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16D-015 (3)
BP-2022-0632 189 NORTH MAIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16D-015-001 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-2022-0632 PERMISSIONIS HEREBY GRANTED TO: Project# BATH BED RENO Contractor: License: Est. Cost: 17000 Const.Class: Exp.Date: Use Group: Owner: GUILLAUME AUBERT CAREY L & Lot Size (sq.ft.) Zoning: URB Applicant: GUILLAUME AUBERT CAREY L& Applicant Address Phone: Insurance: 189 NORTH MAIN ST FLORENCE, MA 01062 ISSUED ON:06/06/2022 TO PERFORM THE FOLLOWING WORK: BATH/BED RENO 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 V 51-111 Fees Paid: $111.00 • 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED The Commonwealth of Massac usett4 Board of Building Regulations and tandardsJUN - 2 2022 ;OR • Massachusetts State Building Code, 780 MR MUNICIPALITY JSE Building Permit Application To Construct, Repair Rer 1 DtBerflolas ac-r vised Mar 2011 One-or Two-Family Dwell NORTHAMP?pN,MA 01060 This Section For Official Use Only Building Permit Number: , P Z-C!24)- Date Applied: 1; sit I( �: IPA/A:9s Building Official(Print Name) Signature to SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 189 North Main Street 16D 16D-015-001 1.1 a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: URB residential .26 AC 82.5 ft Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) interior-only project 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Carey L.Aubert and Guillaume Aubert Florence,MA 01062 Name(Print) City,State,ZIP 189 North Main Street 603-843-7202 aubert.work@gmail.com No.and Street Telephone Email Address • SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition © Accessory Bldg. 0 Number of Units 2 Other 0 Specify: Brief Description of Proposed Wo k2:One bath and one be room reno,Replace main,.plumbing stack,Remove basement toilet SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ /a CD 1. Building Permit Fee: $ Indicate how fee is determined: �-y� 0 Standard City/Town Application Fee 2.Electrical $ ,.�-t/v 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ CO 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire Total All Fees: $ Suppression) Check Noo/2_Check Amount: iii/ Cash Amount: 6.Total Project Cost: $17.000 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVI' S 5.1 Construction Supervisor License(CSL) CS-098 5 12/22/2023 Jeffrey K.Parsons Licen Number Expiration Date Name of CSL Holder CSL Type(see below) 150 Woods Rd No.and Street Type Description Florence,MA 01062 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-563-1624 jparsons@mctz.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor HIC) 188825 09/07/2023 Jeffrey K.Parsons HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 150 Woods Rd _ jparsons@mctz.com No.and Street Email address Florence,MA 01062 413-563-1624 City/Town,State,ZIP Telephone SECTION 6:WORKERS'C s PENSATION INSURANCE AF AVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance a; davit must be completed and submitted with this application. Failure to provide this affidavit will result in the deni. of the Issuance of the building permit. Signed Affidavit Attached? Yes 0 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�ation is true and accurate to the best of my knowledge and understanding. CO June 1,2022 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.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms One Number of bathrooms One 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 AT NA BAY) +w �5 s� Massachusetts '4" IL t DEPARTMENT OF BUILDING INSPECTIONS 9• 212 Main Street • Municipal Building\ 17.7tri41 u115/ 4 ., Alt.C1� a Northampton, MA 01060 ON 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: Valley Recycling, 234 Easthampton Rd., Northampton, MA 01060 The debris will be transported by: Name of Hauler: Jeffrey K. Parsons Signature of Applicant: Date: June 1, 2022 The Commonwealth of Alassachusetts ".a.a.lr=•- Department of industrial Accidents VP.3np / Congress Street,Suite 100 =.31111— Boston,MA 0114-2017 www.mass.gov/dia V%go kers Compensation Insurance Affidavit:BuildersiCantractoridElectricians/Plumbers. It)RE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibls Name(ButohesseOrgamiztionlInclivicluoli: Carey L. Aubert Address: 189 North Main Street city/state/zip: Florence, MA 01062 phone#: 603-843-7202 Are yea as employer?Clerk the appropriate hot.: Type of project(required): l. l am II employer with employees(hill and in pan-time).* 7. [3 New construction 2.17 I am a auk proprietor or partnership and have mi einployees,YktOrkiTIN for nie in 8 Remodeling any capacity.[Nu Wurken comp.netursewn moral] 9. sVs Demolition 10 1 am a hurneowne:doing all*mit myself.INo*otters'comp.insurance misled"' 10 Building addition -1.i1.1 am a homeowner and will ht hiring Lxnurachwa to conduct all work on my property. 1 Will ensure that all contractors either have workers'curripensation insurance or are aole IlgElectrical repairs or additions proprietors with no employees_ 12.2iPlumbing repairs or addition.; 30I am a general contractor and l have hired the sub-contractors hated on the attached aheet. I 3.0 Roof repairs Thew.Alb-concracturs have employee.,and Istise workers'comp.insurance.: . tiEl Wu are&corporation and its offaceva have eternised then right of exemption per MIGL 14 00ther 152.§I(4),and we ha...e no employees.[No winters'comp.insurance region:41.1 An applicant that checks boa al roust 116/1rin uut rfr ixllon heIi.ne show Mg their workers'compensation lathe"istformation. Homeowners who stabil:at thai.allialasit Lndicaong thev arc during all work and then hue outside:imam:too ubnist a new affidavit usiiiewing such. :Contrac(ors that cheek this box must attar:hod an additional shmt showing the name of the soh-eta-La-actors and state whether or not those amities have cinployees. If the sub-contractors have e-mployees.they must prosprovide their workers'...mop,pulley mamba/urn an employer that is providing workers'compensation insurance for my employees, Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: CitytState.tZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under!VIGL c. 152,§25A is a criminal violation punishabk by a fine up to S1.500.(Xl and/or one-year impnsomnent,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.04)a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA fi.)r insurance coverage verifieation. f do hereby certify under the pains and penalties ofpedury that the information provided above is true end correct. Signature: Date: June 1, 2022 Phone#: 603-843-7202 Official use only. Do not write in this area,to be completed by city or town official t'ity or Tow a: Permit/License Issuing Authority(circle one): I. Board of Health 2. Building Department 3.fib/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: