24D-162 BP-2023-0687
9 MYRTLE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-162-001 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-2023-0687 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIR ROOF 2023 Contractor: License:
Est. Cost: 9300
Const.Class: Exp.Date:
Use Group: Owner: BHATT RAJESH
Lot Size (sq.ft.)
Zoning: URC Applicant: BHATT RAJESH
Applicant Address Phone: Insurance:
9 MYRTLE ST
NORTHAMPTON, MA 01062
ISSUED ON: 05/24/2023
TO PERFORM THE FOLLOWING WORK:
FIX LEAK IN SUNROOM
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 NO HAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: $ ( • ja
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
RECEIVED �' .. 0
Grn aV ruAyyvt.
MAY 023 3 The Commonwealth of Massachusetts
Boar' of Building Regulations and Standards FOR
Boar
State Building Code, 780 CMR MUNICIPALITY
PFPT.OF BUILDING INSP USE
" 'a` g of oivpp}icattbn To Construct, Repair, Renovate Dr Demolish a Revised Mar 20I 1
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 4 l0- 3- Log 7 Date Applied:
,�►�i`o� /ff/ 5.23-zoz3
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
q M1 TLf Si• :vcrt1 4M PDo,.J 24-b- 162 - oo I
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
0.oc1 4ciecs
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 Waterat Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 8 Sewage Disposal System:
Public kV Private 0 Zone: _ Outside Flood Zone? unicipal I9 On site disposal system 0
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
R.Al-6sl1 Gil A T T N o r�11-i j v+�` M A C) I o 6 0
Name(Print) City,State,ZIP
q I''v`lA1%.E S 1. 512- 660- 225 1 81-1,RT► e L&MA S S.
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs( ) Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: T 0 F-1 % LEA K i N --Su R QOM
- REP LAC ON 41 RcOF CAQ
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ , 3 n 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees: $ ,y�
Check No.Jo Check Amount' V Cash Amount:
6.Total Project Cost: $ 9) So 0 0 Paid in Full ❑Outstanding Balance Due:
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 L'nrestricted(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 ad.' - s D Demolition
5.2 Registered Home Improvement Contracto (HIC) S 6 03/t a- 25
�U N 1 02, MA► N r£N A N C& HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
. F S112 E r DAR`, P ci l e elmAIL , City
No.and Street Email address
9-4ST N A M P T of M 4 413 — 236
City/Town,State,ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE • FIDAVIT(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 1ilr 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
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.
Si') 13►-1 ( MAC 23) Z 02 S
Print Owner's or Authorized Agent's Name(Electronic Sign ) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owtter who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will orS 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.govroca 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
Cart,041, ��s arc'•..r
Massachusetts �w� �� �r
DEPARTMENT OF BUILDING INSPECTIONS ��, ,'
£ 212 Main Street Municipal Building of O°
Northampton, MA 01060 '�s ,y T,)�'N
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: C AST il A-M►,ro NJ 12t_cy c L ► N C.
The debris will be transported by:
Name of Hauler: Sz' `''�' DO ALvA 9- E—
Signature of Applicant: T Sh �`H `\ Date: a\ `"' �--3i 1 ° 23
1
h
4,-
The Commonwealth of Massachusetts
Department of industrial Accidents
1 Congress Street,Suite 100
• ",
Boston, MA 02114-2017
www.mass.gov/dia
n takers l'ompensation Insurance Affidavit: BuildersiContractors/Ekctricians.'Plu whets.
TO HI rttio 1•11i THE PLICHITIT'sf;AtTHORl1 .
Applicant Information Please Print Letilth
Name liiusInvs.s—OrgantzationlIndividual): R :I- --S}-1 2 I-1A YI
Address: 9 M'1Q1L ,
City/State Zip: N0g-T1144No1 19-M NI MA 0\ 660 Phone#: .S 1.2.— Cz>C) —
. .
Are)uu at.employ er?check the appropriate bus: Type of project(required):
•
LEI I an a employer with _employees(full and or part-tiinct.• 7. a New construction
213 I am a..ole gruprietor or Ilannership and have nu employers worting forme sn S. Remodeling
any capacity,[No workers'comp.insurance requiredA
9. Ei Demolition
30 aill hUlaILVW/itT 4.10111S all Wuric myself.No workers'tunilt.irtiorance mellowed]
10 0 Building addition
4. ant a ittillteNnkilc1 and*ill be hoists.r.-ontractors to conduct all work on my property. I*ill
alzlift:that all contractors either have markers"compensation insurance in ITC MAC I lip Electrical repairs or additions
prupncturs with no employees.
12.0 Plumbing repaus or additions
.5E1 I arc a general contractor and I have hired the sub-contracturs listed on the attached sheet
I 319-friCof repairs
These sub-contracturN have memloyees and have workers'comp.oisurartee;,
60'We are a curTsoradaun and its officeni have exercised then right of exemption per MCIL c. 14. Other
1 . 1.and sve have no employees.[Nu wuri.ers'comp.insurance required]
*An.? applicant that checks box ci must also fill uut the section bcluss show int;their nurkcr, compensation policy information.
*&immix^sera wipe submit due aftidak it indicating they are doing all w urk and dam hire(MAW&.•urttruclur.must>almi a new affidavit uaitieanng such.
:Conuactors that check this Isos must attached an additional sheet shins ing the name oldie suir,:untractur.and',raw,A!tether or nut those artistica have
empluvce, It th..:NUb-iuntrAauts ki employocs.they must pny,ide their u,orker.: INJIrcy number
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job she
information.
Insurance Company Name:
Policy#or Self-ins. L lc.#: Expiration Date:
Job Site Address:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dates.
Failure to secure coverage as required under NIGI. c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
anitor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
cover,p2_
I do hereby certify under the pains and at:hies of perjury that the inhIrrnalion provided above is true and corrci r.
Signature: s Date: 144 e 23) 2":)2"---3
Pho : I 2- - 6so
Official use onl). Dr)not write in this area,to be completed by city or town official.
City or Town; Permit/License#
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#: