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35-201 (11) BP-2023-0719 1300 BURTS PIT RD COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 35-201-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0719 PERMISSIO IS HEREBY GRANTED TO: Project# RENO 2023 Contractor: License: Est. Cost: 11500 BEAUDRY HOME I PROVEMENT CSL108605 Const.Class: Exp.Date: 03/20/202 Use Group: Owner: PEAR DORMAN, KAITLYN E &HALEY E Lot Size (sq.ft.) Zoning: WP/WSP Applicant: BEAUDRY HOME IMPROVEMENT Applicant Address Phone: Insurance: 117 FERRY ST (413)320-1348 6S6OUB2E863000 EASTAMPTON, MA 01027 ISSUED ON: 06/06/2023 TO PERFORM THE FOLLOWING WORK: 2ND FLOOR HALLWAY RENO 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 NOR HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: e, . ,V• 2 r1 • I Ia Fees Paid: $74.75 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissi ner / 1 The Commonwealth of Massachuse s \C. Board of Building Regulations and S n �' FOR wt Massachusetts State Building Code, 80('.�1 N. ,- MUNICIPALITY ',f\.,`,' USE Building Permit Application To Construct,Repair-1 tj,.vate O4 )-• olish a • Revised Mar 2011 One-or Two-Family Dwelling''o '%, �� This Section For Official Use Onl�t,''4/, BuildingPermit Number: �� A / 6,9-3•.3 -"7 19' Date Applied: \ -6- 410 a•-.)-5 //�� Q t vs 6-s-2OZ3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 P� U�d( iA)-- )1"" Ra 1.2 Assessors Map&Parcel Numbers 1.la Is this an accepted street?yes 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 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 O`v per:of Rec d: I-iql� ea^ 13©veur±5P)* - RG, Name(Print) City,State,ZIP m -4j )3y•-; --(o --�Ul€ , pear; @ q►wui) . (Iyl ) No.and Street Telephone ymaft Address J SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Descr' tion of Proposed Work2: ye0.4;luve Uo4_i-q gIIwK IGy01tfi SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ 3 C-60 I. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ �_/0(�) 0 Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: Check No. I I 0Check Amount7q — Cash Amount: 6. Total Project Cost: $ f I/ Ei--(jU CIPaid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Cons ruction Supervisor License(CSL) I ��f D O.� 1 (�� u(ll License Number Ex iratio Date Name of CSL Holder ' List CSL Type(see below) No.and Street Type Description q- �n r1 U Unrestricted(Buildings up to 35,000 cu.ft.) !, rG 1 1 r t � �v � R Restricted 1&2 Family Dwelling City/Town,State,"ZIP M Masonry RC Roofing Covering WS Window and Siding LJ13-3O-13'l� l' d l51/( yQ ht,.CO SF Solid Fuel Burning Appliances I I 1 I Insulation Telephone Email address D Demolition 5.2 Regi tered Home Improvement Contractor(HIC) )� r_'7�( 2 �c� '1 '1 �\ r1 1 / lU I J O' C'UTAIAI^�, f u }pro �W1 h� HIC Registration Number Expira on Date HIC Company Na dr HIC Re trant Naihe I,, I (� No_and SI 1e� tr �cb iS I l" JAW,Cil'IN1 Emai address a avr 5 , � f\M o )0-7City/Town, tate,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 Issuance 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 1 oJi.- 40,4 604 to act on my behalf,in all matters relative to work authorized by this building permit application. lia\-tki Peer I Ia3 Print Owner s NameElectronic ignature) l 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 an 1\-\ accurate to the est of my knowledge and understanding Pau ei 11 G Print Owner's or Authori d Agent's Na e(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" The Commonwealth of Massachusetts i_; I=f!. Department of Industrial Accidents —.:0i=_ 1 Congress Street,Suite 1a11 i41/4,. Boston, MA 02114-2017 „1.� wwtar.ntass.gotr/dia Wooten'('onupensation Insurance Affidavit:BuilderdContr*cfor iElectriciansfP1umhers. 1.0 HI FILED is rill rllt.PIJttiIITTINGALlilionrii. Applicant Information � y� Q Please Print I.eeibh Name(Hutii ess.(kr,:utt�itit�an•In.luw!duj) C(k_ 6_ h1_�v� . �IJ� Yt Address: 1 i-) FQrr\ St Eii 5+6inp'on,/4 010 a-7_ City/State/Zip: Phone#: 913"3.20_..13 t/ .-----__ Are cin au erptuya'i( k the:appropriate box: Type of project(required): 1. I ant a employer with arpokyac>flirt[aria part-twine)..' 7. O.New.rtinaattuctton .2i am a sok proprietor or rKutnctship and h:ixc no cirgolooyccs wanking tot me in 8. Remodeling any capacity-l im utakers comp.unnium:1: n-aluued-I 9. Demolition 4;1 t an{a Hippo ena doing all*oft.myself.(No vouaki7li"comp-insurance nlpnrialli i If]I aim a hotrtexn.itcr and will be hiring contractors kr conduct all work on sty .pcopaty. I 10 El Building addition e-rtwrc that all eYaitrae1ors tether Iia%c wtKkcrs'el mpl'rts:rtrmt utsuranec ur arc sole 11.fJ El ctrical repairs or additions proprietors with rem 4.71r1404,4:4 l .,�..,�y,�_L_,� 12.0 Plumbing repairs o r additions 50 I am a geiic.al ctnttacttir and I have Iun:l tlrc sill-ctaitractutx listed ma Me attached ahem 130 Roof repairs I1rcx stib-ecux irtmrs Iu 4c t employees and has *corkers'camp.gbutranciell 6.Q We arc a corporation andofficers a its ocers has c exercised tlreirr right of cscn�rtion per ttlClt c. 14. — 152,If 1(4),and we have no employees.f No a cams'comp..insurance ictlutncd.f *Any applicant that checks but a I mama also till out the ruction helm*show ing then i iH raers'earneveittaioa policy irttarmatimr. ♦I oincuw iwrs a lxo submit this afftdmnit inifi atisig du-y arc doing all work and then hnc outside contractors aim submit a ilea at ntin it irolic.'♦troy much. Cm.ntr:icemts that elictk this lox mina attached**additional dicta abusing die name of the%U 1 cYrttritl'trn3 and Mal:w ltcIher to not Mos.e-rtaitte%haw employees.. Et the sut+-contra krs kacc et►rldayvcs.they must provide their workers"camp.r1r .iti trttltlaer_ I am an employer that is providing workers'compensation insurance fate`ay carlo.nres. Below is the polity and job site information. insurance Company Nance: —ThN1' 1 p �^ /I ! Policy#or Self-its. Lic.#: Y 'C i 000 Expiration Date: tJ Job Site Address: 1 3 G V 'J l 1 ) 1 £d ! ),(40,,,, i 11" City/Statc Lip:_ Cj 1 O(L10 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration distil. Failure to secure coverage as requini d uskit;r NA L c. 152,*25A.is LI criminal aicrlatican punishable by a fine up to Yl.500.00 andor 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 tray be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I de hereby certify under the pains and penalties perjury that the in forntatlon provided a rc i- true and correct 6 / a3 Phone 4: L//3- 3 X- 13 V j Official nse only. Do not write in this area.to be completed by city or town official. ('i4 or Town: Permit/license aE issuing.Authority (circle one): I. Board of Ilealth 2. Building Department 3.('itylTown Chit) 4.FJettrieal Inspector S. Plumbing Inspeclrer 6.Other Contact Person: Phew#: City of Northampton optHMrro Massachusetts * c DEPARTMENT OF BUILDING INSPECTIONS c;' 212 Main Street • Municipal Building d CDC \ ,,. < Northampton, MA 01060 s-1% `'‘O 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: \ a\\ �e CAI CI i n PG,S 11 1\ Nor$4191Ar\ trA The debris will be transported by: Name of Hauler: ( (WY1J P(u �t Signature of Applicant: � Date: eii _____ ____ - \ \,e0 (-) &Ay-J-5 1 (IA, 1 i , ,,,., , , Ai, „..,,L,„ Vic ..:11,11:5 )4.1)( 1'6'5 1‘'1°1“)k /' ' 11. 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