25C-097 (5) BP-F 022-1531
193 NORTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-097-001 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-2022-1531 PERMISSION IS HEREBY GRANT, D TO:
Project# DECK REPAIRS Contractor: License:
Est. Cost: 14115 JOEL BIAS CS-115346
Const.Class: Exp.Date: 07/03/2024
Use Group: Owner: L MCLAUGHLIN HEATHER
Lot Size (sq.ft.)
Zoning: URB Applicant: JOEL BIAS
Applicant Address Phone: Insurance:
250 HENDRICK ST (413)658-8215 SOLE PROPRIETOR
EASTHAMPTON, MA 01027
ISSUED ON: 12/05/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE DECKING AND HANDRAILS ON DECK
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:
I
I ' 1
Fees Paid: $91.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
RECEIVE
DEC 1 2022he(omn>pnwealth of Massachusetts
I' Board of Building Regulations and Standards FOR
Massachusetts state Building Code,780 CMR MUNICIPALITY
4 DEPT.,OF BUI ING!NS EC JONS USE
Bctrizting 0atton To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
—One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: /b f-)).," IS 3/ Date A plied: i I ' 3° - a -2.
/�tvliv 455 I 12-7-70ZZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
tq3 145 NorF-h a.
1.1 a 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(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❑ Private 0 Check if yes❑ Municipal 0 On site disposal system
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
, -1= rIc Iirua id Ai A101MA-0l I 0/0 ( O
Name(Print) Ci ,State,ZIP
113 vi;Kil 5/yee-1 D7 lynela u �i1® ►ai/• owl
No.and StreSt �. Telep one Email dress U
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 'fa Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':-I(Q,Le de�X in9 On-k handVQ (S' On exist-IN C�2Ct•
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1(fl 11 Jr. .l00 1. Building Permit Fee: $9l.Db Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fee
rif
Check No Check Amount: a 1 Cash Amount:
6.Total Project Cost: $ ' `11l5,(e 0 ❑Paid in Full ❑Outstanding Balance Due:
City of Northampton
Massachusetts �.._ ,.
ItDEPARTMENT OF BUILDING INSPECTIONS : !
Sc 212 Main Street • Municipal Building —,`- ?,
Northampton, MA 01060 Ps'�`Yjt't�'''
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY 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 filled out and signed by applicant.
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 Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner(if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW / private land by Building Dept.
13. Stretch Energy Code -all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
4
0
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS— (,S34
�J\0,S to �io a4
License Number Expiration Date
Name of CSL Holder
050
Vkn 'c c n �� List CSL Type(see below)
No.and Street C�x , V�- Type Description
T1 `Q� �k?_ m R +o t) 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
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I(Z (_%5 ds 06 I a4
oS HIC Registration Number Expiration Date
HIC Company/sktne or 1-{IC Registragt Name
DSO 1 0c t @-• 3rrnservtcQQS f q \
No.end Str e lcisil (nod1�M 9t3 S Email addrds
City/Town,State,ZIP f lJv t 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
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 Kj _
to act on my behalf,in all matters relative to work authorized by this building permit application.
leyi- r Pc L � c / / Z2
Print Owner s Name(Electronic Signature) 1� r� Date
SECTION 7b:OWNER1 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.
Jag 3iq.5 /1-3O -qa
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 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
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"
41
1
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
4
City of Northampton
>� s Massachusetts
col
A DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building *3y+
;' Northampton, MA 01060
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: �,103.1,\ c`.j (11C`
Location of Facility: .,(1S44)a01 on , Mr)
The debris will be transported by:
Name of Hauler: 1i
Signature of Applicant: C Date: il-
41-
(
'Z.\.. The Commonwealth of Massachusetts
i , t
Department of Industrial Accidents
I Congress Street,Suite 100
Boston.SIA 02114-2017
,....,..-
www.mass.govldia
Si orkers'Compensation Insurance.,Affidavit:Builders/Contractor. Electricians,Plumbers.
I it HE FILED WITH THE PER:MATTING AtTlIotr I I).
Applicant Information Please Print Leoibls
.
Name lBusiness.Organzzation.I nkli,It'.il.i:k: A
Address: c"5).--._erOc\( S , , , , , .... _ „ ,
cit,, state;zipfaik,o),„piorv,Aw ()n)--) Phone#: Lkk 5-(053'(-4 1050
kr c)sou All employee?Cheek tht-appropriate hut: Type of project(required):
i.7 1 4m a employer with_ employee%ifull aklikor part-time I." 7, Q New construction
2.-ci I.11/1 a sole proprserear or purtnership and have NJ employees Working tor me in 8. 0 i Remodeling
capacity [Nia ourkeri.'romp.insurance required]
. 9. MI Demolition
.3..L.73 I am a ismscov.Ther doing all work myself.[No workers*comp insurance required]'
, 10 El Building addition
4.0 I am a Isonteownwr and,k ill he hiring contractors to intndiset Al work on tll'y property. I well
moire that all/:knotruloor.,emits have%tinkers'corrapietrvation insurance or are sole 11.0 Electrical repairs or additions
pnipnetors w ith no employees..
' l la Plumbing repairs or additions
5C3 I am a vsn.sai contractor and I.he se hired the rub-cuotraetkn%Listed on the anadurti Ain&
13.EjThew subscontractors have employem.and have workers'c e..amp insuranc )." Root repairs
. 14.0 Other
6.E3 v,,, are a corperation and its officerse hav exerciaed their nght of exemption per MCIL c.
151 4'1141,and we have no aripluyees.[Nu workers'comp.insurance regurred.1
*.linv appiaant that checks box 41 must also till out the section below showing their workers'compensation polio!information_
!Jinn...owners who YANnii this affidavit indicating they are doing ail work and then hoe outside contractors muss submit a new affidav it aid:eating such.
:•Contraetors that cheek thoi bolt must attached an additional sheet sho4 um the name of the sal,.cinitractors and Awe v.hc.thcr.n 11.,t those snlitics have
_:•.11)Isiyees, lithe sub.coitaiaCtors Issue ciirlity cc:,they must pro,id,::1,I: workers'svirnp
I am an employer that is providing worAers compensation insurance fin-ary employees. Below is the policv flint job site
information.
In:soma:ix Compan> Name: _
Policy 4 or Self-ins.Lie.4: Expiration Date:
Job Site Address: City/State'Zip:
Attach a copy of the workers'compensation policy declaration pate(showing tbe policy number and expiration date).
Failure to secure coverage as required under MOL c. 152. §25A is a criminal violation punishable by a tine up to S1,500.00
andlor one-year imprisonment.as well as civil penalties in the limn of a STOP WORK ORDER and a tine of up to 5250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance
coverage veriliwtion.
I do hereby certify under the pains and penalties of periary that the information provided above Ls true and correct.
Signature:
Phone rit:
Official we only. Do not write in thi.%area. to he completed by city or town official
Cit,!or Town: Permit/License#
Issuing Autborit).(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*:
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