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23B-064 (3)
BP-2023-0506 15 BERKSHIRE TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23B-064-001 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-2023-0506 PERMISSION IS HEREBY GRANTED TO: Project# REPAIR WALLS 2023 Contractor: License: Est. Cost: 8500 KRIS THOMSON Const.Class: Exp.Date: Use Group: Owner: HALE RATTIGAN MATTHEW J& MARILYCE A Lot Size (sq.ft.) Zoning: URB Applicant: KRIS THOMSON CARPENTRY Applicant Address Phone: Insurance: 362 KENNEDY RD (413)695-6487 LEEDS, MA 01053 ISSUED ON: 04/25/2023 TO PERFORM THE FOLLOWING WORK: REPAIR WALLS IN BASEMENT 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: 3 ; Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner , The Commonwealth of Massachusetts ' APR 2 I FO 1-. ,!, Board of Building Regulations and Standar s 4 2�Massachusetts State Building Code, 7$0 C R IC ALITY US Building Permit Application To Construct,Repair, Rlenovate'4:'Du 'sed ar 2011 TIONS One-or Two-Family Dwelling `_._. 7 1-1 A2 `7 11 N.2 r,4AoE 0 This Section For Official Use Only Building Permit Number: 3 A— A 3-SO(1 Date Applied: VCpiL .d. I 1//a5 a Building Official(Print Name) Signature r Date • SECTION 1:SITE INFORMATION 1.1 Property hAddress• 'O Y2 H c e_ 1.2 Assessors Map&Parcel Numbers I5 ?e.r (< SLirQ, I ev. 1.1 a Is this an accepted street?yes 0( 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 Private❑ Zone: _ Outside Flood Zone? Municipal 161 On site disposal system 0 Check if yes] SECTION 2: PROPERTY OWNERSHIP' 2.14Owner'of Record: c� 1 1 L1j-r+i) J„L._ 2q ':S W\ r 0 r�:.L.. / � O i('G, l 2\ Name(Print) �` City,State,ZIP i c Er kk�.;(re., ( Li a— -114iLl ylx h-4.C-44 elf J!v`-&.1 . ccvA No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied Repairs(s) Ill Alteration(s) 0 Addition 0 Demolition 11 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': o `P--e Wvl61/`{, •geYi S+i hS S 'fro G IL + I n S v 1 Gk'C-}�,i`�, I h g ctSe h-)VA-NA-. • ©A l G h d.ry e� 0 S e R..)e S ?'1A'I h ,G S A.H c, W SIeN2C4 v'� Gf • vp4rctr e_ c tr, Cex. SECTION 4:ESTIMATED CONSTRUCTION COSTS I Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ A U V I. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 2 D p 0 Standard City/Town Application Fee 0 Total Project Cost (Item 6)x multiplier x 3. Plumbing $ --r 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ .-- Suppression) Total All Fees Are ri. �('1 Check No.� heck Amount: 16 Cash Amount: 6.Total Project Cost: $ / K W 0 Paid in Full 0 Outstanding Balance Due: ;rrr4i; City of Northampton y t . Massachusetts ;, T. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ,, -- Northampton, MA 01060 J?>1, .,4 . 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. r 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS CM. 5 h v)S I vv . S License Number Ex ira' n Date Name of CSL 9 a _ older 1 , t 36 2 �� r List CSL Type(see below) V — No.and Street V�O Type Description I nI. `f V Cl- M ' h 6 3 U R Unrestricted(Buildings up to 35,000 Cu.fr.) �V Restricted 1&2 Family Dwelling City/Town,6tate,ZIP M Ma3onry • �1 RC Roofing Covering �f 1 OV►'�S�11fi 1"CpC�V�iYtk��' Wet r l \WS Window and Siding .....1 SF Solid Fuel Burning Appliances A 11 S. /S• L ' 7 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /7/5 g //_ 50.Irv,e, IiIC 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 ark 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 V.(' 1 5 to LOB S d) ( C1,y to act444. on my behalf,in all matters relative to wor uthorized by his buil g permit application. 4 PA A44 .tiAi ,•c l . R.`1t4: cn 7 1"+/ 1/..10 - Print Owner's Name(Electronic Siglature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below ere.• .ttest under the pains and penalties of perjury that all of the information contain d in ''0��• icatio is true an . . e to the best of my knowledge and understanding. 21/2 3 Print Owner's or Author :: •gent . ectronic Signature) ate 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 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.govidps '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 1Y�F , Massachusetts : _ , y '' 'a DEPARTMENT OF BUILDING INSPECTIONS � ` 212 Main Street • Municipal Building rj, --:k' Northampton, MA 01060 'r � , 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: 4, 3 ' S ce I J 1----- Signature of Applicant: Date: 2/ 2-3 The Commonwealth of Alassachusens Department of Industrial„Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 WWW.mass.govidia • -!-I:=1:0* ll'orkers*Compensation Insurance Affidavit:Builders/Contractors/ElectritiansfPlumbers. TO BE FILED WITH TIIL PERNIMINC AUTHORIt'V. Applicant Information Please Print Lei:ibis Name tiumnrsa,Oroantzatton.lndletdunlY. VOr'lS Address: 3 ()2., _e•gzi t C -. ity State/Zip A - A OE 3 Phone g "-/--S • (z' VTLC-4 Art,tun AO eolith,"et?Clerk the appropriate box: iIX of project(required i LEI l am a tamploytx with employees(full mad-or 7. 0 NeXtd conatruelion .1111 a auk proprietor ut puttnership and have no cmployet. winking for me in g Remodeling au!,c•apacity,[No workers comp.insurance roitaired..] 9. El Demolition 30 I ant a lioniontsner nrt all work myself.[No.4m-torts*eurivi insurance manual.]* I El Building addition 4.C3 tam a hanssrwiter and will be hiring Waractun,to conduct all WUtli.on my proprity. 1 will ensun:that all cvn.tracturtt either have workers'compensation tnaurana:ur are sole 1 1.0 Electrical repairs or additions aropnctors with no employees. 1 2.0 Plumbing repairs or additions 301 am a inmeral contraetor and I base lured the stds-conitractor,bated on the tached sheet. tt Picse sub-contractors have employees anti irate workers'comp.insurance.; I 3.0 ROW' pairs 14.EI Other EJwc are a corporation and officers have exercised dam right of exetnpuun pet M(aL c. 132,§ I,arid 1Ve 11411V no employers.[No w orkers',:4}1r1p,in uric reutarcd.1 'Any applicant that clweks box a mint abo fill out the action below allowing their winters'competoution policy information Huantuwnem who submit this aftwhoot oulteatmo they are doing all at urk and then hire outside contractora must submit a new affus,,it indicating such. 4:contractors that check this box MUNI attached an additional sheet showing the name of the sult-controMitil•and Atfic whether us nut those entities L . z clnplo)cc, lithe sub-covaractoss lame employ et:a.they ntuat provid:!hoe workers'ecntip.policy mother 1 ant an employer that Is providing woriers'compensation insurance for on employees, Below is the!Why and job site information. Insurance Company Name: Policy#or Self-ins.Lie. Expiration Date: Job Site Address: C it s State-Zip: Attach a cos of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NIGL c. 152,-§25A is a criminal Iola Lion punishable by a fine up to SI,500_00 and-or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a line of up to 5250.00 a day against the violator. A copy of this statement may be forwarded tio the Office of Investigations of the DIA for insurance coverage verification. 1(if+herc certify and r the pain enables of perixtry that the information provided above is trite nd correct Signature: 2 Phone 4: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circk one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other 'ontact Persim: Phone#: City of Northampton Massachusetts ? �. a • Y • DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Cb' Northampton, MA 010600' HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born _ (insert 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"has defined at 780 CMR 110.R5.1.2: Person(s)who owns a parcel of land on which he/she resides br intends to reside, on which there is,or is intended to be, a one-or two-family dwelling, attached or d-tached 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 licensie 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 day of , 20_. (Signature)