23A-189 (4) BP-2023-0393
130 SOUTH MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-189-001 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-2023-0393 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS TO BARN 2023 Contractor: License:
Est. Cost: 23200 BENJAMIN SYLVIA 097008
Const.Class: Exp.Date: 05/03/2024
GILLIS TIMOTHY F &CATHERINE M SWIFT CO-
Use Group: Owner: TRUSTEES
Lot Size (sq.ft.)
Zoning: URB Applicant: BENJAMIN SYLVIA
Applicant Address Phone: Insurance:
123 MONTAGUE RD (413)768-8393 SOLE PROPRIETOR
WENDELL, MA 01379
ISSUED ON: 04/03/2023
TO PERFORM THE FOLLOWING WORK:
REPAIR TO BARNS
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
. a . Cg'1 •
I I '
Fees Paid: $151.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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The Commonwealth of Massachus is I Aft FO
c, Board of Building Regulations and Standards R
_ Massachusetts State Building Code, 7'80 �1 ` 3 Mi NICI ALITY
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Building Permit Application To Construct,Repair, Renovate i h a R4visedMar 2011
. 4'.n;_, r
One- or Two-Family Dwelling r,:�;, v pPC
This Section For Official Use Only
Buildin Permit Number: b P" '13—3 13 Date Applied:
1/ LI-.3-20Z3
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
110 5 I(naa,. SF god/144'04
1.1 a Is this an accepted street?yes x 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❑
i
SECTION 2: PROPERTY OWNERSHIP'
2.1 of R rd: �y �
1/11�, y' / 1 J v %-6 -L it 1X d �7 • (,,
Name(Print)) City ta�,ZIP i i 41-I PO ., �-II
No.and Street l Telephone EtOil Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) . Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': ref cc\r a,V1d. c;, .if ,ex i5-1-�'1 . karrl jai jf 1
in e;,� Co c. ax'�. n e.1/r) -Fa-o„4- dmo rs o
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ a� I On. — 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ) 0 Standard City/Town Application Fee
106, 0 Total Project Costa (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire of
Suppression) $ Total All Fees• 1��,"'
Check No.IC b Check Amount: Cash Amount:
6.Total Project Cost: $ 9.1 .3 0 0, — ❑Paid in Full 0 Outstanding Balance Due:
1
City of Northampton
FC`0.M�T
;�?,�'„ �r;✓4 Massachusetts ti`�S`S s._ c�c'<<
* e.'" 'I 4; DEPARTMENT OF BUILDING INSPECTIONS
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212'Main Street • Municipal Building SJ ;b
a. " ~? Northampton, MA 01060 •sMh {NC..
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW / private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL)
1 ) C'S-0g7o0� 6S a -,Aoa.L(
-jet_m eJA ► n F1�1t0. License Number Expi tion Date
Name of CSL Holder ��
List CSL Type(see below) 0
a3 Mor%Iue. 12.4
No.and Street Type Description
V v „�e i I to /� 4(3� q Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,cState,IZIP ( "`f 1 l i R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
11 13-7 6S b3q3 kj evt .) i v filetn I k I Insulation
Telephone En&il address LOWt D Demolition
5.2 Registered Home Improvement Contractor(HIC)
I O a'8
5a-r-vte. 4.s abo� o� is ,2t
HIgo Numberation Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town, State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.g 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 0
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 Sa, At SyI v 1
to act on my behalf,in all ma rs lative to work authorized by£his building permit application.
b l y13 •13
Print Owner's Name(Electr is ignature) 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.
g ee 1✓L ih 306
Print Owner' or Authorized Ag is Name(Electronic Signature) I 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
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.1 Massachusetts a . .:- '
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,11 I DEPARTMENT OF BUILDING INSPECTIONS 4:
212 Main Street • Municipal Building .3` L+
`• Northampton, MA 01060 ss4ii---",4O
A.
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:
The debris will be transported by:
Name of Hauler: AIk 's or44k D vg6r-
Signature of Applicant: _ Date:
The Commonwealth of Massachusetts
I yardDepartment of Industrial Accidents
y 1 Congress Street,Suite 100
11 ',' Boston,MA 02114-2017
.,. www mass gov'/din
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PER111111NC AUTHORITY.
Applicant Information Please Print Legibly
Name(Buatnes (�'Organuzationi1nditidual): 4.7_,.6 ,'n t,~?,..w.s1 Ivj11n
Address: 1'). 1'l0vl 4- et... kl
City/State/Zip: bA(te,q + KA i 6C37c _ Phone #: ILL j 3- 7 6 S-. 8 39 3
Ark you ar employer?Check the appropriate hos: Type of project(required):
l.❑lama employer with„ ,_�,._enzpiluyees(full aand'cn pata*time)• 7. Q New construction
2m I am a sole proprietor or partnership and have no employees%wiling for e in 8. D Remodeling
Kit on any capacity.No workers'comp.insurance required"
30 i am a homeowner doing all work myself.No workers'comp_insurance respired"1/ 9. Demolition
4.01 am a homeowner and will be hiring ourterac to conduct ail work on my property. !will 100 Building addition
ensure that all contractors either have wokers"compensation insurance or are sole 11a Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
50 I am a general contractor and I ism hired the sub-contractors listed on the attached sheet 13CIRoof repairs
These sorb-contractors have ertipiktyees and have workers'comp.insurance.:
6.0 We r a corporation and its officers have exercised then right of exemption per AMGL c_ 14. Other
are
152,$1(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box Rl must also fill out the section below showing their workers'compensation policy information_
i Homeowners who submit this affidavit Mc/seating they are doing all work and then hire outside contractors mini reboot a new affidavit atxliritmg such.
:Coeiractots that check this box must attached an additional sheet showing the name of the sub-s:cmtractoes and state whether t o not those clinic=have
employees. If the sub-contractors have employees,they moat ptu.ide their workers'comp.policy numbrr
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.Lic.#: Expiration Date:
Job Site Address: City/StalelZip:
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$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 certify under the pains and pen 'es of perjuty that the information provided above is true and correct.
: ::
e: , , Date: c(/ 3/ .3 9I�`76i- t
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
b.Other
Contact Person: Phone#:
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