24A-168 BP-2022-0613
311 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-168-001 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-2022-0613 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 GAS APPLIANCES Contractor: License:
Est. Cost: 10000 CORBIN CHICOINE 113093
Const.Class: Exp.Date:02/16/2023
Use Group: Owner: HUNTER,LINDSAY & SCHERZER,OLIVIA
Lot Size (sq.ft.)
Zoning: URA Applicant: CORBIN CHICOINE
Applicant Address Phone: Insurance:
24 PRINCETON AVE (413)214-4659
EASTHAMPTON, MA 01027
ISSUED ON:06/01/2022
TO PERFORM THE FOLLOWING WORK:
INTERIOR RENOVATIONS
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:
.5g _ CDNIT
Fees Paid: $130.00 •
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildine Commissioner
cajun read
_ .740° ,117a/'fV.-- 4,...41.X___
Qp�'he mmonwealth of Massachusetts
kir 3 , Bo d of uilding Regulations and Standards*6 MUNICIPALITYOR
F
,,, M sach setts State Building Code, 780 CMR USE
pr.oa 'lding Permit ppli ation To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
NOpT qp ��,/ I One-or Two-Family Dwelling
/.........,.......... ....
H Nc
TON MA 06pONs This Section For Official Use Only
Building Permit Number: -r!A A -G/ 3 Date Applied:
ILLev1t 4Z.55 /t./ 61-2022
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
l,l Property asPEGT ST 1.2 Assessors p&Parcel Number$!_
ei
1.la Is this an accepted street?yes_ . no Map Numbe'r7? 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 0 Zone: _ Outside Flood Zone? Municipal,ErOn site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
L;iVDsAy &cm-rex tyc JiGG�' A/C. -Z88o3
Name(Print) ,State,ZIP
/12 i.0 AN /JoRST Al), 1'29 SbC 9108
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)X Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units / Other ❑ Specify:
Brief Description of Proposed Work2: -7—/Vt € Reur u.2 ' R4M ov< .SX.oE/MGK
"fee P/mmher, /A) r.2 f9 .r1 S�eft AA ,/e-
/9AD /fWe jEst FA"At K.iC tit Cal'PA Ieo . 5 .Qe/rbGX I�$:r'
AG flat( G* - b.- - : -_----____
= -..=1•
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated C sts: Official Use Only
(Labor apj.40raterialsk40
1. Buildin 1. Building Permit Fee: $ Indicate how fee is determined:
g , fir�DO , 0 Standard City/Town Application Fee
2.Electrical $
/ O0 0 Total Project Cost3 (Item 6)x multiplier x
3.Plumbing $ /' 2. Other Fees: $
4.Mechanical (HVAC) $ / List:
5.Mechanical (Fire •
$
Suppression) Total All Fees: $
Check No. Check ount / . ash Amount:
6.Total Project Cost: m
t D_ 0 Paid in Full 0 uts: d. lance Due:
L, Y1 )7°
1 /
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
_ GS //3 093 0 x 3
6RB'�/ C/7,'G o/ei/6 License Number Expiration ate
Name of CSL Holder
A ,f)NLeT� C
No.and Street List CSL Type(see below)
T / Type Description
'j,257-7/1//ijdTv�j /�� O/027 U Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1/43 •?►y /4 —7 CO//,i/1 CX/e0/4Q,1041i1 te.1 I Insulation
Telephone Email address D Demolition
5.2 istered Home Improvement Contractor(HIC) �4y y�7 O�/�y/3
Oris v'n r//�t�,,� HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
A Y Pr,q/L.a Tip/ i5 Ue Cdo/i4 1h G4 Co41, a/ )/Gon
N&/d Street.
Ai 0%z7 -2 if'9151
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 to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .2- No ❑
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 (?et' a7i (4/o['n/t44
to act on my behalf,in all matters relative to work authorized by this building permit application.
L1'Al o Ay miff ,-- 3/- ..2 2
Print Owner's Na a(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
contai ,1 in 'is appl' at' n is true and accurate to the best of my knowledge and understanding.
Prin •• er'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"
City of Northampton
? K�ar�pr°* 0.- . -S.,C
:4— L: Massachusetts ��? - <,,
b -I 1 4. 4" DEPARTMENT OF BUILDING INSPECTIONS
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` .' '< 'f 212 Main Street • Municipal Building ,)
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. .F Northampton, MA 01060 SNW'.. ;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: Va4Y /-e'
c%
0
The debris will be transported by:
Name of Hauler: O/e/3/Ai ac°,>,
Signature of Applicant: �' Date: f'3/- 02 Z
The Commonwealth of Massachusetts
Its'_W Department of Industrial Accidents
I Congress Street,Suite 100
`""'`t. Boston. MA 02 114-2017
. �: www.mass.gor/dia
11urkers' (.untpensation Insurance Afftda%it: Builders('ontractorslElectricians`Plumhers.
Ili 111. I-II_f l)5%I f11 I iii:PF:Rmi I fly(:AlriHORI'fl.
Applicant Information h
� � � Please Print Leeib
Name(BBusinc OrQanizattotulndividualI: �� /�e?---�a 1 ( I 4(
Address: A / Porn CeT,t/ dase_
City/State/'Zip: .S,7 j4i'142—j W ,/lj9 Phone#: 9/3 c / - O'.5-jam
%rc you an en pioyer!Cheek the appngrriate hot:
T}prof project (required):
I.D I.inn a employer with employees(felt ara oe part-time)-' 7. O New construction
I.1n1•a mile pruprictor ur partnership and have nu employes working fur me in K. Remodeling
auk capacity.[Nu workers'coop.insurancx required.]
30 lain a hum euv.ner doing all work myself.[No workers*comp_lmtira:toe required.]
9_ p Demolition
4.a I am a homeowner and will he hiring cxnuraltors to conduct all work un my property. I will 10 Building addition
noun that all contractors either have wwrken'eonsperuaiion'insurance or are sole 11 r j Electrical repairs or additions
prupricwn with nu employers_
12.RITlumbing repairs or additions
30 I am a general contractor and I have hired the subcontractors listed on the attached sheet.
13 f J Roof repairs
These sob-contractors hese employers and have workers'camp.insurance.:
6.0 5Ne are a corporation and its officers have exercised their nght of exemption per Mc ii c.
14.0Other
152,*H4i.and we lose nu employees.[Nu workers'Lump.insoranccrequired.]
'Any applicant that chaicks boa n1 mint also till out the section below show ing their workers'compensation policy information_
+Horneuwners who submit this affidavit unehcatina they arc doing all work and then hire outside contractors mint submit a new atidavit indicating suck.
IL'untracturs that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or nut those imbue.hasc
employees It the sub-cuntractoa tarok emuplu}ccs.they must prul ide their workers'comp.polies number.
I am air employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
informuNuo.
Insur:ut,:c Company Name:_
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State:'Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152.Zi25A is a criminal violation punishable by a fine up to S1.500.0()
andk or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
cos-erage vertficatiirrt.
I do hereby certify under the pains nd penalties ofprrjury that the information provided above is true and correct.
t.twre: a.-- " Date:. 3/ -2 2.-PlIonc .: w3 -2'y ,V65—y
Official use only. Do not write in this area.to he completed by city or town official
( its or Town: Permit/License#
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3.('its Joss Clerk 4. Electrical Inspector 5. Plumbing Inspector
(.Other
('intact Person: Phone ti: