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06-010 (10)
BP-2023-0198 595 HAYDENVILLE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 06-010-001 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-2023-0198 PERMISSION IS HEREBY GRANTED TO: Project# 2023 basement reno Contractor: License: Est. Cost: 4600 Const.Class: Exp.Date: Use Group: Owner: J GREGORY, SETH H&ANGELA Lot Size (sq.ft.) Zoning: RR Applicant: J GREGORY, SETH H&ANGELA Applicant Address Phone: Insurance: 595 HAYDENVILLE RD LEEDS, MA 01053 ISSUED ON: 02/21/2023 TO PERFORM THE FOLLOWING WORK: BASEMENT RENOVATION 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 VIgLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I� �� • . 51-1.1 • f Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts FEB 1 I I 0) Board of Building Regulations and Stand rds OR Massachusetts State Building Code,/780 7 20 I(FER _Ty x pp© USE Building Permit Application To Construct,Repair,RenovaOALl -- ievised Mar 2011 One-or Two-Family Dwelling .-"�' 'Mq oloso Ns This Section For Official Use Only Building Permit Number: OA-O -" t i Date Applied: ,a di i Building Official(Print Name) Signature Da� 1f SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 595 Hel-4 60V O LLE b• 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: �/ Public 0 Private Check if yesf� Zone: Outside Flood Zone? Municipal 0 On site disposal system 1 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 5 7/1 f ' o i4 o iey A494- ,a.-c)-rr>v, A 4A 0 i OS'"3 Name(Print) City,State,ZIP S�5 t1v1ii 6 n.rLC E-12 6 v/3-52a-s3/y Stci/H f 2E-6 02y$2 67444 4.caM No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WOW(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': J sJC& $/NET Opp-ice- spit-4. „v Otl-SCttdnrr 1 -rto 6s 0002 4&*triN6- it. /tece-PT, to 5 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ y 0,90 1. Building Permit Fee: S Indicate how fee is determined: 2.Electrical $ ^,6t70 El Standard City/Town Application Fee 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ — List: 5.Mechanical (Fire $ i:146 Suppression) Total All F s, Check No.` ,k Check Amount Cash Amount: 6.Total Project Cost: $ (/ (00 0 0 Paid in Full 0 Outstanding Balance Due: City of Northampton s Massachusetts S `e w1 1% DEPARTMENT OF BUILDING INSPECTIONS ? •�j' 212 Main Street 40Municipal Building Northampton, MA 01060 ti... 4 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: V4.11e ejd i Z311 El2S e(T11w The debris will be transported by: Name of Hauler: Ot4i( Signature of Applicant: Date: 2/-7/73 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.h.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP 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) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,State,LIP l clephone 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. Print Owner'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 - ' application is true and accurate to the best of my knowledge and understanding. ''� 5e ( /G z/7/2_3 ' Pnnt.O er's(r 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" The Commonwealth of Massachusetts _ Department of lndttsh�tt Act dents �" r-: ti`= 1 Congress Street,Suite 100 ";w N: „ Boston,MA 02114201 a� wwncmass gov/ilia 1%hikers'Compensation Laurance Affidavit:Builders/C etorsfEkctrkmaas/Plumbers. TO BE FILED WiT11 TIlE PERMITTING AUTHORITY. Annlicant Information Please Print Lei/ibis Name( s,'Or ankration1ndi idusUi: 5E3-" / -‘-01e'/ At +ess SKIS A GL City/State/Zip:. Js , if4,4 0/05 3 Phone#: el/3 Zz 5Jiy ' An yowl an employer?Cheek the appropriate box: ype of project I.0 I am a employer with employees Mgt artdnar pant-time).* 7. 0 New construction 20 I am a sok proprietor or partnership and have no employees wanking for me is 8, l.�r Remodeling capacity.[No workers'camp.insurance ngtuired.l a.� S an a homeowner doing all work myself.[No want comp .mp.inruxrner ttecilitesii t - 0 Demolition in lam a homeowner and will be Airing oantractosa to conduct an work on my property. I will 10 J Building addition emote tuat all troreractora either%Pot Walters'comps ion Maumee or ma sure 11 a Electrical repairs or additions ptuptietoes with no employees. 12 Plumbing repairs or additions SO I am a omens'contractor and I Wive hired the sub-contractors listed on the attached slime. 13I'^'I Rom{repairs 'These sub ontrectors have e stud have workers'comp_itunetteCe t i.�i t We area corporation and its°Mend Aave w ised their right*resemption per w i.c. 14. Other IS2AR(A),and we hare no employes.[No warkene cam.insurance required.) •Any applicant that checks boat SI mug atsu tin out the Medina below showing their workers'converutaion policy infatItilakel. ._ t Ilufnteo4'net9 who submit this affidavit indicating they are doing all work and then him outside et:e aractcrs must submit a new affdevit iodiestrag such «Contractors that check this box must attached an additional sheet showing the name of the seb-c-untraetuun and gait whether or not those entities hair employees. If the stab-cottlraetura has etoploy ecs.the' stout pros i&their workers'c+ouip.pcuh y ttinnhct I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy*or Self-ins,Lie.#: Expiration Date: lob 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 fine up to$l;SOO.O0 and/or one-year imprisonment,as well as civil penalties in the farm eta STOP WORK ORDER and a tme of up to$2 50.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance colerage verification. I do hereby ce ,un a pains and penalties of perjury that the information provided above is true and COMM Sigrttutute, Date: �— -2//?/2-3 I Phone#: Official use only. Do not write in this area.to be completed by city or town official City or Town: PermitlLicense!t Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspeelsr 6.Other Contact Person: Phone#: ______ City of Northampton e. s`S S! r ..-, , �; Massachusetts ��' n �'e t=; `{(K DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building '. . <"C} r Northampton, MA 01060 .i"v1� HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT //// 8/ I, 5 7rf 6YZ_EF.0-2(../ (insert full legal name), born — nsert 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. 1 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. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R51.2: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on whi there is,or is intended to be, a one-or two-family dwelling, attached or detached structures accesso to such use and/or farm structures.A person who constructs more than one home in a two-year perio 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 pai nd penalties of perjury on this ft day of 1 G frICOUry , 2015 L (Signa re) N fi�. > � w -s S, a o s3 Zti , i-f vok c, ,I EEE 5-272a-D/,iN6- —mac- 44 AN+CseLoct G-11-Uerogil wl Lt atiert �----- r RI;I _ - 913-5-22-5-3 t cf 50^Q n ill: � r �bt -' Dap 7 �zaPpfrj(r uti�' � . .- oo 0 l TeD 5 P�'f '''� r LAN) VI nAl (vttv u't14�a'" M { I ,. ^ 1, 1 f2�, pRstwu. Joss-r5 , iy; 1 / 1 Dnra°cotes* IA" - i • u / ox zv2 oplityrAt) b/ ZvyIIj b FaAi t _ ZD /, {'r2OJ c�SI"CE 1u� _n or 71 tvO01 4&A- s PP fht Wl c,nit°f Fo /'Fl t)b6 tits s Joao' 7 N H— 5wKc / L n,/qzy 4 , `. 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