29-051 (6) BP-2023-0578
296 RYAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-051-001 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-2023-0578 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIR PORCH 2023 Contractor: License:
GENERAL CONSTRUCTION &
Est. Cost: 4300 ENVIORNMENTAL INC 014679
Const.Class: Exp.Date: 02/11/2024
Use Group: Owner: CORTNEY WHEELER ELIZABETH A&
Lot Size (sq.ft.)
GENERAL CONSTRUCTION & ENVIORNMENTAL
Zoning: WSP Applicant: INC
Applicant Address Phone: Insurance:
PO BOX 546 (413)478-3913 VWC1006010839
FEEDING HILLS, MA 01030
ISSUED ON: 05/04/2023
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO REAR PORCH
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:
bit
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
i `,L ,
��i
The Commonwealth of Massachuse,t,� �qy
Board of Building Regulations and Staridar Q FOR
L,''S Massachusetts State Building Code, 780' c� ? . ICIPALITY
Building Permit Application To Construct,Repair, Renovat IP ish a evise Mar 2011
\ ' SA
.
One-or Two-Family Dwelling �.,,2,q Fb
This ion For Official Use Only o7`'6P4'S /f
Building Permit Number:ea, ,9 3^ 7, Date Applied: �_7,
Building Official(Print Name) i Signature i i --' e
SECTION 1:SITE INFORMATIOI1
1.1 P o i e : ;d e,s: k t\/ RD 1.2 Assessors Map& Parcel Numbers
1.1 a s this an accepted stre ?yes I/ 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 El Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
X81 i z.c t\. L.)hem Co P r41) 1111) L'I CS Z(.
Name(Print) City,State,ZIP
1-11L-V►x a�1e_—, dia Q-1 44N-4 1b rm hmogic:ZDtrncti.\.cam0%.
No.and Street Telephone Email-Address
SECTION 3:DESCRIPTION OF PROPOSED WORD(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. ❑ Number of Units Other 0 Specify:
B ief Description of Proposed Work': j(= v/Z S Oki 7----- Ad l_PJZ,
Brief
e.I-I 1----0 A-1& <X 7 L' To & ' -
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ / I�,00 I 00 1. Building Permit Fee; $ Indicate how fee is determined:
6
2.Electrical $ /J ❑ Standard City/Town Application Fee
❑Total Project Costa (hem 6)x multiplier c x
3. Plumbing $ 2. Other Fees: $ %7
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$ ;I►
Check No. Check Amount: `�
6.Total Project Cost: $ �/
_/ t(/� ElPaid in Full CI Outstanding Balance Due:
7
City of Northampton
Massachusetts
< + ' DEPARTMENT OF BUILDING INSPECTIONS �_ 1fb
'• `_, .:'�« 212 Main Street • Municipal Building
Northampton, MA 01060 'sy
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS,RENOVATIONS,ROOF 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 specifications of proposed work(Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements(if applicable).
9. Energy Code—all new construction (Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
The Comntonwealth of Alassaehusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
IMINN
Boston, MA 02114-2017
woottmass.govidia
in kers'Compensation Insurance Affidavit:BuildersdiContrat orstElectritianalPlu tubers.
1'0 Bt.1-ILED 111111 I BE PERMITIViC Atcr 01(111.
Annlic ant Information Please Print
Name Busincss;Organizattory CO64261maLLTAL 11\1C,
Address: p, goy syg . .
City/StateiZip:Fiff..Trnxic HIC.cy MA 0 0,3_15 Phone g: (--//3 99p,---,19t1
Aft)0o sto mph")re?Clerk thy apprnpriate box: Type of project(required):
La 311I empkiyei vth Et17013.yeeh wave part-time 1..* 7. New construction
20 1 ant a wit:prupnevir tat partnership and have no employet.working tin me m g. CI Remodeling
any capacity.[Nu workers'comp,insurance. required
9. D Demolition
qjI am u hunseownor dump all winit myself thin*oriels'comp,'mutative required,r
10 0 Building addition
4.01 ant a homouwitm•and iv ill hc hiring contractor-Ito conduct all work on my property, 1 will
oisure that all contractors either have waiters°compottmation imuarance or are ii.0 Electrical repairs or addition:.
propnetoira with nu employoix,
12.0 Plumbmg repairs or addition,
:ID I aril a general CunIitur and 1 laaae hued the.4i-contractors listed un theattached.heet
1 3C Roof repairs
Theme sub-euntraichini have innpluyet,and have worker.'comp.utsurance)
14_noch.
„at um a empursoun and it.officers have exercised their tight of ei.ettiption per h101.-
I and ute no anployeei.USio workers'comp,inisance retinned.!
, I
Atrt
410.1%.".ini thitt dbeVICi bus el mitts also fill uot the iectrou below show inc their%Lace.'inirripensraturt poLu. xdormatturt
t thimuiiw tiers who iiuibinn tint affidavit indicating they Am.:Ionia all work and then line t'utaidc cosktrairtorr mum suhnut a new Affitla%it ind waling stoch
Contractors that check thus box must attached an additional sheet about ing the name of the sillnettractlnft altd aLak whether ix mit those entities'owe
employee. ir the sub-contractlX%63/Re CillphJYtteS,OM' rn.0:.ide their v,orkcn." polity 1s1n4T
am an employer that is providing worAcrs't ttinilenA4dlit,11 IfIsurfutt for My employees, Below is the policy and job site
information.
Insurance Company Name: /4/4/ )2/147-.QA / CO r
Policy#or Self-ins.L . #: VIVC /00 LO °q3 9 .02,3 A.. Eitpiration Date: 3 02.-q
Job Site Address: 2-96 RyA 4/ D1 City'StateiZ kriti4filf 76A./1M.
Attach a copy of the workers Cintpensation policy declaration page(showing the policy umber and expiration ditte).
Failure to secure coverage as required under MGL c. 152.§25A is a criminal ‘iolation punishable by a tine up to S1.500.00
artlibr one-year imprisonment.as well as civil penalties in the form of a STOP W RK 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 f Investigations of the DIA for insurance
coverage verification.
I do herein'certify under the pains and penalties of perjury that the information proided above is true/vitt vtorrect.
Sivriature: Date. -57"? 3,62
Phone#: 41/3 2r-- j7/3
Official use only. Do not'trite in this area.to be completed by city or town o.,Orieita
City or Tow n: Permit/License Jt
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Cif
/'22 ? 2',1 --20�v
PI J1 GW SO C�( 1 License Nu9um`ber Expiration Date
Name of CSL Holder
^,� �QX ��� List CSL Type(see below) IL
No.and,Street Type Description
t r1^ �3 Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP (,+ /� Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
4-I3 --zee 39/.3 gz/i r ,4J 7 I Insulation
Telephon Em ddress D Demolition
5.2 Registered Home Improvement Contractor(HIC) p��
Gk.NL/�A L � c7iO1 t i vj'1 oJU hoof HIC egistration Number Expiration Da e
HIC Company Name or HI Registrant Nam //
0, [�0 _rvc c' l u 02 A L C;C vgn 1 a
No.and Street ' Email adlUress .
Fee-VIN�� Nc-
, s M4- 01030 9/.I/ - I
3�/3
(City/Town,State,ZIP r 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 eptviGiir _5--fc,07 T
to act on my behalf,in all matters relative to work authorized by this building permit application.
atizzbet4. 1_JJ 2. 2O23
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.
P ttf' till 7 .- -z- ?
Print Owner's or(►uthorized 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
�T`x:146:?:
. .
1-' Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS ''
c 212 Main Street • Municipal Building -;
--le Northampton, MA 01060 ,s
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: U 1 C V L( C - IRU,cIL ‘ t,V
\,f
A
The debris will be transported by:
Name of Hauler: 1,J1ck_LA; C /1N p(A-07 -7-2_77-2.
Signature of Applican • Date:5-- ,1,.-)023
City of Northampton
a Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
i "`w "`^"` 212 Main Street • Municipal Building �r, ?'
Northampton, MA 01060s171t
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"as defined at 780 CMR 110.R5.1.2:
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, 1 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)