25C-144 (10) BP-2022-1631
35 ORCHARD ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-144-001 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-2022-1631 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 RENO Contractor: License:
Est. Cost: 40
Const.Class: Exp.Date:
Use Group: Owner: KORD GETOFF SARAH B& ANTHONY
Lot Size (sq.ft.)
Zoning: URB Applicant: KORD GETOFF SARAH B &ANTHONY
Applicant Address Phone: Insurance:
37 ORCHARD ST
NORTHAMPTON, MA 01060
ISSUED ON: 12/20/2022
TO PERFORM THE FOLLOWING WORK:
RENO 3RD FLOOR HOME OFFICE INTO SEPARATE LIVING SPACE, ADDING SAFETY FILM TO POTENTIAL
BEDROOMS
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:
Fiv
•
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
:�c•.; The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
w One-or Two-Family Dwelling
cD
This Section For Official Use Only
Building Permit Number:13e-2C127,-(lo 3( Date Applied:
1
idiatureh2 � t 1I, c9�;
BuildingOfficial(Print Name) �Datl
SECTION 1: SITE INFORMATION
1.1 Property Address: 1 4%9-5 % .2 Assessors Map&Parcel Numbers
3 5—5/ Dc c.k.a.42, 4—t rP Pr 0 O o 26C-1 c1' 1—00 1
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
11Z6 ..2 a.e-re-
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
l
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. Owner'of Record:
0.s—Ae'• 6-? cC 1N.9.5 vA.vk eN YYN A- 0 t 0 to 0
Name(Print) City,State,ZIP
tit-- f> , 3l0 5 3 lLa'-'—
let�3 v'°-
3 ? 0 rc�o,r�- - 123 iiDO -kxir W•r'0. ,sc ro. d1,,4 , co►�
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Er Owner-Occupied lel Repairs(s) 0 Alteration(s) RI Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': \a h,t-o �v,4-r\ ,,nn 3 r-�-- --c to�- YsO vr�.
ok_ 'cN.�. rr.� o— �o..r. 1 iv. S A o..r.;�- s'o�.,
V�.S 4�.-t2- O�v,�- GLGQ -\ ♦ .. 0.-Al o-� "
1, .. o - 3vNk lvv. 4 (p o ct d o .
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ + /3 goy' 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ �� 0 Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ -er— List:
5. Mechanical (Fire Suppression) $ .„er- Total All Fees: 65:
$ ,
Check No. 9q3 Check Amount: lab Cash Amount:
6.Total Project Cost: $ 4" 6 yo•- IX Paid in Full 0 Outstanding Balance Due:
City of Northampton
<" ' Massachusetts �� '�
DEPARTMENT OF BUILDING INSPECTIONS ��
\ =y 212 Main Street • Municipal Building vy c1
Northampton, MA 01060 „,;.‹.
-st, „,J
,.....,
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.
1 - 3 v W k vc2o -�l w` w tti...vim. u M .e,,-h- -x ‘ • A
c�•.b �' �� c ln�.S s S v�.� 1.v`sir
",r e.A".0 •..o ar=e.-. v'e s\-C6v\ c.� ate..-6 r S w t L\ I'42—
The debris will be disposed of in:
Location of Facility:
r
The debris will be transported by:
Name of Hauler: (\i/ // (
Signature of Applicant: Date:
The Commonwealth of Massachusetts
►` =Ls, Department of Industrial Accidents
G _i'eB►_ 1 Congress Street.Suite 100
;_ I t-" Boston. MA 02114-2017
www.mass.gov/dia
11 urken'Compensation Insurance Aflidan it:BuildersfContractorsiElectricians!Plumbers.
IA)BE FILED% 1 t11 I IIE PERM!I I l (;Al CHOkl I .
Anniicant Information Please Print Leelbty
Name(i3usine»Ors;antratton lndt'.tduall:
Address: 3/ O
City/State/Zip: rr M 13 5 A, -.3�5
c�
rY P A'�r �A.A0,—� D.-to(as2 Phone ; : y 13
titre yea se employer?(lrrk tier appropriate but:
1�pe of project(required):
la I ant a rmpkn a a tih rxnplaycc+t tuft and or part-time 1-' 7. New consU uction
:0 I am a tole proprietor or partnership and hate no employees vitiating for ate in 8, f 1 iZem0deling (.' YY\1+'��C' \)
any Lapsert. [No...mien'cutup.nuurmie rryuana11 ■
9. 0 Demolition
.1E11 am a hotruCr'wts:r doing all'work myself:(i+o workers'Corer.rnwturtce required.''
4❑ tto I ant a Ioa n V.and ill be hiring Leonean to ctxtduci all work on my property. I Meat 1 Building addition
ensure that all contra.-tan either lute workers'compensation urtur s ur ate sole 1 t,Q Electrical repairs additions
proprietors u ith ctu employees
12.0 Plumbing repairs nr additions
5 I am a gent-sal contractor anti I have hired the wb-euntracwn Itstcd tm thr atradlod atteM
13.�Roof repairs
Thaw tub-Contractors have employees and hats a otters*comp.nuurance t 1
14.fl Other
6.0 1\'e an a corporatl.nt and Its olliet.have exercised thou nght of excrnptkon pet Wt.e. — —
1 S2.§114 t.and w a hat a no employees.(Su winters'comp.insurance reyutred.l
*My applicant that checks box a!nurse also fill out the srctiva below showing then wasters'compensation policy information.
Homeowners who submit Out atTtttasat uarheawtg they are doing all wort and then hue outside contractors mew submst a new aftidat it trattcatim:-ia h
tCuntractun that check the tax must attached an additional sheet shuwiag the awe of the Buis:ttruraet.rs and state whether or not those.n t:,n.i
cmplot It the sub-c mtras tars has:employees.that mast pro'.id,-their w inters'c.yttp Tv uhct number
1 am an employer that is providing workers'corn penwtion insurance for my employees. Below is the policy and joh.+its•
in/ormation.
Insurance Company Name:
Policy#or Self-ins.Lit.#: --- Expiration Date:
.Job Site Address: City!State2ip:. -__..._.
Attach a copy of the workers'compensation ration page(showing the polies number and expiralion date,.
•
Failure to secure coverage as required under GL c. 152.* cA is a criminal violation punishable by a tine up to 1,500.00
andlor one-year imprisonment,as well as c$ penalties in the onn of a STOP WORK ORDER and a tine of up S250.00 a
day against the violator.A copy of this s ernent may he forwarded to the Office of Investigations of the DIA for' ce
coverage ventication.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
I2.I1elaa
StLnatufY: ���� Date
Phone#: kve.tr.SA.tvy_. 413 5 V, 3 4963 4�k tq 13 1 Z3 17(D o
IOfficial use only. Do not write in this area.to be completed by city or town official
City or Town: Permitil.ieense k _ _Issuing Authurtis (circle one):
I. Board of Health 2. Building Department 3.City Town Clerk 4. F:Irctrkal Inspector 5. Plumbing In+Ironer
6.Other
Contact Person: Phone n:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
1\}'
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)
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 Issuance of the building permit.
Signed Affidavit Attached? Yes 0 No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONT CTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby aiithoriz
to act on my behalf,in all matters relative to work tho ' y this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:O ER1 0 AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under e 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.
SO. LA_ fZf/ (0/Z2--
Print 's or A zed Agent's Name(Electronic 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 fo d 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
oPt RAMP o\ ._..._s
"" Massachusetts --,„,„
'<<.
y; F DEPARTMENT OF BUILDING INSPECTIONS
f" 212 Main Street • Municipal Building
Y"';_ Northampton, MA 01060 sr-iy T,i'
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT (9-11 5(41q
I, -5 al..ra 6-) O CC (insert full legal name), born (insert month,
day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use
and/or farm structures.A person who constructs more than one home in a two-year period shall not be
considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in connection with any project or work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this iv day of , 20 ZZ.
`�(Signature)