29-137 (2) BP-2023-0368
311 RYAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-137-001 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-2023-0368 PERMISSION IS HEREBY GRANTED TO:
Project# GARAGE RENO 2023 Contractor: License:
Est. Cost: 5000 KUEL MCQUAID 051394
Const.Class: Exp.Date: 12/11/2024
Use Group: Owner: KLEIN PATRICIA A
Lot Size (sq.ft.)
Zoning: WSP Applicant: KUEL MCQUAID
,applicant Address Phone: Insurance:
131 FERRY ST 41335375063
EASTHAMPTON, MA 01027
ISSUED ON: 03/27/2023
TO PERFORM THE FOLLOWING WORK:
8 FT PARTITION WALL INSIDE GARAGE
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: I / '
• . >2 To1 •
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
fJ, The Commonwealth of Massachusetts
W Board of Building Regulations and Standards MAR 2 3 2023 FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a . ' �Rervised Mar 2011
One- or Two-Family Dwelling
This Section For Official Use Only
Building Pe it Number: 'Q t 3" 30 f Date Applied:
5��� ,�1<n} -2 Z
J � 5 //& � y Zo 3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Addr ss: 1.2 Assessors Map&Parcel Numbers
3 i i g'41 j'a o Porc.ice 4 0/46Z
1.1 a 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
p4+1,.�'a A. K1e,'---1 '(ort.kt c-e I //'I4- C/C'C� Z.
Name(Print) City,State,ZIP
3f1 ky4rt /COGei r/3-6I 4/-1de p mew)f}Rf5 C- 9tymji
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 hh Number of Units Other 0 Specify:
Brief Description of P�ro,Posed Work': 4 + r PcL-c \- l ctO \ '.JC&tl .�S;p'Q-C_ e
L�c4.5e_ /140 Deo s
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ 20 0 0_ — 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ,6b ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ LS 0 0 — 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees: $ ilti
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 5 0 0 0 -- 0 Paid in Full 0 Outstanding Balance Due:
Clc.frA a/o -- 3.). d^n
Q,JG4417 f - 3.).62,
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
� / �� CS — 05)34/t' i2,�1/�zoz�
�V e—t C Qtic�c License Number Exp rati n Date
Name of CSL Holder
/3 ( `� ��-- List CSL Type(see below)
No.and Street Type Description
e' 4-LO. MA i 0�7 C_' Unrestricted(Buildings up to 35,000 cu.ft.)
P v_ Restricted 18c2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
43-53 7—S O 0 _I t SF Solid Fuel Burning Appliances
/ / Qilac�• kv�F C/tMa k.cotK Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) �� . -i O
kve-1 /'C Quay 1131 aC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
/3 I f'e_�� 54- � :�. kvet yv►\4;( ,Ca,+.t
Ns-and S�eet Email address
aS- �lN`�v / 1 /3 55 2- So63
City/Town,State,ZIP oz7 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
I,as Owner of the subject property,hereby authorize 4✓e,/ Me_<e_ a iej
to act on my behalf,in all matters relative to work authorized by this building permit application.
3122_/2 oZ3
Print Owner's Name(Electronic Signature) / ate
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.
&,//tfr ,t/e) Q✓& 6' 2 iZ023
Print Owner's or Authorized A ent's Name Si nature e
g (ElectronicSignature)
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
k(
„:„...
Department of Industrial ileckknts
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mos,s.govidia
1$takers'Compensation Insurance Affidavit:BuiklersiContractorsiElectriciansfPlumbers.
TO HE FILED WITH THE PERNIIIIING AUTHORITY.
ADDIICani Information Please Print Legibly
Name(Businessi )rganirationAndividuab: &lel A c 60A-\d
Address: /.3 1 r-ccry . -(----
°KAI
City/State/Zip: Fk-&-144-4htA2C0 CA A14 Phone#: 413 — c3 7— .4-0( -3
Arty..an ciankiver?Clirdi the 1111prepriair box: Type of project 4 required):
0 1 4111.1 curadover with employees lull and or part-hirk-i. 7 0 New construction
Illtalam a sole Fiera/am in piuteership and ha.ke no curio!,eus workum tor me in It Remodeling
• 1.:,,aixi..ay.Ls',%oilers"comp.Insurance required.k
9. Demolition
30 I am a!WIT/LAM net done all*oak myself.INu workers'comp ntsunuice required"'
109 Building addition
40 i am a homeowner and Is ill he luring contractors ii0 Llwidact all work on my pnyerty. I w ill
ensum that all contractors either ha%c workers'compensation insurdtice or;tar sole ii 41 Electrical repairs or additions
popricton with no employees_
12. Plumbing repairs or additions
NOI am a pimeral contractor and I has kilted the sub-contractors listed on the attached sheet.
I 34:71Roof repairs
These sub-euntracton have employees and lane wiellams comp.instinance..1
, 14.1:10thet
h-EI We am a corporation and lb ulTusers have exen:ised then neha ol excerption per WA.c_
I.11.§1441k,and V4 v.:base no employees.[No workers'comp.11r1hIllfAE14:l:required.]
I
*Ari applicant that chinks boa.#1 must also till out the section heitib skims nap their is utters'oimnpensanun potie±. aducination
*tionioori MT%who submit this aft-Wave intheaung they are doiny all work anti then hire outside einitraetoni mutt suliniii a new alliiko it nadieating such
It...intim:tors that cheek this box must attached an additional sheet%bossing,the Marne of the Mlb-contraekies and state whether or rim those entities hese
employees. If the sub-etnerachas least empkwoes,they mud pros:de their workers"comp policy number.
I am an employer that is providing worbers'rnmpensahion insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: _____
Policy#or Self-ins.Lie.#: Expiration Dale:
Job Site Address: City State2ip:
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$1500.00
andlor 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 violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certif.und r the tins and penalties of perifiny shot the information provided above.is trite and correct.
*nature: i (2221?./ Roc:
Plit„ic-'::
t
Official use only. Do not write in this urea.to he completed by city or town official
( its or Town: rerillitiLieeliSe At
Issuing.tuthorit) (circle ono:
1. Beard of Health 2.Building Department 3.C it:crio%a Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person:1Plume#:
City of Northampton
Massachusetts
+
DEPARTMENT OF BUILDING INSPECTIONS 1
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: VQI(e keC-2 [e_ /1/4 c T\-Ol/v /4A
The debris will be transported by:
Name of Hauler: v � L (.:12L)
pp
Signature of Applicant: /`1/ 2 Date:
g