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31A-170 (2) BP-2023-1280 60 MAYNARD RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-170-001 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 \I I Permit# BP-2023-1280 PERMISSION IS HEREBY GRANTED TO: Project# FRONT STEPS 2023 Contractor: License: Est. Cost: 300 Const.Class: Exp.Date: Use Group: Owner: ROGERS MICHAEL&ALEXANDRA JESSE Lot Size (sq.ft.) Zoning: URB Applicant: ROGERS MICHAEL& ALEXANDRA JESSE Applicant Address Phone: Insurance: 60 MAYNARD RD NORTHAMPTON, MA 01060 ISSUED ON: 09/18/2023 TO PERFORM THE FOLLOWING WORK: REPLACE FRONT STEPS 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 )2 . 'Pi • • . , . i Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIV . gma i ( w it (cad The I ommonwealth of Massachusetts FOR ., )1, SEP B•:rd o Building Regulations and Standards MUNICIPALITY 4 3` 2O M.ssac� setts State Building Code, 780 CMR USE ,._.. PT of g; -..' 'ermit • pp!' ation To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 NoRTMA 'TpN IMA oEOHS One-or Two-Family Dwelling This a tion For Official Use Only Building ermitNumber: ,6 '..13- /2 Date Applied: evrio (? - ,,e____/_,__.._._________ ' Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers D /►1 ity Ina tet 116,...Z 3 t A 11- o 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 1 rGo 5-- Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public® Private 0 Zone: Outside Flood Zone? Municipal I.On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: AA MiC ka.4( ave��t.tS wi-.� �1 C 1teeKe (ee N k ei , ,l 1wt MA- d l 06 a Name(Print) 1e SL. City,State,ZIP /)) (h4,vI Il o t A 4t3 sr.( 6.19 9 1 ,i-f+fik rottmic k&ti®9 vk,,,1 .r or,, No.and Street 1 Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building El Owner-Occupied 0 Repairs(s) ter Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: 12 eD(*it r-, i.4.y fro.a, + pore- it Svc/Sj ado( A$ j irlii( . r J SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ )00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ _ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: 5 Cash Amount: 6.Total Project Cost: $ 6 00 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.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 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 0 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. (4 L64,( ant V/4/2oZZ Print Owner's or Authorized Agents Name(Ele onic 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 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" City of Northampton Massachusetts . e c, DEPARTMENT OF BUILDING INSPECTIONS �- 1 ' 212 Main Street • Municipal Building ph Northampton, MA 01060 ry, $ ��' 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: 14 +41 p.ec 1[ t,i , ¢ L'o14 -�h,,,,,,6 . 12d, M 11... e;Tz v\ The debris will be transported by: Name of Hauler: .M, kI,E ( ( G 1 tl Signature of Applicant: Date: 9/19 t2 6L 3 City of Northampton 49a F. des •,s, ; Massachusetts ti ( � � DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �,� i)': • Northampton, MA 01060 "�'!%yy ,3Oy'l HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT AttI, t v�lat/( a 6 4.ri-c (insert full legal name), horn (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 11 day of `acp (t,« , 202. (Signature) The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street.Suite 100 Boston,MA 02114-2017 wwmmass.goildia 1,s others'Compensation Insurance Affidat it: BuiSders1ContractorstElectriciansiPlumbers. ID HE FILED wail in E. PERMITIING AUTHORITY. Applicant Information Please Print Leeziblv Name i BusiniessiOrginurationilndtvickial):JAI C(A rue ( 0 Address:_ _All/.44W6Vir 44 11—0. ort_ ..._ City/StateiZip: 4.._,244_044,or Phone ti-.. q 0 5 e7 6- Art yell AS employer?OKA(the appropriate bor. Ty pe of project(required): 1.0 1 nrn a employer 55ith .......employer:5(tail ant.14r part-time!+ I 7. c]New construction 20 i am a Wig 1Xupnet.or or panne/41T and IIIINt no cnsployec.5*ink tag for rea:In K. 0 Rcmudeiling an)tLeapacity [Nlt We Tr.*',eromp,in:ammo: rcr4anW.1 ; 9. 0 Demolition IXII am a hum:owner doing all tkenie rnylel I.[No workt.75:eomp,wilorninev required.]' 1 100 Building addition 4.0 I am a isncowitcr and well 6.e itttutg tvilitlictari,to condua ad work on my property. I will I enstere that all cent:rate liars cithci haYc Yvorters'compcmation attune:me or are viilk i I I.C3 Electrical repairs or additions proprwlvra with ni)CittpluyevN ! 12.0 Plumbing repairs or additions 3.0.am a govrral contractor and 1 6104 c hued thc 51.111-cuntractor5 listed on the afttudial iher.A., Thes b ntra I 31:1 Roof repairs e su -coctor s IvsYa empkiyem anti have wurkcm'comp.insurance.; - : l 41q0t1tvl_fee _.4.t2L4,- __5:...6 6E3 Wc an a corporation anti 115 officers have exercised ascii right of c veroption per MU . 152.§1t41,and t;e haw on employee's.[No 1.4orkimi'comp.anacranee required.] fr.--4- € P45 r i' ga *Any applicant-that checks boa al most alau(di out the section below Alms ing their*misers'compensation policy information. ' tiornoovencrs A ho huinnil that.affidavit irtaicattny they are doing all wirti;and then hat outside contractors must 3,dbilEll 3 Usai...affidavit sadicatmg saa:h. '4.2untracturs that check this box mina attached an adaitional Aver showing the name of the vo II-contractors atul AMC vilyether or nut dame entatim have ce$ If the sul",cortr,c....o..la.'.'onriluvccs.thicy must provide their ''.t o;i.et, ..,:litr, pulley 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: • ______ Policy#or Self-ins.Lic.tP. Expiration Date: lob Site Address: City,StateiZip: Attach a copy of the workers`compensation;tube, declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a tine up to S1,500.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator,A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penoltieA at perjury that the information provided above A true and correct SignJtup.:: --27 ..------ Dui, phone 4: 4 (-1 cC( i-i. . - - - -- --- - - -- - - - " - tyficial use only. Do not write in this area,to be completed by city or town official City or Toss n: Permit/License#, issuing Authority(circle one): I. Board of Health 2.Building Department 3.Cky/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector t).Other Contact Person: .9 9 /, ,. . .",...,,,C9 def--,c "eiAl a,,.,.,. �`� 1. ._.._ £�j srooddns biz • r r o J� fi `C 711aq' 11 �, --‘I' S�,f _— � _ w JT • 4 ~ P$P$P$ w, : i t L,4. I PlQie -z 3 / -ti W Ni oi 3-vv, -.„.1,),,..,ni a2Q1f pA 10 AlL.y . Q9 ,, )az" BU y^ a 'v 4,vvV1 Q_.1 l_. gb } !r 1r l �} i m a E E �......,m. .. «me....e,e.,.—..,_.emP_e....m.......mm.,.»... e................�..,..m. , i / 11 t 6 • t �. (� O Q . ) 01 v op,A/V" .AN * 7 �� a1,.,4.(1 ,yv c79 --T 7' .90 0 77 '19inh,,w al A zevl,d.J 1i J J9d c ilk° -,‘