28-026 (10) BP-2023-1217
6 O'DONNELL DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
28-026-001 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-2023-1217 PERMISSION IS HEREBY GRANTED TO:
Project# BASEMENT DRYWALL 2023 Contractor: License:
Est. Cost: 3000
Const.Class: Exp.Date:
Use Group: Owner: ALLEN, KEVIN & RANOVA, ELITZA S.
Lot Size (sq.ft.)
Zoning: WSP . Applicant: ALLEN, KEVIN &RANOVA, ELITZA S.
Applicant Address Phone: Insurance:
6 O'DONNELL DR
FLORENCE, MA 01062
ISSUED ON: 09/12/2023
TO PERFORM THE FOLLOWING WORK:
DRYWALLING BASEMENT
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 p
• , yU . CP,Ovr"
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
' C�
�1/FO
The Commonwealth of Massa' use s SFP W • 6
Board of Building Regulations . •d S . tb, • 20
7 'OR
i CIPALITY
Massachusetts State Building Code, ' : l ,� 'u,�o�a
: USE
Building Permit Application To Construct,Repair,Renovate n �G4.•,, . : R• sed Mar 2011
One-or Two-Family Dwelling A°'06o01,'s
This Section For Official Use Only
Building Permit Number: S P' .3- /4?" 7 Date Applied:
41 ts•-) n / /2 C-I e'&23
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Ad ss: 1.2 Assessors Map&Parcel Numbers
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 CI Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2 In l o b Cc Fl o►eipiCZ 1 r✓A o 10-6 Z
'
Name(Print) City, State,ZIP
DooJ!kit )( 113344361. 0 Ilan• Cf 3r (I.Cr
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 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Pa
Brief De cription of Proposed Work': ti r,�J b � pt(, (J , ,4iic._
t,, ,ps + �►0 v,'1J 1 fi�R4 �or r7‘,
vMSiIJ a y
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 $ �j �� 0 Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All F s: 4
Check No. I Check Amount: C/6 Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
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.II.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing 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))
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.
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 as true and accurate to the best of my knowledge and understanding.
CJtIU AL( , Zs
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
Information on the Construction Supervisor License can be found at \�
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"
_ City of Northampton
Massachusetts -�` --..- 17) ,:_-'
)r///� _ L)PARTlEENT OF BUILDING INSPECTIONS
ma;
,
f. '` 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:
Location of Facility: 61i/J0l31—� (2aap TiA/JS&— l b .gitd,klz CO flw Mp
The debris will be transported by:
Name of Hauler: IN A )✓V
Signature of Applican • Date: P•qAy
'� The Commonwealth of.11assachitsetts
f Department of Indrt srrial Accidents
( _''„is_ N 1 Congress Straer. .Srtrte'100
-;r; Bosrorl, 111 0211.1-?01"
} »'vllnmass.goi ilia
11 u tier:' C oinpen ration In-w•ance Affidavit: Builders Contractor:Electricians Plumber:,
TO BE FILED WITH THE PER%SITTE G AUTHORITY.
Applicant Information Please Print Legibly
Name (Business Or a,!7ador.Ind:�.� ,: I )11J A t I f...,J
Address: 6 cDo Jpie k DC
City State Zip: iJ NAP —OI1f tZ Phone$: 7 L 31111 36 ' 6
y
Are 7os es employer'C heck the appropritee born
- Type of project(required►:
: Q I am a snap:07,11 aid: amFla..srr.:ttul:a_d c:;ar-::..ci • 7 U'9w -on:Iruction
:❑I lm a:c:,proptiotc:c:pa tza. iF aad a o n3 omp:a•.all:n oriia: fir ma_ S l'�' .r,,eniodeh n
a� .gnat:v [27c w mien•ccmp :a:v.-aaca res::.uad.]
3. • 9 0 Demolition
am a homeowner coax al:work my self.[Nc•a•orioc: comp rnsu.-aace raq-rrad.; '
10 0 Building addition
4.0 I am a her aoa nor and wish to hanag ccntraron to conduct a l wc:k on m.•prcfartc• I wish
ensure that ail concocts::actin bra workers :0211F4a:27cn ia:::ranca cr are sole 1 1.❑Electrical:ep ul: o: ai.drnon_
proprietor:with tic employees
i_.❑?.uiiiainr].Fans or additions
0 I ac a penal:cmtn:tor and:hove hired she:ut-ccan-actors L•:tad c .the attached :seal •, .,
The:a sub-ccsma.:tor.have rmp oyes:and Ira..a w xia:s'cater-:n:u:nace r i�.n �I]'eF ail':
5.❑LL'e are a corporatca and it:office-::.rve axe:tiled Bair rig:.cf exemppca per 31C,L c 14.❑ er
:52.11(4),and ars have no scoployess.(No woriaas'comp.:nstuanca:agaa3.;
'Any applicant that chocks box al net also fill ont the sectonbeLow:hem ins hair wcrium•ccr a:,:atoll policy information.
'_cmecauter:who submit this af5da:itiadicanca Ch y are dcmg a:2 work and Men hire r_tsrde:ant:actc,mast submit a new affrdr:_indicants:such
c:Ara,:tms that be: this beat must ar acted as ad,dinooa::hae::hc'a-iaz the name of the:tio-ccntti•:tor:and:tale whether cc not fzole auntie:is e
ar pIcyvo; If the su -:c:.cr:tor:ha.:.em oa:._ev must pro'•:ill heir wckar: comp.pciic-:z.:mtor.
I am an employer Mar is providing workers'compensation rnsurance for me emplon ees. Belo% is the policy and job site
information.
Insurarxe Cotupar}-bane:
Policy=or Self-in.Lic. _: Expiration ation Date
Job Site Address: City-State:Zip:
Attach a copy of the workers'cotnpen:anon policy declaration page(shoaling the policy number and expiration date).
Fai:ure to secure coverage a:required unaPr MGL c. 152. ;25A is a cnntini' violation punr:hable by a fine up to S1.500.00
ardor one-year tmprtsor.n tit. as well a:civil peralues in the form of a STOP WORK ORDER and a fine of up to S2SC C0 a
deli araji t the violator.A copy of this statement maybe forwarded to the Office oflrvest:ation:of the DL4 for in:utance
coverage•:enficati _
I do hereby c fi' the pains and penalties ofptijun}-that the information provided above is nxe and rrect
Simnature Date. ` Z 5 z
Phone 4: 7 1 .3 3LIy .c41 V
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit: ices:e=
Is:wing Authority(circle one):
1.Board of Health Z. Building Department 3.CityToaan Clerk 4.Electrical Inspector =.Plumbing In:pector
6 Other
C outact Person: Phone^_:
4111.
Electrical Experts
28Pleasant St_,
Easthampton,MA 01027
7/13/2023
Kevin Allen
6 O'Donnell Drive,
Northampton MA 01062
Dear Kevin,
We hope this letter finds you well.We are writing to inform you that we have completed the onsite evaluation of the basement
electrical and we are pleased to report that everything follows the required standards.
Should you have any questions or require further information about evaluation process or the specific aspects of your
basement's electrical systems,please do not hesitate to reach out to us.We are here to assist you and address any inquiries you
may have.
Thank you for choosing our services for your electrical inspection needs.We greatly appreciate your trust and confidence in our
expertise.We are committed to providing exceptional service and ensuring your satisfaction.
Best regards,
Alora Cirillo
Client Care Specialist/Dispatch
Electrical Experts
28 Pleasant Street
Easthampton,MA 01027
(413)52 7-2400 Office
(413)521-1470 Fax
City of Northampton
� � ys:.. s,,.,
!'' Massachusetts �w� x '�;
,, DEPARTMENT OF BUILDING INSPECTIONS
�,• r ' 212 Main Street • Municipal Building y'-. :�b.
�. : Northampton, MA 01060 s'i'i%yy �,�k'�4'
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, Kevin Paul Allen (insert full legal name), born_(insert 7/3/74
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 qualifij 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 11 day of September , 2073.
(<C v n' A.0 e-1z
(Signature)