18C-162 BP-2023-0181
43 WARBURTON WAY COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-162-001 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-2023-0181 PERMISSION IS HEREBY GRANTi'D TO:
Project# BASEMENT RENO 2023 Contractor: License:
Est.Cost: 33300 BEAUDRY HOME IMPROVEMENT CSL108605
Const.Class: Exp.Date: 03/20/2023
Use Group: Owner: WALSH JASON B
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: 02/16/2023
TO PERFORM THE FOLLOWING WORK:
RENO BASEMENT ADD BATHROOM
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 VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I it
Fees Paid: $217.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
.1.01V i io& -:-*=(4) I.
;... ;� ,.. cR'i r0 c.-r,r-rtsc.
r.
2-1(.0
/ CEO �
The Commonwealth of Massachusetts
20 Board of Building Regulations and Standards FOR
:_• ii Massachusetts State Building Code, 780 CMR MUNICIPALITY
rt+ 'N -- - USE
Biiitelif ; Olutt Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
//�� This Section For Official Use Only
Building Permit Number: () 2 3 —D/g/ l Date Applied:
Kau' ( I<o�5 ,//// 2- 1( ZDZ3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Propert dress; 1.2 Assessors Map&Parcel Numbers
IV) WC1r6tirliM V.-)MI
1.1 a Is this an accepted street?yes noi 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' f Record:
i'hi9Cil.!� k;ov'r- Alor*arm hyv ,MA 0101.0(0
Name(Print) City,State,ZIP '
H \Ja, ion WAti
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'-: biSQ�yi� .Pir),sll 'P be cpitic - ` rOleAVM 10.1i\c\
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ as 003 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ l'h 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression Total All Fees: Sri. 1
Check No. 1'1heck Amount: A Cash Amount:
6.Total Project Cost: $ P2).1' Q(, 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction upervisor License(CSL) )0 Number 3/2.oI2-3
\tolctii- U oy License umber Ex 'ratio Date
Name of CSL Holder1 11 VeXY ti 51— I '
List CSL Type(see below) U1
No.and Street Type Description
r6 eoNA AAA'
. '1`01 U Unrestricted(Buildings up to 35,000 cu.hJ
City/Town,State, ,r 1/� (J I O R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
q13/ 11`.1% 1l� ,.`�a/, , SF Solid Fuel Burning Appliances
I I Insulation
Telephone Email address D Demolition
5.2 g
�istered Home Improvement� Contractor(HIC)liect
���
a '� 1
'\ �efi HIC Registration Number E pirati n Date
HIC aann e or Registrant Name
tvrryi kJ)• (I"
N s� � r 01+>)77 4 t3.3)o-13 u� Em l address
City/Town, tate,ZIP J Telephoneel� 1
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
I,as Owner of the subject property,hereby authorize ' kl
to act on my behalf,in all matters relative to work authorized by this building perm t application.
46i ciq }hover i it e3
Print Owner's Mine(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.
4br o ver 1 / 3 I 0 3
Print Owner's oiluthorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contraCtcr
(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
H r
`�,oa —Pc; ?SNs t,,
4; Massachusetts �4,
R
'; .f DEPARTMENT OF BUILDING INSPECTIONS :
212 Main Street • Municipal Building �,_ 4
-,. p.a� Northampton, MA 01060 4S!_j T7CC�,
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: p �� 1 G� �� ''C'1`AiM' y\ ' ` i ; YM`ilAe. r�
The debris will be transported by:
0
Name of Hauler: (1)2(A(A(1'6i ) ��h\i `-�- . rn11-' t---7---- ,
f k u r U�p�
Signature of Applicant: I,/ .4, r--' Date: 3� ?3
The Commonwealth of Massachusetts
sitirs° Department of IndustrialAccidents
•
_ :� ` I Congress Street.Suite 100
r.
"a t; Boston. MA 02114-201.7
wwvw:mass.go►"/dia
)1 others'( umpensation Insurance:Affrdas it:Buildersj('untractnrs Ede trician 1Plumhers.
TO lit: FILE )i 1111 l'111.1 P1:I %11111 'I(:AI'f110R1 f1.
Applicant lafurntation Please Print LettiN
1 y
Name(Busit (1r�tntion�lsdisidoal): ^ )(7(}, Yi 414
Address: l R,'vel St` VT-.:- * V \ M4 e 1 Q T 7
City+'StaletrZip: Phone#: i J" 3 -' 3 e6
Are)ar stir t heck the appropriate but:
Typettproject(required):
tin I am a curlews-4-with \ employees I611 imam part-tirnep_• 7. 0 New construction
211 am a sole proprietor or p urtnenhip and halo:no employ.e-s aerking liar are m 8. Remodeling
any capaerty.(Nu worktn.'cwnp.unuranez rerpure l
9_ ❑ Demolition
I am a li onxr,wri r tkwing all stork myxlt:.[No wewrko rs-comp_insurance n-quired_l"
103 Building addition
4.0 I am a homeowner anti will kw:haute contractors to conduct all work am my property I will
ensure that all contractor.either lace umbers'cvnge.matiuu Insurance or arc hide 11 g]Electrical repairs cot additions
no
proprietor,with n employees_
12.EiPlumbinp repairs or additions
.0 lam a tgencral contractor and I have hind the sets-u+nuaciurs hstcd la the atiailled slicer.. 130 Roof repatr).
These sub-contractors have employees s and lu e workers'cusp.insurance..';
tee❑We:an: officer.
a acurpwxatitn and its uuer.hac..tereised thews np;ht uCest- whim per e. 14.eDiex sc1)14o bWSt n\p4fi
15Z111(Ag,and Tam:have nu Znplttwtcs.tNuwork r,'comp..2nhnranc.taplued.1 (3l(Qi. 6(.)3
".Any applicant ihai checks box ttl inust also till out the wat.utt blow slowing their workers.compensation poise}information_
lkwneuwncrs whir submit thus atria:.of ntdt.:atonr they are doing apt work and then hue outside ariaracurs muse sulhnut a new attidac ei indi.atmt•such.
('ontraetory that cheek this Nor nou't attachrid an a:7ddttional sheet show ins the name of dec.*idea-cantraetursand rate whether two not hawse sumacs have
employers. If the hutvcontraeitn+hose etrgwlovees.111c10 MUM pno ids-their workers"strop..policy number_
I urn an employer that is providing'writers'eanlpersatiun insurance for my empteples. Below is the policy end job site
information.
Insurance('ornpany.Name:
Policy#or Self-ins.Lie.#: L05 W V u ;E 0 1O3 OI J Expiration Date: 5 /a)--3
"/�
Job Site Address: to cArI)U r)n \ikikkti CityStatc,Lip: 1\i'il_ Btwh) )'1 NIA O ,,O 9 c)
Attach a copy of the workers'compensation policy dletit lion page(showing the policy number and rxp radon date).
Failure to secure coverage:as required under MGL c. 152.§25A is a criminal violation punishable:by a tine up to S1.500.00
ancVor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a line of up to$250_00 a
day against the violator_A copy of this statement may he forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the,pad ..'au ies of per' ry that the information provider/nbo>,a is kit•and correct.
St^.nature: r. , Dine.
Phone#: 4 J — 320 1 3 1i1"
Official use only. Do not write in this area,to he completed by city or town official
City or Tow it: Pernik/License
issuing!.Authority (circle one):
1.Board of Health 2.Building Department 3.('ity.Tuwn Clerk 4.Electrical Inspector S.Plumbing inspector
6.Other
Contact Person: Phone#:
•O ` t/ `
(a Cc-►c_►Nc, ire—q0H= `I - 1
etj
Pau( 0 1 F�rf,gq -L(-\\ '' JI
c4\ -6 r .--
P z isk - 1...._67.
-. Q_ 1- ----- ---;-
4 op-En my
DT
Cs
.. --Y n _______,
---4 ___>.
„,,z.
c, _,
v,
--c
,-s s s 0( --?
d ,,,
i \
_ , o
wr 3 0
s
/ -7j'
1 i
--- -- -