24B-015 (4) BP-2022-1266
26 DENISE CT COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24B-015-001 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-2022-1266 PERMISSIONIS HEREBY GRANTE TO:
Project# RE-WIRE 2022 Contractor: License:
Est. Cost: 2000
Const.Class: Exp.Date:
Use Group: Owner: J. WIENER, DANIEL
Lot Size (sq.ft.)
Zoning: URB/WP Applicant: J. WIENER,DANIEL
Applicant Address Phone: Insurance:
26 DENISE CT
NORTHAMPTON, MA 01060
ISSUED ON:10/06/2022
TO PERFORM THE FOLLOWING WORK:
ALTERATION
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:
)9 • i
Fees Paid: $130.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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Oura Commonwealth of Massachusetts FOR
r u22 Bo d of Building Regulations and Standards
,f_' : MUNICIPALITY
l M sachusetts State Building Code, 780 CMR
- ' ,�,�,.`qo,N U E
Tolle, ofli •NsmitApplication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: g/- }. - ' I Zl(/ Date Ap lied:
u1,�,
C. o*5 c / ID-6- 2O22
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Ad ess: ` 1.2 Assessors Map&Parcel Numbers
C : -.-e.Cr
1.1 a Is this an accepted street?yes J 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
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief c5iption of Proposed Work' w -ej."0 ye, hail -/octal-1 e a.r i,gyp Gv,.`f of
G 4c,ll clo -th ' fez , f/.0 l�d.C.r.; s�
S .- c. Cr 4."e -�✓cr;lci
J / J SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ / , t�� 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 2?5;- 0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ — 9 2. Other Fees: $
4.Mechanical (HVAC) $ O List:
5.Mechanical (Fire
Suppression) Total All Fees ,t1 �O
Check No.f,1 U�"1!Check Amount (
6.' 61 Project o $ > d
)0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
`' Massachusetts �?c' «_ G'`;
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 ss1` '4'0%
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS, RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
1. 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. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code —all new construction(Gut/Rehab) requires a HERS Rater Affidavit
10. 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)
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.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
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 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 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.
`1.70 ,', ;J, t ,� �',. r i/ /(O/3/ram
1 wner's or Authorized Agent's Name(Electronic Si
NOTES:
I. 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"
The Commonwealth of Afassachusetts
gto, Ci. Department of Industrial Accidents
..._. _
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1 Congress Street,Suite 100
Boston,MA 02114-2017
‘
www.mass.gov/dia
.
‘Iotters'Corlipenha iion Insurance Affidal,it:BuildersiContractursfEleetriciansiPlunthers.
I ti ItE FILED 18 11'11'111E PERMITTING AUTHORIT‘.
Applicant Information Please Print Leeiblv
Name tlittain.Ms.Organization,individual):
Address: ... .
City/State/Zip: Phone#:
Are you an ettipkiyee Check the appropriate but: :., '11.:pe of project(required):
la I am a employer wtth employees(full antlor pan-timet..* 7.. 0 New construction
2..n a vole proprietor or partnership and have tto employees working for me in S. 0 Renaxieling
any capacity.[Nti*0 .thers'eimp.trouranize required.]
..." Ii aamm aa huhorrscorneu:ncrlic7 andvidn:iallilbiew°4hutr:1<civritracult ENI)rswt.rkto rs:duccuirrara'1-liu.ri:rkralp-onern7p,u17:,T, I.di
in
ensure that all contractors either ha s,e Workers'corrilltination insurance or an:mJ14:: 9. D Demolition
, 10 13 Building addition
11 4:3 Electrical repairs or additions
prupneD.:4•4 with no employs:1.N..
12.0 Plumbing repairs or additions
5Ci I am a general claritnetur anal ll have hired the"sib-contractors listed on the attached-.beet
; 13 Roof repairs
These itih-cottlThelon.have employees and have 144..triert'comp.titsurrnix .0.
' 14.0 Other
6.Q we are a corporation and its officers have eat:ringed their right of exemption per NCI..e.
152,41{4 and woe have no einployees..[No*others comp.insurance requireal
(
'Any applicattt that checks boa=1 mini aLa fal out die section helow showing their*tatters'compensation policy inform:awn_
'tlemeois nen who subnut this Landow Indicating they are doing all work and then hire outside eontrats mint vubrnit a neis atilitio it indicating such.
Contractury that cheek thus boa,must attached an additional sheet shut...wig the name of the suls-contractors anal,ir,re w liether or not thuNe entities haVe
cilirluVet. If the ub-cuntrictor,hate curium,'ors.they must provide their *oaten',:arrip.poIrclu, rank:r
1 am an employer Mot - providing ovarAers'compensation insurance for my employees. Below is the polies and job site
in fir ition.
Inseams-0 rilip: _
Polio. :: orS :--1:, L..c. 4: Expiration Date:
Job Site Addic . CityState:Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy member and expiration date).
Failure to secure coverage as required under NIGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
andior 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 violator.A copy of till statement may be forwarded to the Office of'Investigations of the DR for insurance
coverage verification.
I do . .,., , . ,'I,.. ' e pain urid penalties of perjury fluff the inliyrinalion provided above iN 1r e and correct
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Oficial wse wily. Do not pyrite in this area.to be completed by city or lawn official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing inspector
6.Other
i
Contact Person: Phone 4:
r Cityof Northampton
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DEPARTMENT OF BUILDING INSPECTIONS
,� - .. 212 Main Street • Municipal Building ��� fib`
Northampton, MA 01060 �"IiY Z��
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:
The debris will be transported by:
Name of Hauler: 0 Sig a, ,,,/,12,n5
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Signature of Applicant: Date:
n-� sir: .,,,,,, gil
City of Northampton
Massachusetts �?�` �:. '�,,
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rf DEPARTMENT OF BUILDING INSPECTIONS p. R
�oft" ` 212 Main Street • Municipal Building .. �b�'
Northampton, MA 01060 ssy �„5�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, ....V (insert full legal name), born_(insert
month, 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 /enalties of perjury on this 3 day of DC '', 20 z 2—
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(Signature
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