25C-081 (4) BP-2023-1356
321 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-081-001 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-2023-1356 PERMISSION IS HEREBY GRANTED TO:
Project# RENO 2023 Contractor: License:
Est. Cost: 5000 KD CARPENTRY INC 111815
Const.Class: Exp.Date: 01/28/2025
Use Group: Owner: HEALTHY NEIGHBORS GROUP LLC
Lot Size(sq.ft.)
Zoning: SC/URB Applicant: KD CARPENTRY INC
Applicant Address phone: Insurance:
7 SOUTH STONE MILL DR 3FH 1658
DEDHAM, MA 02026
ISSUED ON: 09/27/2023
TO PERFORM THE FOLLOWING WORK:
REPAIRS/REPLACEMENT WINDOWS
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:
ActilL., -
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
t
*eme si &1
fila .J sep Fp
The Commonwealth of Massach setts J
roe Board of Building Regulations and .nd (90 FOR
Massachusetts State Building Code, 780 04 i'°yq��,oq ICIP• ITY
•
Building Permit Application To Construct,Repair, Renovate Or ..-f oOh vise' ar 2011
One-or Two-Family Dwelling *Oh
o� S .
n
This Section For Official Use Only
Building ermit Number: +34)'•'-i 3 I35G Date Applied:
/ kV/aJ i Z5 • f"27"2625
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
.,3 2. / Z3pi fe J�'f /�/rth , Oi 0 �.la,,�y 0
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 Owner'of Record: 44
/teed/f47 /1/4y!�6e hood S G/'o%�� lCC 32/ BIn .f7'-• jvo44.04,d i 2/oCo
Name(Print) City,State,ZIP 4 atiM y 4ely,4erAoJ15
3 2 / Cfril e If• V/3Sos-V39/ V3Marl.6nM
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': r-e'OQip 6-Ct s-te," T,+ dry74'i/ O i1�ni 41(,4 ,
4 ref J4.CP,+4 hi��o�f1 1Aly/ ci ii, ,;f 4Pvra,orJ•
o z. >`-4'115 D 29 •
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) _
1.Building $ 5, .,.,,, 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
estk Suppression) Total All Fe : 1
Check No. Check Amount:
6.Total Project Cost: $ S oe o 0 Paid in Full 0 Outstandin�:alance Due:
City of Northampton
Massachusetts f
,> DEPARTMENT OF BUILDING INSPECTIONS Sk °
212 Main Street • Municipal Building trtr
Northampton, MA 01060 NY.�
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled 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.
fr
1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction SupervisorLicense(CSL) C. 'I lq C a 5
ID(- - C7� / /' �l-W License Number `� xpiation Date
Name of CSL HolderA-4
n , (kl lk di
vC +5 List CSL Type(see below) di, �� ,�G
No.and Str et S Type Description
eo\ e A r�1 p 0 Qo C ® ) Unrestricted(Buildings up to 35,000 Cu. ft.)
11 I` R Restricted 1&2 Family Dwelling
City Town,State,ZIP M Masonry
RC Roofing Covering
AD Oo� o-BM.. WS Window and Siding
SF Solid Fuel Burning Appliances
5 0, 9s-Vscp a'\ '7 i F Go t'V (. .s S 0 14 I Insulation
Telephone Email address D Demolition
5.2 Registe ed Home Improveement Contractor(HIC) Q �� r /a f QLj
Ca re Y1. /`. HI Registration' Number Expiration Date
HIC ompppanyy Nan1e qr HICrRegi rant Name ^n i [1 d(. 1,, ,�1(.G0(u uN ESSOc�.,1� Cp Q o+Coo k.
(.) .- h , ,o -� 1�l 1
tv_nixt,rf,A, Email address C��iv) / Ob1��(o 50cic cs. \
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
XI,as Owner of the subject property,hereby authorize Li/eye) fru,1e2
to act on My alf,in all matters relative to work authorized by this building permit application.
e - z?Al
Prin wner'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 a plication is true and accurate to the best of my knowledge and understanding.
ti..t—r-, X — 9�2 23
Print O is or Authorized Agent's Name(Electronic Signature) ate
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"
t,
...,
The Cotnntonoveolth of Massachusetts
,F.1,121:11111.0.....le Department of Industrial Accidents
i / Congress Street,Suite 100
Boston, MA 02114-2017
Www.muss.govidia
1$orkers'Compensation Insurance Affithtvit:BuiklersiContractorsfElectriciansiPlumhers.
It)HE FILED wan THE PERMITTING AV-1110RJ I I,
APPliCki II I Information Please Print Letibl%
Name 413uatmcss,Organtzait,oi.individual): \-Qk Ca r (f.Wkrt s4 1\ L. a
Address: ...3 (---,2,.±.--k 5 kia.r. Q_
City/State/Zip: eQ.Z.AVI.ZIAAA N\ P- Phone r,-*: 5 0___cli-mifl,
Arc yaw an employ or?i'herk the Ippruprkatr box:
Type of project(required):
1 -
la I am a.o.uplo.±.a visth , ,,,,, cavioyets(full andspr part-tincret.' t 7 0 Neu construction
!Slam a arse prop-It:tor Or pconmailip and base nu erriployees worlong fur roe in ' 8. C..] Remodeling
illl'y carumty [No uorlwraf comp,insurance required 1
9. El Demolitton
31:11 am a iltlEIVOWISCT Litring all wort mpelf.ENo isorktis'cow.insurance miasmal'
10 Ej Building addition
la I ant a hurnorrveruz and..,,,ill be hiring contras:U*1.W conduct all%soil on rny prxwperty 1 will
immire that all contractors tither host v.Nrrkers'campotamion insunaux or are sole 11.0 Electrical repairs or addition:.
piorio.:wr kill no employees.
12.D Plumbing repairs or additions
sC3 I am a jirnmat curametut MIVILI I ha..e hued the.ub-euntraetun,tinted on the:mauled sheet
I 3,1j Root repairs
'Neu sob-Lootraccumlo%v iatiployees,aunt has c*utters'euznp.LIbloirMIX)
14,D WWI
h Ej We ore a corporation and its officers haw exercised their nest of exemption per NMI c,
I.1.2..t,1141..and lac haw no emplu)ves.[Nu%Arlen'comp.insurance requweJ.1
'At::,applicani that.1t.o.:1,,INok.1 mutt also(di out the section hekrae shost.nig their A‘eker,',...4nrkromi,in policy En tot-mann&
' 11,aineuva two,.IA NI N1.4bIllii all atr1/1141i indicating they arc Jonas all woli,and then hoc outside color-actor.,must'vlitanut a new affidas tt Ind waling stieh
:Contractors that cheek this box must attached an additional sheet shirk inn the name of the sub-contractors and)LIE holler or riot those musics ha....:
Io,Lc, if the suh-Lt31911.3i:Elir,11.2,i,:mplos c•en,tlit,) mu,1 roo,1.1,Iii.ic wuri.en:;.vtrie.i It..,nuartho
1 am an employer that is providing ovarAers'compensation insurance,for my employees. Below is the policy and job site
information.
Insunuwe Company Name: 1--.') \cs _A--'- t-, 7\A, 0 A'l)
Policy 4 or Self-ins.Lie. 4: 3 F 4-‘ ) 6 Expiration Date: 3
..,_,0
Job Sue Address: 3a) Z?.r,;be 11-. /frortAAA41 AA qg- citytstatezip: "DiZcA INaA.,,,, VA n
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under NIGL e. 152,§25A IN a criminal s halation punishable by a fine up to SI.500.00
andior one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 52.50.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations°Idle DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the Information provided above is true and correct.
Signature: Cit.j.....: .-, - Date: ,/ -- -4 / -20 -D--
Official use only. Do not write in this area.to be completed by city or town official,
City or TON n: Permit/License 4
Issuing Authority(circle one):
I. Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
t'onbict Person: Phone 4:
---
City of Northampton
e-->rx Massachusetts ,. ",
.::, ''''''' :I: ''' --1'.
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 �S k l-, �'
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: 4 . I(r/(1 ,"e/ Atl-
iThe debris will be transported by:
Name of Hauler: / ffof/g /P tv.21k-e- fo✓47101f
Signature of Applicant: //s� Date: ZY2
City of Northampton
Massachusetts
s
DEPARTMENT OF BUILDING INSPECTIONS �a
212 Main Street • Municipal Building 0L �1"
--" Northampton, MA 01060 r► t1�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_(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 day of ,20 .
(Signature)