09-011 (2) BP-2023-0313
325 KENNEDY RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
09-011-001 CITY OF NORTHAMPTON
Permit: Temp Structure
(Tents)
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-0313 PERMISSION IS HEREBY GRANTED TO:
Project# FIRE DEMO 2023 Contractor: License:
EMERGENCY TEMPORARY
Est. Cost: 2400 HOUSING INC 080509
Const.Class: Exp.Date: 11/29/2023
Use Group: Owner: S ADAMS STARR S &SHERID
Lot Size (sq.ft.)
Zoning: WSP Applicant: EMERGENCY TEMPORARY HOUSING INC
Applicant Address Phone: Insurance:
129 FERRY ST (508)887-8778 WLV01474101
SOUTH GRAFTON, MA 01560
ISSUED ON: 03/13/2023
TO PERFORM THE FOLLOWING WORK:
TEMP MOBILE HOME
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
de/
The Commonwealth of Massachusett MAR 1 0 1
ew Board of Building Regulations and Standards 2023 (FOR
Massachusetts State Building Code,;780 tM.1 ,iVIUNICIPALITY
,, ::T�F rui���,;; FUSE i
Building Permit Application To Construct,Repair:Reno'vafd`at°De�taloido*,F0""NRevised Mar 011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Q A&3j 3 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1P�roperddresq: Lee MA 1.2 Assesors Map& Parcel Numbers)
1.la Is this an accepteditreet?ye ✓ no Map Number Parcel Number
1.3 Zontug Information: • 1.4 Property Dimensions:
WsV IDID )n,,it- pill 1pg2. at r+c 7z53
Zoning District Proposed Use V Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
V asS 704/04
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information.. 1.8 Sewage Disposal System:
Public 0 Private Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 4
Check if yes❑
SECTION 2: PROPERTYT OWNERSHIP' ref
2.1� G rl of E-+� Rec��� Le edS � o1053
Name(Print) A City,State,ZIP
32,c 1 -' nl2� gtA 9I312L - Wo;3 STIk ridiv,-QUGLh6o.&6)1
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other AI Specify:NWD MObilti YOU,'
BrkfDescript' of P op ed Work': A o�,c, nt,,t (r r - Slp IA tip t J
at P mlid e ! 1'1'ktm l✓' ttie e JA �''ate.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost3 (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ _
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:r It();
Check No.0\"k.,"Check Amount: Cash Amount:
6.Total Project Cost: S 7;00,63 0 Paid in Full 0 Outstanding Balance Due:
Ir,c,, 6 c!-wCCC. CoM
SECTION 5: CONSTRUCTION SERVICES
5.1 Const ruction Supervise h � License(CSL) CC s 0i0501 3
,Vv nC l — License Number Expir on Date
Name of CSL Holder
Ut-
ip� � List CSL Type(see below)
o.andpavic
et T Description
(�(� ���� /� `� �� 3
Unrestricted(Buildings up to 35,000 Cu.ft.)
'V A R Restricted 1&2 Family Dwelling
City/Town,State ZIP M Masonry
C RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
• 3 .l j,„,cti„ v Q .0 I Insulation
Telephone ail ad ess D Demolition
5.2 Registered Home Improvement ontractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name br HIO egistrant Name
No.and Street 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 Issu ce of the building permit.
Signed Affidavit Attached? Yes E No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,� 1(
I,as Owner of the subject property,hereby authorize E\meer lC/1'�l 2Of-"' �(�W In r,
to act on my behalf;in all matters relative to work authorized by thi build' g permit application
aOAell
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
conta. -., this application is e and .- isto to the best of my knowledge and understanding.
p tbi,c,
zbui)0)-3
Prints er' 'or'Authorized Agent's Name le , . $.ignature) 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"
Commonwealth of Massachusetts
r` i Division of Occupational Licensure
• Board of Building Regulations and Standards
•Const boor Sprvisor
.1,
CS-080509 _�: !Spires' 11/29/2023
JON M YAK"( x
60 DAVIS ROAD
MILLBURY M1j 01527 i
/1 '
Commissioner Au. ; f,. tle4vi_u>_
l
•//, �inunrn it i///,/. /6744iierii.i,/%i
Office of Consumer Affairs&business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Suoolernent Card
Registration Expiration
141641 05/04/2022
QUALITY CONTRACTING INC.
JON YANCIK ,
534 CAMBRIDGE STREET ,,,,,,;,a' ? v/.li/Fr
•
WORCESTER,MA 01610 Undersecretary
® Commonwealth of Massachusetts
Division of Occupational Licensure
Board of Building Rl ulations and Standards
Constrtt1on'Scrvisor
•r•
CS-080509 63pires: 11/29/2023
JON M YANO,K
60 DAVIS ROAD
MILLBURY MA 01527
r rrl.f.t`rl
Commissioner -;wrb f
l
.Ti- �ivirrii/virrrvi///r/. ////.ii////n.;r//)
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Supplement Card
Registration Expiration
141641 05/04/2022
QUALITY CONTRACTING INC.
JON YANCIK
534 CAMBRIDGE STREET
WORCESTER,MA 01610 Undersecretary
City of Northampton
%r.., t Massachusetts ,
S C S OF T DEPARMENT BUILDINGINSPECTIONS}' +
jq �, ia-
212 Main Street • Municipal Building if,
Northampton, MA 01060 3f-jy 3 ��\
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: 6 L \--AR-o lopkv}-40-, �,s1�(�(
The debris will be transported by:
Name of Hauler: Ssh' t '14 (Art..-,,
b
pp
Signature of Applicant: kA1. 0,4--- P3 Date: ailo .
g
The Commonwealth of Massachusetts
Department of Industrial Accidents
R =,: i j��� I Congress Street,Suite 100
t' ' � ` Boston, :VA 02114-2017
isvioc.muss.gov/dio
11 urkers' ('onrprensation I.sarance Aflidin it: Builders/('ontractors/Eleet ialans Pluntlirr3.
TO NE FILED Wfl II I Hi:PERMI-ITIM;AUTHORITY.
.tnilicant Information (� r i/� n Please Print riblv
Name(Business Organization lndtv:dual): G�(`n E. C. C-I t�(0 1�-A ti N J)'" --1-
Address: l ifl V.c,f-(1 --\--
CitylStateiZip: r ll\, c?,f 6 ( 0 lc(o t)Phone#: GV- q 1 )3 q ! q
Are yes me employer'?Clinch die appropriate 4: Type of project(required):
1.0 I am a employer with \ employees(full and or pat-tun.).' 7. 0 New construction
_v I am a sole proprietor or partnership and has c no employees working lair me in 8. 0 Remodeling
an capacity.(No workers"coup.insurance required.[
9. ❑ l)etnolition
s.D I ant a hunieow nor doing all work myself.(Nu workers"emir.insurance regwnnl.l'
I 0] Building addition
4.n I am a honreowner and will be hiring contractors to conduct all work on my poverty. l will
ensure that all contractors either has I:workers'compensation at sumo:or arc wile 1 I.❑ Electrical repairs or additions
proprietors a nth no anployces.
12.0 Plumbing repairs or additions
:10 I am a genteral contractor and i have hired the suh-cmntrMOM listed on the attached sleet_ I ❑Roof repairs
These orb-contractors have employers and have workers'coop.unurancc.• I /�
CO We arc a corporation and its officers have exorcism(their nglu nr of caeptiort per h1(iL c.
la. oat V (nsrmS
152.i I(4).and we have no employees.[No workers"comp.insurance required[
•Any applicant that checks box t'l must also till out the section below slowing their workers'compensation policy information_
'Ikmuvwrers who submit this affidavit indicating,they arc doing all Kurk and then hue outside contractors roust submit a new afiidav it indic-ating such.
:Contractors that check this box must attached an additional sheet show ins:the name oldie sub-contractors and state whether or not those angles have
employers_ If the sub-contractors have ems+loyers,they must provide then workers"comp.policy number_
I am an employer that is proridin,er u-urbers'compensation insurance for my,employees. Below Is the policy and Job site
information. � �.
Insurance Company Name: A�t w`A
V� , e. Hirt fiLc lirwi 0.)) , _
Policy P7 or Self-ins.Lie.#: ,v LV C' ) 41 Lt I o l Expiration Date: 1
Job Site Address: 3`i k ntet ul Pek. City/State/Zip: tie MA 01 053
Attach a cop} of the workers'compensation pommy declaration page(shoeing 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 S1.500.00
and/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 m-.urance
coverage serific- 'on.
I do hereby cc h f the pains and/ Itit of wring that(he information prurided above ' traeand correct.
J
I
Signature: I ) (a A - f . Date ,d-r 3
Irhonc#: '' -1� ? J ,../
Official toe unit. Dn iwa wrier in this area. to be completed by City or town OffiCIAL
City or I t t ss n: I'ermit/LhYese a
Issuing.%utltorils (circle one):
I. Board of Ilealttt 2. Buildini. Department 3.('its-Town Clerk -I. Electrical Inspector 5. Plumbing Inspector
ti.Other
('outset Person: Phone 4:
EMERGENCY TEMPORARY MOUSING
"We Deliver Temporary Housing to Your House°
129 Ferry Street Grafton, MA 01560
Office:508-887-8787 Fax:508-887-8786 Cell:774-261-0010
I rOX r S A A Q s , as Owner of property located at
5 k-e)Av Rind, , L-c.- -5, ,MA 0 ) 053
Do authorize Emergency Tenm5orary Housing Inc., 129 Ferry Street,
South Grafton, MA 01560, to file, on behalf, for any permits including
building, electrical, plumbing, zoning, BOH, zoning and gas permits, as
required for placement of temporary HUD mobile home on my property.
Signature S �� Date / _a -t=23
(Practice Areas/CORP/25227/00001/A2495085.DOCX[Ver:3])
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: C 1 LOT: O I \
I, GI
LOT SIZE:
REAR LOT DIMENSION: -RP 'i"C WAL
REAR YARD G' )
'<QSIDE YARD SIDE YARD
_ST_____
4 Wirt j
okniV641 /
FRONT SETBACK as n
FRONTAGE -//L`J "f,
2/9/23, 11:46AM Northampton MA,Web GIS
325 KENNEDY RD
Search Results 325 KENNEDY RD 10-003.001
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ADAMS STARR S&SHERID S 362
Parcel Details Parcel ID:09-011-001
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ADAMS STARR S&SHERID S 32
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