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32C-187 (7)
BP-2023-0915 408 PLEASANT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-187-001 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-2023-0915 PERMISSION IS HEREBY GRANTED TO: Project# BATH RENO APT 2 Contractor: License: Est. Cost: 6000 RICHARD PALMIS 0 CSL89485 Const.Class: Exp.Date: 03/05/202• Use Group: Owner: LLC 418 PLEASANT STREET Lot Size (sq.ft.) Zoning: GB Applicant: BAYST TE EXTERIOR RESTORATION INC Applicant Address Phone: Insurance: 87 SHATTUCK RD (413)374-2719 6HUB-6B21339-4 HADLEY, MA 01035 ISSUED ON: 07/14/2023 TO PERFORM THE FOLLOWING WORK: BATH RENO APT 2 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 Driv 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: a y2. • r, . Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner R 'CEO VE The Commonwealth of Massa huse s jut 3 Board of Building Regulations add Sta dardsuL 12Op ORCIPALITY W Massachusetts State Building Code,7 Fa R USE r OF Building Permit Application To Construct,Repair;-Re{�Yvv q u 4)§ iy.p I a Rev.ed Mar 2011 One-or Two-Family Dwelling ON.M r4��g oN` Th' Section For Official Use Only Building Permit Number: 6 P a 3- 71"6 Date Applied: er....:v i-i 7 1 ss ///' 7-,"/'ZdZ3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Prpth pert�y A ess: Q/14- Ste,4,Q 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? Mµnicipal 0 On site disposal system 0 Check if yes❑ / -- __ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner' g or �4 ► S�, Ll.L S.W' 4' M�4 0(O7S Na (Print) ity,State,ZIP I1A r�• �x 4f9s' $s)C76442 aideSN,Edba CL- c & , No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing BuildinjOwner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units aOther Specify: Brief Desc ton of Proposed Work!: — i.J �t ri'►b C ltcf t�q , I p r,;"+ e wac �.c S 30 ,�r�u Cad P oNM SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ D 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ' 0 Standard City/Town Application Fee �.__ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ ZSZjO 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ (y,, " tn. Check No. 1)y9 Check Amount: Cash Amount: L 6.Total Project Cost: $ (XXD X Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5 onstruction Sue tor License(CSL) 9125 3IS- /a,/ ��A ,k e.,r.c License Number I Expiration Datete Name of CSL Holder n � List CSL Type(see below) t/l S fta Z� l�,f` . TypeDescription No.and treep AAA ©�J 3�� U Unrestricted(Buildings up to 35,000 Cu.ft.) Cityown,State, VU R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 677)Syg— f 4 tt Skki )ct-ttiP `e,IIJ I Insulation Telephone Email address D Demolition .2AM Registered/ Home Improveme Contractor(HIC) 413 I�`a'1-30-44 S 1 k C:k.cQ-u•te_ TOQA ria� I . HI i RegissttCt o umber Expiration Date HIC CaMpany Name or HIC Registrant Name Ckt• No.and Street Email address City/Town,State,ZIP Telephone SECTION 6:WO• ' 'S' 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 CONTRACT APPLIES f'Q BUILDING PERMIT I,as Owner of the subject property,hereby authorize 10 M,l O'a to act on my behalf,in all matters relative to work authorized by this building permit application. cS k 0 bo1c 7112_1 a3 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 perjtry that all of the information co,lip ed in this a ' at' n is true and accurate to the best of my knowledge and understanding. Q AA,l�ena 76 1 3 Pri,t Owner's or Authorized Agent'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 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 7.pP'-i"O ,S S, ,',0' Massachusetts 4?S . '''c 'Iv(-, DEPARTMENT OF BUILDING INSPECTIONS �_. j 4 & � ,y, - 212 Main Street • Municipal Building yJ`.,. �b� 4y Northampton, MA 01060 SSbW .~.. 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: e2,,Cift The debris will be transported by: Name of Hauler: It),:t_ Ve--S ib-e-4411.4k, Signature of Applicant: Date: 7 /i The Commonwealth of Massachusetts sainr �,�t Department of Industrial Accidents 1 Congress Street,Suite 100 t?' � Boston, MA 02114-2017 - c www.mass.gov/dia t t 1l ut kers' ('utupensation Insurance Affidavit:Builders+('ontractors/Electriciatis1Plu tubers. Tt)BE 171.E W1111 111E ER111 FI'TNG A!,r1I1OFRITY. Applicant Information Please Print Letih1% Name{13usiness Organizatturtrindtvidual}: k ttAi cD Address: A-7 Ski cock e 1. City/State/Zip:___I4C14. _ _..__j !� ___Ol bs" Phone#: Are you an employer?Cheek the appro riete box: Type of project(required): I. am a employer with _ employee%(full andrue part-time)' 7. o New construction ...Q I am a sole proprietor or partnership and have no employees working for roe in K. modeling any capacity.[Nu workers'cunnp.insurance required" 30I am a homeowner doing all work myself.INo worksworkorie comp.insurance required]' 9. Demolition 4.0 I am a humor wrier and will be hiring corurac'tura to conduet all work on my property. I will 10❑Building addition ensure that all contractors either have workers*compensation insurance or are sole 1 I a Electrical repairs or additions prupruetors is idr no employees. 12.[D Plumbing repairs or additions 51 I am a general contractor and I have hired the sub-contractors listed on the attached shed. 130 Roof repairs airs These sub-contractors have cnipluyeca and have workers'a p.insurance.: p 6.0 We a a eorporabun and its officers have exercised their right of exemption per Wit c. l '®oil,Lt am 152.f 1(0),and we have no employees.[No workers'comp.insurance required.[ 'Any applicant that dlceks lox al must also till out the section below showing then workers'compensation policy infonnatwih. +11.mm:owrscrs who submit thus affidavit iridicatrne they are doing all work and then hue outside contractors most submit a new affidav it indicating such. Contracture that check this box must attached an additional sheet show ing the name of the sub";utraetura and stale whether or nut those entitle,Lase employee.,_ It the sub-contracturs have employees.tile),must pro'.idr their workers'comp.policy number. I am an employer that is providing workers'compensa " n insurance for my employees. Below is the policy and job.rite information. Insurance Company Name: 5.1-" S Policy#or Self-ins.Lic.#: (p '3 39 —(i Expiration Date: 3o ia3 _ Job Site Address: ltJ O k'J d6C��'itv'1 �4. CityistateJZip: L t AAAAttach a copy of the workers'compensation policy declaration page(showing the policy number date). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to$1,500.00 andior 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 v'. .. r.A cop '• statement may be forwarded to the Office of investigations of the DIA for insurance coverage verilt tin . I do hereby ce Ify und\ +f penattie`a�o perjury that the Information provided abo is tau••and correct Signature: t 4 Date- 7 / 3-- l'hutte>+: • (3 37t{-.1-7/r Official use only. Do not write In this area,to be completed hi'city or town official ('its or Too n: Permit/License. Issuing .Authority (circle one}: I. Board of lltaltlt 2. iluildin;,1)epnrtntent 3.('it)r"futon Clerk 4.Electrical Inspector 5. Plumbing Inspector (i.Oilier ('mitact Person: Phone#: