23C-097 (2) BP-2023-1680
137 BAKER HILL RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23C-097-001 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-2023-1680 PERMISSION IS HEREBY GRANTED TO:
Project# BATH RENO 2023 Contractor: License:
Est. Cost: 38600 KEITH GUYER CS-095143
Const.Class: Exp.Date: 02/16/2024
Use Group: Owner: DOLE CHRISTOPHER T&JOY R HOWARD
Lot Size (sq.ft.)
KEITH GUYER dba KEITH GUYER CUSTOM
Zoning: URB Applicant: CARPENTRY
Applicant Address Phone: Insurance:
60 RIVER ST (413)768-0607 WC531S621408013
BERNARDSTON, MA 01337
ISSUED ON: 11/29/2023
TO PERFORM THE FOLLOWING WORK:
BATH RENO
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: I )1
�' Iv
, ‘
Fees Paid: $251.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
19, 04.,./ �
v42
The Commonwealth of M ssack
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Board of Building Regulations andSOR
Massachusetts State Building Code,78(l'eftli°�c;�,�� USECIPALITY
v S p
Building Permit Application To Construct,Repair,Renovate R iced Mar 2011
One-or Two-Family Dwelling so S
This S tion For Official Use Only .r
Building Permit Number: _1 'st.3'0 fC 50 Date Applied:
,) (Z5 //� //• Z9 xL , .2d23
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1. Property Addres : 1.2 Assessors Map&Parcel Numbers
!�7 g�.k-c r' �1►11 ��
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 OWNERSHIP1
2.1 Owner'of Record:
<So 4 Howi-re Ekt-enC.e , MA, _
Name Vnt) City,State,ZIP
137 ac.ker 1i;ii rd
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) 0 Alteration(s))5( Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:VVe- `t L f`e> t)•N 'AL- L./h r^ , Ix/e ((`.e ren i
- -1-It 4/aD( 'n S1 'l le lap — uie.(, NRv 1'S
Ile ;i, ckii./ r S Ji./ i S Ct f.-c r . `✓r l./,1I . 3 ti r
Ro Ckki i_ Te, li
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building $ 3/ 1. Building Permit Fee:$ Indicate how fee is determined:
p' 2.Electrical $ ❑ Standard City/Town Application Fee
• ❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ _ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression Total All Fees: $ 14
A/;
Check No. (74"heck Amount: 4t✓ Cash Amount:
pie 6.Total Project Cost: $38 G co ❑Paid in Full 0 Outstanding Balance Due:
1 n CJAA ells P i 67
Piec k3cco5 ,,,.I ,core
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
(5- 095-i/3 t
( l)rn License Number Expiratio Date
Name of CSL der
;,.-/ I t List CSL Type(see below) V
No.and Street �1�, Q'337 — Type Description
derne4d6fa PA A &Pip U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and n Siding
I SF Solid Fuel Burning Appliances
913—xicco7 7 c-110,0r, I Insulation
Telephone �/ / Emailss D Demolition
5.2 Registered Home Improvement Contractor(HIC)
<�tJ C�.Sh Cc-ye/if 7r�� �p a 1
J HIC Registration Number x t on ate
IC Company a or IC Registrant Name
No.o dSwggr 3 G kscU j eC7E: 9f'"•,1 ,turN
erCnr(e,VJ^ PI 4 _ ?I 3 Xi Er,Tdll address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ❑ No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDINGG PERMIT
I,as Owner of the subject property,hereby authorize Kew CCU G ? ✓✓
C6t y
to act on my behalf,in all matters relative to work authorized by thi building permit application.
Ctir s Q 14/2$/Z3
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 is application is true and accurate to the best of my knowledge and understanding.
_ 17c) 70D
Pri ( er's Authorize ent'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
7,;;;-,AM,h - ..
Massachusetts �qt'` s.
r
6` i' DEPARTMENT OF BUILDING INSPECTIONS
%� 212 Main Street • Municipal Building �� -�"��`
Northampton, MA 01060 sy 04
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: ri )f `-f.edr) MA
The debris will be transported by:
Name of Hauler: 1-'6 n
Signature of Applicant: Date: ( 1/4 JP3
The Commonwealth of.1Iassachusetts
NT' 71:7 t Department of Industrial.4ecidents
I Congress Street,Suite 100
Boston, ill 02114-2017
www.mass.gor/dia
orkers'foinpensation Insurance AlTklavit:Ruiklers/ContractorslEkctricians/Plumbera.
11)Kt 111,ED WEIH I HI. P1 RSIITI'LNG Al1110R11 N.
Aoxilicant Information Plenw Print 1.efilits
Name(HUS11SCS.S, kft,anus tort I ntinidua I I: r..e.j.41 tiy( C Jr.t L-4(9 yrtt
Address: Co kikkef 5+
CitylState/Zip: Geo)(0540- J Phone#: _3 7 ft 0(32
Are,”iet ea enaployir?(lark fire apptuproitc bat: Type of project(required):
' tam.1 tenspIoycv with _5. rnoycer.Mtn*mho,.put-time)" 7. 0 New construction
am a sole preptletix urpenneethip and hasc ha employee%it minv Sur me in 8..)2TRI:modeling
42r,1/4-sfeeity worker$'comp EnvtAnfricr tcquarrd
9, El Demolition
t AM a ilktilt04.04 TWI 4tainK *bit n11. worko*."cense itUtiralf: hammed
o 0 Building addition
4 I am a hosntxmnel and wsfl bi boutg watt Adoc.). ut.,Jodui:t alt week ma cm Immertt I'art!
Cali=that alt Lmnrat.tort olive%hove tiuxker,' !a ID instsnrnev ue tole 1 CI Electrical repairs or additions
ptupodum with noemploycee
12.0 Plumbing repairs or additions
5.0 a.a gemexal%LinueLtue and(kart teb-coottaLton!uioran dar anadwAl shmi
13.0 Roof repair*
floevc sub-owl-4,1nm Nave entplayveitsiad lbsve*utiken'comp.manancc
14, Other
We se a...vapor:awn au! a:Ica=lave tx.ecciteri then meg ot exemettLie pet Sit LE L
iSt t(4),and AV hAVC rio ciasploymak Nra veutter."comp inmatazo:Irtitnted
'Aus!?applu-ant ihat INIAA 6044 it nur4 abu um the temtwat bele*%ben mg Men*Lniteet°‘4,1nyamotoort twitss eniormitkm
flaa1.4.11.M.X.*OW.tibtrui du 4t44.44,.it Inth...ktawg dray art doing all work,anti Own hot,outwSe mt1msL alio;,ubsnit aist-iv allcd.r• tulk.alartg hud:
Cenme.en%that eheLk errs hilt mutt 3tIa.herJ an%Mons!%beet%hint mg the nOlift rhthe tuheLnerwchiet 444%we itratIOZT I It tart thole 4:111*IKI hasr
einrloy'ee% It The teh-Ltdairsettet ht%% ntrrs Met mom revs iLte*wit f,,voimp pvhs quintet
I am an employer that is providing woriker compe.uation insurance for my employee'. Below is the policy and job site
information.
In.surarwk..Company Name: C..Q. 1-(15v-f linVVL
-S
Policy eor Self,ins.Lie.#: WC 53/SC!?-/yo?oi), Expiration Date: CiA.Y01,3
Job Site Address: 13) &Ica< H. I/ rd /le
Attach a copy of the workers'compensation policy declaration page(allowing the policy number and expiration date).
Failure to%mute co%erage as required under MCiL c, 152,f25A is a crtnurial siolation punishable by a tine up to S1.500.00
anitor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage veil fiCallOn.
I do hereby certify wider the pains and penalties of perjury that the information provided above L+trate and correct.
Sto.itun: 1)asQ 77)-3
Phone r: "1 1_3 26 t OC 07
Official we only Do not write in this nreit,to be completed by city or town official.
City or Town: Perniiklicense
Issuing Authority(circle onel:
I.Hoard of Health 2. Building Department 3.fity/Town Clerk 4.Ektirical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: