23A-237 (2) BP-2023-1339
171 NONOTUCK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-237-001 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-2023-1339 PERMISSION IS HEREBY GRANTED TO:
Project# PORCH REPAIR 2023 Contractor: License:
Est. Cost: 6500 ZEKE ROZELL 81717
Const.Class: Exp.Date: 12/18/2023
HAGELSTEIN EDWARD L/E ERIC HADELSTEIN
Use Group: Owner: TRUSTEE
Lot Size (sq.ft.)
Zoning: URB Applicant: ZEKE ROZELL
Applicant Address Phone: Insurance:
151 NORTH RD (413)210-0300
WESTFIELD, MA 01085-9721
ISSUED ON: 09/27/2023
TO PERFORM THE FOLLOWING WORK:
REBUILD FRONT PORCH
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:
8 .
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
.. .
RECEIVED
i
The Commonwealth of Mass chus tts $EP: v , Board of Building Regulations a d St dards2 5
2023 FOR
Massachusetts State Building Co e, 7 CMR MUNICIPALITY
1?FRT O r. USE
Building Permit Application To Construct,Rep it Renq �f DON Revised Mar 2011
One-or Two-Family Dwelling A 01060
This Section For Official Use Only --__-.
Buildiingg Permit Number: -d-.3 - ) )3CL Date Applied:
15t isJ /1Zy5, 9-27.7423
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: ` L 1.2 Assessors Map&Parcel Numbers
1-7 t Vvo,noi-ocik S'src-
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(It)
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'
2.1 Owner'of Record: 1 ,t�
rt 4�a 5osavx )4
C, c Gb A 5 \ Q t o /'
Vlore` ' \Cc5S 0 (0 & .
Name(Print) S City,State;ZIP 1.k-1I /Uoncli(.) ck fCee.�. 9\3-433 3011 'P Ua JeCplc,.\ . roM
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) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brig(Description of Proposed Work2: (2,e m o-'c O\a. 'C"�.�'� vdc—c. ( 'Ck-t.\`�1 20c.-��
G+�J� NO v \\ -4 ..1.,) -cS- � .(7or-c V
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
11.Building $ 2. 5 G o I. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fes:,
Check No.o� Check Amount:
ft Total Project Cost: $ GEO Gl ❑Paid in Full ❑Outstanding Balance Due:
City of Northampton
dig 'yl �5 si,_
- Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS fr
212 Main Street • Municipal Building
��a' Northampton, MA 01060 ss'y ,:1E��
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR, ETC.
1. Building Permit Application signed by legal owner and tilled 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 HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton. viom ik Rom„
•
1 r
SECTION 5: CONSTRUCTION SERVICES
5.1Construction S rvis000 r L' ense(CSL)
`�"'4P K/ZC /Ld0 Q/7/ 0 na
License Number Expirati Date
Name of CSL Holder U
5-7nvl'/A / 14e List CSL Type(see below)
No.and Street `�✓(1 !!1 Type Description
tt /� U' Unrestricted(Buildings up to 35,000 cu.ft.)
1�5 �{ / r /� Restricted 1&2 Family Dwelling
City/Town,State,ZIP
M Masonry
RC Roofing Covering
-- WS Window and Siding
/ //� 7/ q,' / SF Solid Fuel Burning Appliances
/l/ 0�� C( W Gt�°��fpD I Insulation
Telephone Email address c 6k? D Demolition
5.2 Re tste ed Hom ,Improvem t Contractor(HIC) �O(.,�4 �� /0 f
HIC Re istration Number E pir ion Date
HIC J /y''ame op_HIC�t gist ant Name nt��� i r n y
Na.addJ Street Email,C9 �[� Di0 1fc c)/0,0 O/� C Email a"dldfess
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 jr7. No 0
SECTION 7a:OWNER/A_UTHORIZATION 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 is applic ion is true and accurate to the best of my knowledge and understandin .
j
Print Owner's or Auth ized 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
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"
. .
The Commonwealth of Massachusetts
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'21Tirz'o
Department of Industrial Accidents
I Congress Street,Suite 100
Boston. ,11.4 02114-2017
..., 4.1
'''' ' -:47- *N14". www.moss.gorldia
IS'orkers'Compensation Insurance Affidav it:Bulklers.l'ontractorsfElertricians/Plumbers.
It)Iii.I-It.E0 SI I I It 1 IIE PE ILNIITT1NG AtrTHOR11 I.
Annlicant Information Please Print Legiblv
Name(Hits inessiOrgantzattom Indit,itiunIr Z--"ekt ',,,.- ---'?„..././
Address: /c/ if‘/(/4 e
City/State/Zip: OUt;:.54*- -,--/I
i
Phone P: //3 t /a 0 3a . ......._
.iire yowl our entplott er7 elatelt thy a pproupriale two: r -r)p,of project(required):
it]i sal a tariployer with ensphayeas(full aiall'or partth I 7. 3 New construction
am a .uk propnctor or vartnershrp and have no employees working for roc in 8. 0 Remodeling
at13 capacit., [No u torkers'comp insurance respired]
9_ ri DttrtiOiftiOn
ant a hum:owner doing all wont rn)aelf.{No win-ills'comp_insurance revise-W.1'
I 0 0 Building addition
4.0 I am a Iturosuown.a and will be burn e contractors to conduct all work.on crey property I
otsure that all contractors either&tie workers"ounipensation insurance or are sulc i 1 a Electrical repairs or additions
proprietors with no employees,
12.0 Plumbing repairs or additions
I am a general iNtntractur and I ha*...hired the sub-contractor*listed un tbs:attached sheet_
• i 10 Root repairs
These subs.uninickm,W..4:employees and base winters'cOrnp.inaliraliX.:
14_ElOthet
ro.EI We are a canparation and ib,officers hate exercised their right of exemption pet MIA c
and we halve no employees.[No'workers'comp.insurance requinsil
applicant thus checks lux:•91 mutt also till out the section,below show une their w,ni....x,'...1,131periv.Ilion Nil...), in tvcinallon
' tturneovincrs who submit this a flak:Nit ontlwatinE the:y arc douse all work and then hoc our.ide.tmlractot.mint.tibmit a new affidaN it ind waling usi.h
:Contractors that check this box must attached an additional sheet show ing the name of tho slit,-...-ontraOLors and air c J.hclho:in riot thus.:,.attlti,...-,Its.,:
,ttipluN et'. if the sub-Contractors h. ,:ntplol,oc,,th...!, mat pr pie lit,ir: ,Norkerb .vrrort roil.:.: nuontei
1 am an employer that Ls providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy g or Self-ins.Lic.g: Expiration line:
Job Site Address-, City/StineZip:
Attach a copy of the workers'compensation policy declaration page(showing the polies number and expiration date).
Failure to secure coverage a' required under M(L c. 152, §25 A is a criminal violation punishable by a finc up to S1,500.00
artiVor one-year imprisonment,as well as civil penalties in the fomt of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Otrii.v of Investigations of the DR for insurance
coverage verification
I do herein certify under the pal $and penalties of perjury that the information provided I hove is true and correct,
----..._
,
Sitnature-r . Date: f a -.3
Phone g: V ) D A)0 -)
Official use only. Do not write in this area,to he completed by city or town official.
City or Town: Permit/License g
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
ti
City of Northampton
Massachusetts 2
;\ i 'a -
DEPARTMENT OF BUILDING INSPECTIONS
` 4 212 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:
D
The debris will be transported by:
Name of Hauler: U S A _
Signature of Applicant: Date: 9 aJ aoa3
City of Northampton
Massachusetts `�r
DEPARTMENT OF BUILDING INSPECTIONS Da ;
212 Main Street • Municipal Building �,�...
Northampton, MA 01060 �4 • s'��
t
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_(insert
• month, day, year), hereby depose and state the following:
1. 1 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)
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