24D-088 (16) BP-2022-1286
60 NORTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-088-001 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-I286 PERMISSION IS HEREBY GRANTEI TO:
Project# KITCHEN RENO Contractor: License:
Est. Cost: 58500 JB WATSON CONSTRUCTION
Const.Class: Exp.Date:
Use Group: Owner: FREY JOHN D& JENNIFER K DIERI GER
Lot Size (sq.ft.)
Zoning: URC Applicant: JB WATSON CONSTRUCTION
Applicant Address Phone: Insurance:
50 MAPLEWOOD DR (413)522-7769
AMHERST, MA 01002
ISSUED ON:10/12/2022
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
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 VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I ! I >, 1 CS-11
Fees Paid: S380.00
212 Main Street, Phone(413)587-I240,Fax:(413)587-1272
Office of the Building Commissioner
4/.....,P:i.... ...b--..,
The Commonwealth of Mass hu s O F R
iik`t Board of Building Regulations d S (122
`,i, de;Massachusetts State Building Co 98O r /1 4 USE IPALITY
Hq
Building Permit Application To Construct,Repair,Renova a Rev' ed Mar 1011
One-or Two-Family Dwelling •Mq n o 2.,, I
This Sc'tion For Official Use Only _
Buildin 7 Permit Number: ' A • .0f 2 3 ate Applied:
�vi� �s / //37 l/-1!.ZeIzZ
Building Official(Print Name) Signature Date
_ SECTION 1:SITE INFORMATION
1.1 Pr testy Add r1 p, S� 1.2 As s rA,,ap& Parcel Numbers1
-
lJ� NN�� II�� `4-1
I.la Is this an accepted street?yes no Map Number Parcel Number
____I
1.3 1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) 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:
Zone: Outside Flood Zone?
Public 0 Private 0 — Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 qw er'of Record:
J0L f*-6.? N Of-TN tc-w0C'0'^
Name(Print) City,State,ZIP
6o N olrt-TK S , 413 -3ZO -tZ V 4o INN ditt.Cy- 1 ft..ft;r.- '
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
rNew Construction 0 Existing Building lir Owner-Occupied Iii Repairs(s) 0 Alteration(s) a Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: R En4)u a i i & tr 4 ;-t-US G,.. I1. fl.A1-t . e v+^A.8;4+1
c a : -.., t A.t a A c Fti R A k 1, c.al.:, N tt_.R-'t'� c r OS a c% C.c c. . _
SECTION 4:ESTIMATED CONSTRUCTION COSTS
C Estimated Costs:
Item (Labor and Materials) Official Use Only
1.Building $ 1. Building Permit Fee: S Indicate how fee is determined:
01 U v 0 Standard City/Town Application Fee
2.Electrical $ a So o ❑Total Project Cost-(Item 6)x multiplier x !
"•.Plumbing S S 1 0 n D 2. Other Fees: S_ --
4.Mechanical (HVAC) $ List: _ _._
S. Mechanical (Fire
$ Total All Fees:$ __4 gl
Suppression)
Check No.l4 I 'Check Amount: I Cash Amount:
6.Total Project Cost: $ S RI So V 0 Paid in Full 0 Outstanding Balance Due:
3 Gt I'I-1_5 / i? flats
a—
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
( S ' 61q , OS Ivf q/ z2 1�
j AY w fiazs 0 ^ License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) t&
SO /tnAeL-e t 4ofl D i
No.and Street Te Description
PA AZ (jr)V Unrestricted(Buildings up to 35,000 cu.ft.)
v 16 R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
IV 4r2 Po wfl 4-4-e trsrm-oi SF Solid Fuel Burning Appliances
413 s2L 4"1-16't , t,J ` I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
-14 _ Al f►11 Z `f
J g w*Tap e.. O HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
.t0 'oboeLt a oi) 614Kfoto 6.1 foib1 MA-a1.. ^
No.and Street Email address
h.r.Is% sa% MA 0) b 41? 522 ' 1-1-e1
City/Town,State,ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(111.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 No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of thc subject property,hereby authorize -a-y
to act be alf,in 1 matters relative to work authorized by this building permit application.
l /
Print ner's Name(Electronic ature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,1 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.V
_iRy t....YT60— �� _ oc � iZo i Z-
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 Homc Improvement Contractor(HIC)Program),will not have access to thc arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the IUC 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 he substituted for"Total Project Cost"
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CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
,s
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
' 212 Main Strout • Municipal Building3°yob
a °" k Northampton, MA 01060 a 1‘
Ufa
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 a t_ e_4_`1 «, ti
The debris will be transported by:
Name of Hauler: H oMe 6 , N r, (LI;`7
Signature of Applicant: Date: 0 4--i }' Zo z
The Comntonweolth of Massachusetts
Department of Industrial Accidents
I Congress Street.Suite 100
Boston. MA 02114-2017
t'-as,,C• wwwatass.govIdio
si!Pi ker•'compensation losorsart Alrida it:BuildersiContratton/ElecirlehomMitiliters.
to Bk.FILED WITH PEltiliTtISC At 111101411Y.
Applicant Information Pleaye Print 1.eeitily
Name t Busines ,Organtrationandtv:idual Y.*
— '
Address: 5 P.'N A et— ‘e•-+'Z1 o r) .
City/State/2 iry A cvN A Oiuvz Phone 0: 3 s- 2 T- 6
Art,VW ouptu.k cr.!4'heck I .appnapriane has: Type of project freilmirttlY
ID I ant a...411pLiryce wiTta crardareet fun and,at parf-rirml 7 0 New etinStruction
20 I on A 111UFWACE4 pitnnerAnp and have avi eiziplawm,workout t.Vt Ma;111 K.S Remodeling
alt!. apacit} [Na wurkera' tanarano: mtpured
9 ID iknioiihun
10 aul A hutti,mv,uer don*all vvitel,my,,,At.(No*clans'asap usraranteratustall*
It)0 Badding adtlitton
4 Ell lan a howinowner mai*di latttna amstrudors conduct all wady ea say prnporry.,
cumin t1i.I all tunir skluer4 odor have loam'kanaprmabou numnantr Me Pak I I Pn Electrical repairsi additions
pruptetricars%AI%or>wittaktystea_
I2.,g Plumbing repairs or adsktions
50 I ant a general k:4)eattaul4)t mai I Ern•e hired the sub-cantradora thatd as dit atal+two
I 31:1Roof repatrs
'1h,:se!tub-emit:leans have ertattloyeta and hav,t*takers renep.teattmace,4
14.r:10thei
F•Vj V 1:rue it corparactua and utimen.ha%4r ax4.14:nrad dans right ot own/peon pat)444 a 4
114),and l..'4 •Inelloyrcw.[No*orlon.'comp Imusnanear
*As}uppheaettttuu eheeke box 01 nukte.*ato ffl out the yelf.-4uut bek blooms etas'411411ko•t:...ontiathan• latorindtbor
liusneowuer.eehU suktatt du%attitityht taillitWaN the air antag all wont&Ad this Ws outside,allatrA,:tot mmt valattat a tiok anstlav olkiitaaa,avh
Collation that check du,taix tria%1 attached an saldnumai aluxtaswm the nunth ub-cuentractor and att whal.bcr or not those*manta are,
onployem It titc,446,..,741.1134.14111N howl: OW/Mad pm,.46:%,..ttr .norko,'44>Itty. 041111441
I iss as(implorer that iN providing woriars'compensation insurance Or my eimplvier+. i+the polli aml job sire
information.
Insurance Company Name:
Policy te or Self-Ms.Lie.tt: Expiration Date,
lob Site Address: CRy/StatofZip,„„.....
Attach copy of the workers'compeosation policy declaration page lshnaing the policy number and espiration
Failure to irXiire coweragi:as requited under NIGL c. 152, §2$A is a criminal violation punishabk by a tine up to SI,500,90
andlor one-year imprisonment.as well ascseiFatrialtic*in die loom of a STOP WORK.ORDER and a tine of up to$25001 a
day against the violator.A copy of this sLitiatiem may be forwarded to the()flier of Investigations:of the DIA for insurance
coverage vertficat ton.
I do hereby render the pains and penalties of perjury that the irtjarman'om provided above a.trate end cawd,
Z. 0
Date.4-I 757 5 2
Official'Ise only. Do not write in this area,to he completed by city or town official
rlty or Town: Peratit/Lketise
Issuing Authority (circle one):
I. Board of Health 1.Build*Department 3.Cky/Ttron Clerk 4.Eirchritai lastwctor 5. Plumbing Inspector
6,Other
t (intact rerun: Ihunv
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City of Northampton
,9,r v •. SRO •*'Ft's
>-, Massachusetts 4:7 ,<r
i f�; DEPARTMENT OF BUILDING INSPECTIONS
� �'� 212 Main Street • Municipal Building ��►.
Northampton, MA 01060 7,'
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (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 homeowne s'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 C ' 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R" 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 accesso to such use
and/or farm structures.A person who constructs more than one home in a two-year perio" shall not be
considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent t t I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the ,roject or work
on my parcel, I am not engaged in construction supervision in connection with any project or ork involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity re, lated 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 o 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 day of ,20_.
(Signature)