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36-247 (16) BP-2023-0126 41 SPRUCE LN COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-247-001 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-2023-0126 PERMISSION IS HEREBY GRANTED TO: Project# BATH/LAUNDRY 2023 Contractor: License: Est. Cost: 2300 Const.Class: Exp.Date: Use Group: Owner: MERRIGAN MARGUERITE A&M:LINDA B SHAW Lot Size (sq.ft.) Zoning: WSP Applicant: MERRIGAN MARGUERITE A&ME INDA B SHAW Applicant Address Phone: Insurance: 41 SPRUCE HILL RD FLORENCE, MA 01062 ISSUED ON: 02/02/2023 TO PERFORM THE FOLLOWING WORK: BATH/LAUNDRY 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 VI LATION OF ANY OF ITS RULES AND REGULATIONS. Signature: , Sri 1 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner r r— _� / ai t F E B - 2 2023 1, Fes The Commonwealth of Massachusetts 2023 o� , ZP; Board of Building Regulations and StandaAds._� ,FOR f�ING INSPFCTIOida MUNICIPALITY "' ^TON.MA OOGI Massachusetts State Building Code,780 C �!7r n,,,�----- USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2911 One-or Two-Family Dwelling This Section For Official Use Only Building ermit Num ber. '?3— /S-(O Date A plied: c-vlt� Z-2-Z0Z Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers V 1 s prvcC lctK�. W v+rt�►l'At Nu`L a b - 2`i 1 - D D 1 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 ID 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: MGI1�.c(a. S 11u. .-.'Wielkork M nyo .�Ge fiew t e m4- oleo_ Name(Print) City,State, IP `lI So✓vc( LA•.4 YV3-310-&771 ✓'klbi ter e *OL. coai No.and Sueet Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied Erl Repairs(s) 0 Alteration(s) fle Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description pfProposed Work2: ''—A/ ef‘40 vafrn+i of 6 4 f f./.eOw( 1 IA c fQeI •'I 5 v ro..al o' si f' sal Vp t .r, reeicesuokf of t/d 614ft b fy, (140,411 l tit do ce f yb c k stslaI rr e t Kc1et of si J14 -/de r- an SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 3 Od , gip 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ y�0 •. OD 0 Standard City/Town Application Fee .__ 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 16 0 0 •D-V 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees $ Suppression) (.906 Check No O 7 Check AmounP Cash Amount: 6.Total Project Cost: $ Z 3 0 Q , 0-0 0 Paid in Full 0 Outstanding Balance Due: / SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofmg Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) , �. r N-• ., •...{, .." HIC kegtstration Number Expiration Date HIC Company Name or HIC Registrant Name 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 0 No .❑ 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 to act on my,behalf,in call mattersk.E0tive to wofk.autlLorized by th1g•.bpildinuermif applicatiot.' •: • • • Print a . " _''ctronic Sigriatute) • • 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. ‘41°'6‘t4'• • • - • 2'/22-3 P Owner's or Authorized Agent':Name(Electrbriie Signat, e) • ate ' NOTES: 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 basemehti ttics,decks or porch) Gross living area(sq.ft.) Habitable room copnt , Number of fireplaces Number of bedroom?; ''' • 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 G�•"' Massachusetts 't • • 7 DEPARTMENT OF BUILDING INSPECTIONS Z . "t' 212 Main Street • Municipal Building Yl Northampton, MA 01060 fS,y 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: N /lo (AJ I D� UII7 r Location of Facility: o/ aru � a { Q.+PC yC,c r�5 The debris will be transported by: Name of Hauler: © c Gov - 1 e ea bt,ta.( '11^41 Lc • Signature of Applicant: .ck%�r, Date: X/2 Z3 The Commonwealth of Massachusetts I W O Department of Industrial Accidents , u1 I Congress Street,Suite 100 71 ' ,. • Boston, MA 02114-2017 www.mass.gor/dia 11 inkers'Compensation Insurance Affidas it:Builders+('ontractors/Electricians/Plumbers. i'O BE FILED WITH THE PEKWH-TING At'THOR1T . Applicant Information Plc:ne I Print rL'iblx Name 1 Hors,.:>,(Ir_en:funon Individual): i') il/4 d a Sl1a w_ Address:. y/ S P✓(,cC La mot,{ City(State Zip: •fir.(4 00- d/D&7_ Phone#: /3 -37-D —677/ Are yea an rngrioyar.'('hack the appropriate hot: Tape of project(required): 1.❑I ern a employer with employees ea(full and'or part-tine 1.• 7. O New construction 20 I am a sole proprietor or partnership and have nu ersipluyees working for me in 11. f -Remodeling any capacity.[Nu workers'comp.insurance nulruntl.) Ca 9. ❑ Demolition 3.11j I am a lionanwner doing all work myself.[No%tickers'comp.insurance nnluind.)' 4.�am a hunsouwner and will be hiring contracturs to conduct all work on my property. I will 1 U Q Building addition ensure that all contractors either have worker.'compensation insurance or are sole 1 I.B'Electrical repairs or additions prupnetors with no employees. 12.0-Plumbing repairs or additions 50 I am a general contractor and I hoc hind the sub-contractors listed on the attached sheet. 130 Roof repairs These sob-contractors have employees and have workers'sump.insurance.. 6.0 We are a corporation and its officers have exercised[lieu nght of exemption per MCiL c. 14.0 Other 15.2,D 1141.and we have no iaripluyeea.[No workers'comp.insurance required.] 'Any applicant that checks boa al must alxi till out the section below showing their workers'compensation policy information tl.m:owners who submit this attiolasi!innceatinu they arc doing all work and then hire outside contractors must submit a new attidav it indicating such. i.orirracton that check this Lox must attached en additional sheet showing the name of the sub-contractors rs and state w Nether or nut those entities!lase nirl sec+ It the sub-contr ietors lase crripk.y ccs.rhos nos'rive ide their ,. .il.er, ;.rtip r tics number - - I am an employer that is providing worbers*.compensation insurance for my employees. Below is the policy and job site information. • Insurance Company Name: Policy#or Self-ins.Lic.4: Expiration Date: Job Site Address: City:StateZip: Attach a copy of the workers'compenxatiiin polio declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152.*25A is a criminal violation punishable by a fine up to S I.5(U_U0 and,or one-year impnsontnent,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 insurance coverage verification. I do herein-certifd'under the pain.and penalties 0/perjury that the information provided above is true and correct. SiLmaturc: )/tj&e4A.Ze. A, (it,,- ll.ti: /Z/LZ2 Phone': I/3- S20 - (077l Official use will. Do not write in this urea.to be completed by city or town official City.or Town: ' PermltiLicense# Issuing Authority(circle one): I. Board of Health 2.Building Department 3.('ihfTown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other ( ontact Person: Phone#: 11\ 040000000000000000 Q `I- ' -- o. i a- ( C 3 am.. t\---- 0, ---.- t \ - ill b'".''''' .,4 1 "A P ; , - _ - ,, s S