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24D-017 (3) BP-2023-0185 219 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-017-001 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-2023-0185 PERMISSION IS HEREBY GRANTED TO: Project# KITCHEN RENO 2023 Contractor: License: Est. Cost: 24000 RICHARD WEST 086947 Const.Class: Exp.Date: 07/05/2023 Use Group: Owner: A SENECAL ERNEST & BETH Lot Size (sq.ft.) Zoning: URB Applicant: RICHARD WEST Applicant Address Phone: Insurance: 10 BARSTOW LN 413-519-7692 HADLEY, MA 01035 ISSUED ON: 02/16/2023 TO PERFORM THE FOLLOWING WORK: KITCHEN 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: w S. liiskri Fees Paid: $156.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner ltto 1 / a.) gto a T ommonwealth of Massachusetts �ER 1 5 202 Board of Building Regulations and Standards, , FOR _____„ MUNICIPALITY Massachusetts State Building Code, 780 CMR i>,_;, - ` USE Building Permit Application To Construct,Repair,Renovate Or Demolish a ,Devised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 'A ,3--/g 5- Date Applied: HittA,„ �• 7 7 Building Official(Print Name) SignatureDat 3 J SECTION 1:SITE INFORMATION � er r�ess: ,, 4/ 1.2 Assessors Map& Parcel Numbers al?1.1a Is this an acc 't r ed 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 Requir Provided �Required Provided Required Provided ii/ /2 1.6 W er Supply: (M.G.L c.40,§54) 1.7Flood Zone Information: 1.8 Ser4ageDisposal System: Public Private 0 Zone: _ Outside Flood Zone9? MunicipalWOn site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.19wnert of �d. / // /� Jai) a/aoi rr7�l.y oGGG, Y 'at ct rye Itr Name(Print) ity,State,ZIP a�9gf,E„, ,,,,,L / cy- - ic 13/ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Pk Owner-Occupied R Repairs(s) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Pr9pose Woxkz: / ,,��/� 5 l� c, /ihr ') � 3?/ h" 1,0{2 ct ') di ,, J���.-� ./.4/er J .) , 7- ' i' .. �i..�, , 14 ,,� �i'S �' J -Y" /i/Ar <<n Cam- /J ih i—�3 R r� �'���, P ,� ✓elf!�i a/ 7) 1 �C ,X / S ION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ � 00a 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ 0 Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fe ,s,:t I, r/' Check No. LJ (I('�heck Amoun :(JU Cash Amount: _ 6.Total Project Cost: $ ,?Li Q e p 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 3 —©27 Y License Number // Expir io Date ame of C L Holder jp� A J List CSL Type(see below) zi if'. ,1 y ile_ No.and Stfeeti, Type Description / j /� D/DcY U Unrestricted(Buildings up to 35,000 cu.ft.) G1 ,, R Restricted I&2 Family Dwelling City/Town,Sta1 ZII M Masonry / RC Roofing Covering �I l/��i✓1�� �+� �, �j �I1" ��I 1i WS Window and Siding `��9� SF Solid Fuel Burning Appliances (hi / ) I Insulation Tel Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) tP3 3 I7S 1 . i 5,e/71 G! G/ �Na /HIC Registration Number pira'on Date HIC Company Name or MC Registrant me No.and Street �4vi 4:, &Lye.' 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 .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT J I,as Owner of the subject property,hereby authorize .ti ,- ,6, ii Ps"---- to act on my behalf,in all matters relative to work aut orized by this building permit application. Print wner'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. ‘ i.--X,/ PAC nets or Authorized Agent's Name 1�Si Signature) Date g ( bn ) 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" _-\\ The Commonwealth of Massachusetts Department of Industrial Accidents _ fix; 1 Congress Street,Suite 100 Boston, MA 02114-2017 �� www mass.gov/dia Workers' Compensation insurance Affidavit:BuilderslContractorsIEleciriciansfPlumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaalirant Information Please Print LeLibh Name iBusiness-Organaation 1ndividuall:_ PJ/`%Ah•� Address: 1D 48<rin Aretz) C' Phone#-( Are you an employer?(latch th a prupriate hot: I Tope of project(required): l.0 I am a crrtph:Nei-with employees(frill anti err part-brow l.• l 7. 0 New construction 221 1 ant a auk:proprietor or partnership and have no employees workurg for me an }[. Remodeling any capacity.[Nu workers'comp.insurance minimal9. Bemolition 30 1 ant a lwmswwmer doing all work myself.[No worloas`tome.unurrnct moored j 4.0 I ant a Irurnoowmez and will be hustng contractors to conduct all work on my property. 1 will 10 0 Building addition ensue that all contracture either have workers'cornix-rrsatrrm insurance or an:sole II.O Electrical repairs or additions proprietor,with no rrnpluvccs- 12.0 Plumbing repairs or additions 5 1 am a general contractor ant.l I have hind the,uh-cunn:uturs listed un the attached sheet. 3 Those sub-contractors have employees and isas a workers'cornp.insurance:- 1 u Roof repairs 6.0 lI'e are a corporation and its officers have exorcised their right of cacrrystion per hk.L c. 14. Other 152.§1141.and we have nu employees.[No winters'comp.insurance required. "Anti applicant that chucks box 01 must also till out the section below showing their winters'compensation police information. °homeowners who sutural tius affidavit indicating they are doing all work and then hue outside contractors must submit a new all day it tisdac:atmrr such. tContractors that check this hot must att h.-bed an addrtiunal sheet show ing the name of the sub-contractors and state whether or nut those entities have etnpluvice-s. If the sub-contractors have employ cis.they must provide their workers'comp.pulley number_ I am an employer that is providing workers'compensation insurance for my employees. Below is the polio'and job site information. Insurance Company Name:__ Policy#or Self-ins,Lice#: Expiration Date: Job Site Address: City.State'Zip: Attach a copy of the workers'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 tine up to$1,500.00 andi'or one-year imprisonment,as well as civil 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: .�u=A'dl/1 7�0Z Dst v? %4 r Phone#: 7,U� 5/9 Weird use only. Do not write in this area,to be completed by city or town ofciaL l City or Time: _ Permit/License# Issuing Authority (circle one): I. Board of Health 2.Building Department 3.City?Town Clerk 4.Electrical Inspector 5. Plumbing Inspector b.Other Contact Person: Phone 4: City of Northampton `r'� �- n Massachusetts c I, 4. ,_ rot DEPARTMENT OF BUILDING INSPECTIONS µ ) : ��f !� J' 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: Location of Facility: Lbicy Rii)/)/G//) The debris will be transported by: Name of Hauler: /ri i c /4/,:fs---/ Signature of Applicant: 41 1/ /21 Date: o? // ,2 0