23A-137 (2) BP-2022-1167
22 MAPLE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-137-001 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-2022-1167 PERMISSION IS HEREBY GRANT I TO:
Project# ROOF/SKYLIGHTS Contractor: License:
Est. Cost: 20000 MARK SARAFIN 053434053.34
Const.Class: Exp.Date:04/28/202304/282023
KELLY KATHERINE E LIBERATOR &MARC
Use Group: Owner: DAVID KELLY LIBERATORE
Lot Size (sq.ft.)
Zoning: URB Applicant: SARAFIN BUILDERS
Applicant Address Phone: Insurance:
85 RUSELLVILLE RD (413)563-9256 0 WCC-500-5019027
SOUTHAMPTON, MA 01073
ISSUED ON:09/19/2022
TO PERFORM THE FOLLOWING WORK:
STRIP AND RE-ROOF, SKYLIGHTS
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 VIOL• TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
2 CS)
• 1 '`�
Fees Paid: $80.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
1 i
The Commonwealth of Massahus s
w Board of Building Regulations a Sta dai P FOR
Massachusetts State Building Co e, 7 CM 1 5 2022 M ICIPA ITY
USE
Building Permit Application To Construct,Rep ir,$3pp emolish a R ised Mar 2011
One-or Two-Family D el-ling hoRTHZ!,)Tnrc fnlsPEcrio
This Section For Official Use Only -----------2.____
2I
Building Permit Number: t�Q�-A.e i i Q/ -) Date Applied:
�Eviki &55 /47
q- 1L-ZOZZ
Building Official(Print Name) Signature Dat9
SECTION 1:SITE INFORMATION 1
1.1 Property Addr ss: �( 1.2 Assess�}'s Map&Parcel Numbers
�o) p1VvA2\� 5�- t'�U 'icf .."Av'- c 43/1- I-3 7
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 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 R ord•
Name(Print) City,State,ZIP 1
(9a VWAQ\,e S v \ ,bV it..0k 1-6 c C5. U11t1455, ecQv
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) 0 Alteration(s) ❑r Additidn ❑
Demolition 0 Accessory Bldg. ❑ Number of Units�'_ Other xit Specify: QUO t
Brief Description of Pr fRsed Work2: .5 .vZ\ Ark viD S1� s-1 t O F A‘S t� TV +etj,( I
.I E 1.0:a /L404- ppm. -�q CbKP, w'� (I Cn5 i 'n 'i v, Iws 1 '"yv�a�u cv,rt'at5 5 `� lL•e��►-,oU-e/ e IG(r 3 �5 lea 1 5
1 li
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ )() 0 0 0,— 1. Building Permit Fee: $ Indicate how fee is determined:
1 ❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: —
5.Mechanical (Fire $ —
Suppression) Total All Fees:
Check Nol0 Vieheck Amount: s0Cash Amount:
6.Total Project Cost: $ 901 o o 6 — ❑Paid in Full 0 Outstanding Balance Due:
i
1
City of Northampton
oat N1M to . -..f.....
Massachusetts "'?
* a G
$el. 7 DEPARTMENT OF BUILDING INSPECTIONS
'11i r' 212 Main Street • Municipal Building wd D�
• Northampton, MA 01060 S31iyP��
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)
CS- 053�34-1 N-(98-96a3
Mwrz V 5.4sr-lAc-‘ ," License Number Expiration Date
Name of CSL Holder
oK 'Q 1k,,.\\r tec List CSL Type(see below) ti
No.and Street Type Description
$ w, � ` A a l 0 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,XIP M Masonry
RC Roofing Covering
WS Window and Siding
�" c/ O I _n SF Solid Fuel Burning Appliances
y(3' W3-�o` i`r.1 @ � Q P'? vi 4 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) o
,' 2 .AF` \ lJ�" 1 '2S HIC Registration Number Expiration Date
H omeany Name or \\ Regi lc 6 N e �` i n` ���\
0 di
o.a Street Email address
City/Town, Stitite,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' a No .0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN j
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize LA•(L� S w"Lr4 F•-•--•
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my nam below, I here y attest under the pains and penalties of perjury that all of the information
contain in 's i on is and curate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Da e
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
Department of Industrial Accidents
�;,; I Congress Street,Suite 100
: � Boston,MA 02114-2017
;. www.maess gor/die
-'J=f4,t
11 otters'Compensation Insurance Affidavit:Builders./("onlrarctorsIElectricsansfPlumlteA.
TO BE FILED Wil'H THE PERMIrl IM:AI!TomuiI`.
agplicant Information (� Please Print tesilblv
Name tilusmcss t)rgantrataort individual s 1�2 Fi--N r.�\L—'�
Address: �� et�ss`2 tla.��,e 2oc. C/
City/State/ZiAv'L4i o ,tk.4 4\b j Phone#: 1413-- 1 0 Sy -
Ana vita a.employer'['heck die appropriate b.s: TyPe a Project(required):
I I am a cmpkryer with D t�yces(full aod.lur part-tune}+I. New construction
I am a Mlle peoptro aw or purtsernbtp and haw:rm emphryo,.s working for me in S. 0 Remodeling
airy capacity-(No worker'comp.insurance rapired_l
30 l am a lw.rruncr doing all nutk inyhelf.[No uutlois'cony.insur:moe Dtstnt,lition
rm
al.Q I am a Irnneouuer and will be kiting uutrradars io unduct all work on any pluperty. I will lU❑ Building atltlltittn
anon that all dnrraetars either have miters'nm penratio n imuramt or are sole I I.0 Electrical repairs or additions
proprietors uith nu employees.
110 Plumbing rtiparrs or additions
501 am a geoural cn actor and 1 have hired tie inb-cu.traorsos band an de auachod dicer_
Thew a.onIIcs toe Imo ampioycrs and have workers'cutup_ieaarrnee_= 1 �� Roof repairs
Th
6.0 We are a au}wratiun and its offum have emeised their right ofexcla loan per 1�dtiL e_ 14. 14't
152,ILO),and we have no employees.(No*mhos'comp.insurance required"
rAny applicant dna cheeks bus ttl non sibs fill out Tine section below%bowing their mothers'compel trims.polity iatoninai...
+I1urnutrw.eea Who sumo di%affidavit iadioni as. they are dears all work and then hire outside currtractars neon submit a new affidavit indicating nick
:IConnracro.t that Agadir tax mat amehed as Maimed Haar diming die nine of the sik- onnrrctors and raft wtwt6.v or not those maim have
nupioycsts. Ifflt tub ctn traciurs have artyltryc s.they rune provide their "misers'annp.policy number_
I am an employer that is providing workers'compensation inwrrrurce for sty employees. Below is the policy wedJrbsllr
information. � �w1
Insurance Company Name:
, _
Policy#or Self-ins.Lice.#: L -500-5oiq 0 al-okra 14- Expiration Date: 7 I- a 3
Job Site Address: iD o) Ma plse `5 I-- city/slate/zip: f lorre%e 1"''l\A 6(6(o 7
Attach a copy of the workers'consksaatisn policy decisrstisa page(showing the policy number and espiratisn date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up te$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 t a pen o ay that the infwatatio 1madded abort is trmomndcorrect.
✓
Signature: `y, Date: / '/r-
Phone#: 17/3 - 5-40 3 --cfi?5-61
Official are only. Do not write in this area,to be completed by city or tow"official
City or Tows: Permit/License I
Issuing Antbority(circle ose):
I.Board of Health 2.Building Department 3.City/Tows Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone N:
City of Northampton
?i ° SAS SAC
Massachusetts � - die.
.41
'.' DEPARTMENT OF BUILDING INSPECTIONS �'.
' 212 Main Street • Municipal Building �J'•
Northampton, MA 01060 Js6.., `HOC`
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: I/\p(2- �
The debris will be transported by:
Name of Hauler: 17S a.q9
Signature of Applicant: 'i Date: /S/ �