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24C-162 (6) BP-2023-0695 6 ARLINGTON ST COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 24C-162-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0695 PERMISSION S HEREBY GRANTED TO: Project# SHOWER STALL 2023 Contractor: License: Est. Cost: 5000 KUEL MCQUAID 051394 Const.Class: Exp.Date: 12/11/202' SCHW .TZ DEBORAH E &ALDER CLAY Use Group: Owner: STEINB•UER Lot Size (sq.ft.) Zoning: URB Applicant: KUEL CQUAID Applicant Address Phone: Insurance: 131 FERRY ST 41335375063 SOLE PROPRIETOR EASTHAMPTON, MA 01027 ISSUED ON: 05/30/2023 TO PERFORM THE FOLLOWING WORK: NEW SHOWER 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: II Fees Paid: $65.00 a 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissi i ner I — Y 30 2023 The Commonwealth of Massachusetts FOR 1):" Board of Building Regulations and StandardsNICPALITY Massachusetts State Code, 780 CMR;!`,-,.Building INSPEC710NS USE "' V.M 1 Building Permit Application To Construct,Repair,Renovate Or Demoltsht0 a060 Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Buildin Permit Number: 7f Al• CI 5- Date Applied: Ivi�� Ko' S >DZ�2 /7� 3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 rope/_r r1 rldre s: (Cr No 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an acce d street?yes no I 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ • SECTION 2: PROPERTY OWNERSHIP' `' 2.1 Oyv�=:cord:cif4.ark 4ate,ZrillelAhl iti Namme(Print) IP G itylilm S- 9)3''a-p-d i,.-2 . c cru.► ,60 Q l. c4v,.. 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(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units f Other ❑ Specify: Brief Description of Proposeed/Work2: re�14Adh � Cx, c 1 w <L uie 4--- 9- t )14¢Q1( ,k ,V ' $� uferS*JI ' e ,,(I1� r1004.- ih SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 2(.9O O` 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6 x multiplier x 3. Plumbing $ 3 Om0 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ 6;6 ob Check No. 1140 Check Amount: Cash Amount: 6.Total Project Cost: $ 5 00 0 N Paid in Full ❑Outstanding Balance Due: 1 City of Northampton , Massachusetts DEPARTMENT OF BUILDING INSPECTIONS " 212 Main Street • Municipal Building _ ' �! Northampton, MA 01060 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. - _ram , r SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C JC -D 6131if /...///2 e (,a (� Qif c&I License Number Expira on Date Name of CSL Holder 1 ^ ' �G� S� S (1 L List CSL Type(see below) U No.and Street Type Description ECLS 4- U Unrestricted(Buildings up to 35,000 Cu.ft.) u sn/�� A DI o2� R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 13—C37-Soe,3 MaZVq1d.KvC CO qNA,c;,( I Insulation Telephone Email address CO WV D Demolition 5.2 Registered Home Improvement Contractor(HIC) I Q 1 © Cg®D 10/ � JAL v 3a 12 HIC Registration Number E piration Date HIC Company Name or HIC Registriant Name /3 G c c S /mac Qu��d EGaa q w.a.l.Co(,,.t No.and Street Email addra�r FPS u„Q At �if3 137-�063 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 Issuaance of 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 PERMIT I,as Owner of the subject property,hereby authorize A'L/L 1 M L Cuet_ to act on my behalf,in all matters relative to work authorized by this building permit application. elosl,t% .SG arrh 5724123 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 perj that all of the information contained in this application is true and accurate to the best of my knowledge and derstanding. / C r)(je-GICI,/ 6/7‘/2 3 Print Owner's or Authorized Agent's Name(Electronic Signature) bate 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 nAt 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 roo count Number of fireplaces Number of b rooms Number of bathrooms Number of ha(baths Type of heating system Number of de ks/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 Massachusetts ` DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 °� 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: Vet VOc am P+ak lk4 The debris will be transported by: Name of Hauler: i<t-/-0-- ( (�/\ C /4(.) t(f Signature of Applicant: Date: r IZ6 Z 3 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston. MA 02114-2017 .., WWw.Mass.garidia - 1 corkers Compewsation Insurance Affidavit:Builderso'Contractors/ElectriciansiPlumbers. ID BL FILED WITH'111E PtiaminING AUTHOR'R. Aonlicant In fornia tion Please Print Lola his Name t Businesa,Orpnozattion,lndtvnival 1: /(1,-e.-I M c oc,„_,z,,e Address: /3/ c'ec3 S-t"-- City/State,2i p.k-ZS-14,44.idiAtivx /t1A- Phone#. Zfi -- 3 7-- -06-3. Ate is an elimplio,er?Chet k Ilse appropriate but: Citr,e.:7 Type of project(required i 10 I am a eitiploya with _ „._,employeca'full aznivi put t-timet.• 7. 0 NON CLInstruetion 242ram a sole proprietor or ponnership and have no curployevs working for me in 8. tmodeling any eareseity„No workers'comp.maurance systiored] 9. 0 Demolition ant a inancou net dialog all winli inyaelf.[No Ori)lier9.0.1e141 Irlatle4114:Y reipLITLII 1' 10 0 Building addition 4.E]I am a lannorwrier and will bc taring contMetora tO c'onditet all work on tny prop.-rty. I will emote that all contractors either have workers'eolupenaaunn ouurance or we sole I 1.0 Electrical repairs or additions propnetnirs Kith no ettipinyees. I in Plumbing repairs or additions 5 I am a Lateral contractor alai 1 bite hired the aub-contractora tah ciai listed on the anaeinx1 sheet 34:1 These s - tractors have employee*and his‘e vairiers'comp.insurance; i Roof repairs I 4.0 Other ti.E3 We are a et/Torsi:mu and its offieent have exemised their eight of exemption per Wit c. 152,.§1i 4 t.and we li.ne no empli.s.[NI)Vl utit rs'clamp.insUrtiner matured.' 'Any applicant that cheeks boa.1 aunt also till nut the SANE1011i7CILIV.NhtNsinS their workers'eonmensation policy utformatton_ f Ilona:owners who submit dua atinlayst insist:aunt they are doing all toil,and then hire outside confrackiri must aubmit a new affidav it indicating such. :( Inrs that cheek Chia but mina anached an additional sheet show itug the name of the 14/1,-,:0111111630Mand*rate whether ix not those‘aititics ha employees If the sub-ctinuactor%havt:cmplo.l.cc*,they must provide their shotliers*comp.pokey number, I am an employer thin is providing wasters'compensation insurance for my employees, Below is the policy and job site information. Insurance Company Name. Policy#or Self.ins.Lic.#: Expiration Date: Job Site Address: City:State/Zip: Attach a copy of the workers'compensation polky declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOE c. [52,*25A is a criminal violation 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 thy against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under e pains and penalties of perjury that the information provided above is true and correct Stvnaturu: /6,e. t (fill/tel,?../ Date; 6/Z 4 •Z Phone tt: IOfficial use only. Do not write in this area.to be completer!by city or town official City or Town: Permit/License tt Issuing Authority (circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector O.other ('unmet Person: Phone#: