25C-147 (7) BP r 022-1414
27 ORCHARD ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-147-001 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-2022-1414 PERMISSION IS HEREBY GRANT, D TO:
Project# BATH RENO 2022 Contractor: License:
Est. Cost: 15000 KUEL MCQUAID 051394
Const.Class: Exp.Date: 12/11/2022
Use Group: Owner: ZEMELSKY BONN LAUREN M &R : K
Lot Size (sq.ft.)
Zoning: URB Applicant: KUEL MCQUAID
Applicant Address Phone: Insurance:
131 FERRY ST 41335375063
EASTHAMPTON, MA 01027
ISSUED ON: 11/03/2022
TO PERFORM THE FOLLOWING WORK:
BATH RENO 1ST FLOOR
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 y9 5-#
Fees Paid: $98.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
I ki-
The 'Commonwealth oC/
ommonwealth of Massachusetts/ T `1� `_'
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i X_ ip Board of Building Regulations and/Stan ds / ( .
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20 1UN 'IP f TY
Massachusetts State Building Coda; 78R��T 22 USE
Hui!ding Permit Application T.^t_:on.strict, Repair,'Renr, �4rt , _'ism a Rev: ea tlar 'WI
nne-or Two-Family Dwelling ` =7';nN 1Mq QEo rioN
This Section For Official Use Only �, I
J BuildingPermit Number: 50— �)_ I cirri J Date Applied:
kVt,� s5 i/7 l/13
Building Official(Print Name) Signature Date
SECTION 1:SITE LT4FORNIATION
1.1) _y Ad ertdress: /� 1,2 Assessors Map&Parcel Numbers
1.la 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(II.)
1.5 Building Setbacks(ft)
E r
Front Yard Side Yards Rear Yard 1�
Required Provided Required i Provided Required 1 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❑ — Check if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP' j
2.1 Owner'of R"cord:
*- LA.wain tc,i(in 1--eyLlArvve_154 09,1-- 1 -1)\/-4-Lkor--DAi fv\Pr 61060
Name(Print) City,State,ZIP
2 orthvva 5 -r 's- J zf1 y 1-2Z 651 S (r\ G W ' S Ojfilla •
No.and Street 'Telephone {_mail Address I (7
C
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check air that apply) j (,
New Construction 0 1 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 /
t
Demolition 0 1 Accessory Bldg. 0 I Number of Units Other ❑ Specify:
Brief Description of Proposed'Work' I?Q.NA",'1e `sUz �I-S4--- (11)4,NC. 13Gk.A-Lk'f]t)IAA
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ? B d 0 1. Building Permit Fee: $ indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ 3000 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ S @. 0 0 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) Cii$ Total Fees:,„, fI
} Check No.) .m Check Acannt: Cash Amount: `
6.Total Project Cost: $ / SI co 0 I 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
y
4aY�,�"P>o ...."" S�
f .�,,,a . MaJJa�buss �•
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d 1 ( t DEPARTMENT OF BUILDING INSPECTIONS y
4; 212 Main Street • Municipal Building
Northampton, MA 01060 SS frw Srp'
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
I &2 FANAILY 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 tilled out and signed by applicant.
Debris Affidavit IIVIAYI V.V out and signed IIVtAI It.
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 CeILifi-te (nc,,v/ replacement indoww's).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation andior special permit requirements (if applicable). 10.
Driveway Permit(if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
A/l T.�-.--t- Cl-.-.--: LI:- I--J L__ Rl A* / 1- I��J t .. Building J'.-- (l--1
i2: Trench Permit - public land by L.i vv i private lanu by Building uepi.
13. Stretch Energy Coae - all new construction will require a HERS Rater Mmaavit to be submitted with permit
application before issuannce of narmit
4. Please provide the appropriate fee in the form of a check marls payable to: The City of Northampton.
j SECTION 5: CONSTRUCTION SERVICES
I 5.1 Construction Supervisor License(CSL) C -b I39 11- 2 (1 22_
License Number Expir on
Name of CSL,Holder
kV ej 114 i,ist CSL Type(see below)
iNo.and Street Type Description
3 i r 54— O Unresttictcd(Buildings up to 35,000 ci.ft.) !
y R Restricted i&2 Family Dwelling
City/Town,State,ZIP L M Masonry
E k_c MA 0 L' 27 RC Roofing Covering
WS Window and.Siding
/� SF Solid Fuel Burning Appliances
3'S3 7-7//04 3 / ,Q�cs.L 16A.15) 6 NM...L 6o4t I Insulation
Telephone Email address D Demolition
5.2/Re�gisstered Home Improvement Contractor(BIC) , /-,0 0'30. o V
w�( L +�cta �L HiC Registration Number Expiration Date
H1C Company Name or WC¢{egistrant Name '
('�� -(— .0 c. 4'u u:t _ .9 6 ,. 1 C
No�nd S i.y� t 11 Emau.undress
1=1�5 � G�4 _ (r3-s3Z-SDri ( f
City/TOwn,State,ZiP Telephone !1
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 pro ['de !
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes a( No
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES POR ssuI DUNG PERMIT
t,* 1,as Owner of the subject property,hereby authorize /'l 'C.-(_ Q M.L J t .•
to act on my behalf,in all matters relative to work authorized by this building.permit application.
/_..a.yr a n (f4n n .Z ,n�-C b t0i2l�zz
Print Owner's Name(Electronic Signatute) t_.,p. 17ate
'D
7 : O lNE�1 OR T E •R_TT
SECTION ;r. u w-�__ A€ i nORIZED AGENT DECLARATION
i 4
L
i
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information I
contained in this application is true and accurate to the best of my knowledge and understanding.
nvet 1/l c 00.0-L . /0/'2`7 jz2
Print Owner's or Authorized Agent's Name(Electronic_Signature) ate
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor 1
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
p.rogram or guaranty fund under M:G:I.:e: I42A. Other important information on the WC Program can be for nd at
{E 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)
r_ i i ft.) u t.•..a.t.. ,.,.
Gross living as (sq. _ ::ausLausc.s%J;si:.%JUS:: j
Number of fireplaces �umber of bedrooms l
Number of bathrooms Number of half/baths I
i Type of heating system Number of decks/porches
IType of cooling system Enclosed Open
j - - I.
3. ''Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF NORTHALvirroN
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
I
1
st-r
SIDE YARD SIDE YARD__ ,_._ I
FRONT ST-,TBACK
FRONTAGE
_ The Commonwealth of Massachusetts
1* —= Department of Industrial Accidents
gI Congress Street,Suite 100
;t= Boston,MA 02 1I4-201 7
www inass.govidia
urkrrs'('ompeasation Insurance Affidavit:Builders/('ontractors/I:ketrieisas/P1un16ers.
1 O 111.:FILED N till I IIE PERMITTING Al rI H(1KI 1.
Applicant Information_ Please Print 1.ra!ibltr
Name IBusiness ttr aniiattorafiklnaduall:: K./. ( !'vt C. VLUQc a
Address: ] 3_1
C ity/StitelZip: Eck544ka. 1,o 4 /'JA )to 2? Phone#: Le/3—‘3 7- S o 6
Are yea sr eruMl yer?('[leek the.Mmttprianr h.►t:
Type of project(required':
1.0 I am a empkoy.r µtilt curpluyocs Mull amal•tr part-tittle►.' 7. 0 N• -oustruction
I am a sole prolamin or purtncrruip and attic no employees iiurkrrr for ink:in R. Remodeling
any eapaeitt-'%t'wailers'comp.insurance required../
9. ❑ Dettitrlttion
I ant a Immivoimuct doing.ail+.soul myself:[No wu+l.aas`corm[-insurance rewwral..l
10 Building addition
i.®I ant a Itonnnnnner and will he hung.iatitr.r.tarrs to s-oarkect all noel on my property- I will n
emurm.that all etnaraelans tUhcr hate aaarl rt nna cr.'rmergi.1rsatrttMnee or ate sulk 1143 Electrical repairs or additions
prayrtxttrs µits no anployes..
12.0 Plumbing repairs or additions
iS I ant a ecm-cal contra.kir and 1 base hired the sub contractors listed OS doe arse l sbe►t
13.0 Roof repairs
these sitth-cantraclurs bade etrp b k ytes dint ke.c wetits.comp.inter tit t
14.❑Other
!FLO We are a corporation and its utfu:cis base exercised them tight of exemption per Mt&e.
11.S Ir-If and ise lune no eayiloy.+cs.IN..oats,•comp.nisuartce rcaluucdl
'Any appheant that chocks has ttl maul also fill out the section Imams showing their µotters'tunylensatton pth y iulwrrliairit
c-Ikienevw teen trio submit this iiliatait indicating thes arc doting all work and then hue outside eurtrackrs inks submits'new afldova iimheaiinte Neck
:Contractors that churi liia hid mat attached an additional sheet showing the nine of the su1►euiiiraetars and slate w bnik.r or out than alb s have
ewnployees. It theei orieeeCtlttiban:4111.lorsa.7.,.they nuts[pros ialt their µairier clump.polityrmtmber-
/ant an emploret that is providing workers'compensation insurance Or art employees_ Below is the policy Jabs*
information.
Insurance('ompanr, Name
Policy#or Self-sus.Lie. t aptration Dale.
Job Site Address: ("Ii%' State Llp:
Attach a copy oldie workers'canpensatim policy declaralio■page(showing the policy number sod - t 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-tear imprisonment.as well as civil penalties in the form of STOP WORK()RIN_R and a line of up t $250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Ins estigations of the DIA insurance
coverage verification.
I do hereby certify under the pains and penalties of 'art•that the information provided shore is true and
X(.e.
J / 7 /
si�rtature: talc:
Phone t: Ltl — S 3 7- .S96 3
Official use only. Do not write in this area,to he completed by city or town official.
City or Town: PermitAl.ieensr tk
issuing Authority(circle one[:
I.Board of health L Building Department 3.('t r.ffown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
('untaet Person: Phone#:
1'i 1--tr (If Nnr1-11amntnn
•'" � Massachusetts `_ �!?
r' � R`- A. i-
i'At , DEPA -i NT OE BUILDING INSPECTIONS =�°
• 212 qi o - --- a-n �,a1ai• - 7
fir a7i .st.t:: � :i- ..Laa..a.:y 'ti
Northampton, MA 01060 �SY• `,1J'
CONSTRUCTION DEBRIS AFF1I j AVIT
(FoR Al ! I)F'AAlli,]TION ANl) RF,N(WAT!QN PROJFcTS)
in accordance of the provisions of MGt c 40, 554, a condition of Building Permit
w _ 3 i[
l__ 1--- :^ £.k -1! -!k ......,,la:.,..„1.,,....... ak: _ r.!_ f k- !I k^ r!err-- ,e4 ::i-e _
properly licensed waste disposal facility, as defined by MGI c 11.1_, S 15OA.
The debris will be disposed of in:
Location of Facility: UCQ I(7 'r -e-L2,C i`e--- I.7c%-- -(ctLnr,kn' Civ� /V4
The debris will be transported by:
Name of Hauler: kiAe/ A4C Qciqd(
f
cignaturp of Ao.li . • / % ,,'' ''
Date: /0/g/ 2-2-
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