17C-038 (11) BP-2022-1149
24 HILLCREST DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17C-038-001 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-2022-1149 PERMISSION IS HEREBY GRANTED TO:
Project# CONVERT PORCH Contractor: License:
Est. Cost: 55000 DALHAUS CARPENTRY INC 101628
Const.Class: • Exp.Date: 1 1/17/2022
Use Group: Owner: KELLY EDWARD &TERESE A HAMMERLE
Lot Size (sq.ft.)
Zoning: URA/URB Applicant: DALHAUS CARPENTRY INC
Applicant Address Phone: Insurance:
11 CHERRY ST (413)97'7-6094 UB--5R908461
EASTHAMPTON, MA 01027
ISSUED ON:09/14/2022
TO PERFORM THE FOLLOWING WORK:
CONVERT SCREENED PORCH TO ALL SEASON ART SPACE
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:
y ), V
W ll
it
Fees Paid: $357.50
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
1 Vb((Q-eq e(ems
ECEI V
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The Commonwealth of Mass chu tts rD
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Board of Building Regulations d S ndaYtB 1 3 FOR
Massachusetts State Building C de, 7 0 CMR 2022 ICIPALITY
USE
Building Permit Application To Construct,R _ t ,i S ' h evised Mar 2011
AMa HPECTI
One- or Two-Family Dwelling TQN.MA pica oNS
This Section For Official Use Only
Building Permit Number: a p_3-i-"//y et Date Ap lied:
gir
: i • Yiii/9.a
Building Official(Print Name) Signature / . Dite
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
24 -(1(>=sr- D r2. /7C. 0-3$'
1.1 a Is t tron 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 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
��i I-lar-.r,.CC e ��oc�c��e /�/�• 01060
ame(Print) City,State,ZIP
224 1.-\',11 c,c-eS. D r. 6/7 (ice 9/27 -{,9,cp.se, rvwmrd'i+ele rMe._. C or1
No.and Street Telephone i Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Owner-Occupied It( Repairs(s) 1214 Alteration(s) 1' Addition 0
Demolition d Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of ProposedWork2: Con.leri*ineA screened Pnt-LL, -Fo im4e.t',Or keq*ed
ark sp4Le. . Ir-0(..deS : ne,,a w�'r\-A'6A,SS, c)onCS/ he4/ and ir\si..lo.-k',oc,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ D C51/° I. Building Permit Fee: $ Indicate how fee is determined:
1 0 Standard City/Town Application Fee
2.Electrical $ /Si tI� 0 Total Project Cost3(Item 6)x multiplier b' x 5S, °C o
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ sv
Suppression) Total All Fees: $ 3.�7— So
_ Check No..2-b2-Check Amount:35 2 Cash Amount:
6. Total Project Cost: 15 S ->{ '.V 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5 1 Construction SupeVsorLicense(CSL) ,.,
spa\pct.is Lic ( 6 a pLicense Number E ira ion Date
ame of CSL Hol
11 Au
Sk, List CSL Type(see below)
.and Street T e Description
N
��� `r L�j� /�/, 0� U Unrestricted(Buildings up to 35,000 Cu.ft.)
I Restricted 1&2 Family Dwelling
City/Town,State,Z M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
913 .i1-1 60q4 3 \A' > s(ü' I Insulation
Telephone Email address D Demolition
5. Registered HoiRe Improvement Contractor(HIC)
Dm S - t thew S IVIRegistration Number 7E pir tion Date
Cpan Name HIC Registrant Name �
C�mW Sl. 1) 1\14VS CGrPet \4'\.l ecrnc,I (o`'v\
.an reet \OS 911 6,0qki Em il 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 I uance of the building permit.
Signed Affidavit Attached? Yes 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 9 t(\
QvS (pOp ' '
to act on my behalf,in all matters relative to work authorized by this building permit applic ion.
Cede- 4dAft\trke__—_ 7
1 1/1 aD
Print Owner'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
co tained in this application is true and accurate to the best of my knowledge and understanding.
_ir
A-n,,sD,\I-,,,,,, Tfia
n
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
' opS44AMp O\ `� ...s1
�-- 'A Massachusetts x- e
6 A * .
DEPARTMENT OF BUILDING INSPECTIONS
ay 212 Main Street • Municipal Building JG �b
✓ Northampton, MA 01060 ESN ''1+'3\'
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: V RA P1 e-C
1C--V\
The debris will be transported by:
Name of Hauler: PP\ Cnr5'�
Signature of Applican : Date: 9//. PD-
...... , The Commonwealth of Massachusetts
Department of Industrial Accidents
.._... tvi--
miria. 1 I Congress Street.Suite 100
=1* =a
Boston. IL-1 02114-2017
www.mass.govitlia
VI otters'Compensation Insurance Affidavit Builders/ContractorsiElectricians/Plumbtrs.
TO ItE,ni.En WITH I HI PERMITTING AtITHORITV.
Applicant Information MOW Print Legibly
Name niumnes,-,OrganizationhatividualiDg\("\CAN,$ C,Occ\pek/44%.4 .-1-1q.
Address:
City/StateiZip:fevs.,\c•Alt, IA A Phone#M1S qi-t 6°et.4
Art you*a employer?Cheek the appropriate hos:
employe w p (lll ni r ith c--- _erisloyces u ador parbtime)_*
\s3 Type of project(required):
a op
ON construction
I si
7. F?:I
2[3ii iok iwrietor or d nu wrkin er in partnership an Mem cmpltrytes og l roc 8. Remodeling
any capacity.No workers'comp.inswan w mrptiredi
9. E34erriolition
30 I am a homeowner thing all wort myself.No workers*comp..ansontior.monied]'
10 0 Building addition
4.0 I ant a homeowner and will be hitinj contractors to ssmshial all wtnk on ray property twill
enrage that all warietuts ei41ter have workers'compensation Otromme ur ate tole i I 421 .1ectrical repairs or additions
taapnerois with no eirsphr,s cos 110 Plumbing repairs or additions
sC.I i am a general eontraetin and 1 Fuse lured the sub.cootractor%tutted ors the=ached diett
13.1:3 Roof repairs
These lub-contsuctorN hairs ortpkayeerl.and itarVe Workeo"emir).orsurnnee.2
14.0 Other
6.0 we ere a corporation and as office:1s have erdarised their right ot esempoon pet PAW,.c,
152,*144.and we hase no orsployees.No workers'cramp.inaserance retwiresil
*Any ssppin.eant that clbmk%box 01 Mika ithitl fill .Irt &sexism below shown their VrUtieri‘'titiMperhailarl poticy intOrmatom
*Homeowners who wham dos atlioissit inchearing they am&snit all wad and t lam hoe outside contractor%nom%Mann a new atlisiasit itsdimung sock
teontractots that check this box most attacked ara xiaktional asked%/amins tto:name i.kithe lot-clagtaKiOra moisture is healer ea not those CTIIIIICa haw
eariployeel If&se hek-contractor.have employees..they most pow ide thcir 'A CAM.Qt1.4t111,pulw),number
I am an employer that it prodding workers'compensation insurance for my employees. Below is the patio'and job site
information.
Insunince Company Nanie:Csfi(Sc 3.1\5 vf tA A Ce........ (0•, —
Policy#or Self-ins.Lie.#: GS5 0 ?, 5' It, fik.c,t Expiration Date: gill/a3
Job Site Addres&aq 4.‘kloces\-- Dc.. piz.....„ CStateiZip:IcinTetACAC4.....
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 c. 152. §25A is a criminal violation punishable by a line up to$I,500.00
and/or one-year imprisonment,as well as civil penalties in the form era 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
coverage verification.
f do herehr,00 um il •poin. knalties of perjury that the information prodded7 bone is e and correct,
Si a - Date:
Phone :
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: PermitiLirense 4
Ism*Authority(circle one):
I.Board of Health 2.Building Department 3.Ckyilfewat Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
( on tact Person: Phone 4: