18C-083 (8) BP-2023-0691
242 JACKSON ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-083-001 CITY OF NORTHAI$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-2023-0691 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
GOLD STAR INSUL TION &
Est. Cost: 3000 CONSTRUCTION L C 065992
Const.Class: Exp.Date: 03/16/202
Use Group: Owner: KATZ-BRANDOLI JENNIFER &ERIC M BRANDOLI
Lot Size (sq.ft.)
Zoning: URB Applicant: GOLD STAR INSULATION & CONSTRUCTION LLC
Applicant Address Phone: Insurance:
1 CONGER RD (774)329-4664 65620B5N23815620
WORCESTER, MA 01602
ISSUED ON: 05/25/2023
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATHERIZATION
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:
2 da �1
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commiss ner
err Lmairr Gvi21rI 42 acy
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,/__ o, 42 1' ul,, 1RaD
The Commonwealth-of c<tlthZti I,
.,Q Board of Building Regulations, F'C)R
Lei_
Massachusetts Slate Building Code. _h FCMUNIC`If ALITY'
r �0iys USE
Building Permit Application To Construct. Repair, Reno °ate moll a Revised Mar?DI,
One-or Tiro-Family Dtt'e//im
This ction For Official Use Only
Building Permit Number: (2-41.3- (i I I_ (late Applied:
4)0 / // ° 6-25_zoz:
Building Official(Print Name) Signature Da1e
SECTION 1:SITE INFORMATION 1
1, P t is Idd css.JJ f (� 1.2 Assessors Map ctj Parcel Numbers
1.1 a Is this an accepted street Ma Number Parcel Number
.r yes_ �____ no.. . P"
'1.3 Zoning Information: 1.4 Property Dimensions
Zoning t)isnict Proposed Use I.�t Area(,q lit I Frontage(ti)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Pr&widcd Required Provided Required Provided
i
1.6 Water Supply:(AI.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal ElO i site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2. Ownert of Record: ,J , (�
_ f... �_ EGA 3 a 11 -''y�r al�F i n
.� (Prim
City, LIP
N•tmc P q',State, �
No.and `mod^ 1 i CCU S[,' G e ..Cc ]:Yl .fir t )(iCdI`v;.
Street Tele hone Email Address 4..i )
SECTION 3:DESCRIPTION OF PROPOSED WORK''(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.0 Number of Units._..___.. Otherl l pceify:___ l ,- iN.,,.,...,
Brief Description of Proposed Work': .,
1
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Official Costs: Official Use Only
(Labor and Materials)
I.Building $ 3 to , on
I. Building Permit Fee: S Indicate how fee is determined'
0 Standard City/Town Ap lication Fee
2.Electrical S V0 Total Project Cost'(het 6)x multiplier _ _____x
3. Plumbine $ 0 ? Other Fees: $
4.Mechanical (IlVAC) $ 0 List:.__._.
5.Mechanical (Fire ( „ -
Suppression) $ 0 Total All Fcy;
Check No. Check Amount: Cash Amount
6.Total Project Cost: $ act �j
3 �� 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5 1 Construction Supers isor I_.ict tW(C'SL)
�/ License Number Fxpitat n Date
Name of CSL holler
list CS!.Type(see below) _ V
LI I ,,,�c.t_.$t+v1 w `t tA- Type Description
NO.and Street
NO( � Q � U Unrestricted(Buildings up to 35,0t)0 cu.0.1
____ R Restricted I&i Family Dwelling
(.'it)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(MC) .J
+JI.1 U U ... _._.._ .Registration Number it /ion I3wte
1i1 any Name or NIC' egi /rant Name (��
�6 C.-7- `ice!
No.and St • `_. ....._....'
Email address
7City/Town,State,ZiP Telephone
SECTION 6:WORKERS'COi PENSATION 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 issuan f 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 PER.NIIT
1,as Owner of the subject property,hereby authorize 6 11 _to act on my behalf,in all matters relative to work authorized by this b(?° '
lding permit application.
_f`,C-- -r dal; .__. _.... _ _ — a.... .
Print Owner's Name(Electronic Signature) U.
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,thereby 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.
, cr/e.,1 I _Ci d•-/{
Print Owner's or(thorizcd Age is Name(Demonic Signature) Da e
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(h1IC)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,govfoca"Information on the Construction Supervisor License can be found at www.mass,gov!dpa
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"
► J
City of Northampton
- ....-".• .'.?. ,-;''' 7 sic:,
1 Ma s s achu se tts
DEPARTMENT OF BUILDING INSPltiCTIONS ....7 "I'‘'' 'e
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212 !fern Street • Municipal Bulilding
'''''7'**„ Northampton. MA 01060 ,'Y 7, 1
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40,554, 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: ,,, uie sv----cr I The debris debris will be transported by:
Name of Hauler:
.'-I— MCINC• ()e Wic\A-
,..
Signature of Applicant:
i I P i 1
. .
The Commonwealth of Massachusetts
.,_., Department of industrial Accidents
' =rug i........,
, .....:...a"..i=
1 Congress Street,Suite 100
— Y Boston,MA 02114-2017
witqtt mass gowdia
Ilurkeric'Compensation Insurance Affidavit:BuildersiContractorsdElectriciansi/Plumbers.
TO BE VII.EI)liVII'14"HIV 14-RNIITUING Atrtil()RUI V.
AnDlleant Information Please Print Et Hub;
Name(.13usthrsi`Organustim I rut vidual): ' ' ..\C./
Address: t (24- ç2 ,JI.
City/State/Zip: (.4-)01 Le-s\---,,,,c, iNkAA. Phone#:
Are yen as lerree!Check the appropriate box:
aa entplocr with ,6).„employe...-.(full and or part-ttine).•szp
Type of project(required);
I
7. 9 New construction
20 I am a,olc proprienar or pnetncrdirp and have nu emplol,x-x working for me in " 8, 0 Renuxieling
any rapacity.f\u A,irrs`i,•urrip 'mamma: minunall
.
.30 I am a hurraconner doing all%knit myself(No Aortas'comp nourani.e required 9 El Demolition
.]
10 0 Building addition
4 Ej I am a hotneuu am:and skill be hning contractor to evading all work on my property. I will
etiaure that all cordracton either have worker,'etampemataun emurunce ix arc mac I i 0 Electrical repairs or additions
proprietor.A Ith no emplu.)eim
12.13 Plumbing repairs or additions
SC3 I an a gerwrid tiractor and I ha e hired the,uh-contraetor li>ted ton the ausehed sheet
I 3.0 Rio°. airs S
These sati-ermiru ton hai.c employees and tame%Wier,'comp imurance.:
I 4. thet_1 )_ )s ' is,
h.C3 Vs'e sire a corporatom and it,(Aile en hax c exaci.ed their right of exemption per Wit.is -----
Ill.1.1(l),and Y.c have no onploytes.(No orork.en comp,inatirance regoirolj
Any Applicant that cheeks km at moat also fallout the action below%howing their workera'compenaation policy mturinatiorx
'I linneowneni who auarum this atlida‘it indicating they are doling all work and then hire outside ow:actors moot a.nbnut a new artieldn it indicating%mix
Icingractona that shol this h....,A mat arkwhed tan additional aln-a alioking Liar mune of the sutsvognsctors aria gate VI 6.113../or not than&entitica base
emplu)ert. If tJaz sub-ccoritrai.ties ha.. emplo}eva,itae two prisde thctr *oilers'romp ports!,normal
I am an employer that is prodding workers'compensation besuranee for my employees. Snow is the policy and job site
information. ,
Name 1 ) IR 1 C-,r\ 'IVA,C)4--t-tikk
Insurance Company : tz
Policy 0 or Self-ins.Lie.ft: Lg3a1 ( -2 3 , Exp....it..., 6 ), / ) i),;..,.
Job Site Address: 6 Li as i 4-Z=e-..S.41 St-rc-ei-- CityStatelip:/1/eirra-fl
Attach a copy of the%artier's'compensation policy declaration page Ishossing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a croninal violation punishable by a fine up to$1,501100
and/or one-year imprisonment.as well as civil penalties in the form ut a STOP WORK ORDER and a line cat up to$250.00 a
day against the violator.A copy of this statement may be forssarded to the Office of Investigations of the DIA for insurance
coverage verification.
r - i
I do hereby certifj,a er Il e pains and penalties of perjury that the Information prodded above is true and correct.
Si'nature:
D
.ite )
,
1 Official use only. Do not write in this area,to b ,i Impleted by city or town official
City or Town: Permit/license#
Issuing Authority(circle one): „.
I. Board of Health 2.Building Department 3.1 nsil own Clerk 4.Electrical Inspector 5.Plumbing Inspector .
i 6.Other
° .
,
Contact Person: Phone g:
- , „ . . ........ .
4