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23A-139 (20)
BP 022-1392 32 MAPLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-139-001 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-2022-1392 PERMISSION IS HEREBY GRANT a D TO: Project# 2022 BATH Contractor: License: Est. Cost: 20000 CLAUDIO GARRIDO CS-089458 Const.Class: Exp.Date: 08/24/2024 Use Group: Owner: JENNIFER POLINS A STEPHEN & Lot Size (sq.ft.) Zoning: URB Applicant: CLAUDIO GARRIDO Applicant Address Phone: Insurance: 140 NASH HILL RD 4132195906 SOLE PROPRIETOR HAYDENVILLE, MA 01039 ISSUED ON: 10/28/2022 TO PERFORM THE FOLLOWING WORK: INSTALL BATHROOM IN MASTER BEDROOM 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: Rouse # 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: 1-3-1 .; • r . >2 • 0 Fees Paid: S130.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 1-� The Commonwealth of Massachusetts w JI� Board of Building Regulations and Standards FOR .1 q -L, Massachusetts State Building Code, 780 CMR MUNICIPALITY _ ,.,"v USE c B ildi g Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 .A. ry One- or Two-Family Dwelling rNv C This Section For Official Use Only :uilding Perm' is ber: ZD7�^13g2 Date Applied: i ____ _ L gEo 10 t +SOss 1�/� )p 28 ZGi2Z Building Officia 'rint Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers '3 2. Aga ptc shied-) Pidvence M,4 2314—139 —OD I 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: U►`_e) •5D7 ac,r . 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: Je•VV"i kv- Ft,tlei '3 2. AA.bpL! sh.a..1-, NA/4.w A4k D1 C c, Name(Print) City,State,ZIP '3 2_ /''t ptc. XL-, 4131•‘frvlgt Ja..Jc.41- A a' LVvN, No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply) 1 New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ;i1(Specify: 77f4 n 4 Brief Description of Proposed Work': g43 40,,y ( JMT MT/CM/ fey l 5p 60c69 r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ /7 0 00 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ I! i 0 Standard City/Town Application Fee Sv ❑Total Project Cost' (Item 6)x multiplier, x b 3. Plumbing $ .0 � v 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) 6j $ Total All Fees: $ 130— Check No,25 1 Check Amount /31'7 Cash Amount: 6.Total Project Cost: $ o� COO 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C) l�(o ( ( CS` © 75� O� oil !2 License Number E pir on Date Name of CSL Holder elIN O i KO) List CSL Type(see below) No.and Str et ` Type Description t �-y1 C /1, I f v- 0 `D 3c U Unrestricted(Buildings up to 35,000 cu.ft.) City/�Tlo�wl",State,ZIP `!/� / ( R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances (4(3)2P?-S.I 4B(C , , 2i d o—78.2-Q 0f4(Z Cp''q I Insulation Tel phone Email address D Demolition 5.2 Registered Home �Improvement Contractor(HIC) (S e80 D/oe y w� 0 �"` r # I 0 HIC Registration Number xpi ion Date HIc gompany Name or IG gistr t Name I�'ts(4 ifilD eifKkil,tie ? Gm.(1Col* No.and Street Email a.dress keit/vt`i ca4 06937 013)117-Screi Ci /T wn,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 No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDINGJJ PERMIT I,as Owner of the subject property,hereby authorize C tava1O 6 a!'redo to acbehalf,in all matters relative to work authorized by this building permit application. 0�� I c7/2y/ 2o27— Print ►�"�"�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 accurst&to best of my knowledge and understanding. f�r4(J CS %f k /D/2fl/.- - Print Owner's or Authorized Agent's Name lectronic Signature) Date 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 1 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 ear" r o Massachusetts 4"{s c� st % f c+ i DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 fJ'fAc 16° 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: / 2J.' )/ gc C/4e /w(�— The debris will be transported by: Name of Hauler: 't4 piU( .01) R Signature of Applicant: Date: /a/Y �1 The Commonwealth of Massachusetts 31112r7. t �A;' Department of Industrial Accidents ,L71 la N l s+ I Congress Street, Suite 100 Boston, MA 02114-2017 jtil= 1 W!VW.?nass.gob/dia 11 e,rkera' Compensation Insurance Affidavit:BuiLdersl("t ntractcrry Eleetrician ll'lumherw. To BE FILED WI HTHE PERMUTING Al I'lHORfCY. Applicant Information Please Print L etibly Name IHussies'Or;anrxation'lndividuali: Cjil(J /'Q Address: � O f Ci iSeateEZi #4� , tz4�d Phone#:�4t'3)dii —S9O 6" Are ynn employer?Check the appropriate hot: Type ofproject(required): ' I.© m I a a employer with u yetis{toil and'ar par-tirrre)-' 7. New construction Ir:11 am a sate prtrpnetor or punnership and have rui etnplayet-s wurkurg fur me in g. [3 Remodeling any e paety-[Nu workers'Bump.insurance retorted.I 9. ❑ Demolition I I am a hotness%ner doing;all work myself.[No workers'comp insurance nyuued.l' IQ El Building addition am a lu muuwner and will 1e hiring ountracturs to conduct all work on my property. I will t.J ensure that all twniracttln either have workers'wirrepensation insurance or art.sole 110 Electrical repairs or additions proprietors write no employees 12.0 Plumbing repairs or additions 5.1::1 I am a general contractor and I have hated the sub-contractors listed on the attached sheet. 13 These sub-contractors have ernpiuveet and leave workers'comp.insurance.: I Roof repairs 6.O Vr'e an a corporation and ris uffreers have exr7eised their right of exert suun per 54t L e. 14.Q Other 152,§It4).and weleaserio employees.(4t=.Burners'.cvnp.insurancert<luuud.l •Airs applicant that ell k%but III artist also fall out the teeiton below showing thew workers'compensation policy information. +ttvnnn^uwnets who submit this affidavit uulacuhise they are doing all work and then hire outside emit:actori moil stt6nut a new affidavit iariira►ti<ng such, C uniracturs that check thm but must att.a.hed asI tiuntal sheet sht..wing the name of the eattrctxltraeturs and state whether or not those aathlies hate II`die soh-carairactur•.taaw•_:.rh10.recn.dray inunt into. do the r •.cttitkcr ti,rerr.{+�lrcw e alas.1- 1 am an employer that is providing rvurhert'compensalio r insurance,for nt,'employees. Below is the rr,tti J:i in information. Insurance C'antpany Name. Policy it or Self ins. Lie.#: Expiration Date:__ Job Site Address City/State'Zip: Attach a copy of the r,orkers' ctampensatitan policy declaration page(showing the policy nunthcr:end eviriration dhrtei- Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a line up to SI,5O(I_00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and u fine of up to S250.00 a day against the s tulator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance �a Lk' teriiiwation r - I tit,hereby certif)•untie( tit°bolas and cJ pc rtan then'the information provided above is true and correct. Si::naturc: / Date. /U/2fi/02 Phone . ((3) ..�i f- 9c 6 Official use only. Do not write in this area, to be completed by city or town official t itti or Tovin: Permit/License t1 Issuing Authority (circle one): I. Board of health 2. Building Department 3.Cityfrown Clerk 4. Electrical Inspector 5- I'lumbin2 Inspector h. Other ( (intact Person: Phone#: • 9'-11 3/4" -1--� a P /9 y \ ,P---a�q ��Ctst (i.fEl a� 6* CO 1 miliiii--- .9m s ' . • ti�4� 1� �',Tc'��9 V' Elevation 1 -a rp tYQ"' lJ 1/2"=1'-0" °----, .., t,541 -1=1/—Y11 v = Cl �xc Tc ti — YY mem min ro a — ..... ,m r „41 1 w , OBath option 1 i _= 3 Elevation 1-c 1/4" 1'0" • O 1/2"=1'-0" DATE STAMP CONSULTANTS CLIENT PROJECT SCALE DRAWN BY SIMPLE 07/15/22 Jen Polins Polins Renovation As indicated BWB CITY SIMPLE CITY STUDIO LLC ADDRESS DRAWING SET A Architecture Interiors 8 Planning 32 Maple St I www.simplecitystudio.com Bath Option 1 SCHEMATIC STUDIO 206.375.5126 Northampton, MA p 80 Damon Rd Northampton MA