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25C-259 (13)
BP-2022-0692 9 FAIR ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-259-001 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-2022-0692 PERMISSION IS HEREBY GRANTED TO: Project# RENOVATION Contractor: License: Est. Cost: 15000 Const.Class: Exp.Date: LEVY BENJAMIN C &AMELIA CLAIRE NOVOTNY Use Group: Owner: TRUSTEES Lot Size (sq.ft.) LEVY BENJAMIN C& AMELIA CLAIRE NOVOTNY Zoning: SC/URC Applicant: TRUSTEES Applicant Address Phone: Insurance: 9 FAIR ST NORTHAMPTON, MA 01060 ISSUED ON:06/13/2022 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATION 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: W • - 7-11 Fees Paid: $98.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner /,/ / C� The Commonwealth of Massachus is tw. Board of Building Regulations and andar a '4 ♦ FOR Massachusetts State Building Code, 0 �r.ti4 ' 'ALITY ,� USE Building Permit Application To Construct,Repair,Reno �� op,.-molisl R. ised •r 2011 One-or Two-Family Dwelling �1?�n c, This Section For Official Use Only •',q'''$• Buildi • n Permit Number: 3#0- �" Uqz Date Applied: �� ''4P [vat /Z,51/Z 13•ZOZZ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION } i Y-S, 1.2 Assosoors Map& Parcel Numbers a b ZS1 1.la Is this an accepted street?yes X no Map Number 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: Z d/ --‘ 1310' ([0se-f--1-vvvi S i n 00 0{fi a c(etCe - m JC Vie W w►` avJS . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) $ 1000C.) 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2 $ 1 0 0 0 0 Total Project Cost3(Item 6)x multiplier x 3.WIMP $ Lto07 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ ry� Suppression) U rs7I�O Cheek Check Am ❑Pai F� Il 0 Out • ance Due:1i City of Northampton Massachusetts Q,{ DEPARTMENT OF BUILDING INSPECTIONS 7 z 212 Main Street • Municipal Building ON, rC, . ' Northampton, MA 01060 . 44, 1~�, PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR, ETC. 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work (Digital and hard copy). 3. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new /replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements (if applicable). 9. Energy Code —all new construction(Gut/Rehab) requires a HERS Rater Affidavit 10. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description 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 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street 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 0 No . ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject prop erty,hereby authorize to act on m alf,in all hers relative to work authorized by this building permit application. Print Owner' Nam (Electronic Signature) Date afmilijjillIlllRAUTHORIZED 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. ylniaat attire 1\tor . Jv►u J© 20z2 Print Owner's or Authorized Agent's Name lectron c Signature) alliftiallp 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,pr" v e 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" ,46............. The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Roston, MA 02114-2017 , . www.mass.govidia %Yorkers'Compensation Insurance Affidavit:BuildersiContractorstElectriciansiPlumhers. TO RE PILED'VS nit THE PERNII ITING AtrillORITI. Applicant Information Please Print legibls Name I hiusiness.:Orgartizatiorti Individual): s• Address: City/State/Zip: Phone#: , „. „.... .. - .- Are you AO employee Cheek the appropriate holt ,, Ty pe of project(required): 10 1 am a emplay'or wah _ ,_ employees(full:miler partaimet,* Ilk..., 20 I AM a uale proprietor or partnenthip mud Moe nu employees working- for me m 8 0 Remodeling ' any capacity[No workers'tamp.MiLiraticc nerantred] lia lam a homeowner doing all work myself.[No wiairkami"vamp_ man requir ,ed r 0 Demolition to 1.A lionaostancr arid*al he Mimi oinaractar*to conduet all a ark on ray propeary. 1%Ili 7 9 N. ew construction 9.. 10 c3 Building addition smarm that all contractors either hove winker*"eMMumnion insurance in are*tale H. Electrical repairs or additions proprietors*lib no employets.. 12. Plumbing repairs or additions 50 1 am a ginieral coMMCMr and I have hired the soloeontractors Listed Jr the attadied sheet, 131:Roof repairs These subseoritmetors have employee*and base worker*"comp.rnsurance 14.E3 Other 6.E3 we are a*Inversion and iLl officers have eitiarised thew right of east:mum per Wk.c. 15.2,§li 4).and A c fuse no imiployees.[No wortims'comp_inaerance requiredLI *Any applicant that chicks ha*=I mast also tillscut the sectisam helots showiag their worker**compensation policy niformahon *flonteowners is ho mahout this affidavit insticating they are doing:ill or and then hem outside contraoters name submit a new affidavit indicating such. teontractors MAE check this be must attached an Aiktimmal thee showing the name of die indrators and state°whet:et-Le not anrse entities haoe employees It the m..11,---cMIlrACICAN lease employ ties.they most mashie their workers'comp.policy nt_rikl ' .. I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information. hisurance Company Name: — Policy 4 or Self-ins.Lie.#: Expiration Dare: 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 cos erage 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 of a STOP WORK ORDER and a fine 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 c'erfiti•under t, ins and pen€ ,f perjury that the information provided above is true and correct. 401.1111.: .11111.11. Jtri'N-1- I o 2-612- .one 4-‘: I -; 0 4110 Offkial use only. Do not write in this arra,to be completed by city or town official City or Town: Permit/License# ''. Issuing Authority(circle one): ,1 I.Board of Health 2.Building Department 3.Cityirfosin Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other I Contact Person: Phone#: City of Northampton , e,� " Massachusetts --_ ° DEPARTMENT OF BUILDING INSPECTIONS �� 212 Main Street • Municipal Building Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT. (FOR ALL DEMOLITION AND RENOVATION PROJEC S) 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: Vet iI ) 12eC U r/ V' 2 3 t a. G The debris will be transported by: Name of Hauler: cf_1$ Signature of Applicant: - Date: -7dhe 12CLZ City of Northampton Massachusetts S S * � DEPARTMENT OF BUILDING INSPECTIONS / , 212 Main Street • Municipal Building ^r Northampton, MA 01060 3'F44 4aroN.' HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1 l2 19 89 I, — 'VI.Piti4 e'4v P N0 1' (insert full legal name), born_ (insert month, day, year), hereby depose and state-the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under t ins and penalties of perjury on this I o day of J"'N-e , 20 2- - \J (Signature) L-e- -\-- U V i Nf W W t vidow Of IN liv t"d(NJ 1 , 1 1 ol. i ,.. , ', 7_,°'Icioar ccl,. c x" _ . 0 bl --------------) K ._i_v 410. 1 I . - i 1 7 co it c° 1 1 \ )