18-002-024 BP-2022-0646
82 PINES EDGE DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18-002-024 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-2022-0646 PERMISSION IS HEREBY GRANTED TO:
Project# KITCHEN RENO Contractor: License:
Est. Cost: 21358 THOMAS MALONE 055236
Const.Class: Exp.Date:01/18/2024
Use Group: Owner: TYLER CARSON-EISENMAN, REBECCA&
Lot Size (sq.ft.)
Zoning: , RI/RR Applicant: RHI CONSTRUCTION INC
Applicant Address Phone: Insurance:
128RYAN RD (413)885-9038 7PJUB1K060384
FLORENCE, MA 01062
ISSUED ON:06/06/2022
TO PERFORM THE FOLLOWING WORK:
KITCHEN 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
• Jri >2 3-1/ •
II
Fees Paid: $139.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildine Commissioner
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The Commonwealth of Massachusetts
Board of Building Regulations and Standards 6 20 FO
MC
"��1 Massachusetts State Building Code, 780 CUR ° -��oFou<< 0,1
U EAL:'If
Building Permit Application To Construct,Repair,Renovate OrDemdt3ltya N rJSkt 1,, a, 1�I6
One-or Two-Family Dwelling
This Section For Official Use Only _,__
Building Permit Number: GP- )--OW Date Applied: —-
4 1,..,&7, iiiz G-6-7-6Z2
Building Official(Print Name) Signature Dale
SECTION 1:SITE INFORMATION
1.1 K4Aperty Addr 1.2 Ass g Map&Parcel Number��
4' Q►N.,1 p�� nu
I.1 a Is this an accepted street?yes no Map Nuiber Parcel Number _
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) _.__.
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provide l_
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal syster1 0
Check if yes❑ _____--
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner'of Record:
13-cc)k-1 1-‘,-3 .in - i`-n rr \jz.,N,,,,fp 006
Name(Print) City, State,ZIP
Z p- ) Z6€—n4--S
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addit on C
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: _
Brief Description of Proposed Work':
vS, Ca(t,e-N i C..«C)
S k-- ,i'N 54-e e- 12 le-a 2,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) ._
1.Building S 1. Building Permit Fee:$ Indicate how fee is dete, ninet
0 Standard City/Town Application Fee
2.Electrical $ 01) 0 Total Project Costa(Item 6)x multiplier x_—
3.Plumbing $ 1.66.ice 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
Suppression) 17-I q
Check NvCheck oun : C Amount:.. ..
6.Total Project Cost: $ ZI Z,f$ k-i I, ❑Paid in Full ❑ ance Due: :—
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 6S-053 `` I
^�� v (Vv.,ltvL License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street �,�n / T Description
1 t' o OU ) U Unrestricted(Buildings up to 35,00( c u.ft
Restricted 1&2 Family Dwelling
City/Town,State,Z1P M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
-co T Q j Q I Insulation -- -
Telephone Email address D _ Demolition
5.2 Registered Home Improvement Contractor(HIC) --
Q- rU.S ,._11 �ti 1 :cc( cE-u ZZ
HIC Registration Number Expirati oa Da e
HIC Compagy Name or Registrant Name
1
No.and Street �" �� �� • Mt
(Ykf ONO \7 �S-SG�� 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 ❑ No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WREN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize --VAN(! (n 4
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 application is true and accurate to the best of my knowledge and understanding.
6 — ( ? -z
Print 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 con sactt •
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitratior
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be f.fund:I t
v w.mass.acv oc_a Information on the Construction Supervisor License can be found at w�,��,.mass.<zo�da:
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or por;:h)
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
Massachusetts
1a DEPARTMENT OF BUILDING INSPECTIONS
iolifi
212 Main Street o Municipal Building �f r �;,
Northampton, MA 01060 rS•. S ,
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 di:;posr:d if 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: \ C
The debris will be transported by:
Name of Hauler: �-�M� c W ir-P/
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Signature of Applicant: �'� �� Date: �
., .
The Commonwealth of Massachusetts
g'..1 =7. -- -7.-", 1-ri Department of Industrial Accidents
t 1 Congress Street,Suite 100
Boston,MA 02114-2017
141.. ..---- -:-.:x./•,-Y www mass,govidia
Winkers'Compensation Insurance Affidavit:RulIdersiCantractorsiElectrieiansilPlumbem.
TO BE FILED WITH THE PERMITTING AUTHOR/TV.
ADDIkaal Information Please Print ...e...gil
Name 1Busmess,'Organizationindnidualy .t.,
Address: \DOS •••••32..-",City/State/Zip: C11-4-"-<------ Ni\--0101- Phone#:
Ark*OM an erripin!.er?Cheek the appropriate box: 1.
; Type of project(req ired
i
in i Urn a eurpleya A ith______ empZoyees,it'll anti or part-thne t.*
i 7- i1)ew congracpan
I JIM a mi;t:proprietor or Irdrtirorsinp and have no orapieyee:working for tee in i N. Remodeling
;my,..-4r,:tc1ry.[No worker:*CLmnp.in:Llama: rd.,
9. T1 Demolition
30 I 4111 a horneott run doing at%oil.itt,v.:11.{No' ikta-t?eun-ci....Tannin:4.z roquited.1' I
.i 100 Building add:ill i ci
44--1 1 ant a hurl:eau nor and will lao hirine t.-untruetur:El,ixiatItiet all work:on ray property. 1 will
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t-itaexe that all eantractur:t-itlxn have worker::c.cltnpouvaLavi inNi.-rarioe t are wit: i I 0 lEitZ,Lirie...al repa::,07 1:1,_i.
mtor:tt ith no erriph.yee:.
eifro 1 E
t 12.0 PIUMbing tk.Iptl :,_,0:- i Lid• !jib,
5 i am a oraenti contra:tor and 1 La ve hired the 1.tb-curitrartor lihted or:tb. atta6ed Arcet. l'
!
Them:sub-cvntractoris have erripket,y -:ant;have workm*eon*.insizranre.: 30 Roof repairs
i 14.0 Other
6.0 tv.•an a ourptim.lion awl it:oftiocra hate exelviied their right ml.exemption per itttii.3.
I SI§11411.and we haw ro employee%[No worker:*comp in.stannec required.' i
*Any appliozni that ithetl.%K.L.‘=3 iblist al,u lin OLT lilt:to:Clit.11'bCitiW Situ3.4 iriii their W(*lits vUlliperisatiuri pulley information.
1 Horrieowem who attinnit Ili:arlithat it indicating they are ant all wink and thri hire nut:ide elnitraetors nal::auhrnit a new affidavit it: ta::•'.1-,!.. ,t„,.:
rContraetam that diedk thi:bc”..trILI atthtai an ati iitiunal Sheet shut ins the name cf the:iaiii-euntractsirs and state ik haliz ix riot ilium:
orriployeeN. lf the.,Lb-1:ontrar tors Izat e cm loyea.they tnut4 provide their Ntiorkers.ocztp..poliey ntatib1/4.7.
I um an employer that is providing,workers'compensation litilittillee for my employees. Below is the policy
information.
hiunmce Company Name: L i\.20—'(‘. .-- ,".iS L-1Z-/V`C-.__. C ,\evs‘
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Addre1;:___ :-a girt-6 AL ,. (..-ity'S-iate/Zip:
Attach a copy of the workers compensation policy declaration page(showing the policy number and exit ratio id e?.
Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by a line up .• ',..:-
andfor one-year imprisonment,as'well as civil penalties in the forni of a STOP WORK ORDER and a line of u : S. :5::
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA t.ir ins
CO Vc..,rage.verification.
I do hereby eertijj,under th dins . pe it' erjur' ' the information provided above is true and c..orrea
Siunature:Phone :
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- Officiai use rinti. Do Hal Mite in this area,to he completed by tio,or town E..ifficial. 11
I
,
City or Town: Permit/License 4
' Issuing Authority(circle one):
I.Board of Health 2.Buildina Department 3.City/fawn Clerk 4.Electrical Inspector 5.Plumbing:nspei f 1 r I
6.Other
(
Contact Person: Phone 4: I
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