24A-010 (11) BP-2023-0060
130 PROSPECT AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-010-001 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-2023-0060 PERMISSION IS HEREBY GRANTED TO:
Project# PORCH RENO 2023 Contractor: License:
Est. Cost: 20000 STEPHEN ALBERTSON CS081426
Const.Class: Exp.Date: 01/21/2024
Use Group: Owner: JOHANNA BASS GWENDOLYN
Lot Size (sq.ft.)
STEPHEN ALBERTSON DBA S B ALBERTSON
Zoning: URB Applicant: PROFESSIONAL CARPENTRY
Applicant Address Phone: Insurance:
95 CRONIN HILL RD (413)522-3158 AWC-400-7030930
HATFIELD, MA 01038
ISSUED ON: 01/23/2023
TO PERFORM THE FOLLOWING WORK:
CONVERT PORCH INTO CLOSET SPACE
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:
s)? Taly/
Fees Paid: $130.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
.
N
The Commonwealth of Massa/ ettt ,8 �8 FOR
W
Board of Building Regulations an man at., CYl'ALITY
Massachusetts State Building Code, 780 C4,1 °/in,,,,
g44o, in,�� SE
Building Permit Application To Construct,Repair,Renovate Or`Deio 1r,,-;,, evis Mar 2011
One-or Two-Family Dwelling
!, This Section For Official Use Only
Building Permit Number: 6A-07 3 00 Date Applied:
'e i IP • ,T/ ; i _3
Building Official(Print Name) Signature I Dat
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
/3O P/2_dSPcE/' r4l/C q:.4�/�¢ OYO
1.la 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: ,./
-{c�5S/ 31 S5 /Yil� i✓/Alt GI/o 3S'
Name(Print) City,State,ZIP
/30 S % AiJe 9i3-896-3S8g
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 1g Owner-Occupied 4E Repairs(s) 0 Alteration(s)ca Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2:
— CO018Ater rb,ee,f/ }re" /N,4, D/77o.61-e�
oNt-cE , 1 c- ...rre a-s c/D sa rf,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ /s'Oda 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
0
0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fee1:•� ^
Check No. 1 tt, V Check Amoun V* Cash Amount:
6.Total Project Cost: $ ?.O,(VO 0 Paid in Full 0 Outstanding Balance Due:
f
City of Northampton
ro
-�' Massachusetts
t
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 rt . t2
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) CS _as 14 26 /zO,o t¢
,1 '/LTrdA" License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) LI
Pr c,t. , //mil
No.and Street Type Description
//� / /� /D 3 o U Unrestricted(Buildings up to 35,000 cu. ft.)
f7 T�- t I l// �� O R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
'� • SF Solid Fuel Burning Appliances
413— 5Z2—3/$ I bQ�'�✓SD 41p5ANrted* I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Co any Name or HIC Re 'strant ame HIC Registration Number Expiration Date
C#fo.1/Ai f // d algae-{-e.✓s6ilaoo,/co.,
No.and,/tre Emai address
tifike/di MA' 40/0 3g -fg-SZ2-3✓52'
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 0
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 STEN/EA-1 4t .7YeL /
to act on my behalf,in all matters relative to work authorized by this building permit application.
6-wed -sS C76/vg �4 3
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.
S MEPf/eA1 ,4 770"l 2 3
Print Owner's or Authorized Agent's Name(El ctronic Si nature) 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:
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
Massachusetts
t I; ' '' 443, :,, s
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building W 47
�aa Northampton, MA 01060 >.t,rE��'
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: V-/%y icy//TT/0 / Z.31 6 �iidr�
Ne .toia‘7,; _,,, p/D 60
The debris will be transported by:
Name of Hauler: S3 ,q- 730z-761/11
Signature of Applicant: Date: �/3
The Commonwealth of Alassaeltusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www,.ntass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/ContractorstElectricianstPlumbers.
TO BE FILED V41114 THE PERMITTING AllHORITS.
Applicant Information Please Print Legibis
Name fausiness:Otlanintort
AddreNs: CdiefAle,ti 40/
City/StateiZip:_ e/0///49- e/p3g,' Phone
Are yea an employee Check die appropriate hos: Type of project(required):
r4 am a eamieyer with Oemployees.Ohl!anchor pattAntiq.' 7. D New construction
20 I am a sole prmarletor orpinnerstup and have no ettiployeea working for mac in 8. Er Remodeling
any capacity woriers'conm.insurance required.]
9. Demolition
ID I am a honveonther dairie all work mynelf.jaVed,tittra* imatimma revived"
100 Building addition
t am a lienneowner mid*al be ha*contractors to conduct all oak on my property_ I will
ensure that all emitractors other have workers cenmenwatitm intaarance are able 1 I a Electrical repoirs or additions
proprittera with no employees_
12D Plumbing repairs or additnnis
am a phrierai corittattOt ani hinVe inred,tlaffab-tuntrAinn‘Liatod on 11,2e anat.-11,th Alert
130 Roof repairs
neve ittb,ioaratithettath leave emaployees,and lime*mien"comp.insurance:;
14.0 Other
V.c are a eagle:alum and ite officers have exercised thew ragtat‘trea.earaptatata per WL c.
and we base tau employhes.[No workers'comp in . coiled./
*Any applicant that cheeks hex#1 meg Abu Eli utie the etchien htk aon pubrey;attenuation_
ikgreatametaere'who submit this atfidavit ardicaursi they an leave Jaen nate meg aathettat a triew affidavit erefaratitiag%tack
l'Cialarilieran'S that cheek thin Maass must arnitheil an additional sheet show-inn the name of the taahreeinithieteria and‘taie whether or not those=tines has,e
employee, It'd*atthreartarraehars Ita,e employees,they mosi provide their worken'emim.paha:ir mambo
am an envphiyer that is providing worhers'compensation insurance for my employees. Below is the policy and jab site
informathm.
Insurance Company Name: A //Pi /git/C1- /Aloi14411-111C-e Cor3-0714)1,1
Policy or Self-ins. Lie, #: /41(,)e-. le?)—74.396.9?) 2ozzi- Expiration Date: elF2/2./2.5
Job Site Addre : /30 / :c..5,Er-7— Ave City/State,2M:# fifift t c,76 35—
Attach a copy of the workers'compensation policy declaration page i showing the policy number a expiration date).
Failure to secure eoverage as regained under MGT_e_ 152,425 is a eraninal violation punishable by a tine up to SI.500_00
an&or one-year imprisonment.as well a6cisil 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 Ins estigations of the DIA for insurance
coverage verification.
Ida hereby certify angler Ie pains and penalties of perjury that the injannation provietexi above LS true and correct
Signature: Datt
Phone It:
Official use only. Do not write in this area.to be completed kr eity or town official
City or Town: Permit/License
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3,Cii4:Tosin Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
l'ontact Person: Pliant,4:
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