29-199 (5) BP-2023-1358
39 OVERLOOK DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-199-001 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-2023-1358 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
GOLD STAR INSULATION &
Est. Cost: 3000 CONSTRUCTION LLC 065992
Const.Class: Exp.Date: 03/16/2025
Use Group: Owner: STOUT, EMILY&BRESS,JOSEPH J.
Lot Size (sq.ft.)
Zoning: WSP Applicant: GOLD STAR INSULATION &CONSTRUCTION LLC
Applicant Address Phone: Insurance:
1 CONGER RD (774)3294664 65620B5N23815620
WORCESTER, MA 01602
ISSUED ON: 09/27/2023
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERIZATI ON
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:
' 1 3-r .
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
. • uti-,-r )96q
7
\ SEP ? 7 7023
. _... ...
The Commonwealth of Massa huset
,,, ,- Bwrd of Building Regulations an
1 - Massachusetts State Building Cod 780 CARRTHAMPTON,MA 0 TIONS FO Lay
Building Permit Application To Construct, Repair,Renovate Or Demolish a Revived Mar 2011
Sla sOF BUILDING INSPE
One-or nto-Family Dwelling
This Section For Aida!Use Only
Building Permit Number: ____6 Or- ,„.1 .-,.71...)& ate Applied:
—Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pronerty Address: 1.2 Assessors Map& Parcel Numbers
1.1a Is this an accepted street?yes no Map Number Parr. 1 Number
1.3 Zoning Information: 1.4 Property Dimensions:
&fling District Proposed Use
tot Arca tsq ft Frontage lit)--
4
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided .,, Required Prot i,I,I itc,iLprzki Provided
I
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public 0 Private 0 Check if0 Municipal 0 On sue disposal system 0
yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 C, r1 ofalecol
Name(Print) City,State.ZIP
--3 la ve. (c)c) 4 by- tki Y4,31 11/‘I c.-No 4)4,il.f 5rri.I.coo,
No.and Street Telephone Fmail Addres(
SECTION 3:DESCR1 P'FI ON OF PROPOSED WORK2(eked all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 klteration(s) 0 Addition 0
Demolition 0 Accessory 1314, Number of Units Other -\,011
Brief Description of Proposed Work': , 7kt!--:— _0,0_,
_
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated costs:
Item Official Use Only
(Labor and Materials)
• I,Building S 3 COO I. Building Permit Fee:$ Indicate how fee is dett-rmitied:
2.Electrical S 6 0 Standard City/Town Application Fee
0 Total Project Cost'(Item 6)x multiplier x
' - 3. Plumbing $ 0 2. Other Fees: $
4, Mechanical (11VAC) S 0 List:
5.Mechanical (Fire S 0 .„.._
Suppression) Total All Fps• .. 4.,
`---) Check No, Check Amuun)jl Cash Amount
.._,..
().Total Project Cost: S } oCb
i 0 Paid in Full El Outstanding Balance'Doc__...._.., _
6 41
•
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
OP-1'N License Number Expifation Date
Name of CSL Holder
I&-7 Yvia—i\o% S4-r\e-e,ch- List CSL Type(see below) (1
Type Description
No.and Street
i - f"f1 U
, Unrestricted(Buildings up to 35,000 cu.
R n.)
Restricted I&2 Family Dwelling
Cityfrown.State.ZIP NI Masonry
RC Roofing Covering
WS Window and Siding
' I SF Solid Fuel Burning ApplianCes
*11 If 3`254,Cif I Insulation
Telephone Email address I) Demolition
5.2 Registered Home Improvement Contractor(HIC) •••CLtiralc a 3 1
,.,...ot.c, „crle....c .#yv S J k4'•r4^N H1C Registration Number Ex ration te
HIC Pe‘mpan Name or HIC ROs_tcytr t Name
No.and Street •-•' Email address
C 54-ea/I...„. .....____
CityTown.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 oft e building permit.
•
•
Signed Affidavit Attached? Yes 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 1 CC\ 11,1
,to act on my behalf,in all matte4 s relative to work author' d by this buil 'fig permit application.
Print Owner's Name(Elleetrt MIC SIVItallire) Da • ,
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.
C':
Print Owner's or Authorized Agent's Name(Electronic Signature) D.re
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 nor have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important in lotination on the HIC Program can be found at
www.mass.eovioca Information on the Construction Supervisor License can be found at www.mass.eovidos
2. When substantial work is planned,provide the info,illation 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"
10` Ildi
City of Northampton
.*.S /,
Massachusetts 47/'
r- e DEPARTMENT OF BUILDING INSPECTIONS %
212 Main Street * Municipal 'Building
Northampton, MA 01060 41
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: Vc-S---e- 49j . IA Location of Facility: -1 6 LA)
The debris will be transported by:
Name of of Hauler:
Signature of Applicant: Date:
AmmomommiliNumminunimmine
The Commonwealth of Massachusetts
Department of Industrial Accidents
..
1 Congress Street,Suite 100
Boston,MA 02114-2017
--.7.--„. .,,, iv ww.mass.gov/dia
'—' ll'earliers Compensation Insurance Affidavit:Du ilders/Camtractora/Electritians/Plumbers.
TO BE FILED NN lilt TIIE PE10111TING A IFT1101cITY.
Applicant Information Please Print Lezihiv
Name(BusincssOrganizationindivishial): id .2.4•C'r
Address:_i____/0/(r— g '
City/State/Zip: L16,5-1"Cr Phone//: ril lii 3/a9 4.Cclit
........yen an entrikn erl Check the appropriate but:
Type of project(required):
I-C;b• a employer with G _employees(full antl'ar pa:Him).* 7. a New construction
20 I imi a tole pruprichar or Formers/up and has e no employers working for me in S. [3 Remodeling
any capacity,[No wirrIciaa'camp.sanatoria: reaturni.]
9. E]Demolition
30 tarn a hornaussTla 410114 all nod.mrielf„[No worlicas'comp.insumince required j'
101:1 Building addition
ar:JI am a homeowner and will be hiring otslitracion to conduct all work on my property. kcal
moire that all contractors either hate workers'compensation mammy or are sole 111:1 Electrical repairs or additions
proprietora with.no employerni.
12.0 Plumbing repairs or additions
,c3 lam a general eontractor and I hace hued the cub-emir setors[idol un the attached sheet.
131:j Rok)Irepairs
Those aub-contractors tract employ cm and ha\c workers'comp.insurance.:
60 Wr oor a cmeporation and iis officers taa%e exorcised their nght of exertions.per MU e.
152,ti(i).and a c ha Ye no employee% [No nutters'comp.insurance required.'
•Axis 4ritilt....-it that checks but a i mug also fill out the section below show ing their worlir.t.'curriperti..shon poly information
'Htirmitist ricrs i..Fur%damn dos atTsdac it indicating they arc doing all work and then hire auto&cantractorn mud uemit a new a fikta%it indicating cuch.
't orioa:toni that chock this but,mud attached an additional sheet shining the name of the sub-contractors and date an hether or init those mac,lia,c
einpliiy cea litho oilocontractie%hi, einpliiy es:,0,,,,r.,1 pros id.:lhcir unriter.•cutup.polio,MAIII,,
I am an employer that is providins:worAers'compensation insurance for my entployees. Below is the policy and job site
information.
Insurance Company Name: let C‹.. % 0'1 ec kLI..aNtrk ,.
Policy St or Self-Ms,Lic.n: c k s i (3 9 -Cdd Expiration Date:___1/31)Ai _
Job Site Address 3/ t f/RI /Cq‘-- D r City/State1Zip:4/c131s1:1-ett 21410
Attach a copy or the workers'compensation policy 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 S i,500.00
and, one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a
day against the violator.A copy of tbis statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ida hereby certify under the pains and penalties of perjury that the Information pro l'ided abo e is true d correct.
Signature: ...—. ....."4-4.'rfr7'...---..—...---
Date: 7 d7 c)
Phone o' 7-7 q 3),1 Li aii
Official use only. Da not write In tins area,to be completed by city or town official
°
1 tits or TOVIII: Permit/License 4
Issuing Authority(circle one):
I.Board iif Health 2.Building Departnirtat 3.Cityfrown Clerk 4.Electrical Inspector 5.numbing Inspector
6.Other
Cmitart Person;
Phone 4:
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City of Northampton