17C-281 (7) BP-2023-0042
107 NORTH MAPLE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17C-281-001 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-2023-0042 PERMISSION IS HEREBY GRANTED TO:
Project# KITCH RENO 2023 Contractor: License:
Est. Cost: 60000 HANS DALHAUS 101628
Const.Class: Exp.Date: 11/17/2024
KITCHEN,ANTHONY &KRISTA TURNER
Use Group: Owner: KITCHEN
Lot Size (sq.ft.)
Zoning: URB Applicant: DALHAUS CARPENTRY INC
Applicant Address Phone: Insurance:
11 CHERRY ST (413)977-6094
EASTHAMPTON, MA 01060
ISSUED ON: 01/19/2023
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
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:
1 .2 . 51./E,
Fees Paid: $390.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
, r----"-z-z.,_ci a '-- z--,---..,
a ,)
S . The Commonwealth of Massachusetts ; J� 1 3 j
WBoard of Building Regulations and Standai*s 20c FO
Massachusetts State Building Code, 780 n+-,v 4 null ow U E
Building Permit Application To Construct,Repair,Renovate O11Ioc i Sised ar 2011
One-or Two-Family Dwelling A" --' °.
This Section For Official Use Only
Buildin�Permit Number:£ '..a. y" ,' Date Applied:
Li.� /- /q 2023
Building Official(Print Name) ��/Signature Date
Building
SECTION 1: SITE INFORMATION
1.1 operty Addressi A 4 S� 1.2 As'esssor`�s Map&Parcel Numbed oI
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:
Public❑ Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP1
1 caner'of cord 0. i, ` W 1/4 O 10;71 —
Name(Print) City,State
0� • 1��9\1 .. iK'-' T1/46 t 1 11A'UtAa0 lcma;�- con\
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Buildings Owner-Occupied 0 Repairs(s) #d Alteration(s) El Addition ❑
Demolition di- Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Rescription of Proposed Work2: �.�t1-vt a{�. F..oQ jv�Ov.r 0 A. t
civiA'2.k. c c 0.S rPv�4 C \ `4-- t+1`q akin clop urT-yv�-eNj �•(�C klA
k i`V•c�er- Jv`c_.k q ll pin) 4 tc nr,c.S cA b,r•� c 'e.1 , f(xc t l p 4 b",43
ku ri --c \ Weaov \nlA;r . ( U Tr+cr�2 .2e
SECTI N 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ c, Ot13 1. Building Permit Fee:$ Indicate how fee is determined:
1 0 Standard City/Town Application Fee
2.Electrical $ Sst tsw 0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 1/44 0 Op 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) Total All F o
$ 42..fit
Check No. i Check Amount: ,z Cash Amount: r
6.Total Project Cost: $ 6V I (f4) 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS n,
212 Main Street • Municipal Building �,,
--^f Northampton, MA 01060 's i1a
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.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 4 O` 6 a e I a
40(v> r" p6A\-1M6 License Number Expiration Date
Name o CSL Holder
\\ ! WA 5V. List CSL Type(see below) v
and treet Nl Type Description
igtOci l)( Mtk 01( U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,Z 1 `' R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
15 Ct 11 ( ()e SF Solid Fuel Burning Appliances
Telephone lj V DA\\"\COC
(� 9 I Insulation
eP Email ad I D Demolition
5. Regis ered me Improvement Contractor(HIC) VO
Registrati n Number xpi ation Date
om.an Name or HIC Registrant Name
thlikavS(4qtart7.,I d Street CgM 6i II.l�4�,
� IAEmailddr
City/Town, tate, 1P 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 prdvide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes Lr No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR PLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize I
to act on my behalf,in all matters relative to work authorized by this building p it app cation.
kCISik V- I 1/ Ja
Print Owner's Name(Electronic Signature) LJate
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest ,er the pains and penalties of perjury that all of the information
co fined in this appli ation is true and acc . .te te - .:.t of my knowledge and understandin A
..‘..
COS("0 , 1, S 44
1 ,, 3
Print Owner's or Authorized Agent's - -fr -'3T'is -. ' e) 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: i
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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
�#7y Ir. _
Massachusetts' :- ft,;4 it
<<
n 7
DEPARTMENT OF BUILDING INSPECTIONS
� 212 Main Street • Municipal Building "'&
—:: Northampton, MA 01060 's' t, ,, '+�'
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: q\ 1
The debris will be transported by:
w
Name of Hauler: \,\ VitNiSa e `
) ,
Signature of Applicant: Date: Vti/g'S
The Commonwealth of Alassachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
) Boston,MA 0114-2017
WWW.mass.govidia
%%Otters'Compensation Insurance Affidavit:BuildersiContractors/Electriciansalumbers.
tt)BE FILED WITH THE PERM ITING AUTHORITY.
Al)Dilletint Information Please Print Legibly
Name 4 Plustats5.1)%aninon,tli Ineltvidual ik4O
Address:
CityStateilip: 1...4..)0\Ncov-vot Akk, Phone Ft:qlr'S 171 640 ,4
Ate yea ma eatatoyer?tberk tbe appropriate but: Type of project(required):
3m a mptot ith 7. New construction
20 sm a sok propnelor partnership and have nu ernployin=k working for me in 8. c] Remodeling
any tmpiteity [No workers'comp.inburance required
9. Demolition
IDI am a h.msvisnei doing all ssori myself.NO workerN'cony ineittratt TegliMed.)
10 Building addition
tam ihjmma and*111 hiring eonttaciors to conduct ail*ink on my property, tWIll
ensure that all ctottractors either have tiointerS"cenipenSataon malwance or am WIC I I. Electrical repairs or additions
prtrimclers with rm.employee,
12.0 Plumbing repairs or additions
50I am a eeneral cuntrartor and I List:hued the sub,contraetors listed on the adladied sheet.
130 Roof repairs
rh,sc,uh-contrAcunN ha cmployeus and have*mien comp.snsisranee.;
14.El Other
6.0 9.e am a cs.rpera1n.n3 and its otriceri have exeriled then nght of exemption per NCI c.
IJIi,and we have nok,aea.[No*utters•comp.insurance requareti]
*Any applicant that checks bar 41 mug also fill out the section helm,*shms ing then*markers'compensation policy iefursiaation_
litnneuwriers who Ailment dna atikkivit indicating they are doing ail work and then hor outside euntrnctins must submit a new affidavit inelii.ating such.
'Contractors that cheek this but must al Cached an additional sheet shim.me the name the mi&r:Licar.octurk.and,tate whether ot riot those entities hase
cmployees lf the mab-c,,ntractin%hgV.e emphrs ces.th...'y must pnas ide then 4,11,,er.,• ;NA numlso
1 am an employer that it providing icrirAers'compensation insurance for my employees. Below is the polity rind job site
information.
Insurance Company Name:
Polley#or Self-ins.Lie.4: 6$5 iu -5.KtO6M Expiration Date:.61 (1Ifa3
Job Site Address: 0-1 14.0\43A-C A Citv.Staie/zip:
Attach n copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. I 52. §25A is a criminal violation punishable by a fine up to SI.500.00
and/or one-year unpnsorunent,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.O0 a
day against the violator.A copy oft. statement rtray be forwarded to the Office of Ins estigations of the DIA tear insurance
coverage verification,
do hereby c tifit u er " s and penaltieN of perjury that the in forma:hut provided iive is true and correct.
SigSinatur . p (
Phone#: (1)1'S 'T7,rs1 Nq
Official use only. Do no,write in this area,to be completed by city or town official.
or Town: Permitticense
Issuing:Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone 4: