10B-013 (3) BP-2022-0770
8 AUDUBON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
10B-013-001 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-2022-0770 PERMISSION'S HEREBY GRANTE,' TO:
Project# 2ND FLOOR RENO Contractor: License:
Est. Cost: 20000 TIMOTHY SENEY 061088
Const.Class: Exp.Date:03/25/2023
Use Group: Owner: TRUSTEE SENEY TIMOTHY J
Lot Size (sq.ft.)
Zoning: URB Applicant: TIMOTHY SENEY
Applicant Address Phone: Insurance:
371 PROSPECT ST (413)667-0230
NORTHAMPTON, MA 01060
ISSUED ON:06/29/2022
TO PERFORM THE FOLLOWING WORK:
RENO 2ND FLOOR APMT, BUILD 1/2 BATH
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:
.>2 . Tv
Fees Paid: $130.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVED
The Commonwealth of Massa hus s
1 FOR
* .„ Board of Building Regulations an Sta dar ICIPALITY
Massachusetts State Building Cod 78 c N 2 7 2022
_ USE
Building Permit Application To Construct,Repa ,Re ovate Or Demolish a R 'sed Mar 2011
One-or Two-Family Dwe lingDEPT.OF BUILDING INSPECTIO
ti^ INSPECTION;MA 01Obu
//�� This Section For Official Use Only
Building Permit Number: �j r- -7v7~17O Date Applied:
eA o ) 4?5.5 ���� �'Z�'2622
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address:
1.2 Asses ors Map&Parcel Number6�3S- 0�Qtic 2r, L c s 10 z
1.1 a Is this an accepted street?yes of 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:
Zone: _ Outside Flood Zone?
Public Private 0 Check if yesCJ' Municipal ErOn site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Qet'_.of Record:
/,, 1 ,S2.4e0 A42TT,/a-rfo i /149-_ 0/D6 G
Name(Print) City,State,ZIP
31/ , osPlCCr Si.. yi ' 6,26 /7,7
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) ❑ Alteration(s),0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: Sprig. oZ F[oriK di= , 'fiR i iYR. r A x ✓ ✓!.47ti,
'9 i✓O /.t/.S✓[. ►T7.A cJnJ` /30/L.) /Ifni= .t3✓fH T . / wt,r✓ G
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1. Building $ 7ouJ 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
IOaO 0 Total Project Cost3 (Item 6)x multiplier x
3. Plumbing $ 7/. 060 2. Other Fees: $
4.Mechanical (HVAC) $ r o6 a List:
5.Mechanical (Fire $ �_
Suppression) Total All Feesr$ �f,'
• Check Noo?(43 Check Amount: I Jv
6.Total Project Cost: $ ad C000 Paid in Full 0 Outstanding Balance Due:
City of Northampton
M•
assachusetts
k^ ( t" DEPARTMENT OF BUILDING INSPECTIONS a
80f; , 212 Main Street • Municipal Building
;ram, Northampton, MA 01060 � ��. .�,.�•,''
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.
II
i
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Su ervisor License(CSL)
rs - a610F 23
/f( License Number Expiration ate
Name of CSL Holder
List CSL Type(see below)
37/ t?osizzc" ;.
No.and Street Type Description
/ \/ orIPTGJ ff� C'v(� r Unrestricted(Buildings up to 35,C00 Cu.fr.)
R Restricted l&2 Family Dwelling
City/Town,State,ZIP / M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 RegisteredHope Improve ent Contractor(HIC)
/9y,oi , 22
//o' > evi 7" . 1 C-. HIC Registration Number Expira 3
ion Date
HIC Company Name or HIC Registrant Name
s1rir
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 Issuanance of the building permit.
Signed Affidavit Attached? Yes ❑ No . 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the sub'- :•erty,hereby authorize rfYs/t(.-F
to act on my behalf rs relative to work authorized by this building permit application.
6 / /
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 a'•li»: on i : le and accurate to the best of my knowledge and understanding.
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"
The Conentonwealth of Massachusetts
Department of Industrial Accidents
!it
=..
1 Congress Street,Suite 100
Boston.MA 02114-2017
MOStmass.govIdia
Workers' Compensation Insurance Affida%it:BuildersiContractors/ElectriciansiPlumbers.
TO BE FILED WITII 11W PERMITTING AUTHORITY.
Applicant Information Please Print Lellibls
Name(fiusiness;Organizationihu101kivalr //pi (Ip../7/2 1 C77.1C,-- L
Address: 3 1/ /-?e osPiTcr-
CityiStateZip: AX/er-Hav-rp-r1 /164 Phone #: c ? /
;In Check the appropriate hot: Type of project(required):
1.D an I a zinoloyer with erriployees(full anclot pint-time I.* 7. New construction
a sole propneior or partnership and have gErternodeling
any capacity.[No*utters'eurnp msurance required.]
;.0I ama hATMC(1,411e1 doing all wink myself.[No workers'comp.irons-awe required.]• 9_ El Demolition
10 0 Building addition
4.3 tarn a homeowner and will be hiring isnitramars to conductaft work Ut3 ray property, I will
ensure that all llfl Electrical repairs or additions
proprietors with nu employees.
12.0 Plumbing repairs or additions
30 I am a ittaklal contractor and I have hired the sub-contractors listed on the attacked sheet
130 Root'repairs
These sub-curnmni ets have employees and have workers'comp.utsuiltrice.
14.0 Other
6.0 We oiveratiun and ill otireers have exercised their right of exemption per MIGL c.
1.12,§114 f.arid we have no erripkryees.[No winters'eorop.insurarICC required.'
'Any am:the-ant that check.%box 41 moo al...!till out the YeebUil below aho law.then--worker.'compensation itulicy information.
tfann.voirom*fit)sUbtnit this atria,,t Indica tine they are doing all or and then hut outside contractors must submit a new affision untieatmg such.
:Contractors that cheek this boit atta..±ied an additional Awe%thowirn::be name of the ialb-+euntractors and aide whether or not those Immo.have
employees lithe ,u1,--.4:unirsi:tors have tçkicta.they must pros idc their kta p.nI ra.ankei
1 am an employer that is providing worhers'compensation insurance for my employees. Below i.s the Indic).and job site
infUrmation.
Insurance Company Name:
.Acit czt/4_
Policy#or Self-ins.Lic.#: azo6/6,) e-/t3 Expiration Date: 3 3 /Z3
Job Site Address: /q4?4/./30,3/4-1 /( ) City/StateZip: bt/Z45 0/6.;-3
Attach a copy of the workers' compensation polics declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152. §25A is a thminal violation punishable by a fine up to S1,500.00
andior one-year imprisonmeta,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 herebv tern i• • a* a and penalties of perjury that the injUrmanun provided rhove • Mile dtdl7eet
Sqpiatute: Date: 2
Phone#: 4-/(S — Ad4 - /7f
Official use only. De 1101 write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Anther* (circle oner
I. Board of Health 2. Building Department 3.Cityrfown(7Ierk 4. Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone 4:
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
<c r 212 Main Street • Municipal Building
Northampton, MA 01060 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 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: V6 --/ 4,c( YCc
The debris will be transported by:
Name of Hauler: v�
Signature of Applicant: �C/ Date:
i �J
City of Northampton
k Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
: 43S;14
212 Main Street • Municipal Building
Northampton, MA 01060 r10
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
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 the pains and penalties of perjury on this day of , 20_.
(Signature)
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