10B-048 (3) BP-2023-0921
23 RESERVOIR RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
10B-048-001 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-2023-0921 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS 2023 Contractor: License:
Est. Cost: 5000 TIM SENEY CONTRACTING INC 061088
Const.Class: Exp.Date: 03/25/2025
Use Group: Owner: INC TIM SENEY CONTRACTING
Lot Size (sq.ft.)
Zoning: URB/WP Applicant: TIM SENEY CONTRACTING INC
Applicant Address Phone: Insurance:
371 PROSPECT ST 413-6261797 2001X1846
NORTHAMPTON, MA 01060
ISSUED ON: 07/14/2023
TO PERFORM THE FOLLOWING WORK:
STRUCTURAL MODIFICATIONS/REPAIRS
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:
1.
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
BP-2023-0921
23 RESERVOIR RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
10B-048-001 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-2023-0921 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS 2023 Contractor: License:
Est. Cost: 5000 TIM SENEY CONTRACTING INC 061088
Const.Class: Exp.Date: 03/25/2025
Use Group: Owner: INC TIM SENEY CONTRACTING
Lot Size (sq.ft.)
Zoning: URB/WP Applicant: TIM SENEY CONTRACTING INC
Applicant Address Phone: Insurance:
371 PROSPECT ST 413-6261797 2001X1846
NORTHAMPTON, MA 01060
ISSUED ON: 07/14/2023
TO PERFORM THE FOLLOWING WORK:
STRUCTURAL MODIFICATIONS/REPAIRS
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: 14 .
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massac kat
Board of Building Regulations and S :''i.,,. Tri ICIPALITY
W Massachusetts State Building Code, 781 4.. 0 c�cj?� SE
Building Permit Application To Construct,Repair, Renov.l Nemorsh a Revise, Mar 2011
One-or Two-Family Dwelling �'1 <,..,c'
This Section For Official Use Only fio02s
Building Permit Number: 6319-'�3-'' PLAI Date Applied:
(, , iIi i) • or •.1 7 ii a
Building Official(Print Name) I Signature i D to
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
.23 REsr. uoIR— .R�
1.1a Is this an accepted street?yes aG_ 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 1 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 fit Private 0 Check if yes❑ Municipal NI.On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: �
i SF.,✓K-1 N eTPA4P7rb✓, 1-0- 0/0 6 0
Name(Print) City,State,ZIP
37/ aoSPi5. -r Sr. y/3-6a6-/791 irlseneie yo»cu I Cal
No.and Street Telephone Email dress
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s), r Alteration(s) fd' Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work': jahN EATNRooPt (.JAIL BACK 3/ ib («oivta.DRr*
n//rk/ 9Z" 51-4o4✓F2 PfPAie, A/rli7 PORCH SUP PO2TS LJ11-14 SoAh Tuttf5
AAA) PizetsscJ2g 'T1Zit-m 7-t-D 6x(. R/5/c/Rei.SN epLCA2 5777 i iZS.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ /C C'() 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ o ❑Standard City/Town Application Fee
/ 0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ j 00 U / 2. Other Fees: $
4.Mechanical (HVAC) $ ✓✓✓ List:
5. Mechanical (Fire $
Suppression) Total All F
/ Check No�J Check Amount: D
6.Total Project Cost: $ , i G UV 0 Paid in Full ❑Outstanding Balance Due:
City of Northampton
Massachusetts
.yh
DEPARTMENT OF BUILDING INSPECTIONS
x
• ,," _ 212 Main Street • Municipal Building
`•" Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. 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. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate(new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction(Gut/Rehab)requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS— at.1 oil s s
l/ SrxiiC y License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
37/ vsi'rcr -Cr.
No.and Street Type Description
/Yolz 77-/i ,'-1P OA./ /4/A. o/O6 U R Unrestricted
es ride 1 2 Family up elto 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
7/3"eog-/7,7 /InSefieif g,-r o I Insulation
Telephone EmaiYaddre6 D Demolition
5.2 Registered Home Improvement Contractor(HIC) /9%U/ /�L I
5,c-�41 [ 4.7/7r11C'77n/ls _..L.✓C- fIC Registration Number Expiration Date
HIC Company Name or C Registrant Name
37/ zasPIC r ST.
No.and Sf�reet Email address
1UOC77//4r/46)iOn/ /1/4 0/U60
City/Town,State,ZIP / Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE A AVIT(M.G.L.c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitte with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes 13I' 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
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.
-----
i.i,r , K.t /c y 7///2 3
Print 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"
i...,;
The Commonwealth of Massachusetts
nilli/CX:,=2:I I
Department of Industrial Accidents
1 Congress Street,Suite 100
r 7014 =I
4. ar.mir- 1 Boston, MA 02114-2017
WWW.mass.gov/dia
Waiters'Compensation Insurance Affidavit:Builders.17ontractorsfEketrichanx/Plumbers.
TO BE FILED WITH 1HE PERNIIIIING AtITHORIFY.
AnpIicnt Information Please Print Leiiibh
Name(liusincasiOrgantzatumiruisuldualli: //PI 5-11#../Ay (Mirleog Cri 1.14r Lac_
Address 37, 1205Pri.c-r ST .
City 'StatefZip: 14/eTI-J_Ii 04-4370,-3 f-i4. o(o60 Phone --t: ‘7'/3 — 6,?t — Li..? 7
Xre son an employer?Cheek the appropriate hot: -r)pe of project(required):
. i am a employer with .......oloyees flull and.or part-time • 7. 0 New. construction
_Lial-arn a side prupnetur or purtnershm and have no eniple-yecs'if vricing tor me in 0 Remodeling
axi:i capacity,(No workers'comp..rnsurance required]
I arn a hociariowner doing all am*myself.ISM Yr ilnits%'comp.newt-Ince ro.turredi• [1] Demolition
i 0 0 Building addition
.1,c3 I arn a hurnmskster a nd will he hinny cmunictoes to conduct rill vs ork on my property. I will
=sure that all eonfraetocs either Moe...wrier:-eompensaiion insurance or tut sole 11 a Electrical repairs or additions
prupnetors with no employees
12.0 Plumbmg repairs or additions
I am a ceneral contractor and 1 laa,..e hired the sub-eunuactors,listed on the attached sheet.
These sob-eurarsetuis Kiss!employees and hr...wutiass'eornp.insuran I 3.E3 Root repairsce,:
14.00thet
h E3 We are a corporation and its officers have exercised then right
of CAerription per 111C/L I:,
1$.1..§1(11,and eve hats:no ernployees.[No workers'comp insizance r tiqUIPC4.1.1
•ArA.ippl 1,_co that eitecitS,box r?I must also till out the sr:cirri/I below show me their A or kers compensation pulley calor-matson
' ils.-vmeow tiers who sithmti this affidavit indicating they are doing all work and then hue outside emir:wines mums arihnut a Dew affidav ts indicating such
Coat's:tors that cheek this box must attached an additional sheet show in the name of the sub-emu/actors and'tit,:v.honor,or not time,..../ottik-,lisle
torloyco.. If the suh-comfacEor,Isx,e...irtplu!!, c,-,.th,) titu,1 pri'vide their A orLers'cmp policy number
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and/oh site
informatiOn.
....----
Insurance Company Name: /74/2M f;tiitcy _
Policy#or Self-ins. LW.#:
o700/ x /Of. Expiration Date: 3/2 L /2 V
Job Site Address: ..2.7 /a-Skit 4./01R- t2.0 City'State'Zip: i fit:OS Mn, ota53
Attach a copy of the workers'compensation pulley declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under NICiL c.. 152,§25A is a criminal violation punishable by a tine up to 51.500.00
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 may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
/do hereby certify under the ' red penalties(PI-perjury that the information provided above is true and correct.
Si ture: Date: 7 P- 1 2
Phone#: 9/5 - e2 — / 79/
Official use only. Do not write in this area.to he completed by city or town ofliciat
City or Town: PermlliLieense#
-
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('ontact Person: Phone#:
- _
City of Northampton
Massachusetts 40
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 1 ."
Northampton, MA 01060s'�y �1\
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: 11ry lac ycc-
The debris will be transported by:
Name of Hauler: 417-/Kje5 I A./
Signature of Applicant: / Date: 7/) ? 3
City of Northampton
Massachusetts 4'
g� DEPARTMENT OF BUILDING INSPECTIONS 2'
'"" 212 Main Street • Municipal Building 0`,
w —' Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_ (insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one-or two-family dwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in
a two-year period shall not be considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of , 20 .
(Signature)
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