31A-036 (3) BP-2023-0623
219 ELM ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-036-001 CITY OF NORTHA11'IPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0623 PERMISSION IS HEREBY GRANTED TO:
Project# Contractor: License:
Est. Cost: PETER RADKE 047846
Const.Class: Exp.Date: 11/20/2023
Use Group: Owner: CO-TRUSTEES KNAPP KARL E&KARI S KNAPP
Lot Size (sq.ft.)
Zoning: URB Applicant: PETER kADKE
Applicant Address Phone: Insurance:
4 MOUNTAIN ST 413-335-3371
FLORENCE, MA 01062
ISSUED ON: 05/16/2023
TO PERFORM THE FOLLOWING WORK:
REBUILD 5X8 SIDE 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: ( I
• i, 1. r
Fees Paid: S65.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissioner
EIV R
9
The Commonwealth of Massachusetts ,
023 •
WI
Board of Building Regulations and Standa dsOR Massachusetts State BuildingCode, 7�O -- INI IPAL1TY
nF sUAILDINC INSPEC—�
�nRTHA"dfl'?< N.MA01R30 I�SE
Building Permit Application To Construct,Repair,Renovate Or Demolis1 a Revised Mar 2011
One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: (A. 3--4 3 Date Applied: __
J u 72y5 /7 Z- 6-16-z6z,
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address 1.2 Assessors Map& Parcel Numbers
9iq El if/ (DV-
1.1 a Is this an accepted street?yes t/ 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: 18 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Krrk 1. K�iR' P JUoKri-INm Pr$27A>, fl7A 6)LObv
Name(Print) City,State,ZIP
al q EZ./) s 58S -0 2.o q ka ( kvtct N pp 1 Z3 f: w.Ki/, co r,,,
No.and Street Telephone Email Addfess
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': K e b u t Id C$' 51 pj 7 'r -J-f
WQW,O Pe( t, 51`1=)l 1es, t`'P%I 1 all 6- 1 co 1 cs>nn •
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 5 DO 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
/ 0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ -- -
Suppression) Total All Fees: $
Check No. Check Amount: 0, Cash Amount:
6.Total Project Cost: $ f` 0 Paid in Full 0 Outstanding Balance Due: _
SECTION 5: CONSTRUCTION SERVICES
—
5.1 Construction Supervisor License(CSL) -do r
PV'Q License Number Expiration Date
Name o CSL Holder -- n
l f .. 'An 0 U 4) l) ,� S� List CSL Type(see below) rN
No.and Streetl I'�'L /V Type Description
F/y-t n ,t/►,^ / AIR
D t D 6 R Unrestricted(Buildings up to 35,000 cu. ft.)
City/'Town,State,ZIP /►`T r (R Restricted I&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
ya-3,s--333I 4, tad ke C e _I)V Q, C ti,yt, I Insulation
Telephone E—mail address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number i &e
HIC Comom N e or HIC Registrant Name
No and Sta bU �� ST jD d/�e /CID I/,1-l Den'
F/Df5„-,ID ` �� in OW b ? ? s337� ]`mall address
City/Town, State,ZIP Win
1 `l /T'ellephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted witli this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached'? Yes EY No........... ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
D 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.
ki4 AL KNAPP S^ - lZ - 13
Print Owner's Name(Electronic Signature) Dale
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 an understanding.
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.govloca 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" 1
= ----, The Commonwealth of Massachusetts
eV=. ----,
Department of Industrial Accidents
1 Congress Street,Suite 100
=a;I r= Boston, MA 02114-2017
, 1: --
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%%wit ers'Compensation insurance Affidavit:Builders/ContractorsEectricians/Plumbers.
TO lit.FILED WITH THE PERM I ITING Al t titiiti I N
Applicant Information Please Print Legibly
Name 4 Business'Organcutionlindis lanai f 4"Cfr' -1", 3ea4,,k A- ,...,...,...w i
Address: ty ynotin.--Ice.--tyl SY .._, _ ... . , .._
City/State/Zip: Voce/rite,Mt .0/0‘22.._ Phone#:
Are yea sits risrplqtr?Cheek the appropriate hot: • Type of project(required):
11:3 I ant. kiyer with ___rtrasktyves(full ignitor part-rim I.• 7. 0 New constrtiction
al i sole proprietor in parmeraup and have no employors working tin me ni It c-eiRemodeling
any iipitity [Nu workers',,,:tvritis.insurance inquired.)
9,10 lam a}sumo"net doing all work myself iNtr winters'comp.Maum 0 Demolitionee required I'
10 0 Building addition
&Di ant 4 Inn lieournet OW%Ill IV hiring txtestractors hi conduct all work on sty propertyA will
ensure that all 4:06inietun,intik/haw tairr t..m iers'compustion ov tinee sur oe an took I.a Electrical repairs or additions
proprietors w nth no sanployinst.
12.0 Plumbing repairs or additions
5 ri I arn a gelactal‘:unuaLior and 1 have hind the tab-curitnictors listed on El*attached sheet
These isib-contractors have imiplitynts and have workers'comp.insurance.; 1 30 Roofrepairs
14.0 Other
60 tvc arc a gvnixosuun and its officers has c est/I:bed ant:right of exemption .per 10,461 c
in..f;i I 4 I,Allii tV e}UM'no employees.(No workers'comp.U1Sitratli:e required]
--•
Any applicant that chocks bus of mutt also fill out an seetion below showing their workers'compensation policy infortnation.
3 lionicovelart%who submit this affidavit indicating they arc doting ail work and then hue outside contractors must sohnut a tic*allidas gt arabLatirtli such
:Contractors that cheek tins box must attached an addatiorall si,tyet showing the mune of the‘1111.-CCidiraCtars.and state vs!tether ot ri.,1 I ii*1.,e Cft11111,r1)i,:.4,,::
Linploye.:-.. II t.lh',.4.:1,i.or.‘11-ALtorN 11.3w cirailoyins.they largial pli."0.IlJe.their workers'tsin .policy nuniher
I am an employer that is providing workers'compensation insurance for my employees. Below is the polity anti job Alit'
information.
Insurance Company Name: -
Policy or Self-ins. Lie.u: Expiration 1)ate_____
Job Site Address: Coty/StatelZip: _
Attach a espy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secum coveratp:as required under N461. c. 152. t,A25 A is a criminal violation punishable by a tine up to S1,50(JOI)
andior onewyear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250,00 a
day against the violator. A copy of this statement may be forwarded to the Mice of Investigations of the DIA for insurance
coverage verification. ...
__./fi Ida hereby certif• nder the pa s and penalties at perjury that the intOrmarion provided above,is true and correct.
Signature: " 42(..) x Date: ,Y
Phone v. 3 -5 7 -------
Official use only. Do not write in this area,to be completed by city or town official
City tw Tows: Permititicense a —
Issuing Authority (circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inyector 5. Plumbing Inspector
6.Other
Contact Person: Phone : [1
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City of Northampton
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Massachusetts ."_ -•.
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DEPARTMENT OF BUILDING INSPECTIONS
a 212 Main Street • Municipal Building
Northampton, MA 01060 �s� 1'
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: V411,_ r IVty
The debris will be transported by:
Name of Hauler: F(../Ak\f' e
Signature of Applicant: J Date: ,S /z a3
5ele grcA ?ma/Sin - QM 1707 44,4/740/
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City of Northampton
.0 Massachusetts
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ti � DEPARTMENT OF BUILDING INSPECTIONS x''
212 Main Street • Municipal Building A: -'
Northampton, MA 01060 sty ve)%��
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. 1 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, 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)