17C-218 (13) BP-2023-1375
29 NORTH MAPLE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17C-218-001 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-2023-1375 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIR FIRE ESCAPE 2023 Contractor: License:
DOUGLAS B THAYER DBA
DOUGLAS THAYER
Est.Cost: 1500 WOODWORKING 107699
Const.Class: Exp.Date: 04/07/2024
GRIMALDI KATHERINE RYAN &JOHN OLSON
Use Group: Owner: PICKARD
Lot Size (sq.ft.)
DOUGLAS B THAYER DBA DOUGLAS THAYER
Zoning: GB Applicant: WOODWORKING
Applicant Address Phone: Insurance:
P 0 BOX 60322 (413)530-4785 6HUBGR15002
FLORENCE, MA 01062
ISSUED ON: 10/04/2023
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO FIRE ESCAPE
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:
9F.,
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
igiall
Office of the Building Commissioner
cF
The Commonwealthof M hu tt ° /ea assac s Cj
" Board of Building Regulations and Sndar4l Q OR
`\ Massachusetts State Building Code, 780 CMVIRo..���� <90 ,,IUIP. ITY
r ii
Building Permit Application To Construct,Repair, Renovate Or' fl. • . ' • ised ar 2011
One- or Two-Family Dwelling 0�t'"� '''go,Qno,
ty
This Section For Official Use Only �0
Building Permit Number:5 j.1j • J3 75 Date Applied:
II 9 I
` ` 1 i; '— . f o 3
Building Official(Print Name) Signature t 7 e
SECTION 1: SITE INFORMATION
7 I�1.P operty Address: �e 1.2 Assessors Map& Parcel Numbers
g Na nth —
I.I a Is this an accepted street?yes S 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 r'of Record: Alf
Iii"A IC I,aIft&tc I s Pank- J L< ie(o(
Name(Prink City, State,ZIP
I PaKk` PA 9(3— 2Y7- loft
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)A. Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
P 0 A rt S RK Q�
2 nd uocN e9 res6 �;re, ese d
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ ` bOQ 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ _ 2. Other Fees: $
4. Mechanical (HVAC) $ — List:
5. Mechanical (Fire $ Total All Fpqifftl
Suppression)
Check No. Check Amount. W Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES /
5.1 Construction Supervisor License(CSL) C S 107 pq 9 o7/j V
'Do f� \q 5 They sr License Number 7 l Expirationr` Date
Name of CSL lder i
n Z` c2.0)(
x ('/o361� List CSL Type(see below)
No.and Street T e Description
Aj Unrestricted(Buildings up to 35,000 Cu.ft.)
Flo���t<< R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
C
(3- SI0-'/7 p S I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ' 796 SS 10f/X/y
DJP k5 -r�� HIC Registration Number Expiration Date
HIC Com Name or HIC Registrant Name n
s spYN4 S * yI3 floe iss 7h i4 krtdI tcor,
No.and Street ! l /1 O �2G_Y7 U Efnail adds
City/Town, State,ZIP Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.C.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 O(4 rq3 Th i "
to act on my behalf,in all matters relative to work authorized by tht�, building permit appli ation.
SQvldra �rQkc.c 1424
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 penaltie of perjury that all of the information
contained in this application is true and accurate to the best of my knowl dge and understanding.
act, Thu tt
Print Owner's or A horized Agent's Na�e(Electronic Signature) Date
NOTES:
I. 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"
it
City of Northampton
A'' >A Massachusettse �- '">
I 1' DEPARTMENT OF BUILDING INSPECTIONS t .'
`
�`� ��: ,C 212 Main Street • Municipal Building ,s,J .?
a s.
Northampton, MA 01060 s1'byy, 1/.,A1� "
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: GPI lie1 2C�C CttilyS
The debris will be transported by:
(--- 1
Name of Hauler: 1 0 k la 1-114l' i
Signature of Applicant: ii, ,� Date: /0/V02-
�
The Commonwealth of Massachusetts
Department of Industrial Accitlents
4 i,,I=A..... I I Congress Street,Suite 100
',.... ra. . ow 1
,f4, ,i.,„:‘4,,,,..,
Boston, MA 02114-2017
'..::: ..•,i.,,,,,,,..,,,,: www.mass.gov/dio
ii'oilkers' ('ompensa thin Insurance Affidavit:Builders/ContrattorsiElectricians/Plumhcrs.
'It)RE FILED WITH THE.PERMITTING AUTHORITY.
Applicant Information Please Print Leib
Name illusiness,tirganizaiioivtridieicival): 1)(3c.i 4 ¶
Address: 6)0 63.0 , 63,2),_Fl _____.
City/State/Zip: Qvte‘i,c, 11 A- Phone #: ytl- s)6- y 7 g f
Are yea Eztti employee!Cheek the appropriate has: Type of project(required):
1$1.1.ant a erripkryer with77 _employees(fall anskin pat.-hart).* 7. 0 New construction
2C1 I arn.a sole proprietor or partnership and have no eittployeas working for me in 8, Remodeling
any CA rocky[No worked*coarip.insor.JfICV requireil
9. " Demolition
30 I am a hooray*nor doing all work myself,[No workers"comp.insurance regulated.]'
i I 0 CI Building addition
t..C3 I ama homeowner and wilt he hiring comaractori to conduct all work on my property. I will
mute that all COVI3EALIVA either have workers"isargansatimi insurance or are sole It.C3 Electrical r•,.,:irs or additions
proprietors with no employed.
12,0 Plumbing repairs or additions
50 I am a general contractor and I have hired the sula-coutracton listed on the wailed ailed.
130 Roof repairs
These suts-anitracton have employees and have warted*camp,inurrance.:
14:0 Other
6. We are a tarporistion and its officers have exercised their right adenoma per 1‘.461 e.
1$2.,0(41,and we have no ariployoes.[No workers*comp,insurance requiseill
—
'Any applicant that checks bra n.I man"also fill out the-section below showing dart workers'compensaion policy inierauttion.
1.Ileancownets who!iiil,ma this affidavit intticeiny they sac doing all work and then hoc outside contracIors nada submit a new affidavit indiaiting such
4."..intractors. that check this box must attached an isidniunal sheet show me E.br name of thy. sub acid tale whefila ot not awst vilitics 11.3 .t.
_:lt:111..1±.,eetL If the sub,....untr.lh:ten-",l',4“.:,:rrepleyee.i,day must provide their workers'comp Folk's Trumbvr
I am an employer that Lc providirtg workers'compensation insurance far my employees. Belo 4"iie the policy and job site
information.
Insurance Company Narile:, -IV PVC(IR r1/5 ._.. —
Policy g or Self-ins. Lk..#: 6 our5 - 6- pi SoO Expiration Date: i /i4&iji
_ ,
Job Site Address: 9 '7 NONA' II ar I e , City/State/Zip: F/OICH.2 ail
Attach a copy of the workers'cotripen.sation policy d laration page(showing the policy number and expiration date).
Failure to secure coverage as required under?AGE c. 152, §25A is a criminal violation punishable by a fine up to S1,5()0:00
andlor 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
da) against the violator.A copy of this statement Inlay be lonvarded to the Office of Investigations of the DIA for insurance
COVerage verification,
I do hereby certify ander the ins and penalties of perjury that the information provided nb9te trite and correct.
Signature: ,_.)Z5) I.).oc.
Phone g: (iii- 30 - 547 3
rilTfilerai use only. Do nut write in this area.to be completed by city or town official.
City or'Town: Permit/License#
Issuing Authorit:k (circle one):
I. Board of Health 2, Building Department. 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other ,
Contact Person: . _ Phone*: