17D-015 (8) BP-2023-1102
11 VERONA ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17D-015-001 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-2023-1102 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 BATH RENO Contractor: License:
Est. Cost: 20940 KIM RESCIA 022464
Const.Class: Exp.Date: 01/02/2024
MULLER,AUGUASTUS H&JESSICA E.
Use Group: Owner: MATTHEWS
Lot Size (sq.ft.)
Zoning: URB Applicant: KIM RESCIA
Applicant Address Phone: insurance:
311 Locust St (413)320-1831
FLORENCE, MA 01062
ISSUED ON: 08/16/2023
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 DriNeuay 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:
4 • V • 13-1
Fees Paid: $136.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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v 'a The Commonwealth of Massachusetts
`r' ,. Board of Building Regulations and Standards FOR
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, i _ Massachusetts State Building Code, 780 CMR MUNICIP
USEALI
a Bui ldirg Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
s,
1 One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Nutnbe/r:3P.202311 D 2- Date Applied:
_
4.4 A..) < 255 I ti-►L-ZOZ3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 .
Property Address: 1.2 Assessors Map&Parcel Numbers ,
Ve roka c'`d- 17 b -015'
1.1 a Is this an accepted street?ye"l no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
L/RB ► 2 36Z. S 1 I S�
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:
Pubui? l Private❑ Zone: Outside F4% Zone? Municip�al`GI On site disposal system IDCheck if ye
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner' f Record:
AOtp) 1�� MI.1.02 f100Ncf \ MD( ()Oa
Name(Print) City,State,ZIP
it Vgo N 31 (-11 .1)1.o.q' i A J(suY li 5(hut-cc (PAIL.011
No.and Street 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 l Addition D
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Irks* uLLD-- -I—LA {-j -4-r,► (A—
iJLVtn -C7 `Z,r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ cd (, LI(3, 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ i ? O 1 w 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ I I ) 00 O ,0, 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees:$ 340,..wy
r
6.Total Project Cost: $ ��D oe Check No./3 72o Check Amount. :-Cash Amount:
0) 0 Paid in Full 0 Outstanding Balance Due:
IllOri
City of Northampton
Massachusetts � f,
f w
c
ii DEPARTMENT OF BUILDING INSPECTIONS �� x
` 212 Main Street • Municipal Building \,�o
—^? Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. 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. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable). •
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW/ private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
4
1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) S Q ZZyo `/ o� ��
-1 l Wl 1?-e- c I a_ License Number Expir ion Date
Name o CSL Holder
1 ' 1 k)GU L J--i-- S 1I"^ List CSL Type(see below) L
No.and Street Type Description
` U Unrestricted(Buildings up to 35,000 cu.ft.)
t ` O' A C.Sz_• (__Cl ' R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
V
r,� i v G a RC Roofing Covering
- - - WS Window and Siding
SF Solid Fuel Burning Appliances
1//3 — 3 zd — r.3 / I Insulation
Telephone Email address D Demolition
5.2 Registered Home I ovement Contractor(HIC) )(Pr '
f"1 1 IAA_ pr Sc 1 HIC Registration Number pi xpira ionn Date Date
HIC Company Name or HIC Re&tranve
3 ( l )(--t-4S
No.znd Street Email address
• e.A , v 1 v6 ?O l 8-S /
City/Town,State,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 . 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
NI,as Owner of the subject property,hereby authorize r 1 1 1/1,i 1?,... C 1 et__
to act on my behalf,in all matters relative to work authorized by this building permit application.
e' 1S ' Z3
Print Owner's ame(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.
K1' eci & a- i � a3
Print Owner's or Authorized Agent's Name(Electronic Signature) relate
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"
1
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
0
I
City of Northampton
Massachusetts , ��
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
,� Northampton, MA 01060 £ �`
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:
ll 11 1,1:t
Location of Facility: �JU)-- (,(..Gctr4al& K, l Lptt\i
C_
The debris will be transported by:
Name of Hauler: / \ I kA-\ 1/ `eC.... ( 4
Signature of Applicant /' Date: ls" 3
The Commonwealth of Massachusetts
21.19F1111 Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
WWW.mass.gowilia
01 kers ('ompensation Insurance Allida%It:Builders/ContractorsiElectricianx/Plumbers.
ID BE FILED WithI I DE PER111-IING AUTHC)RIII.
.‘ritilicant Information Plea Print l_ettihl%
Name _tee r j..4
Address: 3 I
sP—Ct
City ti CA 010 6 (/
Ate you All CMpioyer!Cheri.die appropriate hot: Type of project(required):
LC]1 dm a envie:.a with larlpitrf4Ch 1 full andor part-tonci• 7. 0 New eons-Indian
I am a wale proprietor en puninership and have nu enipLoyciti working. our me in g. ti Remodeling
any capacity[Nia workers'evatip.=mance rcquired_i
9. D Demolition
3.0 i am a homeowner ii iari ll work myself.[No w4irkers"corry mstiranoc regional °
10 El Building addition
4.C:i I am a homeowner and will be hams cointtactors so conduet all work on my property. I will
ensure that all contractors mhr have worker!'compariation insurance or are aole 11.0 Electrical repairs or additions
propftetors with nu employees.
11[]Plumbing repairs or additions
.sr3 I am a gown]contractor and I hav c hired the sub-contratio%Listed on the attached Aces.
Ihese sub-contractors have employees and his,.w3tricirs'comp,insurance.; I 31:Roof repairs
14. Other
an a corporation and its officers have cxercis.ed then ripht eftenizirn e.
I2.§I t 41,arid we have no employees.[Nu wUrk-CrA.‘..earap..MMITIMCC requira]
'Any applicant that cheeks boa F I mint also cal out the section below show ing than workers'comperoaition puIiwtitformatiort
•Homey%nen,who au no this affidavit indicating they medal:lig all work and dam hire outside contractors mint tubing a new Aldan it indicating such.
iCuntractors that check this box most abed an additional sheet showing the mune of the sufs-eontractors and...LIU Ito holier it not those%some-shave
CftIc It.xtw SLAY.1.AMilaCEM5 11.11i:employ ecs.Litey pro,tide their w oilers°eomp kV:.number
1 um an employer dna is providing workers'compensation insurance for my employees. Below is the polity wit/job site
infisratuttion.
Insurance Coniparty Name:
Policy#or Self-ins.Lie, Expiration aate:
Job Site Address: City:StateZip:
Attach a copy of the uorkers'compensation policy declaration page ishouing the policy number and expiration datel.
Failure to secure coverage as required under MOIL s. 152,§25A is a criminal violation punishable by a fine up to S1.500.00
andfor 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%iolator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
cov era 'e eft ikation.
1 do hereby certify uncle Jui-pifir"ts an pe es of periory that lite information provided above Is true and correct.
1111;f7
Sivutture: DA,L,
Phone e: -3/6' 3 /
Official use only. Do not+wife in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.Citylioun Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('onto ct Person: Phone#:
City of Northampton
Massachusetts 'f
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 411 ��
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)