16C-037 (6) B -2023-0157
378 SPRING ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
16C-037-001 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-2023-0157 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 KITCHEN RENO Contractor: License.
Est. Cost: 42000 JOHN SACKREY 079384
Const.Class: Exp.Date: 10/14/2024
Use Group: Owner: L DECARO LOUIS J& JAIME
Lot Size (sq.ft.)
Zoning: URA/WSP Applicant: SACKREY CONSTRUCTION
Applicant Address Phone: Insurance:
83 SOUTH MAIN ST (413)563-6639 0 WMZ-800-800-5793
SUNDERLAND, MA 01375
ISSUED ON: 02/09/2023
TO PERFORM THE FOLLOWING WORK:
REPLACE CABINETS, COUNTERS &FLOORING
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 11 LATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
1
l
Fees Paid: $273.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
7:1"
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
OD Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
o One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Nunhber:92 20233bf57 Date A plied:
411-5 &;1S 2-Ct ZOZ3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
3-7 5 5P'4iu-Lks- S"C. /(oC -O3`7 0 o t
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
(UR/4/05P 4,724.ce
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard f F A- 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 1:!( Private 0 Municipal El On site disposal system LY'
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP' 1
y._ 2.1, Owner'of R ord: i Z
q t Y e 'Wo f w321 c.,rz 1 W�.Ep
Name(Print) City,State,ZIP
318 5 P Kt a U Sc, (4(7 -(a f 2-3 MV A,A�rkt YI4,S�rreluit.ca.ovn
No.and Street Telephone Email Address
t
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 Work2:
RT P L,A-c-rE k I Tc b(R-i CA:I,a WITS , (LW NI Tf&s Vkt-c,D C 32(cC C"
No 0-4 AlAUl. -CoV.0-4,rMl4.1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ .3 5_ 0150 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 3 t 4:5-67O 0 Total Project Costa(Item 6)x multiplier0..coo x bs= I
3. Plumbing $ 41 I art.) 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees: $
Check N06.-Check Amount: 273:1
v Cash Amount:
6.Total Project Cost: $ I 'Z 1 61.50 0 Paid in Full 0 Outstanding Balance Due:
X (a .hoA°'s0
as
'z-132-
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) e.S-U, 4(38 4� (V((y tz9
C 4 1A , S`,�U License Number Expiration Date
Name of CSL Holder
5 1 A 1 ^ V� List CSL Type(see below) (�
No.and Street v� Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
S � -(�1� ( V M I' 0 1 5Tc R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 ( -$ (a 3 (v(o3'f A-C t 6-)CJ C k(41- . Q I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)/' I fo .t
CJ (414S-evtAKM.ASl HIC Registration Number Exp. tion Date
HIC Company Name or C Registrant I nae
63 5, • SA 16� c , LA—
No.and et (A"-- (f13 ✓ (° 4>1 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 prov.de
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 _S b M- 14 • S A-G
to act on my behalf,in all matters relative to work authorized by this building permit application.
alaiar
► er'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.
�O) b S -c-1441-tz zJs /7, 3
Print Owner's or Authorized Agent's Name Ef ctronic Signature) 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
• :1TTf
/7- - „,..
Massachusetts
•
'{� , ` DEPARTMENT OF BUILDING INSPECTIONS 0,,,
�„, , yam . 212 Main Street • Municipal Building
Northampton, MA 01060
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:
O
Location of Facility: \ikt--t- Pitc-`J Ll..�� L-
y
The debris will be transported by:
/l
Name of Hauler: `DA'C . L ,
Signature of Applicant: Date: % z3
•
The Commonwealth of Massachusetts
)•'- --- Department of Industrial Accidents
c —T�=
e�_ a1 I Congress Street,Suite 100
M;?_',�{= Boston, ,17TA 02114-201 i
't... " sow .mass.gov/dia
Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plutubers.
TO III FILED WITH THE PERMITTING At1THORIT .
Annlicant Information Please Print LetObly
Name ll3usincss Organization•Indtviduall: S A'GV..42--tZej ( s-C- C ' _ _
Address: 33 S . \M-A-t,44 S"C •
City/State/Zip: 5 c )6\lAree.A.41,64Z kik Phone#: ti(3- 5,6 3 ' 6, (0 3�?
Are roe m Employee Cheek the apprprtate box Typeof project(required):
�, p J
i. 1 am a employer with employees(full and or part-tiara t.• 7. O New construction
20 I am a auk pruprieme or pmtnaabip and have nu emphtyccs working for me m 8. "Remodeling
any capacity.(No workers'comp.insurance resquinsl_j
9. ❑Demolition
30 1 am a tic,doing all wort myself.(No workers'comp.insurance required.)'
4.0 lam wmT a humw and will be hiring contraclurs to conduct all wort on my property- 1 will
10 0 Building addition
cmun that all Cuntr:a'tun either base woken'compr.tuatron insurance ur an sole 11.Q Electrical repairs or additions
proprietor,with no nnpluyecs. 12.0 Plumbing repairs 4r additions
5I lam a general contractor and I lane hired the subcontractors listed on the attached sheet 130 Roof repairs
These sub-contractors lase employees and have workers'comp.insurance.:
14.0Other
6.0 V.a are a corporation and its officers have exec ised their nght of exemption per MGL c.
152. It.1 1,and we base no employees.(No workers'comp.insurance required)
*Any applicant that checks has al must also till out the section below show ing their workers'compensation policy information_
Homeowners who submit this atfrdrsit indicating dies are doing all work and then hire outside contractors must submit a new atlidas it Milirating such.
:Contractors that check this lox must attached an additional sheet show ins:the nave of the sob-contractors and state whether on not those aWtief has.
employees- if the sub-contractors base etttplus ccs.they lutist pips idc their workers'comp.policy number
I am an employer that is providing wortlers'compensation insurance for my employees. Below is the policy and job.site
information.
Insurance Company Name: A C . : . /
Policy#or Self-ins.Lic.#: D 0 b`7 1 q 3 Expiration Date: 2/ Z)Z ci
Job Site Address: 31 S SP RI-1.k (. 5 CP CityiStateiZip: O 1 0(o-2—
Attach a copy of the ssorkers'compensation policy 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 .500.00
and/or 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 insurance
coverage verification.
I do hereby cee3tjy under the pains and penalties of perjety that the information provided above is true and correct.
Signature: ✓1-----\ Date: 7/6(z 3
Phone z: , 1( 3 ' 54,3' 6 3
Official use only. Do not write in this a tie be completed by city or town official
('its or Tossn: 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
Contact Person: Phone#:
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