32C-243 (6) BP-2023-0205
116 HAWLEY ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32C-243-001 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-2023-0205 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIR 2023 Contractor: License:
Est. Cost: 4500
Const.Class: Exp.Date:
DECHANUPONG CHAOWALIT &SAOWANEE
Use Group: Owner: DECHANUPONG
Lot Size (sq.ft.)
DECHANUPONG CHAOWALIT & SAOWANEE
Zoning: URC Applicant: DECHANUPONG
Applicant Address Phone: Insurance:
114A HAWLEY ST
NORTHAMPTON, MA 01060
ISSUED ON: 02/22/2023
TO PERFORM THE FOLLOWING WORK:
REPAIR ROTTEN FLOOR JOIST
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:
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
fr? — / 5 70 30 3 -7
The Commonwealth of Massachusetts
Board of Building Regulations and Standards
FOR
Massachusetts State Building Code, 780 CMR
MUNICIPALITY
USE
Building Permit 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: 'Y 1:1" -,i(6 Date Applied:
I9/ (x2
Building Official(Print Name) Signature If
SECTION 1:SITE INFORMATION
1.1 Propeitilirla 1.2 Assessors Map&Parcel Numbers
I/fiAtiat,ti
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:
Zone: _____ Outside Flood Zone?
Municipal 0 On site disposal system El
Public 0 Private 0Check if sO
2.1 Owner'of Record:
P'60 W A NJ Eg 17rCki foN NOPTh/ t1f1ON riA 0 l0 °
Name(Print) City,State,ZIP
HDA HAW LE- 3i. 41 3-44 6' 60 sAo r\IDA 06 yfk 1,40, COM
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) Alteration(s) CI Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other CI Specify:
Brief Description of Proposed Work': CAA 1- ceigSce ,p c-k- (A a cr‘A-c r CcAocc yiek
WhIch
411111111MATED7C6Sfiiinillall
Estimated Costs:
Item Official Use Only
• (Labor and Materials)
1. Building $ 500 00 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2. Electrical
0 Total Project Cost'(Item 6)x multiplier
3. Plumbing 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression)
Total All FFis 06
Check No.U.0" heck Amount: ) Cash Amount:
6.Total Project Cost: $ 4 600. 0 o
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. II.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) air3,7 9-Z1 ,3-0 /p,,,
gl
O O0 ' .,c---c:?"'U11e vd— HIC Registration Number Expiration l "te
HIC Company Na e or FlIc,1egistr ame
f tt.:N C'1 ' C • �l✓ ,�I[ev� pc�u rtfEgbadif!ccwt
No.and Street — J Email address J
Noc+iflatngkox , MPS ,01060 (u,5�a-7O--4o?7
City/Town,State,Z elephone
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 all matters relative to work authorized by this building permit application.
.SAdwRNEL -171 a1.00 vfoNO 2 `.-k/ -°23
Print Owner's Name(Electronic Signature) Date
7
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.
.........),n
'nt Owner's or Authorized 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 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
Oa<N9M`C ro\
Massachusettsfrt ,4
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I DEPARTMENT OF BUILDING INSPECTIONS �. j'
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""Tv 212 Nair Street • Municipal 8uildinq Jt•, b:'
'.11001.0 Northampton, MA 01060 Est a.)
INONMMINMOMMOMMONNINMEnYMOMMUTri
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1, SP JA-N E 1Z E CE-1 N U d (insert full legal name), born (insert month,
day, year),hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3.
3. 1 qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use
and/or farm structures.A person who constructs more than one home in a two-year period shall not be
considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in connection with any project or work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this 2-1 day of r E 77 , 20 2
SiclswP,t\
(Signature)
..kii....14\ The Commonwealth of Massachusetts
1.7 Pk--fr Department of Industrial Accidents
4
.47 )
—r
I Congress Street.Suite 100
Boston.MA 021141-2017
www.mass.govidia
\I Inikers't'ompensation In lira nee Affid II%it:Bu itdera/ContractnratiEket ricians/Plu in hers.
TO HE I-11.ED V%1 Ill I DE l'ERNII ITINC AUT1101UTY.
Annlicant In io riii a lion Please Print Legihlv
Millie Iliusiness,'Organizationilnchviduall:
Address:
City/State/Zip: Phone #:
. ,
Ate)tsr an caftan)er?t hrek the appropriate hot: Type of project(required):
1.01 am a eirmloyer with einardoyetts(fon and or part-time).* 7. D New construction
2r1 1 am a sole proprietor or partnentlip and hate no employee*working for me in g- 0 Remodeling
any capacity.[No teorkerie comp.insuranct mantirtd-1
30 lam a borneowner doing all unik myself.Rao weekere cone.insurance Inquired"' a Demolition
i 0 CI Building addition
,ICIIIIIIIIIIIIIIIIIIIIIIIINFIIII
110 Electrical repairs or additions
12.0 Plumbing repairs or additions
30 I am a general contractor and I baste hired the*oh-contractor*Listed on the atta‘-hcd*beet
130 Roof repairs
These sub-contractors hate empluyem and hoe workera'comp.insurance,:
14.E1 Other
6.0 We turc a corporation and its officers have exercised their right acacia/Mon per Pokit.c. —
04 f 1[4,and we irate no employees.[No workers'comp.insurance required.'
"Any applicant that checks box c I trim;elan till(Jul the settinit below awnp their workers"Conmenargion policy informatiOn.
'kborneowners who submit this affnlii‘it imheaurie they are&Sing all work and then hire outside contractors must.about a new attidas it IncliaalusEr suer:
:Contractors that check this box must attn.:bed an additiunal sheet Avvfinn the name Mute sub-coritmlors and state 4t littler or not those anilines haw
employee, It EIX,sot ante bass:employees,thus must pros ide their workers'comp.policy number.
I am an employer that is providing worAers'compensation insurance for my employees. Below is the policy and job.site
in/in-motion.
InSUrai 1,4..Company Name: _
Policy#or Self-iris.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'conipensation policy declaration page(showing the poliq number and expiration date.
Failure to secure coverage as required under MOE c, 152,§25A is a criminal violation punishable by a fine up to S1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the Si iolatot 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 injOrmation provided above is true and correct.
signatnre:: , 5AO wkt•iec-- 13 -cuAou-FoNa Date: ' .(2t / 20.23
Phone#:1-1132-k 4- S S ipo
• Offitial use only. Do not write in this area,to be completed by city or town official
City or Town: PermitiLicense#
Issuing AuthoriEs (circle one):
I. Board of Health 2.Building Department 3.Citv"Tow n Clerk 4.Electrical Inspector 5. Plumbing inspector
6.Other
Contact Person: Phone 4:
City of Northampton
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a Massachusetts ��� 'r{�
i' DEPARTMENT OF BUILDING INSPECTIONS
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'' iLa 212 Main Street • Munici al Building
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Northampton, MA 01060 4ss�W i��"
YS' RT DEBIIPD AVIT
(FOR ALL DEMOLITION AND ROVATION 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: V \k
V---e_C- - CA1Y1(,\
1
The debris will be transported by:
Name of Hauler: \wvj) M3 t(_ / Nu ��
�J
Signature of Applicant: --c 1--,-- -� r ------ c Date: