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35-165 (4)
B -2023-0052 817 RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-165-001 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-2023-0052 PERMISSION IS HEREBY GRANTED TO: Project# ALTER ENTRY 2023 Contractor: License: Est. Cost: 1500 JAZAB EDMOND 050099 Const.Class: Exp.Date: 04/02/2024 Use Group: Owner: E. MONSKA, JOYCE Lot Size (sq.ft.) Zoning: WSP Applicant: EDMUND JAZEB Applicant Address hone: Insurance: 9 SHEPHERDS HOLLOW 413-222-4910 LEEDS, MA 01053 ISSUED ON: 01/19/2023 TO PERFORM THE FOLLOWING WORK: BUILD ROOF OVER ENTRY 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 VI LATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Ie, • )2 . 5.90t, Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner v / The Commonwealth of Massachusett 4. N * Board of Building Regulations and St ards 4 1 MUNICIPALITY ; Massachusetts State Building Code', 78t ✓ E Building Permit Application To Construct,Repair, Renov -0x emolis a �evis id Mar 2011 One- or Two-Family Dwelling o;v %ys / / This Section For Official Use Only ,�` � /Uhs / Buildin Permit Number: 6P A3— 6� Date Applied:�ul� ss // I-19-ZOz Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Addr ss: 1.2 Assessors Map&Parcel Numbers B Ii RYn-nl FLo azyJcz _ 1.1a Is this an accepted street?yes j 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 Di Private 0 Check if yes® Municipal. I On site disposal system"4 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of T Record: l• M S M Jove M©ni5KA YL�PI ) \o— l�JQ2o'NC-C, 1-�A 01062- Name(Print) City,State,ZIP B17 /RYAvJ rRo No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) ,l Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: 1 Brief Description of Proposed Work2: 13 U i LD ft 'R O of' O M_ �C 1 S i 1N.3 Cs LiN►J 7)N C-- cKJfl Smi(ZS Tu.Pr ' CiST 01.1 1R1G-14-T Slur of - ov5 F- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ i 55 Do 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ C) ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 0 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees: $ Suppression) Check No.IA)" Check Amoun . 6. Total Project Cost: $ t 5 0 0 ❑Paid in Full 0 Outstanding Balance Due:___ City of Northampton Massachusetts i ; y DEPARTMENT OF BUILDING INSPECTIONS . � , i4 212 Main Street • Municipal Building *,, ; 'i Northampton, MA 01060 ss:•fi �l� PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS, RENOVATIONS, ROOF MOUNTED SOLAR, ETC. 1. 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. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new/replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements (if applicable). 9. Energy Code —all new construction(Gut/Rehab) requires a HERS Rater Affidavit 10. 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) ED CSrPs- o50099 oy4 jtrzl2Lk �/4zAB License Number Expiration Date Name of CSL Holder 9 SI4ETA-1 IX5 t-}°t..l-O List CSL Type(see below) No.and Street Type Description LE DS MA 01053 U Unrestricted(Buildings up to 35,000 cu.ft.) Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances y 13• 2.22. -49 l 0 e J a-za Yp ,L� I Insulation Telephone — Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Z fl 3 Z 82 09 130 23 Eip Z74.z#4b HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name A-rv\-E" e —Jc`7,Zc`�D c�J"(f o°. cow. 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 ❑ No .121 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• EP JabzA-e to act on my behalf,in all matters rel tive to work fZrW*" uthorized by this building permit application. S�eQ�ev m�iYlS�6� 4 2-21d2'.a2-3. Print Ovdlner'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. En JAZAB `�� tItt� I2-- Print Owner's or Authorized Agent's Name Ele'btronic Signature) Date g ( � ) 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" 4.....a .'-', 1111111.111111111.MMINIMMil The Commonwealth of Massachusetts 17,•11=-..;',. ....,—=.1i; Department of Industrial Accidents ,i‘.. —I....- 1 Congress Street, Suite 100 Boston,MA 02114-2017 1/4 www.ntass.golVdia SVorkers' ('ornpensaiion Insurance .‘flida%it: Builders.l'ontractoniElec-triciansiPlumbers. It) HE. 111.1-.1)N11111 I Ill. PLK‘111-1rING AtTHORITI. Applicant Information Please Print Lei:ibis Name i Business:OrganizationAndividualr E r) .0.-A Z.0-0 l Address: 9- 1-1--E-171-1-C12-D5 \40 ir_k_o V) City/State/Zip:LEK9_S MA. .) i 0 53 Phone#: 1-11-3 - 222- I-19- 10 — Art you an eniplarier,Clerk the appropriate lout: il)pc of project(required': 1.D I.flit a employer with employees(Wled: r part-time I.• 7 :j New construction 22 lam a sole proprietor or punnership and ha no employees working for me in 8. 0 Remodeling any LA11.y.[No workers'comp.insuranix required] 9. Dem 3.1:3 lam a homeowner doing all work myself[No workers'comp,insurance nequired....y 0Demolition 10 ci Building addition - 4.0 I am a homeowner and will be hiring contradors to 1.:xiesixi all work on nry property_ I will ensure that all contractor%either have workers'corm:x.11,4mm insurance or are vole 1 1 a Electrical repairs or additions proprietors with no employees_ i 12.0 Plumbing reruns or additions SO 1 am a general contractor and 1 have hired the 4k-contractors listed on the attached sheet These sub-contractors IsaYv employees and has e workers comp.insurance.: 130 Root repairs _gi 2A- 6.0 We are a corporation and its officers have exercised their right of exemption per!1/4461.c. I 4 Other A L-Ttl -ri ci-t.) I52,§1{4}.and we?woe no allpkweeti.[No workers'comp.insurance required.' *Any applicant that chixks box 4 1 must also fill out the section below show ing their workers'compensation policy information_ 'llorromsoners who submit this affidavit indicating they are doing all work and then hire outs,40 contractors must submit a new affidav it methai.i.:-.1...i'.. :Contractors that check this box moat att.a.thed an additional sheet showing the name of the sub-earitractors and state whether or not those mule,11.., ‘: cropluvera, lithe sols-contractors have erriployees.they must provide their workers xmip.pulik-: nunker loan an employer that is providing worAer.s'compemation insurance fin-my employee,. Belo IV ilt the policy and joh.,,ite information. Insurance Company Name: _ Policy 4 or Self-ins.Lie.#: Expiration Date: Job Site Address: City/StateZip: Attach a copy of the workers"compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NIGL c. 152. §25A is a criminal violation punishable by a fine up to S1.500.00 andior one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against tlic .,tolator.A copy of this statement may be forwarded to the OtTice of Investigations of the DIA for insurance co erapt: ,.err.riL ation. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. )11,,.../.. Signature: I 11 1 2.2- Phone#: Li,V.6---- 2229 (0 Official use only. Do not write in this area.to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other ('ontact Person: Phone 4: , . ........„.......... 1 City of Northampton -'� Massachusetts ' 4-- - it - . - DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �, ��" Northampton, MA 01060 'S'f.}y 4.1ti;, 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: VI\L.L�'( Nc. CYCL I'mG , P/4S (-1F4-,li5?ToNi ! ,A- The debris will be transported by: Name of Hauler: C0YCT R Dv‘,. NEYZ Signature of Applicant: G., ✓' Date: ) \ l`j 22 City of Northampton i rr J S Massachusetts 4,x ' ��'e DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 "*--0% HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (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 thraforem tioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for id project or work. Signed under the pains and penalties of perjury on this day of , 20 . (Signature) . . I S ! q I S e ) 6b -7,ZZ \ \--1 - qt4-Z.. .C. (1_,- i N\,, 1----1- '- ' ' -----7-::— i. ' ' / t-. 8 kceNc N ofk") 1 1 \ i i . 1 N i 0, I--0. • - \ ; • - 1 1 . , . I . 0 - ' ! 1 , • I \ tej i TS I . 1 t 1 , 1 • N,___ r —1--S (1)a li 'Y'• 1 : : ,D4-9 0 — --_—_--- - -..._ M 3-cv ; / El la (\k. t\t I . _ , . — _______ 1-- -- °I SI : I, i 1 411Pir I - ____""i' - • Si k Z , il •Ft.- I li 4 .---111- - •.-. )3.13:35/f\• 6 _______ r il, e_. -alia.-:sve_.1 9 x Z .. '!,ar ' I it 1 . twri`li- . b xz II , 4 /7‘, -li -0(\kk i-u.Nd,3\-•\ 5 K1 u 1 . te•-\''\2)4/4ci . 3 N 1 i J 0 a NI* --‘). 11--VAA .33 1/4kPzio CC. • /7 . 3 sn Oil j rS OH —9 cA ii_S1)(q > I i