32A-245 BP-2022-0567
149 BRIDGE ST COM MONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-245-001 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-2022-0567 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est.Cost: 14485 RICHARD PALMISANO CSL89485
Const.Class: Exp.Date:03/05/2024
Use Group: Owner: BAKER RANDALL G
Lot Size (sq.ft.)
Zoning: SC/URC Applicant: BAYSTATE EXTERIOR RESTORATION INC
Applicant Address Phone: Insurance:
87 SHATTUCK RD (413)374-2719 6HUB-6B21339-4
HADLEY, MA 01035
ISSUED ON:05/20/2022
TO PERFORM THE FOLLOWING WORK:
STRIP AND RESHINGLE
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: cff
.11
Fees Paid: $150.00
212 Main Street, Phonc(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
•
VNY 1 n The Commonwealth of Massachusetts
k.
Office of Public Safety and Inspections
I i G' Massachusetts State Building Code(780 CMR)
_ ' Building Permit Application for any Building other than a One-or Two-Family Dwelling
++- (This Section For Official Use Only)
R»ilding-P-efnit Dumber:p? -S- i- 7 Date Applied: Building Official:
SECTION 1:LOCATION
S 0.44. 11«- n t O(stO
No.and Street u City/Town Zip Code Name of Building(if applicable)
a: oo )
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building Repairfr/Alteration 0 Addition n Demolition L' (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy ❑ Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No Ja-
Is an Independent Structural Engineer' Pe Review r qured? rr Yes 0 No,'
Brief P•scription of Proposed Work: �M $ a— S
Aka
bAtId� S�'—'�°s c4-- /Qc/..lVAL(O /e I J
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2❑ Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 0 F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2 0 I-3 0 I-4 0 M: Mercantile 0 R: Residential R-10 R-2 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 i Special Use❑and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA 0 IIB ❑ IIIA 0 IIIB ❑ IV ❑ VA ❑ VB tr
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:• Trench Permit: Debris Removal:
Public' Check if outside Flood Zone❑ Indicate municipal❑
A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
w and Ad es of Property Owner
ara.L \11ck Bf,, ,SC.. o- 0(as,c7
Name(Pri t) No.and Stet City/Towvn Zip
Property Owner Contact Information
Ro.(4 30tle-ciL - - 13_3(12. k W/
Title Telephone No.(business) Telephone No. (cell) e-mail address
I plicabl t erproperty owner hereby authorizes:
0-el rT %mar Pcf 14.a. ___;(1 A- 6163c-
Name Street Address City/T n State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
J J.-4 C_
C.4; . iti) 1.-
Name of Per n Responsible r Construction License No. and Type if Applicable
2-7 Skids t- 'i$
S eet Address City/ o State Zip
l3-sq7 68all 03 -37 -7/q TAisrti 13C .1.) '
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes O No CI
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor IL/� (�
and Materials) Total Construction Cost(from Item 6)=$ —!
1.Building $ `tt '
Building Permit Fee=Total Construction Cost x /0 (Insert here
2.Electrical $ appropriate municipal factor)=$ /50"??
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (con,�ct municipality)�
5.Mechanical (Other) $ Enclose check payable to iJ /�'"6.Total Cost $ j 1/ T i, (contact municipality)and write check number here Qidd
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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.
( al/nisano C —S' _ is 43-371m 5-i /2
Please print and sign nape( Title QQ Telephone No. Date
$'l Sr7rt� K� W Ql t03s !�a/Si w ZGfMR .
Street Address City own State Zip i Email Address
r
Municipal Inspector to fill out this section upon application approval: • TI2 ►U Q0 01�
Name Dat
City of Northampton
S`5 f'c
r`•"F Massachusetts mow?
I '1 DEPARTMENT OF BUILDING INSPECTIONS �'. (t!+ $4
Fc'. f y' fti
R� 212 Main Street • Municipal Building
\ Northampton, MA 01060 fy , �k:0
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: doaL„,
C2(16.1—
The debris will be transported by:
r �
Name of Hauler: ,
Signature of Applicant: Date: 1 dd.—
CONSTRUCTION CONTROL WAIVER
From: 1)A(\ '-n(�
d7 5Q 0I,
______ H022
BAce
To:
Jonathan Flagg
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10, I request that you
grant a modification to waive the requirement
for construction control of the project at
because the work is of a mini nature,will not affect structura elements, health, accessibility, life or fire
safety, and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,
The Commonwealth of Massachusetts
I ..._.—
r ram,
f MIT- 1E1 i'"i't
I. renti. ,1
notal. 4,,ki=
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
tommass.govidia
Workers'Compensation Insurance Affidavit:Bulkiers/ContractorsiElectriciansfPlumbers.
TO BE FILE!)WITH THE P IITIING AUTHORITY.
Applicant Information Please Print Leeibis
Name(ilusincs.VOrganizztionandividua1): A.410-1/.6
Address: Y7 j1,.,4i Truck- i?c_(_
City/State/Zip: / 14-(4 oiO3s" Phone#: 0-3) 5 /17
Are y no an eurployer?Cher e Appel) late boar I Type of project(required):
2/13‹..-earn a employer with_ _empiloyees(full andeor part.tinaj_* 7. 0 New construction
-C1 Sot a sole proprietor or partnership and have no employees iremitists kit tat in 8. 0 Remodeling
any capacity.[No workers*comp.insurance required.'
0
30 I sin a horrbOti*Mkt doing all work myself.[No workers'conc.insurance resutinedl 9. Demolition.
100 Building addition
4.0 I ant a homeowner and will be hiring contractors to etinduct all work on trty property. I will
ensure that all corameturs either have workers cortipmation insurance or are sole 1 LO Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub.eonthictors have erriployem and have workers'comp.insurance.; I 31Rat)f repairs
14.n Other
6.0 Vs'e are a corporation and its officers have exercised their right of exemption per WI c.
152,§1(4).and we have no employees.[Nu workene comp.insurance required.I
*Any applicant that checks box al must also till out the section below showing their workers'compensation policy infornuition.
t Ifmneow nem who submit this affidavit utdicatinir they are doing all work and then hire outside contractors man submit a new allude..it indicating such.
ICurarattors that check this bus must attached an JatiAlunal*boll showing the name of the stib-eontrators and slate whether or not those aitititS,have
employees. If the suLs-euntrictors have employ,ees.they must pros ide their workers'comp.policy menisci..
I am an employer that is providing worAers'compensation insurtutce for my employees. Below is the polity and job site
information. _
Insurance Company Name: 3
Policy#or Self-ins.Lic.#: (0A4Ab-... (0(%Q.,i"3 3 9 --(-1 Expiration Date: d13i Job Site Site Address: \tf431 b rt. ? ..'---- j i
444 City/State/Zip: XJC.r,- cks4 ,,itiA Olococ)
w compensa policy Attach a copy of the orkers' declaration page(showing the policy number and expi lion date).
Failure to secure coverage as required under NIGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
andtor one-year im.risonment,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 i'la' r.A co.y o is statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage yeti icati . A
I do hereby c ( u, I, e ,,ins , , aldis ofperjury that the information provided above true an correct
41
1 —
Signature: ‘ Qf Ili \ are V,Ukv ,--- Date. ID Q---- '/ -
Phone 4: ' t 3" 5-1(9 --&aaii
Official use only. Do not write in this area,to be completed hy city or town official
( it) or Town: Permit/License#
Issuing Authority(circle one):
I. BON rd of Ilealth 2.Building Department 3.cityrro‘i a Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: