38B-069 (2) BP-2022-0507
239 SOUTH ST COMMONWEALTH OF MASS CHUSETTS
Map:Block:Lot:
38B-069-001 CITY OF NORTHAMPT 111 N
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FU D (MGL c.142A)
BUILDING PE ' MIT
Permit # BP-2022-0507 PERMISSIONISH4 REBYGRANTED TO:
Project# 2022 PORCH REPAIR Contractor: License:
Est. Cost: 4850 STEPHEN CAMP 082531
Const.Class: Exp.Date: 11/23/2023
Use Group: Owner: L DUPREY NI f.HOLAS D& BETTY
Lot Size (sq.ft.)
Zoning: URB Applicant: STEPHEN CA P
Applicant Address Phone: Insurance:
46 EAST ST (413)527-7124 O 65621JB-5B90972
EASTHAMPTON, MA 01027
ISSUED ON:05/11/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE BEAM ON FRONT PORCH SUPPORTING 2ND FLOOR PORCH &REPAI'/REPLACE SUPPORT POSTS
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 NORTHA PTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I. ' I • �( 3-1 I •
•
Fees Paid: $l00.00
212 Main Street, Phone(413)587-1240,Fax:(413) .87-1272
Office of the Building Commissioner
•
d
Versionl.7 Commercial Building Permit May 15. 2.000
Department use only
• City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
n; Room 100 Water/Well Availability
r Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address This section to be completed by office
v
v
Map 3�(3 Lot 06, C7 Unit U
Zone uRQ Overlay District
Elm St.District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent:
At4 '_ CAt [9f 74. $ v
Name(Print) Current Mailing Address:
F-7-7/zf _ i 1 s .-o yy%
Signature _ Telephone
SECTION 3-ESTIMATED CONSTRUCTIo COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 1/s60 (a) Building Permit Fee (Oo
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2+3+4+5) .7t/Y52? Check Number -1k8302
This Section For Official Use Only
Building Permit Number Date
BP-2022--050-7 Issued
Signature: /7/Z
5 - l1' ZD2Z
Building Commissioner/Inspector of Buildings Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs 0 Demolition❑ Repairs, Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use 0 Other ❑
Brief Description Enter a brief description here.
Of Proposed Work: y /�
/CA1 AWL ) rc,B,,t/ g,/Gi4 )(4,/ zia /e,,'✓c - ,,',D p
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A I ❑
A-4 ❑ A-5 ❑ 1 B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ I 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
•
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage 0 S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: ..._ Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1st 1st
2nd 2nd
3rd _.......... _... 3rd
4th 4th
Total Area(sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone Municipal 0 On site disposal system
•
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor /� )
C,4- CMG?_r'L r^-7 Not Applicable ❑
Company Name:
S—
Responsible In Charge of Construction
(o f?- S-�c�,et 4 -, ,1 'I/Li--
Address
jz7-- 72/
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No Q
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 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.
Signature of Owner Date
I, 'a` , as Owner/Authorized
Aggeenn hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
'and belief.
Signed under the pains and penalties of perjury.
Print Name 7 "777 /
/ 37V2,--a
Signature of Owner/Agent i Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable El
Name of License Holder: - h t h) C OO .Sr�/
License Number
q‘ f)95r- C -e 4' ,1-$ .4J° A` l 1 �3 ' 23
Address 1 Expiration Date
SignatureIle 52,-)-7 1 2_y
Telephone
SECTION 13-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
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 2.),- fov=ti
The debris will be transported by: 51-174-0Ati
The debris will be received by: v 9// y / Gj
Building permit number:
Name of Permit Applicant 57- 1pL_ C�
5/7/2
4;'
Date Signature of Permit Applicant
a.
The Commonwealth of Massachusetts
t_'` - 1, Department of Industrial Accidents
WO
- p 1 Congress Street,Suite 100
'' i1=_ `1 Boston,MA 02114-2017
',,� � www mass.gov/dia
Workers'Compensation Insurance Affidavit:General B sinesses.
TO BE FILED WITH THE PERMITTING AUTHO .
Applicant Information Please Print Legibly
c3
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Business/Organization Name: 44/ (-4,441, I
Address: `G G ¢-J' r S74,..„...74---
City/State/Zip: 7r0)' _4' IfVlti 0/0,i7 Phone#: TZ 7 7/2i
y
Are ou an employer?Check the appropriate box: Business Type(required):
1. I am a employer with 2,. employees(full and/ 5. ❑Retail
or part-time).* 6. ❑Restaurant/Bar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers'comp.insurance required] 8. El Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing
no employees. [No workers'comp.insurance required]** 11.0Health Care
4.ElWe are a non-profit organization,staffed by volunteers,
with no employees. [No workers'comp.insurance req.] 12.[ Other X tri9 (/ tlfe pAti7
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
I am an employer that is providin workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name: C•t A „( h 5/ C C,
Insurer's Address: �I! 4 4)-r .7 t'Y,'t';
City/State/Zip: E i ?tcr/( /1 101r. 0/B x 7
Policy#or Self-ins.Lic.# 6,1 24 _/8 l 01 2 Expirat on Date: / Z)
Attach a copyof the workers' compensation policy declaration page(showing the policy numb r and e ptration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify, , #er the pain and penalties of perjury that the information provided above is true and correct
Signature: /'/ Date: 2 '7/
Phone#: 52-7 - 7/ Zy
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.City/Town Clerk 4.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply your insurance company's name,address and phone number along with a certificate of insurance.
Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members
or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy
is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of
insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town
that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you
have any questions regarding the law or if you are required to obtain a workers'compensation policy,please call the
Department at the number listed below. Self-insured companies should enter their self-insurance license number on the
appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number.In addition,an applicant that
must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town
may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit
must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business
or commercial venture(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this
affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street
Boston, MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
www.mass.gov/dia
Form Revised 02-23-15
Stephen Camp Construction
46 East St
Easthampton,Ma 01027
(413)527-7124
We hereby submit this estimate for- 239 Sash Street Porch
The work needed to be done is replacing the carrying beam that supports the second floor porch.
Any support posts will be repairedheplaced at this time.
The new beams will be wrapped with pvc trim boards.
Building permit and trash removal is included in my price.
Price for materials and labor=$4850 00
Contractor Supervisors License number 082531
Home Improvement contractor Registration number 135204
I propose to supply materials and labor-in accordance with above specifications.
This proposal may be withdrawn
By us if not accepted within 30 days
4 .44011v,,,,,
Authorized Signature_,.-.-_,. cL--
Acceptance of proposal Signature
Submitted To:Betty&Nick Duprey
Phone-527-5401
Address: 164 Northampton,Street job-239 south street Northampton,ma
Easthampton,Mass 01027
Date—5-1-2022
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