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31C-066 (4) BP-2022-1401 43 HIGGINS WAY COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31C-066-001 CITY OF NORTHAMPTON Permit: Acc Structure PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1401 PERMISSION IS HEREBY GRANTED TO: Project# ACC STRUCTURE Contractor: License: Est. Cost: 7000 Const.Class: Exp.Date: Use Group: Owner: POPPER POPPER, SALLY D& LEWIS I Lot Size (sq.ft.) Zoning: PV Applicant: POPPER POPPER, SALLY D&LEWIS i Applicant Address Phone: Insurance: 19 HILLSIDE RD NORTHAMPTON, MA 01060 ISSUED ON: 10/28/2022 TO PERFORM THE FOLLOWING WORK: DETACHED ACC STRUCTURE 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: lir • .,2 3-)1 • ' l Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner :r 1) The Commonwealth of Massag�'huse a c1022 FO 1'' Board of Building Regulations add Stan "�;' Massachusetts State Building Code,7$0'{ 911t,.,at'rco,n '� 1TY �:•k glrn> ir,rNsp SE Building Permit Application To Construct,Repair,Renovate Or oN bigr4 evise, Mar 2011 One-or Two-Family Dwelling so This Section For Official Use Only Building Permit Number: €j P— ?�''/ Of Date Applied:,,S _ , i'i •L'' IC3 Building Official(Print Name) Signature P Dat SECTION 1:SITE INFORMATION 1.1 Prn erty Adllress: t45 Afiltsc` / IAssessors Map&Parcel Number Q 1.1 a Is this an accepted street?yes no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: l Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) b 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public IX Private❑ Zone: _ Outside Flood Zone? 'Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owne 'of Re rd dWQerTrt)St AA)c4ki11 DA, kAz)rr2( 0 Name(Print) t City,State,ZIP ft-) col its G)cf,G 81(,(Q7q-(QSOS o poeregniall.Cow�. No.an Street 1 Telephone ail Address SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other Cl Specify: ief Description of Proposed Work: , i` II i',' l_ • ' i•kiv " " I,/!' ram., 4 , - _ _, .. s7.:S r'ti li rOilf,,d7t AT I i :si- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building S 71 000. PO 1. Building Permit Fee:$ Indicate how fee is determined: Z.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ tO 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire �` Suppression) S �.J Total All Fees:$ ( .S 6.Total Project Cost: S `� (� C k No. T)!1 Check Amount Cash Amount: �t o DU. 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 1&2 Family Dwelling City/Town,State,ZIP • M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address • D Demolition '� 5.2 Re altered Home Improveme Contract�—(FIIC) //s,,,(/�% 02 Zitz`�" � .f1-(1 QUA�"�VA I HIC Registration Number x irati6n Date HIC C m ny � ' Email address N 10 ' ol\f ©-(4)6p 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 j((. SECTION 7a: OWNER AUTHORIZATION TO BE COMPLET WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR B G PERMIT I,as Owner of the subject property,hereby authorize _ to act on my behalf,in all matters relative to work authorized by this bu. ing permit application. S� I (y U Poni�p r ioia7f ag Print Owner' ame(Electro ignature) 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. SCLR f P�p er 1cl)st ( o(a.)(a Print Owner's'or Authorized Agedt'sName(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 arbitrati n program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at wWw.mass.govic 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.) f' Habitable room count f 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" goa s • The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).' 7. New consr uctiou 2 am a sole proprietor ar partnership and have no employees working for me in 'any capacity.(No workers'comp,insurance required.] 8. Remodeling 9. ❑Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10 Building addition 4.CjiI am a homeowner and will be hiring contactors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 1.0 Electrical repairs fir additions proprietors with no employees. 12.0 Plumbing repairs pr additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance) 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.(No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 fine up to$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 DLA.for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: I 0 Phone#: — Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �`� t a�,, The City of Northampton • �. ` r '� Building Department;" "~��, 212 Main Street 44''oe4,ra,„�,E>> Northampton, Massachusetts 01060 Phone (413) 587-1240 Fax (413) 587-1272 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVAT ION PROJECTS) I In accordance with the provisions of MGL c40, 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, s150A. The debris will be disposed of in: V all R.ercirie Location of Facility ACL/ `0 The debris will be transported by: Name of Hauler C=!/QGZ.O4 V A, c friG/ Signature of Applicant: ,_/4140 Date: I 0 /al a ti • City of Northampton • Massachusetts 'JP DEPARTMENT OF BUILDING INSPECTIONS r% - 212 Main Street • Municipal Building Northampton, MA 01060 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, 5 Gt, 00 a Po Pr (insert full legal name), born _ (insert month, day, ear here �de depose and state the ollo�vin : y ), p f g OS/pi l lgq(D 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 lidnieowners' 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 penalties of perjury on this 17 day of OC. j3-2C , 20 Dla.. (Signature) GREG SMITH, Home Repairs 134 Crescent Street Northampton, MA. oio6o 413-695- 2977 Gil L- Gai ei r , Gam- z) =- i 'i�,� k/A-zez. 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