31B-083 (3) B 2022-0534
25 EDWARDS SQ COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31B-083-001 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-2022-0534 PERMISSIONIS HEREBY GRANT TO:
Project# PORCH REPAIR Contractor: License:
Est. Cost: 5000
Const.Class: Exp.Date:
Use Group: Owner: TAYLOR SHERRY
Lot Size (sq.ft.)
Zoning: URC Applicant: TAYLOR SHERRY
Applicant Address Phone: Insurance:
25 EDWARDS SQUARE
NORTHAMPTON, MA 01060
ISSUED ON:08/24/2022
TO PERFORM THE FOLLOWING WORK:
PORCH REPAIRS
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 • > . '1 •
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
u,c..-o s II'
t4
The Commonwealth of Massachusetts R E C •I V D'—'
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CM MUNTCI �IT
t
US J
Building Permit Application To Construct, Repair, Renovate Or mchtla a 1 6 RdM r20.1
One- or Two-Family Dwelling
This Section For Official Use Only ! n,. '-of n,,,,^,?C')Q,�,�Eri�A 010rccrt60c�n�s
NA tN.P I
Building Permit Number: 6e- ).�• Date Applied:
41.1..s 420,c / '/- 8-2q-2027,
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an accepted street?yes V 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 upply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private El Municipal_ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
...err,1- . N d,, -- off c v t o 4. 0
Name(Print) 1 City,State,ZIP
-Ls EAAJ o✓ Sv tt l3"S 8f� —40 2 I )s L U &? 1 41/ C.. —
No.and Street Telephone F nail Address
SECTION 3: DESCRIPTION OF PROPOSED ORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied VRepairs(s) ' "Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units I Other 0 Specify:
Brief Description of Proposed W ork2: ( K ►S Z.l/X V- -,-4 P 0/"1-N ,
et re-ie- otr 9,te) . ( kv-t.if (Lou er-A .5 i U retii-1/4
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ S,0 p 0 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
0 Total Project Cost3 (Item 6)x multiplier x
3. Plumbing $ "`_
2. Other Fees: $
4.Mechanical (HVAC) $ List: ,
5. Mechanical (Fire
Suppression) $ Total All Fees:
Check No.l�l Check Amount: C�4 Cash Amount:
6. Total Project Cost: $ 5-WO 0 Paid in Full 0 Outstanding Balance Due:
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 I&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 m rs relative to work authorized by this building permit application.
Print Otv s Name Electr is 'gnature) 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.
SLetc Y tr/ , S fS LZ
Print Owner's or uthorized A nt's Name tro ' gn /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" /1.,(,
CITY OF NORTHAMPTON
SETBACK PLAN
MAP?I D LOT: °C - ` °
LOT SIZE: 2 '� S(
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
#r S
Massachusetts
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[ DEPARTMENT OF BUILDING INSPECTIONS ='
*t . 212 Main Street • Municipal Building
Northampton, MA 01060 rs'�%,ti. ki��
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: VLk �1� ' 6 6-
The debris will be transported by:
Name of Hauler: < > > T cv
Signature of Applicant: Date: / .1 1
City of Northampton
a Massachusetts �,'�''' L-L y
tr, Pi.
t O„ ,q4 ' DEPARTMENT OF BUILDING INSPECTIONS 9\ (a'
"' 212 Main Street • Municipal Building y {a
'�, Northampton, MA 01060 �A 1 �
`� -T HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
aI, 1 (insert full legal name), born (insert month,
day, year),hereby depos and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit req irements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a pro ect 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 homeo ers' exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 MR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110. '5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on w ich there is, or
is intended to be, a one-or two-family dwelling, attached or detached structures access ory to such use
and/or farm structures.A person who constructs more than one home in a two-year pe od shall not be
considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent hat I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of th• project or work
on my parcel, I am not engaged in construction supervision in connection with any project o work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity 'plated 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 projec, 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 1S day of 2012—
(Signat'u 1 J
V
7,#:\
.e...-__ The Commonwealth of:tlassachusetts
...__._. ._ ,
74Lir.;_----',.. .,' Department of Industrial Accidents
:
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...,. v._ .• . I Congress Street, Suite 100
Boston, MA 02114-201 7
_ ..., WWWmass.govidia
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%%in kers' Compensation Insurance Affidavit: Builders/Contractors/Ekctricians Pio inbers.
to 01.. I li.t.D N'IltH'UHL PE1011.1TI'ING Al,lii()RITI.
Annlicant Information Please Print II..egibls
Name 4 Hussite>,1./rjont.cistssitt Inds\idu.si t'
Address:
City/State:Lip i'l1011e P:
%rt:sea an emploscr7( hivk ibc apprupriatc but: Type of project(required)
if]1 am a ensplo,y a Alai enapiloyoes{Nil mator past-until' 7. 0 New constructs
201 a sole peupnctor L.:partnership and have no...Triple:yen working fur Inc in
arI
. capactts iSi,A n a sn Le 'comp.stisdifns.-C requiml K. 0 Remodeling
9. E] Demolition
3 au n a IlabIt900,4111,Juing 411..kurib 111).sell.Ilio vs orter,'comp.unurance requarnir
I 0 El Building addita n
...r:i I am a hormy•vi MI and 4 III k tiLTITIN Watt-ad/Jr,tss s.csnsIssil all v.ork on nt,property I will
Vasibil.:liiiil Al...MD a..lors eitiwi hat,:wutiorrs`...-gbrnibol,41,1441 LibtUnlnib:Of:UV N4.11C I I 0 Electrical repa -or additions
propm.iors sy'tit ibu employee,.
I 2.0 Plumbing repai or additions
sCi I an;a general Ls traractos and I has c bred the subriuntracion listed no the imitated thect
I 3.E1 Roof repairs
I laew 14.11s-s.s.nstray tuts ha,....ctrtritt!.ccs and base ssorket, ,otrip mattrance•
I 4.E]Other
6 0 w.:ate a surrot,Uon and alt olito:ts hate cirri.ned thaw nicht ot exemption pet
152,:;114 1...nu,:.l.Iti%.:ne ollyl...)..eca IN,,uutibscrN.:mils ITINIIIIMX fetillIned 1
°Any aprl want that s.Ito-Is box t I must al-au till out Ow section heloss stank mg disco swam.'conipcmaiton pulley uttormatton
+Hornets%nen who sutnrut this atinias st insbcating they arc ilosn$all work and then bac outside contra:tun mum submit a TICK allisdastt nub:Mug stash
Ltontraelon that chcs.k thn hot must atthAssed an ailditional ihect sbovstng die name of the sub-csaytrartors anal Aar whether at nut those cut Ica ts.Lov
crnr10.,,,-• II rh, -.lib.0110.m:tots 11.3,,,:crisrls.s Le,.tbs.-. 1.0.J..1 1•10\1,1...their Aorkir,...\\Mr puli,-„, nialtibs:1
I am an employer that is prof in n' compensation insurance for my employees. Below is the policy and Job Aim
information.
insurance Company Name: —
Policy ii or Self-rna. Lie. ti: Expiration Date.
Job Site Address: City/Stately:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MO_ e. 152. 25A is a criminal siolatiun punishable by a line up to S1.500.00
and:or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the ‘oilatur. A copy of this statement ma% be forwarded to the(Mice of In estigations of the DIA for insurance
cot erage verification
I do hereby certify under the pains and penalties of perjury that the information'Provided above is true and correct
Signature: Dale
.
Phone 4:
......-----
Official mse only-. Do not P'rill*ill ali prea.ta he completed by city or town official
( its or To%a: Permit/license 4
Issuing Authority (circle one):
I. Board of II vallti 2. Building Department 3.Ckyrifown clerk 4.Electrical Inspector 5. Plumbing litspectio
6. other
, ( °mail Persim. Phone 4; .
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