31A-014 (4) BP-2023-0896
229 ELM ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-014-001 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-2023-0896 PERMISSIONIS HEREBY GRANTED TO:
2023 1ST FLOOR LEFT BATH
Project# RENO Contractor: License:
Est. Cost: 17000 KEVIN NETTO 001317
Const.Class: Exp.Date: 10/02/202
Use Group: Owner: LLC B WLES ENTERPRISES
Lot Size (sq.ft.)
Zoning: URB Applicant: KEVIN TTO CONSTRUCTION INC
Applicant Address Phone: Insurance:
90 Southampton kd. (413)527-3168 WCC-500-5008057
WESTHAMPTON, MA 01027
ISSUED ON: 07/10/2023
TO PERFORM THE FOLLOWING WORK:
BATHROOM 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 NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: CT-11
)2Fees Paid: $238.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissi i ner
cFi
The Co
�� ✓G` 1 �� .. d of Building egu attons and Standards FOR
_ � MUNICIPALITY
assa• usetts State Building Code, 780 CMR
N,:„�= USE
q ail, IA g P• it A:plication To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
Toff itis, One-or Two-Family Dwelling
o,ZT.o,(s. This Section For Official Use Only
Buildin Permit ber: 3 P-0 OI `-i"-3 - Date Applied:
CO 10 s f/� 7- it)-26Z
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
•aa'Ck \V‘N N. \ \*e.Ssk
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:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record
Name(Print) City,State,ZIP
• ?b' L-\\3-g11-. \-1y
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building IR Owner-Occupied 0 Repairs(s) IS Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 'se-`h%1c\\ c� e?VOOc) \h*CC' 1Vdp'cc•
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ a%SC:1Z). 1. Building Permit Fee: $1 i el G.2. Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ ( I J 000 ❑Total Project Costa(Item 6)x multiplier I760t) x 7, '
3. Plumbing $-3/500 2. Other Fees: $ j0 , 1AJ?1IG W 1 f 117acrMiW-
4.Mechanical (HVAC) $ List: 1 1Gf
5.Mechanical (Fire $ pV
Suppression) Total All Fees: $ �� ov
i 7 00 0 Check No. 1 30 heck Amount:23Z•—Cash Amount:
6.Total Project Cost: $ .soz) 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
o, Cam-CyciN � \ —a,-
% \`C C. License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) ',
q0 ` Type Description
No.and Street
O`0,,, U UnresRestricted
1 (Buildings up toel 35,000 Cu.ft.)
City/Town,State,ZIP' R estricted 1&2 Family Dwelling
M Masonry
RC Zoofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
*1446 "`lpitZhCt�\•Cf I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ‘OgyeJ -ay
v`ne. t�`b`a18�1�C �'c1C. HIC egistration Number Expiration Date
HIC Company Name or HIC R strant ame
qo ,pt % C�1�t?V�C•V07013\•C_Cla`.
No.and Street Email address
CnQ,IZACNT y\3-5a1-3be&
City/Town,Stat ,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 iat 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 yNr e,.tAe
to act on my behalf,in all matters relative to work authorized by this building permit application.
�d�1 rT�� Donna, 7 1 v2 eS ' 7- 01 3
mt Owner's Name(Electronic ignature) 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.
Print Ow 's or Authorized A nt'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. 142A.Other important information on the HIC Program can be found at
mass.govoca Information on the Construction Supervisor License can be found at www.mas;
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 h alf/baths
Type of heating system Number of d ecks/porches
Type of cooling system Enclosed_ Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
'°Y Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
� '.' 212 Main Street • Municipal Building ?
! Northampton, MA 01060 �, a�„
ffe�
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: o...\\may �.ecyC.�h
II
The debris will be transported by:
Name of Hauler: .y\r C.‘No Cs:)vtv.rt\- -N-._tic..
Signature of Applicant: 112,,,, vs-Ne...."-- Date: .1=1 -a3
The ('om mon health of Massachusetts
= - '" Department of Industrial Accidents
• O = b / Congress Street.Suite 100
r;�i� �i{ €,, Boston.MA 02114-2017
www mass.goi'/dia-,
IIr»kers'Compensation insurance Affidavit: Builders/C tractors/Electricians/Plumbers.
lORI?FILED Willi f11k PERNIEITIN(; IITNORUT1'.
Applicant Information i'lease Print I e ihls
Name 1Husincss.Urganization/lndtvidua1I ' srQ Sit\ j g..cevLIon 'vc
Address: gb , te cs�`�c,&--,` izso,�
City/State Lip:\�i +c-0 ` ...,,\\NAc c 1 Phone " V,\3_rjW1 •3\b�
Are you All ernplostr'l heck the ipproprialc Ihle:
• 'fs pr of project(required):
LEI am a employer with 3.____-employe,s(flat an i or part-time1.• 7. j New construction
2.0I am i sole proprietor Ot partnership and have no employees working for me to 8. Remodeling
any capacity.(No workers'comp.insurance n:quited.j
9. a Demolition
ICI I am a hulnlcowncr doing all work myself.(No workers'cone.insurance nquirtvli'
4.0 I am a hulnuown and will be hiring contractors to conduce:all work on my properly. I w it
10 a Building addition
er
ensure that all eonuactors either have workers'ctnipensatron insurance or an sale 1 1 a Electrical repairs or additions
proprietors with no eniployves.
12.0 Plumbing repairs or additions
<::1 1 am a general contractor and I have hired the sub—c ntra:tun listed on the attached sheet. 13.0 Roof repairs
These sub-contractors have employees and have workers'eurrlp.insurance.
6.0 We arc a corporation and its officershave exeveiaed their right of e uenlpla R
n r A c tGL 14.®Other V.VeVs-N.��
132.§1(4).and we have no employees.(No workers'comp.Insurance required.]
*Any applicant that checks box al must also fill out the section below showing their workers'compensation policy information.
t homeowners who submit this affidavit indicating they are doing all work and then hire outside cuntractun rust submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the suh•corttt;lc tots and slate•w,rctlnl or not those crrtrtit',hate
empdoyces. If the subcontractors have employees.they must provide their workers'comp pull. n 1.r._r
As
/arm tin employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insuratt.e Company Name: A_\ gy p,\.-trIfits,t.K t.A, CCytrR <1•:`3
Policy#or Self-ins.Lic.#: GG- Op - jQQ j7 Expiration Date: .. -Z.,a y
Job Site Address: ' Q*\in s, \ - City/State Lip: ,CN1P .O\p'ol .
Attach a copy of the workers'compensation policy declaration page(sho lag the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminals iolation punishable by 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 S250.00 a
day against the violator. A copy of this statement miv be forwarded to the • e of Investigations of the DIA for insurance
coverage senficatt.'n
I do hertbr certify under the pains tend penalties of perjury that the information provided abore is true and correct_
Signature ` �7.\`c sC.` )J `1-1-a�
Phone#:11/4\ aZ_3\\O,t,
Ofcial use only. Do not write in this urea. to he completed by city or town official
(`its or Town: Pcrmitll.icensej#
Issuing Authority(circle one):
I.Board of Health 2. Building Department 3.('itvr assn( lark 4. Electrical Inspector 5. Plumbing Inspector
1 6.Other
Contact Person: Phone it:
From: A /dr7'j7 LZ7 ma, SIL -
ii/vr 7- 46)66,6
To:
Jonathan Flagg
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10, I request that you
grant a modification to waive the requirement for construction control of the project at
o)=,)9 elm S4 . \ ,Yli0,)tekrr, A4 i9 C i o ) Gc./z. / 2_
because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire
safety, and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,
/-)72 tLRitc