30B-004 (2) BP-2023-1350
54 NORWOOD AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30B-004-001 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-2023-1350 PERMISSION IS HEREBY GRANTED TO:
Project# PORCHES 2023 Contractor: License:
Est. Cost: 13200 BEAUDRY HOME IMPROVEMENT CSL108605
Const.Class: Exp.Date:03/20/2025
Use Group: Owner: FONG HERMAN J
Lot Size (sq.ft.)
Zoning: URB Applicant: BEAUDRY HOME IMPROVEMENT
Applicant Address Phone: Insurance:
117 FERRY ST (413)320-1348 6S6OUB2E863000
EASTAMPTON, MA 01027
ISSUED ON: 10/04/2023
TO PERFORM THE FOLLOWING WORK:
REBUILD 2 FRONT PORCHES
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector I
Underground: Service: Meter: Footings: (.0�� )a/ I as
1 r ►
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame: 6,V.; l0-Z7•Zw K Q
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:0 K 0-2:7-23 u�K
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
It
Fees Paid: $86.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
BP-2023-1350
54 NORWOOD AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30B-004-001 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-2023-1350 PERMISSION IS HEREBY GRANTED TO:
Project# PORCHES 2023 Contractor: License:
Est.Cost: 13200 BEAUDRY HOME IMPROVEMENT CSL108605
Const.Class: Exp.Date: 03/20/2025
Use Group: Owner: FONG HERMAN J
Lot Size (sq.ft.)
Zoning: URB Applicant: BEAUDRY HOME IMPROVEMENT
Applicant Address Phone: Insurance:
117 FERRY ST (413)320-1348 6S6OUB2E863000
EASTAMPTON, MA 01027
ISSUED ON: 10/04/2023
TO PERFORM THE FOLLOWING WORK:
REBUILD 2 FRONT PORCHES
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:
)J1
/I
I
Fees Paid: $86.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
/ /�
The Commonwealth of Massachuse s ,'r�c c26, 1/4�R
Board of Building Regulations and Standa e?r cG
Massachusetts State Building Code, 780 CM' ti�z;,,p4t M USA Y
ro��
Building Permit Application To Construct, Repair, Renovate Or II: ,41% evised ar 2011
One- or Two-Family Dwelling %el/0+4,
This Section For Official Use Only
Building Permit Number: 6 a-aj - /3;-0 Date Applied:
BuildingI% i %!i ..2.31/2 0 I/ .3
Official(Print Name) Signature g
SECTION 1:SITE INFORMATION
(5.1. 1.1 qtrer ddress:d 4v1 1.2 Assessors Map&Parcel Numbers
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.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 Own 1- of Record: chly r n 1 . 4 woo
Name(Print) City,State,ZIP
SL( Norwood A- e. ri/?.-al O-377 1 h j oh j 100 u�rb .L'i
No.and Street Telephone mail Ad res.
SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition ' Accessory Bldg. 0 Number of Units Other 1Si Specify: -FYun1- eir6k y-e6wid
Brief Description of Proposed Work':
a 5mo i -Ent porokt5 re bail 1 (f,v p- ±- anc c,dewalk
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ / 3 , .0V 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ / 0 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All F`�: j
Suppression) VV ��
i gs
Check No. Check Amount. Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
uet o PLA1., - CaLI-en- t
IkrT3-t M*lr 9-Z7
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Super' or License(CSL) ' OW/„Q
111('� eM) ', { uel License NumberU Ex ratio Date
Name of CSL Holder
11 (�D rrl s f List CSL Type(see below) Ut
No.and streets Type Description
l�__QS G wO)0 f 4 0 1 t 1 U Unrestricted(Buildings up to 35,000 cu.ft.)
t`--� /" 1 �7 R Restricted 1&2 Family Dwelling
City/Town,State.ZIP M Masonry
RC Roofing Covering
WS Window and Siding
(J/3,.3?0'1 z W m( )i 1,5 y qn t A Q h�,� SF Solid Fuel Burning Appliances
7 v0 ✓ l.�J I Insulation
Telephone Email address D Demolition
5.2 Repkered Home Improvent
jContrract�opr,�,(HIC) � 7 G979
C.W u "V. 44 t p t U Y ea Fctil- HIC Registration Number Exp' ion Date
HIC Co any Name o HIC Re ' trant Namb
7 F-e a6 &rn( un f McbIcy @ a1iva. Con
No.and �y /l //� ,�I'_ E�ail address
4Gl Vd9- "1 3 32-(/ (�
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 a)JL)LQMJ a efil#1 di'
to act on my behalf,in all matters relative to work authorized by this building permit applicatii.
ro
, evh14fl Ponqla(f) d-3
Print Owner's Name(Electronic Sign D,to
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.
Print Owner's or Authorized kgent's Name(Electronic Signature) Dat
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
et Department of Industrial Accidents
7- 1.•— 1 Congress Street,Suite 100
two,
` t� Boston, MA 02114-201'
c\r>;..0 ww'W.mass.gokldia
110,1-kers'('nmpensatioa Insurance Affidavit:Builders'( ontractorslElectricianslPlumhers.
TO BE FILED%s til'f 11E PER%il'1-1'I\C At'THOR1Tl.
Applicant Information Please Print Leei his
Name(Business;Orgamzation lndn dual 1: 6`a.Ud el )--1mi .r-4hpro e en`}-
Address: 10 Ftrry St Cc151-hutA- - n / 414- -o 1d pa
City/State/Zip: Phone#: (.13- 3 J _
Are)oa an employer'(heck the apprupriate hos:
/� Type of project(required):
1. 1 am a empkrver with O`` employees(full andii a prat-timel-*A7. New construction
2 I am a yule proprietor or partnership and have au employees working fur pre in K. Remodeling
any capacity.[No workers'comp.insurance required.] ❑
30 I am a homeowner doing all wort myself.[No*orlon.'comp.insurance required_]'
9. ❑Demolition
d.01 am a homeowner and will be hiring contractors to conduct all work un my property_ I will 10 El Building addition
ensure that all cumirw1ora either have winker;LYrnpennalnm insurance or aie sole l 1.a Electrical repairs or additions
proprietors with no enployees.
12.0 Plumbing repairs or additions
So I am a general contractor and I have hired the sub-contracture listed un the attached sheet_ 13❑Roof repairs
'These sub-eontracton base employees and have workers'comp.insurance.; ���� ye b�l�dS
6.0 We are a corporation and its officers have exercised their nght of violation per MGL c. I4_ Other
152.§1(al,and we have no employees.[No workers'sump.insurance required.]
*Am appli..urt that checks bin art mint alsu till out du:section below showing their workers'compensation policy information.
t Homeow tiers who submit this affidavit indicatane they arc doing all Murk and then hire outside contractors must submit a new affidaa it indicating such..
"untractun that check this lox must attached an additional sheet showing the name of the sub-Cuntrretoin and state whether or not those imim y have
employees. lithe sub-contractors base enrrpk, ccs.they must pros idc their worker"color.poic:+number
e
I am an employer that is providing workers'compensation insurance for my emptorees. Below is the policy and job site
information.
Insurance Company Name: ".(1‘Q -1:Ar —
Policy#or Self-ins.Lie.#: -ECi(9 00')--j Expiration Date: .c1 i J .j
Y
Job Site Address: j`"y war t;� A' e City?State:/Zip: No are�1 j', ' 'J G i V 6 b
Attach a copy of the workers'compensation polky declaration page(showing the policy number and elpirati6n dater
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S 1,500.00
antor 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 penalties of rjury that the information provided abo.e is true and correct.
Signature: a Date: 9
Phone 4: Mj V /34`"
Offit•htl use onll-. Do not write in this area.to be completed by city or town official
('its or lossn: Permit/License#
Issuing.tuthturity Icircle one':
I. Board of I1calth 2. Builtliii Department 3.Cit!,'fossil Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.()(her
( intact Person: Phone#:
City of Northampton
•' Massachusetts At, --- -,-
# G.
• • ! •� y DEPARTMENT OF BUILDING INSPECTIONS y �°
r'''1 "' 212 Main Street go Municipal Building ' . t
~r,s� Northampton, MA 01060 'SHjq 1,,"
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: Vt A )k1y d' E-0 Ir }11, (4 IiUitP'fl1\)fV'\P1.
)*
The debris will be transported by:
Name of Hauler: ( CUiv'y h .kph nlA nt Pd- TYck
Signature of Applicant: Date: V26/023
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