24D-239 (6) BP-' 022-1643
176 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-239-001 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-2022-1643 PERMISSION IS HEREBY GRANT, D TO:
Project# WINDOWS 2022 Contractor: License:
Est. Cost: 16800 BARCELOS AND SONS LLC 103710
Const.Class: Exp.Date: 08/02/2023
Use Group: Owner: SULLIVAN REAL ESTATE LLC
Lot Size (sq.ft.)
Zoning: URC Applicant: BARCELOS AND SONS LLC
Applicant Address Phone: Insurance:
27 LAKE DR WC2-33S-B23R6-012
BELCHERTOWN, MA 01007
ISSUED ON: 12/22/2022
TO PERFORM THE FOLLOWING WORK:
6 REPLACEMENT WINDOWS
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:
TIT
Fees Paid: S119.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts DEC 2 1 2022
Office of Public Safety and Inspections
Massachusetts State Budding Code(780 CMR) i ------ `�
Building Permit Application for any Building other than a One-or Twos , IIr tisiiiliing,'
(This Section For Official Use Only)
Building Permit Numben,U' I Date Applied: Building Official:
SECTION 1 LOCATION
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building$ Repair,® Alteration O Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No,1111.
Is an Independent Structural Engineering Peer Review required? `` Yes C] No JR
Brief Description of Pm Work:ken m a V 41 to 3C 10't e- vu.n d\a wS Ca rlC P Vice 4
wt\-h P Viny w to ow . 1�er�►vva% a-f din 4cAc1i-kio.lc, 1 1estic)tis
wirtelrrw rlet crated 116e:11� a AcAose,l woos Vi e1 ywaer�j Tyve.'IL. afla
virnrl wti►ert AePoloci.
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,AD MON,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub O A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-10 F2 0 H: High Hazard H-10 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-10 I-2 0 1-3 0 1-4 CI M: Mercantile U R: Residential R-10 R-2 O R-3 0 R-4 0
S: Storage S-10 S-2 0 U: Utility 0 Special Use 0 andplease describe below:
Special Use Description:
SECTION 6c CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ® IIA ® IIBO IIIA13 TIIB0 IV VA 0 VB0
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public 0 Check if outside Flood Zone 0 Indicate municipal 0A trench will not be Licensed Disposal Site 0
Private 0 or indentif Zone: or on site system 0 requiredm ®clr trench or specify:
Y Y permit is enclosed CI
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission jteview Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION&CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
I
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Su►Iivr1 Rec/ Es NRAC sy (.c (/;it(ct Rc/e,� - fcC.1
Name(Print) No.and Street City/Town Zip
P perty Owner Contact Information: I
T..sv/fi frcn - - (L((3�-S?)- —GO cv/ Sc47 67S�rsogi tath ti
I11.0 1C1CY1.v1.0 INV.IVUJu1CJJ) SCA:1J1.V1.0 INV. 1LC11) l LL.Q11(.uult.:JD
If a icable, if roperty owner heeectb y a l pt : P�Cr� '/Ug
1VW11C JLLCC.A4.4 CJJ vl.y/ IVVY 11 J.Q1C L.,11.1
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here D.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
506ei M bucce.koL, tAG c is zo o_ 2.1,bci fce k05Qpro\ �,\'3 ( )7
Name(Registrant) Telephone No. e-mail add ess , ,ttKegistration Numbe
a.7 u )a(C, Vr .etct•,�lro n Jie, 01027 <al,l a 3
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
%de ieefi
Compaf iv ame
L d7140 C s/0,7%0 v/4 { /
Name of Person Responsible
for
Construction icense No. and Type if Applicable
C (/i�/Veg//GI/ , - 0'0.9,2
Street Address City/Town State Zip
40_3vi ww _ _ ch,),,,,,,,,f,„,„...3.,„,,,,_ 5,-,,,/ ,..,
1 elepnone No.(business) 1 elepnone No.(cell) e-min as ess
SECTION 11 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes❑ No ❑
SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE
v. I Estimated Costs:(Labor I
"` and Materials) total Lonstruction Lost(trom Item b)_
TV
� ".1 `1""1`b w VO)160°r C70 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ annrnnr;ate.mnnirina)fartnrl=,:
3.Plumbing $ 11 1 1�y GQ
14.Mechanical (HVAC) $ ,..,.3.1Y111.111.LLLL.1%l:- Q (i -1 ,..V1t..1...11.ULULIFaill.yJ
r,r,,,,r,,.,i,ar it i,..,-\ e /
rrrctose check payable togoli
6.Total Cost ( $ `(0 100. 00 ( (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
IPlea,se print and sien name Title Telephone No. Date I
Street Address i City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: __,,Zi_ L-ZZ-ZOZZ
Name Date
Appendix 1
Construction Documents are required for structures that must comply with 780 CMR 107.The
checklist below is a compilation of the documents that may be required.The applicant shall fill out
the checklist and provide the contact information of the registered professionals responsible for the
documents. This appendix is to be submitted with the building permit application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
1 Architectural
2 Foundation
3 Structural
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing(include local connections)
9 Gas(Natural,Propane,Medical or other)
10 Surveyed Site Plan(Utilities,Wetland,etc.)
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Access Review(521 CMR)
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Auras of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified
must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the
authority Navin jurisdiction.
Registered Professional Contact Information
)06(4\ M Vt.;,r fe tIM `it;- (161a- 7e 17 ?-P bark-ids Pojro,040 \ C12 r
Name(Registrant) Telephone No. e-mail address fCA'h Registration Num
D7 LG\te, /3 a3
�' el�ktr wr Met o1c�v�� I
Street Address City/Town State Zip Discipline Expiration Date
- -
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
DiscliStreet Address City/Town State Zips Expiration Date
Please follow this link for construction control forma to be used by Registered Design Professionals.
The Commonwealth of Massachusetts
t'_': 1!i Department of Industrial Accidents
=.:rl_,rs 1 Congress Street,Suite 100
l;i=y Boston,MA 02114-2017
.' ,;.7,- 4; www mass.gov/dia
11 urgers'Compensation Insurance AffIdavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AI THORIT ..
ilanlicant Information Please Print Legible
Name(BwttnessiOr anintion lndwidual): 14,ci'\ ,/v^1 9 ai is t vz,
Address: g.,7 1-44\L e 04 nG
City/State/Zip:��`L,r,c.(-AthA,Tv J A- C)t�a lPhone#:t \13 — 9 a, 7 017
Are yea an eatpMwer'Cheek toe appropriate boa: Type of project(required):
I.D I am a employer with ..____.__employees(fall aniline pan-time►.• 7. 0 New construction
2&I am a sok propriewr or psvtnenbip and have no employees working for me is K. ei Remodeling
any opacity.[No women'comp.iawnmx required)
30 I am a homeowner9. Demolition
doing all work myself.[No waters'comp.instnrara�e ]'
4.0 I am s homeowner and will be hiring Dunn tors to coattail all work on my property. I will 10 0 Building addition
ensure that all Mentors either hare wrxkets'aampen..tiva is uranr or are sole 11 D Electrical repairs Or additions
proprietors with au employees.
12.0 Plumbing repairs Or additions
SO I am a general contractor and I have hired the wbaontruuxs listed on the amdwed sheet. 13.QRoof repairs
These sub-contracwns have employers and have women'comp.insurance.;
14.0 Met
6.0 we are a corpunauon and lb officers have taen'ised their right of exemption per MGL c. t
152.f 1141.and we have no employees.[No workers'comp.insurance required.)
'Any applicant that chocks boa al must also fill out die eetion below showing their workers'compensation policy mfunm:mow
r Homeowners who submit this affidavit indicating they are doing all work and then hire outside corntractors mint wheat a new glider it radioing such.
:Contractors that check this box mow attached an additional sheet showing the name of the subcontractors actors and state whether or nut those a►utists hare
employees. If the sub-cudrsctors hate employ ecs.they must pair sde their workers'warp.policy manbrr.
am as employer that is providing workers'compensation insurance for my employees. Below is the police'and job sill
information. \\
Insurance Company o f Ty AA to v1 a` f is Gt'n f e_
Name: �.r\J � _ .
Policy#or Self-ins.Lic.#:W L J 2 3 tj p i 3e 1. 6-0 la Expiration Date:0 e c. jk''‘ 0 a 3
Job Site Address:\7 (1 ?c d 5 119€c k City;State.'Zip:Al C VA a in Q ,1 t\ Al) (2 W GI
Attack a copy of the workers'compensation policy declaratloa page(showing the policy another and expiration date).
Failure to secure coverage as required under MGL c. 152. §25A is a criminal violation punishabk by a fine up to S 1.500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cat&mid r the pains and pe allies of perjury that the information provided above is true and correct.
Sl nattue:#: �� , Date:/?//4 /2 2
Phone 9/5 9'472 — 7/. l
Official use only. Do not write In this area.to be completed by city or town official
City or Town: l'rrmit/i.kenst.a
Issuing Authority (circle one):
I.Board of health 2. Building Department 3.(.0 Town Clerk 4. Fkctricai Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phony#: I
City of Northampton
,,o •Ml�o� x5 .. S,.
~' Massachusetts w?S - ''e
;: DEPARTMENT OF BUILDING INSPECTIONS 4
212 Main Street • Municipal Building J`
�'' •,��'r:'S� Northampton, MA 01060 k�`.i+7,1.
L.V1II U 11\\JV 11V1• LLL AIL 1U L1IL maIL V 1n
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
Number is that all debris resultine 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: /1� V 1
•�"1�, Q1ci 0
The debris will be transported by:
Name of Hauler:
TT04zo A Ocict..EA0i.)
Sienature; f Applicant- Date:
/1// 2 Z.