38C-010 (22) BP- 022-0847
108 GROVE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38C-010-001 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-2022-0847 PERMISSION'S HEREBY GRANTE I TO:
Project# 2022 RENO Contractor: License:
Est. Cost: 40000
Const.Class: Exp.Date:
Use Group: Owner: SINKLER ALISON BLAIR&ERICH H SEMOLLER
Lot Size (sq.ft.)
Zoning: URB Applicant: SINKLER ALISON BLAIR &ERICH H I SEMOLLER
Applicant Address Phone: Insurance:
108 GROVE ST UNIT A
NORTHAMPTON, MA 01060
ISSUED ON:07/20/2022
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring U.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: $520.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVE
The Commonwealth of Massach setts
E a Board of Building Regulations and an ds R
'`
Massachusetts State Building Code, 180 RJUI. 1 9 2022 IPALITY
�SE
Building Permit Application To Construct, Repair, eno Or Demolish a evis Mar 2011
One-or Two-Family Dwelli g DEPT.OF BUILDING INSPECTIONS
N HI-HAMPTON,MA 01060
This Section For Official Use Only
Building Permit Number: 6% -' Y" Date App ied:
Building Official(Print Name) Signature D- a
SECTION 1:SITE INFORMATION
1.2 Assessors Map& Parcel Numbers
(-),/D Uf S'- 4-- l PLA ("1—g
1.1 a 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
wto )A(Is01 S.Li,k( i
Name(Print) City,State,ZIP
ek J,beUsU&aUlf.Cowl
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 ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
.. _ ral Pfr, i vto l-, P 1.cd iLS f VI.SU60
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.11,117r, $ 3 c7 OO p 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
Tectri $ 5 Op C 0 Total Project Costa(Item 6)x multiplier x
111110113 $ 5 OOO 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $ ,SDelFP 0
C eck No.345'Check Amount:
$ '10 Oo J94 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts z± _
,'� s;� DEPARTMENT OF BUILDING INSPECTIONS S°‘
212 Main Street • Municipal Building ilj,+.,� �tr
Northampton, MA 01060 ,, `" - 11`b
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
r ir
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). r
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.
1- war. 1
ir , I
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Irliffilt, ,r, kY' - ..R
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.)
R Restricted 1&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 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 . 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 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
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.
horized Ag Name atnre) ate
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.govId1i,.;
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 Commonwealth of Massachusetts
t z
18- Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017 r`
. . , .
,,,...- ......•1‘ WWW„mass.gov/dia
- it--50-
11 in kers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTINC.tt`,THORITV.
.tonlicant information Please Print 1.eilibl%
Name iBusiness,`Organizanouludividualr
Address:
City/State/Zip: Phone#:
Art ylle 011 displayer?Cluck the iippru prial t:trot: Type of project(required):
an hutt a rartoyer with empite:ces trial antor part-timei.• 7. D New construction
20 I am a sole propnctor or partnership and have nu entployem working for me in K. 0 Remodeling
any capacity.[Nu workers'comp.insurance nziquirial,)
I am a hinneoAamer doing all work myself. [No worker.'comp.insurance required.I
1 Artt a li
ntrand*111 b a=e h otintracairs to conduct A wo on my o my property. I will
ensure that all coritraeturs caber have*miters'compensation insurance or ate sole 9, -1 1)cinolition
10 Building addition
11.D Electrical repairs or additions
proprietors with no ernployeta.
12.0 Plumbing repairs or additions
.1.0 I am a eeneral contractor and I hr.c hired the sub-contractors listed on the attached sheet
These sub-euciUncliirs have emplu:keM and bay e v.urien:comp.insurance LID Roof repairs
.-
60 We are a corporation and its officers have exercised their night of exemption per h4GL c. 14,0 Other
152,1144).and we have no anplayees.[No workers comp.insurance required.'
'Any applicant that,:lux..:k)but al mini 160 rill out the section below showing their workers'compensation policy inform:11ton.
f Homeowners who submit this atruho it indicating they are doing ail work and then hire outside corttracters mod suiand a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the suls-contractors and state whether ur nut those entities have
employees. If the-4.,1v-contracturs hate employees.they must provide their workers'comp.policy nurnber.
I use an employer that is providing workers'compensation insurance fin-my employees. Below is the policy and job sue
infilrmagion.
. Insurance Company Name:
IF —
Policy#or Self-ins.Lie.4: Expiration Date:
Job Site Address: City/State Zip: _____.. _ .......
Attach a copy of the ssorkers' compensation policy declaration pai.te(showing the policy number and expiration date).
Failure tocxure coverage as required under1s4GL c. 152. :.125A 1.... '..I c nminal violation punishable by a fine up to S1,500.0011
and/er one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 hereby ertifi na er Us p..nis and penalti s of perjury that the information provided abate i.s true and correct.
, 4—k
1111111.11" 7/2-0 2-?
Phone 4:
Official case only. Do nut write in this area,to be completed fry city or town official 1
City or Toss n: Permit/License 4
Issuing Authorit), (circle one,:
1.Board of Health 2.Buildimt Department 3.City/Town Clerk 4.Electrical Inspector S. Plunibing Inspector
6.Other
Contact Person: Phone 4:
City of Northampton
Massachusetts
4 DEPARTMENT OF BUILDING INSPECTIONS k
C�•f
212 Main Street • Municipal Building
Northampton, MA 01060 8fJO�
I -
(F AND RENOVATION PRO )
In accordance of the provisions of MGL c 40, S54, a condition of Builcng 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: V j (Q.1jR--Q
Signature of Applicant: !— Date: 1' 2
City of Northampton
`— Massachusetts : �'
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DEPARTMENT OF BUILDING INSPECTIONS ;
212 Main Street • Municipal Building ; 3`
„T 4! Northampton, MA 01060 i �li 1"�
HOME01111111111111POIWGIIMININWEI
I, £r1 GIB ( -vs (A/lo(&4r (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.
u he ' s nd penalties of perjury on thk___,_is
Si
7day of , 20_.
(Signature)