31B-042 BP-2023-1731
29 SUMMER ST COMMONWEALTH OF MASSACHUSETTS
1B042-01Map:Block:Lot: CITY OF NORTHAMPTON
31 B-042-001
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-1731 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS 2023 Contractor: License:
Est. Cost: 60000
Const.Class: Exp.Date:
DANIELS MARY A& DENNIS E & SHIRLEY
Use Group: Owner: CONNELLY & E DANIELS
Lot Size (sq.ft.)
DANIELS MARY A& DENNIS E& SHIRLEY
Zoning: URC Applicant: CONNELLY & E DANIELS
Applicant Address Phone: Insurance_
29 SUMMER ST
NORTHAMPTON, MA 01060
ISSUED ON: 12/12/2023
TO PERFORM THE FOLLOWING WORK:
REPAIRS FROM INSECT DAMAGE - SILLS AND JOISTS
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:
'!lough: Rough: House # Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final: O < i /If/23
P"fr /,
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
4 • y2 - 9-111,
Fees Paid: $390.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
BP-2023-1731
29 SUMMER ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31B-042-001 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-2023-1731 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS 2023 Contractor: License:
Est. Cost: 60000
Const.Class: Exp.Date:
DANIELS MARY A& DENNIS E & SHIRLEY
Use Group: Owner: CONNELLY & E DANIELS
Lot Size (sq.ft.)
DANIELS MARY A& DENNIS E& SHIRLEY
Zoning: URC Applicant: CONNELLY & E DANIELS
Applicant Address Phone: Insurance:
29 SUMMER ST
NORTHAMPTON, MA 01060
ISSUED ON: 12/12/2023
TO PERFORM THE FOLLOWING WORK:
REPAIRS FROM INSECT DAMAGE -SILLS AND JOISTS
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:
)2 . •
Fees Paid: $390.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
r i
Efri 0
GoL�W%1-4.04 -' -C - .t%lQ5�_ 40 GOA lakL :L.O t-q
14 3 The Commonwealth of Massachusetts _.
W
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPAL TY
USE
c_.)Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 011' z
,1_, One-or Two-Family Dwelling :.` , a a
CM This Section For Official Use Only Lii' g W
s
Building Permit Number: .. „j ,3- 1 7O( Date Applied: 1> a D_
a1 0z
ie...--1)4 ice- `''/l /2-IZ
Building Official(Print Name) Signature Date ;� o
SECTION 1:SITE INFORMATION i LIn, 0w 0 0
:. I 2-
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers _ _ w ,
a.q Sneaker v 01 o( 0 i
1.1 a Is this an accepted street?yes t f 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 yesO
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner'.of Record:
Dei1)t5 £JAttaal-4 kid r#-kJ-clip h"..
Name(Print) City,State,ZIP rr l
tq St)Miner S-t y/3-S)b- kia2') 6loidr16��r tee e C' )I.oi
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building e Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work': tit p i r f Tl_t C -+ Q it off' ' Sie.t.s r=LDO(L
JOis1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ‘D e)0� 1. Building Permit Fee: $ Indicate how fee is determined:
r/ ❑Standard City/Town Application Fee
2.Electrical $
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ J 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ .J�
Suppression) Total All Fees:,9y It'y�q
Check No.A 1 A heck Amount: t% ( �Cash Amount:
6.Total Project Cost: $ (d Oe p 0 Paid in Full 0 Outstanding Balance Due:
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
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
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 this application is true and accurate to the st of my knowledge and understanding.
nn Owner's or Authorized 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"
City of Northampton
..'"',..S/C,
Massachusetts ��?': i� 'ee
DEPARTMENT OF BUILDING INSPECTIONS 4
212 Main Street • Municipal Building vy, Ob
.-- Northampton, MA 01060 Pg1 %
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT i 6 f )- /' /F
De,r1 n n t I s (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 perju s . this Wilay of reCei4r,- ,20 z3.
(Signature)
City of Northampton
. . si
Massachusetts ���� c'<<
N *
'd I1' w
•c 0 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building Jy CD
Northampton, MA 01060 �sN 7\\
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:
The debris will be transported by:
Name of Hauler:
Signature of Applicant Date: 0- — ° —�3
The Commonwealth of Massachusetts
iDepartment of industrial Accidents
Li �' I ._ -; 1 Congress Street.Suite 100
z.(kkv.
Boston. .tf.t 0 114-101'
,~' wtt,►l:mriss. of/ilia
1l ut kers' ('unipensalion Insurance.lfftdas it: Builders.('ontractorvElectriciansiPlunthers.
t(1itr-1,11.1.1)NIlll IlII•-I' .R%tll IIM;Al ilIORJI1.
Applicant Information Please Print f.ei:ibls
Name(Husincss,Utttanoation:Individual):
Address:
City./StateiZip:_. Phone ir::
Art*Jens 0a nisi l( to llEack the apprupriaio tors: 'Type of project(required):
1.0 1 am a engrlova with erntrlovves hull endue putt-linen.• 7. 0 New construction
10 I am a sole ptupnerur ur partnership and base no employees wonting for me m B. O Remodeling
any capacity.(Nu workers'comp.insurance nyuirail
9. ❑ Demolition
�1.�1-arn a homeowner doing all work myself.[No workaaa'comp_insurance moored.)
10 Q Building addition
�4.a I am a homeowner and will be hiring contractors to conduct all work on 1ny mown). I will
unsure that all coruraeIurs either ILLY a workers uags.nsanem insurance ur are sole I In Electrical repairs or additions
prupnators w isle no employees 12.0 Plumbing repairs or additions
sO I am a general contractor and I has a lured the sob-euotraeturs listed on the attached sheer.
These sub-contractors base employees and has e workers'comp.uniuranee. 130 Roof repairs
ti.Q We are a eorp.catrun and its officers baseeseri:wed their nubs of exemption per M(rL c. I4.0Other
152.;1141.and w e lime no onpluyccs.[Nu workers'comp.insurance required.'
'Airy applicant that eho'ks box al must also till out the section Laluw shun mg then 1.4 urkurs'cunrp:m.4.n n pulrcy uitunnutwm
' Homeowners who submit this Aida;it indicating the}are doing all work and then hire outside contractors mint submit a new atfrdas it indicating auck.
•L ontrxturs that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or nut those entitle lase
emph.yee lithe sub-cuntr.cuvs kiss:a rrmIi, :es.they most provide their Aorkers'c.rnp. 'uhc.uurnbet
I am on employer that is'providing workers'compensation insurance•for my employees. Below IS the policy and job site
information.
Insurance Company Namc:_
Policy x ur Self-ins. Lie. #: Expiration Date: -
Job Sue Address: City:State Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date'.
Failure to secure coverage as required under NGL e. 151 *25A is a criminal violation punishable by a fine up to 51500.00
andior 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 this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 du hereby certify under the pains and penalties of per urn that the information prodded above is true and correct.
Stcnature —'� 0Th -.i-L- i) AC: I �_— e—
Phone#:
Official use only. Do not write in this area.to be completed by city or town ufficiut
( its or To►sn: PermillLicense ai
Issuing Authority (circle duel:
I. Board of Health 2.Building Department 3.('ity:1 own Clerk 4.Electrical Inspector S. Plumbing Inspector
h.Other
Contact Person: Phone#: