30B-002 (6) BP-2023-0115
60 NORWOOD AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30B-002-001 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-2023-0115 PERMISSION IS HEREBY GRANTED TO:
Project# BATH/LAUNDRY RENO Contractor: License:
Est. Cost: 19000 BEAUDRY HOME IMPROVEMENT CSL108605
Const.Class: Exp.Date: 03/20/2023
Use Group: Owner: HINTON,CLARENCE W. III TRUSTEE
Lot Size (sq.ft.)
Zoning: URB Applicant: BEAUDRY HOME IMPROVEMENT
Applicant Address Phone: Insurance:
117 FERRY ST (413)320-1348 6S6OUB2E863000
EASTAMPTON, MA 01027
ISSUED ON: 01/31/2023
TO PERFORM THE FOLLOWING WORK:
1ST FLOOR BATH RENO/ BUILD LAUNDRY CLOSET
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:
• 42 • 14
Fees Paid: $124.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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The Commonwealth of Massachusetts 3 /
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Board of Building Regulations and Sanda O FOR Massachusetts State Building Code, 780-CN140.,���, MUNICIPALITY
Building Permit Application To Construct, Repair, Renovate Or'>Te#' ' Rivised,ttlar 2011
One- or Two-Family Dwelling :44.1 nFcrro"`
\,G N` r
This Section For Official Use Only,
Building Permit Number: & 63"3— I 1 Date Applied:
intijiitii\
► 3►
Building Official(Print Name) Si S. g
Signature
SECTION 1:SITE INFORMATION
1.1 Property Address:Nov- i c) i- 1.2 Assessors Map&Parcel Numbers
ve
1.1a 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)1tec : l P l)r`1 ull a Mk 01060
Name(Print) City,State,ZIP I
o . ONOC cl Avg 154 s15-TO Co WAlti 1)1141 @.9°10. ` '\
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: .
Brief Description of Proposed Work'-:
Tbb , 6 allo lutvdti c1o5e r NW W o.51‘ilr 1 Dryer .0(6-7�n ((ay Mill
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) --
1. Building $ !`--1 5-6f) 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ /�U� 0 Standard City/Town Application Fee
l ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ a' 000 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees: $
Suppression)
!�l Check No. PliS Check Amou*` Cash Amount:
6.Total Project Cost: $ / 0 VV Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction /S,u rvisor icense(CSL) �,O a J 444_
Picti 1 1/�(!'i✓` LicensellNumbbe'r ExxpiratDate
Name of CSL Holder
List CSL Type(see below)
In RYA/ </i--
No.and Street Type Description
�-;a5+- I 1 m JJ 0 )n 3-'7 U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP 11l R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
0.'3 -13 yt rildo 611a6 con SF Solid Fuel Burning Appliances
I Insulation
Telephone Email addr`ss D Demolition
5.2 Re •' red Home Improvement Contractor( C) l 7 CI ( C
llam�,, r p '/ ,�y� -I . .i-
L ` N1'��� HIC Registration Number xpira on Date
HIC Co an N e%or I�IC Re 'strant N me
N dS et ry br/ l (��/ f I� ))JagLic0160,41),\
c' tl 'r 1 o;oa`7 4,� 3 )-13 7 0 &flail address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE Ah'1F1DAVIT(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...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR&LOP/
BUILDING PERMIT
I,as Owner of the subject property,hereby authorize M#to act on my behalf,in all matters relative to work authorized by this building permipplication.
WOC,Ch 1:1HTt ii.30/)"3
Print Owner's Namei(Electronic Si nature) Date
SECTION 7b:OWNER1 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.
\A)c 113 -3
Print Owner's or Authoy'zed Agent's!Name(Electronic Signature) to
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
�Z,,c.r.�/if-1
I-,.° • Massachusetts ''�
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DEPARTMENT OF BUILDING INSPECTIONS �,
.���' 212 Main Street • Municipal Building ��� C`s
Northampton, MA 01060 rs14y0'�
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: 1�� �1 ► (,iIan f)-3 a 1'�t� i. Aikhof
'sql
4
The debris will be transported by:
I
Name of Hauler: (1)eCitAdAtkidh,Q� ,►�Vr►"hf )(14 tA/O +'U1Gk
Signature of Applicant: Date: 1 3 1 1 3
The Commonwealth of Massachusetts
=roiir= Department of Industrial Accidents
:wi , 1 Congress Street,Suite 100
',__tr1: ' Boston,MA 02114-2017
www mass.gov/dia
%%urkeri' ( utnpcn'atiutt Insurau.e Affidavit:Builders!Contractors!Ekctriclans/Plumbers.
I(}131-. 1-I1_1-:0 N I flf'fllh f'!R1tf'f IN(;At'7'Ht)RI'1'l.
Applicant Information //� Please Print bis
Name filusittess,'grganizationilttdividual): I(�� � Tidy r e
Address: l=-(15 cop"pttr /'4_ O
City/State/Zip: Phone#: ui - 34 )5 y
Art you on employer?Check the appropriate hot:
Type of project(requi ):
101 am a employer with __employees(full and;or part-time).' 7. CI New construction
2171 I am a rule proprietor ur partnership and have no employers working fur me in B.4Remodeling
any capacity.[Nu wurkem'comp.insurance required,]
9. Demolition
i[j I am a humnwwner dying all wuei.myself.[No workers'comp.insurance required"'
4.0 1 am a humnownr corm-actors will be hiring corurs to conduct all work un my property. 1 will 10 Q Building addition
ensure that all contractors either have workers'compensation insurance or the sole 11.0 Electrical repairs r additions
proprietors w ith nu employees. 12.0 Plumbing repairs additions
SC:j I am a general contractor and 1 lave hired the sub-cuntractura listed un the attached sheer. l 3.0 Roof repairsThese sub-cuntrx hat tors have employees and c workers'comp.insurance.; Other
6.0 we ate a rpvraeiuo and its officers have exercised their right of exemption per MCA c. 14.0
cw
132.41(4 and we have nu employees.[Nu wu ken'comp.insurance require-al
*Any applicant that checks box*I must also till uut the.section below showing their wurkern'compensation pule*information.
'Homeowners who submit this affidavit indicating they are doing all work and then hire outside co ntra:tun must aubnut a new affidav it indicai ng such.
1Contracturs that check this box must attached an additiunal sheet show ins the name of the sub-contractors and state whether err nut thou*ninth..have
hob .rrs. If the sub-euntraetor>live einpluycea.they mini provide thee- ,n numl..•r
1 am on employer that is providing workers'compensation insurance for my employees. Below is the policy and ob site
information. 1
Insurance Company Name: J 'Vl. )-(011+- OY;,
Policy#or Self-ins.Lie.#: (QC��() 2 t.3 0 Expiration Date: [NI I 3.
Job Site Address: (PO MyrAW, City Statc'Zip: t4OY I' F f I A o l o( o
Attach a copy of the workers'compensation policy declaration page(showing the policy number an expire on date').
Failure to secure coverage as required under MGL c. 152,$25A is a criminal violation punishable by a tine up to S .500.00
andeor 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 the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for i 'urance
coverage verification.
I do hereby certify under the pains and penalties of 'ur).than the i a f remotion provided obit,e is tr,e and co
Sii nature: (� jCe'- 41 l Date 3//P--g
Phone n: 7! / 3 - 3?-0- 1 i', jz
Official tcve only. Do not write in this arro,to be completed by c•it)'or town ofj'icio!
('ity or Town: Per in itiLicense
I„uinR Authority(circle one):
I. Board of Health 2. Building Department 3.('ith:Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#: