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35-194 (7)
BP-2023-0750 1190 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-194-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING P RMIT Permit # BP-2023-0750 PERMISSIO IS HEREBY GRANTED TO: Project# CHIMNEY RENO 2023 Contractor: License: Est. Cost: 2620 CORY MCGILL 107658 Const.Class: Exp.Date: 05/25/202 FOLE TERRENCE W& PATRIA A&TIERNEY A Use Group: Owner: SALVI I &ERIN B CURTIN& Lot Size (sq.ft.) Zoning: WSP Applicant: CORY MCGILL DBA DONE RIGHT CHIMNEY Applicant Address Phone: Insurance: PO BOX 1054 (413)340-1399 WCV 01525601 WILLIAMSBURG, MA 01096 ISSUED ON: 06/08/2023 TO PERFORM THE FOLLOWING WORK: DEMO CHIMNEY 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: lel ir • y9 - ''1 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissi i ner ECEIVE=D -.-- 14 The Commonwealth of Massachusetts two Board of Building Regulations and Star!dardJ{JN a 7 2023MUNICIPALITYMassachusetts State Building Code, 780 CMR USE Building Permit Application To Construct,Repair, Repyia 96111 im9M8TiON ?evis d Mar 2011 One-or Two-Family Dwelling r_� 11-1A',177 0r;.Mn 01060 i This Section For Official Use Only Buildin Permit Number: �-�-4N"-7SO Date Applied: Eu,r•� KD,s // C-6.ZOZ3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1190 Burls Pit Rd Northampton, MA 01062 1.1 a 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: Zone: Outside Flood Zone? Public 0 Private 0 Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Terrance Foley Northampton, MA 01062 Name(Print) City,State,ZIP 1190 Burls Pit Rd (413) 586-0639 N/A No.and Street Telephone Email Address 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 Other Specify:Chimney Tear Down Brief Description of Proposed Work2:Demolition&disposal of existing masonry block chimney.To patch hole in foundation. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $2,620.00 I. 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 $ 2. Other Fees: $ __ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fee W-tiCheck No. V Check Amoun Cash Amount: 6.Total Project Cost: $ 2,620.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 05/24/2025 CS-107568 0L8 Cory McGill License Number Expiration Date Name of CSL Holder List CSL Type(see below) U P.O. Box 1054 No.and Street Type Description Williamsburg, MA 01096 U Unrestricted(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 (413) 340-1399 ContactDoneRight©gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) #178722 08/27/2024 Cory McGill HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name P.O. Box 1054 ContactDoneRight@gmail.com No.and Street Email address Williamsburg, MA 01096 (413) 340-1399 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 Issuance of the building permit. Signed Affidavit Attached? Yes B1 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 Cory McGill to act on my behalf, in all mattersAtive to work authorized by this building permit application. Terrance Foleyv�—. A--,:al ( , /2 _I 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. 1 Cory McGill 11 6/7/493 Print Owner's or Authorize gent'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. I 42A.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" City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 1190 Burts Pit Road, Northampton MA 01062 The debris will be transported by: Done Right Chimney The debris will be received by: Valley Recycling 234 Easthampton Road, Northampton MA Building permit number: Name of Permit Applicant Cory McGill DBA Done Right Chimney 6/7/ 3 Date ignature of Permit Applicant The Commonwealth of Massachusetts lit* I Department of Industrial Accidents =;9fi►= Office of Investigations °mil= 1 Congress Street, Suite 100 • -'��={= Boston,MA 02114-2017 ��) www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: Done Right Chimney Address:P.O. Box 1054,45 Main Street, Unit B City/State/Zip:Williamsburg, MA 01096 Phone#: (413)340-1399 Are you an employer?Check the appropriate box: Business Type(required): 1.❑■ I am a employer with 4 employees (full and/ 5. ❑■ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑ Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]** 11.❑ Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.0 Other Services: Chimney&Hearth *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:Atlantic Charter Insurance Company Insurer's Address:45 Main Street, Unit B City/State/Zip: Williamsburg, MA 01096 Policy#or Self-ins. Lic. # WCV 01525601 Expiration Date:06/28/2023 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of perjury that the information provided above is true and correct. Signature: `/�/[C��I Date: 00/D1 io2Jo13 Phone#: (413) 340-1399 1 Official use only. Do 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia