31A-217 (4) BP-2022-1579
77 HARRISON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-217-001 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-2022-1579 PERMISSION IS HEREBY GRANTED TO:
Project# THREE SEASON ROOM Contractor: License:
Est. Cost: 8000 TODD PEASE
Const.Class: Exp.Date:
Use Group: Owner: CASCHETTA, MARY BETH&COHN, MERYL
Lot Size (sq.ft.)
Zoning: URB Applicant:
Applicant Address Phone: Insurance:
ISSUED ON: 12/07/2022
TO PERFORM THE FOLLOWING WORK:
CONVERT PORCH TO 3 SEASON ROOM
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:
ii ► TI,Go.qty
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
BP-2022-1579
77 HARRISON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-217-001 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-2022-1579 PERMISSION IS HEREBY GRANTED TO:
Project# THREE SEASON ROOM Contractor: License:
Est. Cost: 8000 TODD PEASE
Const.Class: Exp.Date:
Use Group: Owner: CASCHETTA, MARY BETH& COHN, MERYL
Lot Size (sq.ft.)
Zoning: URB Applicant:
Applicant Address Phone: Insurance:
ISSUED ON: 12/07/2022
TO PERFORM THE FOLLOWING WORK:
CONVERT PORCH TO 3 SEASON ROOM
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: f� I
,•
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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The Commonwealth of Massachuse s DF �'•1
T. ° Ei
Board of Building Regulations id S , ards C 6 F R
I' Massachusetts State Building Code,78q <90� IPALI Y
'\u 3 0 USE
9Tyvi
Building Permit Application To Construct, Repair, RenoV lish a R sed Mar 2011
One-or Two-Family Dwelling �'v Mq°Fc7.
This Section For Official Use Only n�`�0o�s
/Building Permit Number: - "n y 79 Date Applied: \ '
1.
Building Official(Print Name) Signature J e
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
-i -14 r;sojg 4r< ItAlt4 .
1.1 a Is this an accepted street?yes f 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?
Check ifyes❑ Municipal 0 On site disposal system El
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
ML<9) cdtr‘ iod 1 ' k- MA- 0/06 0
Name(Print) City,State,ZIP
1l RMcc? s' A Vt sib - 34 -VW rr►c(�lco� ?]��a,rw,1-cc"
No.and Street Telephone Em it Address ���
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) I Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': &c Feet IIi n{o 3 5ciici, tac i
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 80w. d,G 1. Building Permit Fee: $ Indicate how fee is determired:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees: $
41119
o� Check No jj Check Amount: Cash Amount:
6.Total Project Cost: $ y 000 . w Paid in Full 0 Outstanding Balance Due: _
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS — G!1 3L'Y //.27/01,4)y
"Tata 0 Peak i... License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) (J
V Stl'1i T e Description
No.and Street ,�,/ p
%S ��L6-[�C. k i1 4 0./,3),3 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
�.L, SF Solid Fuel Burning Appliances
tt,,
7f3 0G—/')'6 IOC Plj 1L3ebein io J,derh Insulation
Telephone Email addre ,J D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Pio HIC Registration Number Erxpiration Date
HIC Company Name or HIC Registrant Name � `p
No.yar S+ett t44f'et QA laktflA IL 3 gr.4-,/� G<�
s tL.L�I4 M4 Di 3 (r) ` /!/ S/K L ai9�address
City/Town,State,ZIP f, 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 Iss a of the building permit.
Signed Affidavit Attached? Yes I 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 my be ,i 11 ers relative to work authorized by this building permit applicatio .
y2
Print Owner's N e(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.
�`pm o Pt41 arm' l' c Gad
Print Owner's or Authorized Agent's Name(Electronic Signature) l ate
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contra tor
(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.govioca 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,fmished 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
Massachusetts 4' ._ '%
_ * < C.
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building %, te fir a'
Northampton, MA 01060 'p.- \'�
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: 7j Ir1 at"�iv,^vj RtC C c'N+e(
The debris will be transported by:
Name of Hauler: A P� sre
Signature of Applicant: L;71.: (,-- Date:
L..,•\.,
The Commonwealth of Massachusetts
2I3i=• -
=XV,•=1 s'il,
Department of Industrial Accidents
12:E
1 Congress Street,Suite IN
Boston, MA 02114-2017
www.mass.gov/dia
1,10/kers Compensation Insurance Affidavit:Builders/Contractors/Electriciatts1Plumbers.
to HE FILED WITH THE PEILMITEINC AUTHORITY.
Annlicant Information Please Print Ligihls
Name (13usmess Organaationiindividual): 7;,/d P S
PG - '
‘-)
Address: y stelr c„44--et M .
City/State/Zip: , ,S, J44.4.(14 n14- Phone #: V/3, ,,‘ /a -/V7-C
Are y uu-n entphryttl Cher c appropriate but:
Type of project(required):
i. I am a employ er with ( erimioyets i full:intros part-timef•
7. 0 'ekk construction
.•.ri i 21111 a auk proprietor or i•ormership and have no employees working for nu:in 8. Remodeling
any capaerty.[Nu worker;Comp.MalaraniX required I
9. El Demi:Amon
3.1::l I am a homeowner doing all work iriclf.INo worka.ps'corm insurance matured i°
10 El Building addition
4,C3 I am a homeowner and will he him%vontractors to conduit all work on riny propeity. I will
ensure that 311 t.ontractort elthrr hake workeria'conmotaation mummy..taT arc tole 110 Electrical repairs or additions
proprietors with nu employees.
12.0 Plumbing repairs or additions
301 am a ureteral contractor and I he hired the subs.ontractora listed un the an:idled ahcei.
1 30 Root-repairs
These sub-contraeton have u•mploveca anti lam c worker,',,:uniirp.inaurance.:
14,Lit)ther
nip we an a conxyratiun and its vilkers kuOcca.crctacil their right uti exemption per isiCoL e.
it §11-iii.and we hate no ernployees.[No workers'comp mainonce required.
'Any applicant that clunisa lax a I must aia.0 till out the aciettion below ahoy,mg their viatica,'comp:motion policy iriformotion.
*Ilosnoowners who submit thin affidavit aulacating they arc doing all work and then hire outaide contractors mint submit a new affidavit indit., mg mach.
;Contractors that cheek this he most attached an additional sheet allowing the name of the au 6-contractors and mate whether or not dune entities haw
emplol,eeii It the auks. tritrotors have earl,,y cei,they mum proY id e their worker;,...Int, r...,1,::. niimbeit
I am an employer that is prodding workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ecc‘Ch‘ cliph ik(i t .c.. ____
Policy#or Self-ins. LAC.#: 42001 LAI 6 Vc)el Expiration Date: 3 —e9C • Q104:a 3
Job Site Address: 7-7 flotic 7 sy,,, 4 e f IbriAiljot-fek City/StatelZip: A 1--_____ 6
Attach a copy of the workers'compensation polky declaration page(showing the policy number an expiration date).
Failure to secure coverage as required under MCA_c. 152, §25A is a criminal violation punishable by a tine up to 1..500.00
and or one-year imprisonment,as well as civil penalties in the turin of a STOP WORK ORDER and a fine of up t4$25000 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
,
coverage scniication„
I do hereby certify under the pains and penalties of perjury that the information provided above is true and comer:.
Signature: ar:,-Arn.-------- Date: ////‘ /
Phone v: V/'; — D./0 —
ii Official use wilt. Do not write in this area.to be completed by city or town officiaL
('its 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
t, Contact Person: Phone#: