nut thaw ensue,.lusc .rnpla sic.. It:ha:,uh-.Crri!.ntaxs have citric:...,.th..,ens,i pm'.rd.their aurkcr,'.a•mp p.*1:.•:nura'ber 1 ant an emplui'er that is providing weurlrers'compensation insurance jar my employees. Below is dr.'policy and job sites information. 11 11 " Insurance Company Name: �556 G 44e d t soYct s YcSUrar.....L Policy#or Self-its.Li . . UJ(e,.. 6 o 6 - SO(`t 10'( _a.4,-1= Expiration Date K--a14-4—?- - lob Site Address: S.—! t l ore't 49 u G S e k u(K (-S cqt S Cate.State Zip. Attach a copy of the workers'coinliensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MIGL c. 152,§25A is a criminal s lulation punishable by a tine up to S I.5(X)_(X) and:or one-year imprisonment,as well as cisil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a day against the violator_A copy of this statement may be forwarded to the Office of Ins estagations of the DIA for insurance coverage verification. i du hereby err ify under the pails aiul penalties of perjury that the information provided above is tare unit correct. Switature - <- Oak 5i C.(— 9,0.�' P:':,,-,� L((3 S(cl ( q 7 it Official use an►i'. Do nut write in this area.to he completed by city or town official (it. or-limn: Perniltil.ieense Or Issuing Authority (circle unci: I. Board of ilealth 2.Building Department 3.City/Toren Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone b: tr asnPtori 5,S SI�,�� £ Nor ���: ,i; city o • s �. r. C iiiaSs achy.sett IONS 4,-' `~ � INSPECT ssriv_�'� �i,r ,:,.,,,, OF BUILDIN a.INSPECTIONS N o- ti nici8 d��y; DZpA2RM ain gthamPtO MN 01060 Mort uCTION DERENp RIS OFT pgp7E CaNSDEMpLIT1oN AND �+ilding permit s osed of in a (FOR AL condition of � alt be d+ p GL c 40,S54, a this work sh from of the provisions of mall debris resulting MCI c 111 S 150A In accordance _is thatdefined by Number ed waste disposal facility, as properly licensed The debris will be dispo5ed of in: Location of Facility... dottle"( The debris will be transported by: Name of Hauler: Signature of Applicant' 1.. _ KITCHEN ______ r--- , r 1 . __.__ G § s DN TO CL. P g LBSMT Z 1 w /F___ T� EXSTG LAUNDRY RM. z g YARD >- , 11 ON r w 1 1 exk '-t 1 U Z LU Aco,je 5II I I. wru�ox.✓ oWC < ?o)(cq NStliaton a-a-t -40v rR.'iq e_e;111 IY Z now- Q O -E < I ilobi L EXSTG GARAGE ! i z °z J I— uw Z a 1 a. a t. i— X w DATE DRAWN: (i ) 05-19-04 1 EXST'G FIRST FLOOR PLAN © :i_1/4"=1'-0" 1 \ p .„_ _ Iti sO•••••••iroomo***•-••••••••••••••.••••••• 1 1 ---,.., ''•••-' . ,, .r............: 4 klv ,,, , . 4_. in.._... 18 14.,,A*E-rr PLek•CE: I 1 i I t m......1 ‘k A #1 ....,.....0....-raym ‘.. Ili \ , - i — 4.- ...., i A it/ 2- r-' I 0 .0,-- 1 . t 1 ! t .;. , , 1 1 1 -.....-1— 3 4$1 S Tit4(s. CAI!, „.—,..1 ................ , I 1 ! I , ..._,...„. i , i . ! . . . 5/5/22,2:08 PM Office of Consumer Affairs&Business Regulation-Mass.Gov Search by Registrant Last name Search by Registrant First name City/Town State Zip code Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Wednesday, May 4, 2022. Search Results Jeffrey Gougeon Gougeon, Jeffrey 197294 1261 Hawley Road 11/20/2021 Expired Gougeon Builders ASHFIELD, MA 01330 Site Policies Contact Us 2018 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. https://services.oca.state.ma.us/hic/licenseelist.aspx 2/2 5/5/22, 2:08 PM Office of Consumer Affairs&Business Regulation-Mass.Gov Mass.gov Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Please note pressing the Enter key will clear fields. Search by Registration Number 197294 1 Search You must click the "Search Registrant" button to search by name or location. Please note pressing the Enter key will clear fields. ..... Search by Registrant Company name Search Registrant https://services.oca.state.ma.us/hic/licenseelist.aspx 1/2 5/6/22,8:40 AM City of Northampton Mail-hic 1,4 City of Kim Carson tonma.<kcarson northam ov> Northampton @ P 9 hic 2 messages Kim Carson <kcarson@northamptonma.gov> Thu, May 5, 2022 at 2:09 PM To: Jeffrey Gougeon <jeff©gougeonbuilders.com> Hi, Looks like your HIC has expired. Can you show me proof of renewal? Kim Carson Northampton Building Department 212 Main St 413-587-1240 Jeffrey <jeff@gougeonbuilders.com> Thu, May 5, 2022 at 5:06 PM To: Kim Carson <kcarson@northamptonma.gov> 165049 6/24/22 Steven Gougeon Sent via the Samsung Galaxy S10e, an AT&T 5G Evolution capable smartphone [Quoted text hidden] https://mail.google.com/mail/u/0/?ik=28605c8627&view=pt&search=all&permthid=thread-a%3Ar-771959091662714861&simpl=msg-a%3Ar-6471907595795880252&simpl=msg-f%3A173202187250190... 1/1