24D-284 (11) BP-2022-0832
186 CRESCENT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-284-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0832 PERMISSION IS HEREBY GRANTED TO:
Project# SIDING Contractor: License:
Est. Cost: 15000 ERIC PAYNE 086442
Const.Class: Exp.Date:01/22/2023
Use Group: Owner: ANN GOODRICH, TARA
Lot Size (sq.ft.)
Zoning: URB Applicant: ERIC PAYNE
Applicant Address Phone: Insurance:
32 BURTS PIT RD (413)218-4276
NORTHAMPTON, MA 01060
ISSUED ON:07/14/2022
TO PERFORM THE FOLLOWING WORK:
SIDING
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 VIOL• TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
#�
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVED _40 pa d6a t'o clo4:2
JUL1 4 2022 The Commonwealth of Massachusetts FOR
iktibit/ Board cif Building Regulations and Standards
Massachusetts State Building Code, 780 CMR MUNICIPALITY
-PT.OF UILp��G it SPFCTJo S USE
rioirri�tutal mgn i App ligation To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 6af)1- 9 3 a- Date Applied:
K`-v„.17 17 7-/y zozz
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
I G Cre,Sct• V- SA- ��-/P .2I`f
1.1a Is this an accepted street?yes 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 CI Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2�_1 Cneir�'of'�tec C70J ('
Name(Print) City,State,ZIP
A N )( ,p' v , O ;'A- 1lvGv sp3y1.yt3- i lib" --+O4e.gqdo Q ,M / e,;,.,
No.and Street Telephone H nail Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) fill Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: R-e.P\o,e t S t d i vy%
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1 S 1 t a a 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees: $
Suppression)
Check No.--II► Check Amounfy'Up Cash Amount:
6.Total Project Cost: $ % 5-%00 Co 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
O g(o4 2 1 f 22t2"s
11
1" C, ax.'3Y\.— License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) J
No.and Street - Type Description
` t l w� v 10 �� U Unrestricted(Buildings up to 35,000 cu.ft.)
'
V� " R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Zi g 4Z1 G et P�� M C2 S�,\ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) (,l$4L
24
v ` ? �� IBC Registration Number Expiratioi Date
HIC Company Name or HIC Registrant Name (� 1
/' 6 Qa
No.ad)St .) — 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 ..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 on my be t 1 tters relative to work authorized by this building permit application.
/�t Z "� i
Print(iG ner'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
contain in this application-i�true and accurate to the best of my knowledge and understanding.
Print er's or Authorized Agent's Name(Electronic(ignature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered con'actor
(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 fo id 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 porc )
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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
„, . , :x Massachusetts Ns ... st
�„, x. „..
DEPARTMENT OF BUILDING INSPECTIONS .
, ::, ,),,,
ig) « 212 Main Street • Municipal Building y%Y•.,
e�.tit Northampton, MA 01060 y�;..... C
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: \1 ekl ``k' / 1c2- -(_,
The debris will be transported by:
Name of Hauler: 41 J1-‘"\-5
Signature of Applicant: Date: -7 1 L
The ('umntun u'c'ulth of Massachusetts
h== fit Deportment of Industrial
1 Congress Street.Suite 100
Boston. M.-I 02114-2017
:,.r ICWw.nluss.govldia
11orkers'('umpen ai Insurance.Affidavit: Builder`lContraclurdElectricianslPlumben.
It)RI. 111.1.1)V111 II 171E Pt:R%111TING At-111ORIPll.
,Annlicant Informal- Please Print ..ehihhr
Name'Business(►t;z.l'Jtrin ludo.idtlall:.
Address:
CitylStatc''Zip: Phone 0: _
Are you an employ re:'( heel the appropriate litre Type of project(required).
I.Q t art a cntpltna wteh employee%(hull and to part-trim 1.• 7. 0 New cunstrUC hoe •
�+��J+
r�1 an i a sole proprietor or partnership and have no employte%working for ma in IL Q Reititidelirig
.Ns capacity .workers'comp.Insurance n-yuired..1
9. ❑ Demolition
t;LJ I am a Irm et'w itet doing all work myself.INo*taus'come..imuran a required.I
11o0 Building addition
•I.❑I am a honwtown et and%ill be hiring ctwntractor%kw conduit all work to mar prrq+cttti.. I%Ili
ensure that all conir:ictors etllicr luwc wurken"cornp►nsrtuw,t:insurance vs:arc sole t l.Q Electrical repairs or additi
propnctors with no employees..
12.0 Plumbing rival •or addition.
�0 I am a general contractor and I hart hind the wb-contractors listed on the attached sheet..
ih r.esc uh-contracto hate emplcoyee%and kale mat e&comp.nnsutancc.- I3❑Roof repairs Otherp1
6.0 VI c afc a eorpoKalnn and its officers have exercised then right UI ev.%-mption per 5rt(tL 14 ❑ � ' 1 (C.1 "�C
I t - it 4t.and we hate no employees.INte aorlers camp.insurance required.I
•An..applicant that chet•ls bos.=I roust also till out the%xenon blow showing their userkas'contp,n.atton roil r mlrrrmatirrt..
+I loineow ten*Ivo submit this atlidat It man:slam tit 1,are&my all work and then hire'mimic contractors roust sulnmr a new attdat tl I Il3Ung scat.
confacton that check this boo Inusl attasited:rei additional sheet decoy nig tow murex of tile sub-cenlra:tnr.and%talc whether on not tease entitles hasc
employees. It the sub-contractors have cinplos...th0 must pros idc their workers'comr.pr lv,:s nutnb cr.
I ant an employer that is providing warAers'compensation insurance for ran)'employees. Below is the policy and job site
information.
Inuul.utcc Company Name::__
['Mitt - or Self-ins.Lie.#: Expiration Dale:
Job Site Address: Cit} Slate Zip: _
Attach a copy of the workers'compensation policy declaration page(showing the policy■scorer and expiration date).
Failure to secure coverage as reyuin 1 under MGL c. 152,*25A is a criminal violation punishable by a fine up to Sl.5(M).tit)
and or one-year imprisonment,as well as civil penalties in the tonn of a STOP WORK ORDER and a line of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the()nice of Investigations of the DMA cur insurance
coverage verification.
I do hereby certify under the pains and penalties o f perjury that the information provided above is true and correct.
Signature: C f, \J ` Date: ( 1\ IZ�
Phone#: cf137--1 gc{-Z-1C�
Official use only. Do not write in this area,to be completed by city or town official
City ur Town: Prrmitil.icense#
Issuing.Authority(circle one):
l. Board of Ilealth 2.Building Department 3.('ilyrtown Clerk 4.Ekctrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone#: