48-015 (4) BP.2022-1514
150 DRURY LANE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
48-015-001 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-2022-1514 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 RENO Contractor: License:
Est. Cost: 61000 DANIEL DACRI 105989
Const.Class: Exp.Date: 05/07/2024
Use Group: Owner: GOSS ALEC
Lot Size (sq.ft.)
Zoning: RR/WP ,1pplicant: DANIEL DACRI
Applicant Address Phone: Insurance:
247 RIVERSIDE DR (617)543-2843 R2WC357035
FLORENCE, MA 01062
ISSUED ON: 11/23/2022
TO PERFORM THE FOLLOWING WORK:
RENO KITCHEN&MUDROOM, REPLACE 2 SECTIONS OF FOUNDATION WALL, NEW WINDOWS &V ULT CEILING
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 • + a y4
Fees Paid: $396.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
c\, The Commonwealth of Massachusetts
o Board of Building Regulations and Standards FOR
"'
Massachusetts State Building Code, 780 CMR
MUNICIPALITY
c� USE
c`-'Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: tap Z022--i t./- Date Applied:
EUi (Z55 /l. i7 )123-702.2
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 rQ�erty ��s s: i 1.2 Assessors Map& Parcel Numbers
�j8-D/5-oo 1
1.1 a Is this an accept street?yes / no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
1?g/W P
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G c.40,§54) 1.7 Flood Zone Information: 1.8 SewageDisposal System:
Public 0 Private Zone: Outside Floode? Municipal fd/On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1/p caner'of ecord:
Pt c-- os S 4YOcr!?4/I�''t?/ /7 414 o1O6'O
Name(Print) City,State,ZIP
/c0 brix'1 )r1 y/ 3-5-�6--&a(0
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED ORK2(check all that apply)
New Construction 0 Existing Building IV Owner-Occupied Repairs(s) i Alteration(s) l?/ Addition 0
Demolition 13 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Aerbvct i-L- k.,1*thel +/) Jd(.X)M, Ter/a- a$ AA5
04 raindkho^ 114/I Ale ki /01A S I Lica cP1Gl
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 5b 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ 0 Standard City/Town Application Fee
Ool) 0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ c (.100 2. Other Fees: $
4. Mechanical (HVAC) $ / 7 List:
I vl.)
5. Mechanical (Fire $ .._..�— (�
Suppression) Total All F aU
Check No.X Check Amount: Cash Amount:
6.Total Project Cost: $ Pi 000 0 Paid in Full 0 Outstanding Balance Due:
xt.( 396.So
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /05 gFoi S/.� lJ 3
1)Qy� T )c License Number Expiration/ Date
Name of CSL Holder
r ' g IV4/E) , D . List CSL Type(see below) [/
No.and Street J �(/( Toe Description
FA)r4(Q �A 0/
Q/ UJ Unrestricted(Buildings up to 35,000 cu.ft.)
LC L / (7a 'Lf Restricted 1&2 Family Dwelling
City/Town,State,GIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
-5. -(703 dim dc1Cr) ,O ic�,'CD(►�1 I Insulation
Telephone E a address D //Demolition V/rA-3
5.2 Registered Home Improvement Contractor(HIC) /(�' 9a7
"NIA plc 0 HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
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 Issuanc of the building permit.
Signed Affidavit Attached? Yes 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 Dom I)gc,^)
to act on my behalf,in all matters relative to work authorized by this building permit application.
/Vic Goss 1/4l"aZ
Print Owner'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 accurate to the best of my knowledge and understanding.
a't1
Print Owner's or Authorized Agent's Name(Electronic Signature) ate
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"
City of Northampton
o:-_, ti; SAS ,... ,.SAC
\ Massachusetts �v� . - ri'e
i w I E r 4114
'14' DEPARTMENT OF BUILDING INSPECTIONS S',
�` 212 Main Street • Municipal Building yeti .••
+i0 Northampton, MA 01060 j's6i, 3 5^'
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:
I
Location of Facility: V IL712-ecyci)�l
J
The debris will be transported by:
Name of Hauler: \�}3-- al ^i Jam°
Signature of Applicant: — Date: 11 1 L L)--
_ The Commonwealth of Massachusetts
mare,,, i Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
h
st www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/ContractorsfEkctricians//Plumbers.
TO BE FILED W rI a IIIE PERMITTING At iIIORI ii.
Annlicant Information Please Print Lrribiv
Name(liixsincss'Organia tionandividad): �p(In 1)01C Si
/I
Address: a tr9" )114 5)OLC , )('
c yistaterzip:l trance., MA OP6 Phone#: i�--5-y3 09E)1
Amami as esrplayer?('hedt Ile epprepr[ste lint Type of project(required)
la I am a employer with employees(toll and or part-time).* 7. 0 New construction
20 I am a sole proprietor of psmrsigad have no employees.oiling for mr in 8. 3emodcling
an)capacity_(No w.wkears'camp.idtleaeae neylrrud.l
30 I am a hoineuwn-r doing all wort myself-No workers'cusp.insurance required.]" 9. Demolition
4.0 I am a homeowner and will be hiring emerselers to conduct all work on my property_ 1 Midi 100 Building addition
.,sure that all contraction either have wurtem'otmpensanrrn unammes or sees* II 0 Electrical repairs or addition,
pruprirtaxs with no employees. 12.0 Plumbing repairs or additir ell,
S tarn 3 general contractor and I here hind*.obosatrackrrs kited as the a ada 1 Roof repairs
These sob-ttatracto is have employees sad have trorkers comp. t
6.0 We are a corporation and its officers have exercised their tiskt ofeaeg MOIL roioa per M e. 14.0 Other
152,(11(4),and we have no employers.(No workers'comp_msnrsoreryaned]
•A n)appheant ibis shads bag Sl sirs skis fdI out ie section below sowiss ieir workers'ooerpeerreree polity i dsiortiss
Nunituwoes who mbarir this alti wit indicative aware dolls all wadi eel is line oreride ranuseters sits admit a caw allibevit' ' sod
:Caatsetos dist desk Iles boa errs aseeied an addaieed*set shwas is same of die sib-omits:tore sad rise wkeier sr sot doss hove
espisysts Vibe siubisn-ractcws haver employees.they nett provide their worker wisp..p+leey snort.
I on an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name: arc( )n5 (0. J- -----_. —
Policy#or Self O
ins.Lie.#: 4J L 2 J5 70 3 Expiration Date: /a�!73
lob Site Address: /Sv D((/ In CityiStateiZip/4/1490/. ) 1,1V 0j '0
Attack a copy,of the workers'c�easation policy decoration page(showing the policy number and ezpira on date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$4500.00
and/or one-year imprisonment.as well 'vil penalties in the form ofa STOP WORK ORDER and a fine of up to$250.00 a
day against the violator copy of slat t may be forwarded to the Office of Investigations of the DIA for insurance
coverage senile
I do here certifp r t pains d penalties of perjury that the information provided a e is t s and correct.
Signature: t�2 /J Date:
Phone#: /.J ck7 3
Official use only. Do not write in this area.to be completed by city or town official
('its or Town: PermiliLicense#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.('ityflown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
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given are subject to verification on not be released or copied unless Printed: 1Oi7/2022 8
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