24A-123 (7) BP-2023-0408
66 ROE AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-123-001 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-2023-0408 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 BATH RENO Contractor: License:
Est. Cost: 16500
Const.Class: Exp.Date:
Use Group: Owner: MERHAR,MILAN&BARR, ELISSA
Lot Size (sq.ft.)
Zoning: URA Applicant: MERHAR,MILAN&BARR, ELISSA
Applicant Address Phone: Insurance:,
66 ROE AVE
NORTHAMPTON, MA 01060
ISSUED ON: 04/07/2023
TO PERFORM THE FOLLOWING WORK:
BATH RENO
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: �
II; • • >2 .
Fees Paid: $107.25
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
/
�''1,C F�f. .
4pa
1 n,,.›,_ `�;,r
The Commonwealth of Massachusetts � o,-
7� t�i � F R
E ° I� Board of Building Regulations and Standards�rya,t ,n/No�
fj�� Massachusetts State Building Code, 780 CMR h'Ms' cl- AL'ITY
' -..�°row oN� SE
Building Permit Application To Construct,Repair, Renovate Or Demolish a---..Revis d Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building P
ermitNumber: go-- -2'3- y07 Date Applied:
/72/7 I-l"7-20Z3
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 66 ,p6(A V� 1.2 Assessors Map& Parcel Numbers
/1�s7 Q--(114`Mp r +i^/ — -
1.1 a Is this an accepted street?yes k / 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 ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Or'of Record:
.,71ii/LAti T "'ieR'My? Ai 0,2-rl-/AM�-r AAA 0/ to 'J�
Name(Print) City, State,ZIP
A-0 A 1.1 4/3 .-7 2;2— -S‘/ AA//z,A.v, it.II-IC1-HARQii4A) .
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF'PROPOSED WORK(check all that apply)
New Construction 0 Existing Building 0 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': t 13&A-11 ^.e,h U
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:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
)6
Suppression) $ es: $� //��/l.
fZlteck No. 1 Check Amount: \V Cash Amount:
6.Total Project Cost: $ / 5-4)0 — ' Full 0 Outstanding Balance Due: -
6 (i r al /,A
City of Northampton
♦. �o.
Massachusetts ?
A.
a DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building '7,p
Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS,POOLS, DECKS,ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
1. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specification of proposed work(digital and hard copy).
3. Site Plan with location of proposed structure(s)and setbacks.
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.
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.ft.)
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)
HIC Registration Number Expiration 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.§ 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 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
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 in this application is true and accurate to the best of my knowledge and understanding.
/LiiGAAI 3 /14 1? -AR 4/0-3
Print 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
itr
Massachusetts
�:
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
—�- Northampton, MA 01060 ;may. 0:``
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: �3 A' / i-) ' 1 , A !-/AM0 To,v /14'4
The debris will be transported by:
Name of Hauler: Do.✓ .r//v1 e'PA)
Signature of Applicant: ✓���� � Date: 4/¢( 2'-?
The'Commonwealth ofIlassachusems
--
*":....*:::== • Department of Indu striaLlecidents
.01 .6=e
1 Congress Street Suite 100
MI.Ir.11=7 ow
BOS1011,-ti-I 021/4-20/-
tritar.triass.go-ridia
' Wuthers°Compen:ation Insurance.Affidnait Builders'Contractors-Electricians:Plumbers.
TO BE FILED WITH THE YERNII=iG ArnioRrrii
Applicant Information Plea:e Print Legibly
Name(Business,Or."^r,ationTivinidual):
Address:
City/State Zip: Phone;-.:
Art Tett 2Z.t LISplr'Check the appropriate,box: Type of project(required):
0 I 11=1 auip...oyar tuft amployeas(full and cc pict-ththel.* 7, 1-.1‘..,:ew corntrocums,
El 3.a:a snit prude=c:pexterthiF and kayo La=par==thing fa nia ith g.. El Rt.e.triodelinz
any:apacity.pic ercaittrs'cathp.thsist-ance reer--iredi
.t, 9.. CI Demoliticei.
3 i_II 2=1 IICIZZS=INT daME at:arca thyself.[Nc terant='acthp insuzance raertured:'
1.0 El Building additon
,olia=2 itcnseincliez=I vi:1 he ha:n.3 canthervars to:one=ail wadi on thy prape...7. I tyCl
GMYrza that ail canthactars ether have tv others rompentates 1.11=2=4 cc are bk. 11.0 Electncal repairs or aliclusoun
propthetzin,with nc=playlet
12.0 Plimabing rep=or aciditiceis
'..!1:21 i.2=,i genera:conthartnr and:have hazed the sith-centractort lilted an the atterhad thee:
13.ri F-oof repars
Masa sctii-ccmra:=hani ithpLayead and ha:a wthiart'ccthp thinziLIK4i
14.Ej Other
,0 11:4 30 Z CC:F=a136C.Z.Z.141 ill DEkurct nays GINZth4,1 their risk-cf exaniptica par TAGL.c
'.'.:2. '...,1 ,t.esti we hatta no athiplayies L.Nri.WCAS.71.comp.insurance regthired.:
Ady-applicant th&t checks ham el ninst also O ant tha serum Width thawing.their tectien'cc-Li:et sat=polacy infarnizia.cst,
'Hanceownars veep subthit this aMiatte=Icahn;they an doing al2 wart and than kirs mitside:t az-actc:-.thti.r.tthanit a new affidavit inedicadap malt
Zenitactirs than check this lice mast attached an addict:mai sheet thaw*the=the cf to sub-::-::::tars and,:tti whether a rat those entthes hays
athplaYaea Tithe stth-caztrattert lova canplayees.,they matt 3.,,T77.-ZiS their wczic4r7;[cm? pch:- .:-....1.1:1-
I am an employer that is providing workers'compensation insurance for nts'enrplojees.. Below is the policy andjob sire
information
Insmance Couipany Name:
POlicy.- Self-ins.tic,#: al,iratIon Date.
Job Site Address: City'State'.Zip:
_ _
Attach a copy of the workers*compensation policy declaration page(shorting the policy number and expiration date).
Failure to secure cox-erase as requited under MGL c, 152,,§25A I:a cnnimai violation?imam,. ble by a ftne up to$1.500.00
and or orde-yea-unperiorment a....well as cml penalues in the form of a STOP WORK ORDER and a fine of up to S230.00 a
day amimt the violator.A copy of this statement may be forwarded to the Office of lan'estigations of the DLA for insurance
coverage verticanon
I do hereby cern:6 under the pains and penalties ofproUry that the inforniatiotrprovided abort'is true and correct
,• /i.-1..1.,-1-,----t--Zi_-.,.._ /4/
Officral use only. Do nor write in this area,to be cortpletd b,'city or town official
City or TIMM: Permit licert-,*
Issuing Authority(circle one):
1.Board of Health .".l,Building Department 3.Citylown Clerk 4.Electrical Inspector 6,,Plumbins.Inspector
6.Other
Contact Person: Phone At:
�,;r, ,,
City of Northampton
•<':7, d....:'r
t. Massachusetts y t .4..._ �'c
P c,
t 4
DEPARTMENT OF BUILDING INSPECTIONS %'
T
$0. 212 Main Street • Municipal Building ,'j, ..?
Northampton, MA 01060 Ai}` 1,.-,1 '
,
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT_.,„,;
I, "GAnl 3 /UI(-j2 HA k (insert full legal name), born 7 ?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.
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.k5.1.2:
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 4 ay of Art,/ ,202,3.
.,4V/5fA,f _4/ II't".
(Signature)