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38B-031 (2)
BP-2023-1096 15 LASELL AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-031-001 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-2023-1096 PERMISSIONS HEREBY GRANTED TO: Project# KITCHEN RENO 2023 Contractor: License: Est.Cost: 1000 JUSTIN SQUIRES 115236 Const.Class: Exp.Date: 09/02/2024 Use Group: Owner: HYL M THEODORE Lot Size (sq.ft.) Zoning: URB Applicant: JUSTIN QUIRES Applicant Address Phone: Insurance: 177 E HADLEY RD 4136409647 AMHERST, MA 01002 ISSUED ON: 08/14/2023 TO PERFORM THE FOLLOWING WORK: KITCHEN 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: ITIT • • + , >2 Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVED• Eynon I ciullibi -1C K AUG 20,te C mm_ nwealth of Massachusetts i,14), Board of uild ng Regulations and Standards FOR BERTHA PT op �(D�IVG INSPECT ch etts tate Building Code, 780 CMR , MUNICIPALITY E Buil ingTON.' location o Construct,Repair, Renovate Or Demolish a Revised Mar 2011 ne- r Two-Family Dwelling w �2��ecJ:on For Official Use Only Buildingf Permit Number: /�-� ✓— W Date Applied: ilt-A4 . / ), /�'2.- f3 I9.2623 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pro er Address: 1.2 Assessors Map&Parcel Numbers 15 a � ; t��- — 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) I 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 OWNERSHIP1 2.1 Owner'of Record: Ilium& 5 4tvirn Mo©fc NU( kc fv\P-i-ovl , NA O V C Name(Print) City,State,ZIP 15 Lase11 l4 e q1S-75L- 26ki Maple , +dewy o. - No.and Street Telephone Email Address v SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) . New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) l Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': (?tno\6, Li ' „Jc,j ',- -Aviol \ -,.,%C , (iv) (c( C�b;v1e-ry l SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ \ 060 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fee $ h,t „6 Check N N., heck Amount: (jt Cash Amount: 6.Total Project Cost: $ ❑Paid in F 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) • �u s3'i Yi C�9 V,l 0. License�be( Expiration Date Name of CSL Holder { 111E NO ley gd Avvk lkt iS 4- List CSL Type(see below) U No.and Street Type Description � i 002 Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP R Restricted I&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding ,, -.I SF Sclid Fuel Burning Appliances t 3, -/'qO Lt.n l I Insulation — Telephoneb Email address J D Demolition 5.2 Registered Home Improvement Contractor(HIC) n t a J I I .L1 Tv.S."Lkl 4^, +A r( S HIC R gistration Number Expiration Date HICpany Na of HIC Registrant Name ►'17 E bpi ley R - rc, Q 'l c('/1„ No.and Street Email address Igyt11l'ler� /'�(A QI00� o-ill 1 City/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 .❑ 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. Tiro rvA S P 4�n N�oQ 1!e d g-O =a d-3 Print Owner's Name( ectronic Signature) 1 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. L49),I 4/--- d'h-01 - 9-613 Pri t Own-gi, Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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.) t. (including garage,fmished 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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton _ at" Pi c;',. ; ?or9` oti Massachusetts .1. . s'' ( . 4 4 DEPARTMENT OF BUILDING INSPECTIONS y z, �,� ,., 212 Main Street • Municipal Building v, ^ 7n0"^..�.a' Northampton, MA 01060 ''Nh, 3, C 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. 1 The debris will be disposed of in: Location of Facility: Vhc( I0 a ? fS P'' ` "r\ , E S�t" k0k' Q�()Y1 t " _.) The debris will be transported by: Name of Hauler: A U_s4 ( n •Sq IA I {-eS Signature of Applicant: 441:1T4 Date: 0 - Ctg- ad�� \ The Commonwealth of.Wa.s trhuseus tea' Department of industrial Accidents ,ierl.._ I Congress Street,Suitt 100 7--OW Briton,MA 0211 2017 ;' wwtitnnasc,gol'ltfa 1!urkt.:rs'('umpensaliun Insurance AUiidal,it:11uiIderuffontraclnrsfEkctrkiatns!Plulnhers. It)BF_Ftt.F_.I)WITH 'HI :t ERNII I1 N(;AIl'Hi)R1Tl`. Applicant Information Please Print Leeibh Name(Business,(rganixstiun Jndividua11: Address: l i 7 E , fZaarA GilylState/Zip:fi...4 . P:r"- k As, t` r �--..., I'lica110 4 : I t C 0 C1 Ale Ilea an cngtkr\re it hit k tic appoupraatc Inky: Type Jproject(required): in I ant a employ i v.ith ct piiii}ets Cull and tat part-Hanel.• 7. D New construction 2n ant a vatic proprietor tit ga itot.atilhtp and have mcagltuycvs aortr= tot ow ura S. Op Remodeling an'capacity..INtrlwtntcrs cusp auruter e n ui.arrr .l g. Demolition 3.0 I atrt a lautnrrntka doing all K>or myself[Nu atoms cutup.rtcsoran cc n uni oa i lO0 Building addition 40 1 ant a ltonwontaa and,•ill t.c luting:ouniranotsiu conduct all n,,rl.on ins gnagnat... l'Atli ca[nun that all catrtZinf.either low rtatrkens'ourapcmatiat uinurattec to mac,uli 1 I L Electrical repairs or addition proprietors with no employers. 12.0 Plumbing repairs or additions 3C:I I ant a tgateaal contractor and I haw hired tine sub-enarrat.turs listed uu tb.attacitcd slum_ 13 Roof repairs Tiber Nub-4.-nnirackt,hate camploycti and fame workers'camp.nrauranec.= ��'"� I4_DOther ""L_..I%ME arc a lairputration and its affronts bad c eaerciscd Own right ut czc:mo n per Mt.et.c. 131§1(-1l,and we have mu enpin3ctu.[No aorkcr t'coop.insurance required.l *Ally applicant that cheeks but uI toast adart fill nut din sociiur bcknA showing[heir workers'compensation policy rtfunnaliun.. f tilnnusvtcns who submit dirt allidisit inificatittrit tbny ant doing all wink and then lure rnfina:contractorss maxi submit a mt-u,allid n it induatinp:such. k'muttactnmt dog clinic this but_must attached an additional sheer s M%Inx the n uric 41.1 th sul►caaractu s arid stale whethea or nut those,attttir+have enpinyc It the subscmtrx`ttts have cit Iu,eits.,th v mug pruaidc this wurkeas'comp.pnlwv ntmnber.. t ass an employer that is pr'oriding wnrhets'compensation Iir.wr uree,for any employees_ Below is the polio and fob site information. Insurance Company Name: _ Policy It or Self-ins_Lic.tt: Expiration Date: lob Site Atidres.v. City/State/Zip: Attach a cups of the workers'compensation pofky deelaratuw page(shnwiag the policy number and expiration dale). Failure to secure coverage as regional under MGL c. 152,§25A is a Criminal violation punishable by a fine up to SI,500.00 andfor one-year imprisonment,as well as civil penalties in die form of a STOP ORK ORDER and a line of up to S250_00 a day against the violator.A copy of this statement may be forwarded to the Ofi of lnvestigatitwas of the DIA for insurance coverage%'etitR zlliofl. I do herrht-certify ginner the pains and penalties of perjury that the information prnriderl above is tree and correct. Sis nature: 1)aIC. Phone#_ Official Ilse only_ Do not write in this area,to be completed by citi'err tuner official_ ial City or Town: Perntitl.icense I lssidag Authority(circle one): I. Board of llealtb 2.Buildint Department 3.('its)Tosn Clerk 4.1':lectrica1 Inspector 5. PIunrlriii Inspector b.Other ('tint act Person: Phone 41: ,a f ti y 3. , tea, t (1€ , _„„„ t ) ^" Ihj41 :6 - :r,m..