38A-134 (11) BP-2022-0965
86 MOSER ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38A-134-001 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-2022-0965 PERMISSION IS HEREBY GRANTED TO:
Project# BASEMENT RENO Contractor: License:
Est. Cost: 55000
Const.Class: Exp.Date:
PASTRICH-KLEMER KATHERINE MARIE &
Use Group: Owner: DEBORAH LEE PASTRICH-KLEMER
Lot Size (sq.ft.)
PASTRICH-KLEMER KATHERINE MARIE&
Zoning: PV Applicant: DEBORAH LEE PASTRICH-KLEMER
Applicant Address Phone: Insurance:
86 MOSER ST
NORTHAMPTON, MA 01060
ISSUED ON:08/12/2022
TO PERFORM THE FOLLOWING WORK:
BASEMENT RENO
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: OH: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I T,Ati
o . 1. "9 -
Fees Paid: $357.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
✓YlG df pl&lc Ae
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}� The Commonwealth of Massachu -tts
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t,, Board of Building Regulations and S ndar i s AUG
Massachusetts State Building Code, :0 C� R 1 For 202, - Utr TY
Building Permit Application To Construct,Repair, ,'end:tree,Sr :_ • ish a R: ised ar 1011
One-or Two-Family Dwelling NOarHgM or;t isAaEc ()his
7060
This Section For Official Use Only
Building Permit Number: Rol'. C/c Date Applied:
/EU l xo',3 _/�2 -12.202-z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Ass s rs Map&Parcel Number
86 Moser St Northampton, MA (321 1"
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❑ Private CI
Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Dr. Kate Klemer Northampton, MA, 01060
Name(Print) City,State,ZIP
86 Moser Street 646.824.2102 debp326@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition 0 Accessory Bldg. ❑ Number of Units Other El Specify:basement finish
Brief Description of Proposed Work': Finish basement 800 sq.ft ; periter framing, R19
drywall installtion, taping, ainting, trim and baseboard installtion, LVT flooring
interior doors. finish ceiling
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 45,240.00 1. Building Permit Fee: $_ Indicate how fee is determ ned:
2.Electrical $5,560.00 0 Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $4,200.00 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) Total All Fees: $Check No. Check Amour 11�]
Cash Amount:
6.Total Project Cost: $55,000.00 ❑Paid in Full 0 Outstanding Balance Due:
G0-144c,Ct - r O bq4 site n 4 r esl, pros, Cil-,-�.
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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 .......... ❑ No . M
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the su ' ct property, ereby authorize Dr. Kate Klemer
to act on my behalf,in al rs lative to wor thor. it g permit application
1 0 2— _
Print i nt Owner's Name(Electrons i nature) L g/4 2. ate
SECTIO . WNERi OR AUTHORIZED AGENT DECLARATION
By entering my name ow,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 y knowledge and understan 'ng
Dr. Kate Klemer/ --N_.__ ( 9 ��
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.) 800 sgft (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"
City of Northampton
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r..'ram Massachusetts 'e
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DEPARTMENT OF BUILDING INSPECTIONS x
212 Main Street • Municipal Building J�' ^``�
Northampton, MA 01060 frn 3,7�
3i2-aP4
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT \
I Dr. Kate Klemer / at 61 P ` I 01,1-sert` name), born'?seerrttmonth,
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 e , 20d 2
Gk
(S nature)
City of Northampton __
/.`.'t Massachusetts ,`�' .
y
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DEPARTMENT OF BUILDING INSPECTIONS 9
212 Main Street • Municipal Building Jj. `�.
�' 42
A;) Northampton, MA 01060 J''1'W TO}-~
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: Dumpster
Location of Facility: McNamara Waste Services
The debris will be transported by:
Name of Hauler: Green Leaf Disposal & Recycling
Signature of Applicant Date:
9 .-a
The Comntonyveahh of a%lassachusetts
- ( Department of Industrial,accidents
I: ,t 1 Congress Street, Suite 100
Boston,
kpis -,• y
MA 02114-2017
r., cyih wwwntass.got/dia
11utkers' Compensation Insurance Aflidasit: Builder lContractorsfF:lectriciansil'Iumbers.
10 HF FILED WITH HIE PEK.MI rIIM(::At TIIORI I\.
Annllcant Information Please Print Legibly
Name lHusitts.S Organt..atton lndtstdual►: Dr. Kate Klemer
Address: 86 Moser Street
City/State/Zip: Northampton, MA 01060 Phone#: 646.824.2102 II.An,you an employer?(`►rtk for spprupriatt but: Type of project(requireld):
1.0 lain a employer with employees itult and ui pare-tint l.• 7. 0 Ness construction
3 I ant a sole pratpnttur ur partnership and has o nu employees winking fur me in K. 10 Remodeling
any capacity [No wurlers'cennp.insurance nquircd.]
9. ❑ Demolition
t.0 I ant a hurni:ov.n-r doing all suck nysett.]Nowork:rs'curnp inauruite cquireal.]'
Iq d Building addition
413 I ant a hunthounxivr net and+s ill b.Meting:own'e:ura to cianducl all ss ore on my property. I till
ensure that all contractors either hate workers'otriypeyu:itnw insurane-e or an sort I 1 a Electrical repairs ur additions
proprietors+s ieh no ennptuyces.
12.0 Plumbing repairs cr additions
S0 I am a neneral cuntractui and 1 has c hired the sob-contractors lured un tlac attached sheet.
130
These sub-contractors hale empkncea and pate sooners'comp.uuurance.:
Roof repairs
h.D Y an:.a 4.orroratrun and its officers has exetciced then ngh t of e.ceniptaivi per 11,16L c. 14.❑()thee
I S 1..;1141_and w:has,:no employees.I No+suckers'cutup.insurance required.]
*Any applicant that checks host.1 must also till out the suction hpuss shutting then+sorters'cunrpensuliun pulley tnlormauon.
r Homeowners+sho submit ties allidatit uidreatmtt they an:doing all ssork and then hen outside co itraelora must auhciut a now altidas it nadir aing such.
:Contractors that check this,his num a11a.-led an additional sheet shuts In the name ut the sub-cinttrntors and state Y.helher or not those entities hats:
employees lithe suck-cuniraeturs!art:ciripluyces.they must rn'idc their A rockers'ernrip policy number
l am an employer that is providing worJers'compensation insurance for m►'employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Selfins. Lie. Expiration Date:
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 coverage as required under MGL e. [52, ;2>A is a criminal s iolatwn punishable by a tine up to S 1.5(X).00
and;or one-year imprisonment,as sell 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
coserage verification.
I do hereby certify',under the pains and penalti's of per • that t e information proi'icle l b ve i-true'and correct.
t a4fr,c
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si>nature: Dr. Kate Klemer i
�� Date:
Phone g: 646.824.2102 /Gum— flC-' ' - "/R (2-2_
Official use only: Do not write in this area.to be completed by city or town official
City or Tossn: PermitiLicense ti
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3.('ityriossn Clerk 4. Electrical Inspector 5. 1'1(11111)ilit: Ilislicetur
b.Other
Contact Person: Phone#:
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22' 5.7" Water °
Heater I III rm_IN
5'" x4
1/2 B h® ®
1: Heat/AC %/linisplit System
5 9'9 2: Doors 30'x80"
3: Ceiling hight 7'5"
4: Floor Type: LVT
5: Basement to be used as Finis
® ® Entertainment Area with 1/2 Ba
Ceiling ro'ections(support
® Smoke/CO detectors
Open Finished Area LED recess cans 6"
Access panels
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