28-018 (11) BP-2023-1160
203 SYLVESTER RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
28-018-001 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-2023-1160 PERMISSION IS HEREBY GRANTED TO:
Project# BATH RENO 2023 Contractor: License:
Est. Cost: 38644 BRJ BUILDERS LLC I 1 L 4/10
Const.Class: Exp.Date:
Use Group: Owner: SCHIFF ALTWARG AMY S&THOMAS F
Lot Size (sq.ft.)
Zoning: WP/WSP Applicant: BRJ BUILDERS LLC
Applicant Address Phone: Insurance:
PO BOX 505 413-800-4253 A106-587-711
BERNARDSTON, MA 01337
ISSUED ON: 08/28/2023
TO PERFORM THE FOLLOWING WORK:
BATH 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 NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
i � �,1 .
. � . i ,
Fees Paid: S273.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
aG
CAN
1 , The Commonwealth of Massa. us-,i �'
Board of Building Regulations and , cj •►. cf
Massachusetts State Building Code, 780 :' ' e.,,
q �'`ICIP ITY
<0, US.
Building Permit Application To Construct,Repair,Renovate i,,#'I ish a V
sed ar 20/1
One-or Two-Family Dwelling -SAFo
•
This Section For Official Use Only O, Tj
osoO.is
Building Permit Number: 6Q"?3 - //(/.0 Date Applied:
k M s/i =5 /777Z 6Z5-7c73
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
ao?, k/1 vet e — Pct.
1.1a 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.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public El Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2To Owner' Record: f-F
V 10 rerl(p. q - OI O(Q .
Name(Print) City,State,ZIP
ao3 S II vest fd - I-I 13- (CIS-CIL LI -I-omscHi i Q ji ct i I . coM
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) Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work: Ect,1-41 rvonn reI1 o /-Q.�1-i pr)
SECTION 4: ESTIMATED CONSTRUCTION COSTS
item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ ',y 1 (t q 4 .OD I. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ „,0 0 Standard City/Town Application Fee
ilGi SD• 0 Total Project Cost`(item 6)x multiplier x
O
3. Plumbing $ )21 001).0 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fe
0p Check No.2 Check Amount Cash Amount:
6. Total Project Cost: $ 3 g 104. 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
c5- ►121410 ) iq/ L4
e t./ m In Ot'' a . • Jo h n License Number Expiration Date
Name oTC'SL Holder
P.0 . (3O)( List CSL Type(see below)
No. and Street Type Description
Q.st�i'Ot1 , MA- Oj 3.7 U Unrestricted(_Buildings up to 35A0o Cu.ft.)
City/Town,State,ZIP R Restricted I&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1113-600-412S3 gen ED EciL. i idaK.totA I ; Insulation
} Telephone Emai address D 1 Demolition
_
5.2 Registered Home Improvement Contractor(HIC) //
�S .LJ 1 d.u-s l..L.(.. HIC R11 egistration 9 Co Number �>=x +
Q )L ration Date
Iii Company Name or MC Registrant Name p
•
o• Se]x Sz7S Ci.cn bu i I dl US.Ct
N .and Street Mail address
City/Town. State,ZIP Telephone l
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT (M.G.L.c. 152.1 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 13' 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 .enJc2.J% I r- 1R R. "3-451-Ir,
to act on my behalf,in all matters relative to work authorized by this budding permit application.
—1't-1 0 rrl cA SC_Jh;-(-÷ Fj Zj43/Z OZ 3
4irrnt Owner's Dame(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.
139.A Mir, cg. --j—o h tr1 JZ
L-Z
dZ--
Print Owner s or Authorized Agent's Name(Electronic Signature) to
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 f have access to the arbitration
program or guaranty fund under M.G.L.c. I42A. Other important information on the HiC Program can be found at
www.mass.iov'uca 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"
y
City of Northampton
?oar 1"i
'`6 Massachusetts ?
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building Jti P�
Northampton, MA 01060 sSH ��‘'
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: Atin r ttk-- r bL-1'1
Location of Facility: 2 3 Cr ���)Q-r� 1 ✓� ���_
�0 ri-`lctc{l i �Dr'1 J 111 I 61 O(Q O
The debris will be transported by:
Name of Hauler: 1c her 4 1VLt_CJ() �q
pp
Signature of Applicant: Date:
SI7-3 2O 3
g
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
ice,'- Lafayette City Center
2 Avenue de Lafayette, Boston, MA 02111-1750
• ij
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): ER-3- ,r3(44 cik r--S L.L_C_,
Address: P. a • 1.340X SD St—
City/State/Zip: 6er1no_riA S!-o(.1) RA" Ot 331 Phone#: — coo Z S
Arey,su an employer?Check the appropriate box:
1 general contractor and 1 Type of project(required):
1. 1 am a employer with s 4. ❑ am a g' 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [v'Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in any capacity. employees and have workers'
y p ty T 9. ❑Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.12 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their l 1.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp. insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: V€rr Orl+ ACCi d A+ S . C Q . /
Policy#or Self-ins. Lie. #: A i O —, o7 - Ti I I Expiration Date: aft 'I / ZO Zi{
Job Site Address: .223 S. I (y L rad . City/State/Zip: 4(Q t #')(p , /J /4- 0(001
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby ce u e the pai and penalties of perjury that the information provided above is true and correct.
Signature: ,, t Date: I2 1 ZoZ
//T Phone#: / 3 ` F — -la s- 3
Official use only. Do not write in this area,to be completed by city or town off'rciaL
City or Town: Permit/License #
Issuing Authority(check one):
l❑Board of Health 20 Building Department 31:City/Town Clerk CO Electrical Inspector 5E'lumbing
Inspector 6.0Other
Contact Person: Phone#:
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C 3'-6" >l< 2'-6" 5'-6"
C 11'-6"
LIVING AREA
108 50 FT
Order#444276 killIS.(1)1http://jhusa.net
Date:Thursday,August 10,2023 En +cn+Nnc.
Billing Information: Shipping Information:
Company:BRJ Builders Company:BRJ Builders
Name:Benjamin John Name:Benjamin John
Phone:413 345-9615 Phone:413 345-9615
Address: 136 W Mountain Rd Address: 136 W Mountain Rd
Bernardston,Massachusetts 01337 Bernardston,Massachusetts 01337
United States United States
Email :ben@brjbuilders.com Email:ben@brjbuilders.com
Payment method:Credit Card
Shipping method:Free Ground Shipping
Product(s) SG1se
Name SKU Price Qty Total
2066 200 Series Soft Close Kit 2066 $73.95 2 $147.90
2000 Series 30"x 80"Pocket Door Frame 202668PF $290.50 1 $290.50
Sub-total:$438.40
Shipping:$0.00
Tax:$0.00
Order total USD:$438.40