35-266 BP-2022-0620
21 WEST PARSONS LN COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-266-001 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-2022-0620 PERMISSIONIS HEREBY GRANTED TO:
Project# REPLACE PORCH Contractor: License:
Est. Cost: 53000 ROBERT J WALKER 034783
Const.Class: Exp.Date: 10/18/2023
Use Group: Owner: TRUSTEE MANGIONE LORRAINE
Lot Size (sq.ft.)
Zoning: WSP Applicant: JUST WALKER
Applicant Address Phone: Insurance:
36 Service Center (4I 3)584-1224() WMZ-800-8006540
NORTHAMPTON, MA 01060
ISSUED ON:06/06/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE 8X16 PORCH ADDITION DUE TO TREE DAMAGE
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:
10.15,)
Fees Paid: $345.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
3 SoLL56 PL/>S
RECEIVES
111 j � 1 lioj The C mmonwealth of Massachusetts
V
" :oard of uilding Regulations and StandardsFOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
p r�7 7 INSPFG IONS, n USE
�, 0 >e phcation To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 647-.1 D-•0,,gt Date Applied:
Ile ° 'Ir. ' ' �O _ _
Building Official(Print Name) Signature --
ate
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
21 we57- PA-kso NS L- e ) 1Cto4.E -3 5—
1.1 a Is this an accepted street?yes ✓no Map Number Parcel Num-oer
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) N 6 i A0 P Lt c-,r--f5 to 1 (2E.h tAGI F,c' DAMA 0 A-DP,-
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 Gd' Private❑ Zone: — Outside Flood Zone?
Check if yes❑ Municipaln site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
<TAv►nES SC_140 fvli}Ct.I.EIL) LOeiz.A,uE M+0"6 'u'`'C. 1:.0 t.X.k /V\A c-) 1 0(r)0
Name(Print) City,State,ZIP '
21 w -ST PM-5 o -6 t—E- 5 34-- : 2--i-
No. and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK(check ll that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) lie Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: '({gyp Eric Ci- X it,' _ o ex-t - /4 Q p 1 T'C�N
D A-* Arc qv t3 1 c ts,-t.t. t (v i E- - r
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 determined:
t 0 Standard City/Town Application Fee
2.Electrical $ O• ❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ _, List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No.4i I Check Amount:3gcCash Amount:
6. Total Project Cost: $ 5 3, O(x%. ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C_s a 34 8 3
Witt jZ3
t.Q-1— S W-tee Q License Number Expiration Date
Name of CSL Holder
/-66 List CSL Type(see below)
�f11-4�c . c�N n
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
TIrVx t itA A- v 10(00 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
et-1ZZA tcc\L -e S},r.,do.65ociaicS;owl SF Solid Fuel Burning Appliances 16 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) +, ZU I I'SIto 2.4
Crz� S (,,v'4-1AtI�G.2_ HIC Registration Number Expiration Dat
HIC Company Name or HIC Registrant Name
So�QT
No.and Street G wAS_ 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 ❑
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 12.0 6
to act on my behalf,in all matters relative to work authorized by this building permit application.
TA-` IE_S 5 RvMAc /t
Print Owner's Name(Electronic Signature) ‘az
te
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 in formation
contained in this application is true and accurate to the best of my knowledge and understanding.
�'� �- f ( (2Z
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
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"
��AN� City of Northampton
` Massachusetts �s,�'" '1
I °
{ DEPARTMENT OF BUILDING INSPECTIONS 72 }
•x: * 212 Main Street • Municipal Building i ,; ,Ca
✓�.;-= Northampton, MA 01060 r4
1:;
14
..����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:
The debris will be transported by:
Name of Hauler: Ccrn S-c-Y u-a-
Signature of Applicant: l�� �' � Date: 61( 2-z
l
The mmweah of Massachusetts
n DepaCortmenton of Industrial Accidents
I Congress Street, Suite 100
Boston, 41fA 0 2114-201 7
►s'K'w:rnass.gov/dia
ss ulkers'Compensation Insurance Affidavit: BuildersiC ontractorstEkctricians[Plumbers.
ID Bk:F'11.1.1)%1 I ill i ilk:PER\l1111NC At THORI 11.
An plies nt Information Please Print Lceibls
Name titustness,O ganizatuxn-Indr rduall;
Address:
City?State/Zip:_ Phone#:
Are yoaxiaceinplayee Cheek the appropriate box:
Type of project(required):
ltrillam a employer with employees(full and'or part-uns l-* 7. o New construction
2.0 I am a auk prupnetur or po.rtnrnhrp arid have no employees wutkurg fur me in
R. 0 Remodeling
any rapacity..[No workers'comp.insurance required.] a
30 I am a homeowner doing all work myself.ISo workers'comp. insurance nyuirnt.I' 9. r Iition
4.0 I am a homeowner and will be hiring contractors to conduct all weak on my pr�• y.
rt I wall l c kiting addition
ensure that all contractors either lase workers'competh4tion insurance Of arc sole I I • Electrical repairs or additions
prupneturs with no employees.
12.0 Plumbing repairs or additions
50 I am a general contractor:uul I hake hind the sub-contractors listed on the attached sheet.
These sub-contractors hose crn cw.plovs and have workers'comp.uuunu cc. 131:Roof repairs
6.0 We an:a corporatism and its officers have exercised their right of esenrptirm per Mtit.c. 1 4'1_J O��— --
15.s-.r 1(al.and we have no crnpluyecs.(No workers'comp insurance rcyuinvi.(
*Any applicant that cheek,bus al must visa till out the section below show mg their workers'compensation policy information-
*Humruwnen.who submit this affidavit indicating they are doing all work and then hire outside ctratractorr,mint submit a new affidavit indicating such.
:Contractors that check this his must attached an additional sheet shrrwtrig the name of the sub-contractors anti state whether ea not them:entities have
employees. If the sub-contractors hive employees_they must proside their workers'wrap policy number.
l am an employer that is providing workers'compensation insaraadrfor my employees. Below is the miler and Job silt'
information.
Insurance Company Name: A
Policy#or Self-ins. Lie. #: ?s-c o 2-02 c A Expiation Date:
Job Site Address: 2 I �" Qr�✓Sir*s- , Lett ,r' City/State/Zip: Wrs, Ge�e7
Attach a copy of the workers'compensation polity declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152. §25A is a criminal violation punishable by a fine up to SI,500.00
and,or one-year imprisonment,as well as civil penalties in the form ofa 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
coverage verification.
I do hereby certi under the tins and �a
jj' IN piblanttiex of perjury that the injorrxtrllon provided above is true and correct.
Signature: ts� �` Z i>.tte: 671 ( 2_a
Phone d: crg..) -- 17 Z r_i
Official use only. Do not write in this area,to be completed by city or town official
('its or Town: Permit/License#_
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: