32C-204 (10) BP-2023-1106
7 KARY ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32C-204-001 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-2023-1106 PERMISSION IS HEREBY GRANTED TO:
Project# CHIMNEY REPAIR 2023 Contractor: License:
Est. Cost: 500
Const.Class: Exp.Date:
Use Group: Owner: ROSEN KIMBERLY F&CARA M TAYLOR
Lot Size (sq.ft.)
Zoning: URC Applicant: ROSEN KIMBERLY F& CARA M TAYLOR
Applicant Address Phone: Insurance:
7 KARY ST
NORTHAMPTON, MA 01060
ISSUED ON: 08/17/2023
TO PERFORM THE FOLLOWING WORK:
MODIFICATIONS. TO DRYWALL TO PREPARE FOR WOOD STOVE INSTALL
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:
I . 9".120iT
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northam.tonm.`.v/DocumentCenterNiew/15553/Residentia..,
m� �j
The Commonwealth of Massac ett9FA
Board of Building Regulations and Sta .• ''=qT gvi M IC PR LITY
17))
‘Q,(5, Massachusetts State Building Code, 780 C le4 0iy,� ICIP
Ns��
Building Permit Application To Construct,Repair,Renovate Or D- •• 7., 1 evise, ar 2011
One-or Two-Family Dwelling 1a60°4's
This Section For Official Use Only
Buildinf Permit Number: Q12 y3.+J/04 Date Applied:
lti,>s F Koss // 8-I7 Zbz
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
ropetr 1412-1 S 'l 1.2 Assessors Map& Parcel Numbers
a
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'
110/1110411+Pk/ kos I Naf-N,,ct. lyi 6- 01 0(00
Name( • t) City,State,ZIP
tre No.and -t 11 Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(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 0 Specify:
re MO e Jr- wall (f l 74-Ar)-14—a( citfi //
re" le w r, - -'i .-6 - ia -.s-�- bo a.hd 1--- r i i%7( S S
Iv? ovi, - iv (vnS}yt-(( a� w0v1 Sh- t..rt t
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ (r
Suppression) Total All e;''
heck N. r eck Amo
_6' Paid in . 1 CI Outstanding Balance Due:
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780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenterNiew/15553/Residentia...
* City of Northampton
1Mf 4
o\ °" N \.. `S Sin
l •� - Massachusetts �/ 'f.
a2. , %,t DEPARTMENT OF BUILDING INSPECTIONS , hz
212 Main Street • Municipal Building S
k Northampton, MA 01060 i`r`A 3,..)1'
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 HMS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
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780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenterNiew/15553/Residentia...
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
•
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofmg Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
' Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street
Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) wood'
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 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.
•
e rgmaturc)
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(WC)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: +' '.i"`' "' 114
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"
•
3 of 6 8/16/2023,8:52 AM
780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenterNiew/15553/Residentia..
— --* The Commonwealth of Massachusetts
Department of Industrial Accidents
t 1 Congress Street,Suite 100
...zr21 7.L;FL:...... 441
= ,
Boston, ALA 02114-2017
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— www.mass.govidia
IVoriters'(7ompensation Insurance Affidavit:Buiklers/Contractors/ElectriciansiPlumbers.
10 RE FILED WITH THE PERMIIIINC;AUTII0R1T1'.
Anglican!information Please Print Legibly
Name(Busines.s"Organizatinnindivichnilt:
Address:
I.
City/State/Zip: _ Phone#:
. ,
Are y US ILS employer?Cheek the appnapriate host Type of project(required):
I.E3 I am a tariployer with _,____ciropluyee,(full and'or part-timel.• 7. CI New construction
---iftwo 1 am a sole proprietor or partnership and have nu employees%Inking for rise in 8. 0 Remodeling
any capacity.[No workers'comp.insurance reo ano.li
9. 0 Demolition
augnamip I ant s homeowner doing all work myself.[No workers'comp Insurance cocoon:11j'
I 0 0 Building addition
141111100.;(1m a humiowner and wall be hiring contradors to conduct all work on my property. 1 will
ensure that all contractors either have w‘orker,"oorripethathart tnsurano:or are sole I I a Electrical repairs or additions
proprietors with nil iltIplOyet _
I 2.E3 Plumbing repairs or additions
i am a general contractor and 1 Eras c hind the hub-contractor,listed on the attached sheet.
These.4i-with-actors have snripluyees and have workers'comp.insurance.; 13 CI Roof repairs
are a omporation and its ufficni e have exercised their right of exerription per hiG 1400ther
L c.
152,§11 al_and we lane no employees.[No workers'cony.insurance required.]
*Any applicant that checks box 1 mint also fill out the section below showing their workers compensation policy information,
*lionaxssericrs%sins submit this affida%n indicating they an:doing all wort.and then hire outside comm.:tom mina submit a new affidavit indicating such.
tContractor,that k*aS box must attachial an additional sheet showing the name of the sals-contractors and state*hokm or not those armies hare
onployee.. If the sub-contractors base empluyiich,they must pros ide their workers'cutup.poky number
I am an employer that is providing workers'compensation insurance for an employees. Below is the policy and job site
information_
Insurance Company Name:
—
Policy#or Self-ins.Lic.#: Expiration Date:
iPamtion7 16`11 Si-- ?.4-- CitylStateiZip: 1/QuIr-3-1/1 4teJ ,&VI 0)0(op
ry
Attach a cipy of the workers'compensation policy declaration page Ishowing the policy number and etpi Lion dat
Failure to secure coverage as required under NIGI.c. 152. 25A§ is a criminal violation punishable by a fine up to S1.500o
andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a
day against the violator_A copy of this stateniern may be forwarded to the Office of Investigations of the DIA for insurance
cover-age verification.
ofipI do hereby certify , ....tkJi and penalties of perjury that formation provided above is true and currecf.
Phone : gi1 <- S11 - olo92--
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit license/4
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.('it),Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
.. —
4 of 6 8/16/2023, 8:52 AM
780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenter/View/15553/Residentia...
City of Northampton
''" 49 Massachusetts " A._ "iffi,
DEPARTMENT OF BUILDING INSPECTIONS 1 ,.
\f 212 Main Street • Municipal Building vyv
;,. Northampton, MA 01060 '� 46'"° -4
i•
(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: YOt/9h re, v(a-` f-i- 3A 7 ( tc_ up cue_ oc4-
The debris will be transported by:
Name of Hauler:
dilillnature of Applicant: Date: c;iI (t (Z')
Oro 8/16/2023, 8:52 AM
780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenterNiew/15553/Residentia...
City of Northampton
Massachusetts 4',",,�` . ''',.
E i
d
t 9gi, ,# DEPARTMENT OF BUILDING INSPECTIONS ttr
5x ,.. 212 Main Street • Municipal Building -.;t''
'" �� Northampton, MA 01060 `�sf1� y'04
•
r •
EXEMPTION ELIGIBILI
7- 1
I, C �/lJ�r-s�--� � !!!!!! 7- 7:;7 (insert full legal name), born (10000000.
oit sett
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.
• tied under the pains and p es of perjury on this l (D day of G� 174>14- ,2003
Crg
(Signature)
6 of 6 8/16/2023, 8:52 AM
Your Confirmation number is 20230816222676
Date of Confirmation: 8/16/2023
NOTE: When paying by ACH (Checking) it will take two business days for the payment to be debited from your bank account.
Your account number is not verified until this payment is presented to your bank. They have the right to return this payment if
unable to process this transaction against your account.
Your request for payment(s)of$67.50 has been received and is subject to approval by your financial institution. No email
was entered so a confirmation was not sent.
Account Information Payment Information
Name: CARA TAYLOR Payment Type: Credit Card
Note: QUICK PAY TRANSACTION Payer Name: CARA TAYLOR
Card Number:
Transaction Information
Transaction Quantity Amount Fee Payment Type
City of Northampton -Building 1 $65.00 $2.50 Credit Card
Department
Misc. QP
Permit Option: Building-Zoning-Sheet
Metal Permits
Full Name: CARA TAYLOR
Phone: 845-591-0682
Property Address: 7 KARY ST
Notes:
Total: $67.50
Pr!gacy-Toms