15B-030 BP-2022-1052
246 CHESTERFIELD RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
15B-030-001 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-2022-1052 PERMISSIONIS HEREBY GRANTE TO:
Project# WINDOW Contractor: License:
Est. Cost: 1500 STAHLS SPECIALTIES LLC 105598
Const.Class: Exp.Date:07/06/2023
Use Group: Owner: DAILY, SUSAN &BROWN, MICHAEL
Lot Size (sq.ft.)
Zoning: RR Applicant: STAHLS SPECIALTIES LLC
Applicant Address Phone: insurance:
211 CHESTERFIELD RD (413)475-2501 WCC-500-5024941
WESTHAMPTON, MA 01027
ISSUED ON:08/26/2022
TO PERFORM THE FOLLOWING WORK:
1 REPLACEMENT WINDOW
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:
I
,.e .. .21,:1 A . .
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
__ __
F)
The Commonwealth of Massachus E C E I v E +
* Board of Building Regulations and Sta dards R
Massachusetts State Building Cody, 780 CMR MwIFOR
O FO LITY
AUG2. 5 2022 USE
Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling i
This Section For Official!Use OnOrFT nuAnl DtToN.I NMsAr r1c0T6OP.S
Building Permit Number:ce,P— �.)." I OS a. Date Applied:
14-1-"-U„� 4Z5S /742 8 26-ZIjZZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address` n IS � dOS 3 1.2 Assessors Map& Parcel Numbers
L�6 Cke c-r ;e T� )G 15'S 0 30
1.1a Is this an accepted street?yes \/ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
SO, Oqy
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[� Zone: Outside Flood Zone? Municipal 0 On site disposal system sr
Check if yeste
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
S,,s cv.,\ D a;(y Lez hi /4 O/0 S 3
Name(Print) City,State,ZIP
).1f6 Ct-eskAa 2l 8z'— 3 -3210 Svlanh;nsler Py ;1,c
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) 1
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s)`!1 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': /a d WIA4 0 L d vv,r j-' Aa e� Ei N.1
o f,4c i cx2 . 2 3 .
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1 l s 00 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $ 1
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees:i
Check No.1 lu Check Amount. Li/ Cash Amount:
6.Total Project Cost: $ 1 Sb'd 0 Paid in Full 0 Outstanding Balance Due: 1
City of Northampton
sus..:
Massachusetts ��?
I r '11FF n
DEPARTMENT OF BUILDING INSPECTIONS ;. 4
212 Main Street • Municipal Building J. CDC
Northampton, MA 01060 ss'Nyy loN���
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. 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. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new / replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW/ private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. 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) C S-1 ocs-q $ O 0
�G y I;� �� L 1 License Number Expi ion D to Z�
Name of CCL Holder
t C/1/LLS1\^ �� n I List CSL Type(see below)
ik,elftSklaCal
No.and Street 'C Y—�' Type Description
(/ Z''] U Unrestricted(Buildings up to 35,000 cu.ft.)
U' -- " `-'� / Restricted I&2 Family Dwelling
City/Town, State,ZIP M Masonry
RC Roofin Covering
WS Window and Siding
�J J� SF Solid Fuel Burning Appliances
l�3 9 73— 1 S ) i&ci �S"I UI �wa:I. CO' I Insulation
Telephone Email addresscl Demolition
5.2 Registered Home Improvement Contractor(HIC) 6°�
Zo1 23
IS ( frd A Y S HIC Registration Number Expirat n Date
HIC ompany Nan or IC Re str ame
Z t l C --05 `a � ' J al 1 t 1 Stm.LCQ 1. ea—
Nod Street Email ad s
t
,� y1� Olo21 �sal
City/Town,State,L`IP Telephone 5 '_'""ti J 41 Imo' [L v
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 a v1 (i S` LA
to act on my behalf,in all matters relative to work authorized bylthis building permit application.
Svran /imai/y (P-/(-2 Z
Print Owner's Name(Electron c 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 application is true and accurate to the best of my knowledge and understanding.
<7, Dct// �'/�) 2
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"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
The Commonwealth of Massachusetts
ifl. Department of Industrial.4ceidents
x xz10
I Congress Street.Suite I00
Boston, MA 02114-2017
.�. _ nrtrni:mass.gov,'dirr
- 11 oilers'(bnrpensation Insurance Affedat it: Builderwi(a lracdtr•Elect riciai Pluinhere.
l )BE FILED 11 I I ii I Ilk: I'ERI11 EtING AI 11101(111.
Applicant Information (� ,,(1\' Please Print Leitildv
Name Iliusincss Ort;anvatan lndnteittalt: 5�k� S v (r'W JI LS
2(1 C)-es /4�(4k 2�{
Address:
City/StatefZip:__( ,e5H -D'}'o— Nk Phone (--0 _ 1Cf
7 s-- 2d-to)
Arc tell in unpin}re?(lira the appriprinir hot Ty 1w of project(regai ):
I l ant a employer with .nrpdloyecs kWh and unr pat r rime l.' 7. D W'cunstructta,ri
1 sill a wk proprietor or puurtncr>hup and tare ato 0:1111000:4.X.wt,aknus Cut me na X. Remodeling
oats capacnts.ENO worker:comp.insurance regular .l
9. ❑Demolition
(�1 gut;u Ieonklowak1 dome all work ausselt.'j\o sserl,.a s comp. nn,.ur:nuee ocriuned.
'EnI soot a Irmroosstit r and nil!hoc Munn contractors.to conduct all nook on an property.. I w ill
10 0 Building addition'
moue that all contractors either has c workcn"cumapt.naatauat insulance or ore yule 114]Electrical repairs or additions
proptnators with no employees.
12.0 Plumbing repairs or addition.
1 am a rc,wral auntraci tad I love hued die mht-nmrxyurn listed nn it ameba.shed. 13.0 Roof repairs
I hose.sots-contraatt,t.havoc cmployces.anal hat c works,.'c+.,our.roc ucuucr.^
r,.0 v► are a roakenevocation and rtc oaken have at.Yat red then right &Lrht of ore piu.o per Mt
14.DOrlter
n.
1?'_,y ti41.and we lase no emplo►'eoc blear scollops'comp.Insurance resorted.I
"Am appltcattt that cheeks hot.1 roust also till out to scctionheluw stro a Inn Ihrt*otter u:unnptaiii ion policy nntiinnaln!at.
Itomeoatnets who suhOlit this atttdasut andacaismr the}met irrg all wt,tk and thee`i'runiaiulk contractors mime submit a twos atYiulrt'ir itrulncar,nir suds.
,-,nlraclors that.he..[tab is..roust attached an ad.itioad w hnr tin:manse of tilt rallt►rtantra.tn(..aid slate whotucr re nut those.intutles hate
rutl,lt secs. tt the sub-contractors lease curios ccs..they until rtn,s1dc ilhctr wuttkar.'cunp.prrlri►ntrnlxx..
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy anti job site
in firrmation.
Insurance Company Name: I I IAA a. a l IAS1A,✓dam
Polley#or Self-ins.Lice.par: W( f •SO 0 SO 2.9(.LI I I.07.i t ExPialion :
Job Site Address: 1i tit ( AtS4e4 6 Q.4 d Le€As City+Statet'Zip: 0 I
Attach a cups of the workers'compensation policy declaration page(showing the policy amber and ez date).
Failure to secure coverage as required under M(iL c.. 152,*25A is a criminal violation punishabk by a fine up to 1.500.00
ardor one-year imprisonment_as well as cos II penalties in the form of a STOP WORK ORDER and a fine of up t 11250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
ettseragre verification.
I du hereby certify under the poi trod penalties of perjury that the information provided above k*we and correct
I1ttalUre: • Date. tZ 3 /20 a-2—
i'ht ate#: - l 13 • Lf 7 S^1%-
Official use omit- Du not write in this area,to he completed ht city or town official
i itr or Torun: Permit,l.iernse#
Issuing Authority(circle one):
1. Board of llealth 2.Building Department 3.CO[hortn Clerk -I.Electrical Inspector 5. Plumbing Inspector
6.Other
( intact Person: Phone#:
City of Northampton
I4
rf..
} Massachusetts
N 3
'., DEPARTMENT OF BUILDING INSPECTIONS
.�' 212 Main Street • Municipal Building yJi CDC
Northampton, MA 01060 'rs1-h; C�t�
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: LOs --
The debris will be transported by:
Name of Hauler: Jok- 5Ac4-\�
Signature of Applicant: G Date: