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25A-108 (4)
BP-2023-1754 351 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25A-108-001 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-2023-1754 PERMISSION IS HEREBY GRANTED TO: Project# 2023 UNIT 1 KITCHEN RENO Contractor: License: Est. Cost: 46000 BURI BELISARIO 100030 Const.Class: Exp.Date: 10/23/2025 Use Group: Owner: MANUEL LEYTON-PALACIOS, Lot Size (sq.ft.) Zoning: SC/URB Applicant: BUMS GENERATION HI&GC Applicant Address Phone: Insurance: 31 EXETER ST (413)222-2914 EASTHAMPTON, MA 01027 ISSUED ON: 12/18/2023 TO PERFORM THE FOLLOWING WORK: REPAIRS DUE TO WATER DAMAGE, KITCHEN&BATH RENO, REPAIRS TO FOUNDATION 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 ! y9 4 • t • 3-1'I • Fees Paid: $4 0 4,R9 f 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 4 RE___Q-Ivi---i---) \--- ! r i 4 ')n The Commonwealth of Massa huse s .t,, Board of Building Regulations an Stan ards ,FOR Massachusetts State BuildingCode 78 . .gG nun rw INSPFC:: 16IUNI`CIPALITY mri''' MA' SE �;n<<THa Building Permit Application To Construct,Repair, ReitovateUr Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only BuildiniggPPermit Number:I'A A.. / ( Date Applied: GAO iZ 12-/6-Z623 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1• 1io Q l7�- 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted stre r i w?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 lP1' Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2. wflert ecoril o fan ve e yo Name(Print) I City,State,ZIP 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) 0 Addition 0 Demolition 0 Accessory Bldg. 0 umber of Units Other 0 Specify: Br' e€-Prepesec t Q m q? Ce p 0!-s tA) a I S re a(r5 cidvi4 (eno vol c` La owl 1-e ok�' ` / e (de 7 103 r a r e cJ 6evrien1 lock ( ' SECTION 4:ESTIMATE CONSTRUCTION COSTS LIP 44'5C tort ' 901-- Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 0 0 V 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ �J 0 Standard City/Town Application Fee 10 0 0 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 6 C) D Z7 2. Other Fees: $ 4. Mechanical (HVAC) $ List: ; 5. Mechanical (Fire $ if Suppression) Total Al)f Ree 4ha Check N./' Check Amount: r Cash Amount: 6.Total Project Cost: $ L�'6 Q Q 0 Paid in Full 0 Outstanding Balance Due: 1 j ' City of Northampton Aio„,..y4,,..1/4. ,:,,....: , .,<,., Massachusetts 0 DEPARTMENT OF BUILDING INSPECTIONS r r �.„ ga. 212 Main Street • Municipal Building „� -- Northampton, MA 01060 s' �"' PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. 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. Site plan with location of proposed structure(s) and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new/ replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit - public land by DPW/ private land by Building Dept. 13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. Og SECTION 5: CONSTRUCTION SERVICES 5. Con truction Supervi License(CSL) / hD. 030 Q 2 3 2 ' ��Isar (f� (,� ( License Number Expiration N e of CSL Holder / f List CSL Type(see below) V o.an reet Type Description iDn tt1nD/O �4U Unrestricted(Buildings up to 35,000 cu.ft.) 7 / R Restricted 1&2 Family Dwelling Ay/Town,State,W M Masonry RC Roofing Covering WS Window and Siding I �,,,, SF Solid Fuel Burning Appliances 1/(3222-2gIti bel+sotirl�oui-ie d,,,, I Insulation Telephone Email address Uj/� D Demolition 5.2 Register Home Im rovement Contractor(HI I4 5 / / q 03 d y '�er)T� a(n(s 1 (/6' HIC Registration Number Expiration/ Date I Co pany N e or HI istrant Name . xerer s a eetNn r,i-iyi �J14 Gs`0Z9- u(3-21/2y Email dr s ity own,StatZIP I( Telephone iq 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 K (0 f 1 SQ r(JD r/ to act on my behalf,in all matters relat' a to work authorized by this building permit application. HO0 ue( L.e�/ ol) iz/i ofZ Prin%Owner's Name(Electronic Si iatu e) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By enter' g e below, I hereby attest under the pains and penalties of perjury that all of the information con .'•' :I i this plication is true and accurate to the best of my knowledge and understanding. / / /Z/RY Z "wn-'s or Authoriz d Agent's Name(Electronic Signature) IC. 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" 4 CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS e. � 212 Main Street • Municipal Building — ! Northampton, MA 01060 Via, ,-,ey;` 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: U //eye c y �' y ) The debris will be transported by: Name of Hauler: OW tray? uJ le_1014 Signature of Applicant: - Date: /2//©/z 4 — The Commonwealth of Massachusetts mr.... 1,:ii=7,m•:=1 Department of Industrial Accidents ul 1'. I Congress Street,Suite 100 • Boston, MA 02114-2017 ..•,, www.mass.gotyidia 11 orkers'f'ompensation Insurance Affidalit:Buiklers/ContractorsiElectridansiPlumbers. 1'0 RI. FILED SS II II IIIE PCRN11-1'11.NC AtrIVORIII. Applicant I n forma lion ull__lease Print Legibls liumnes.v Name 4 OrganizattonrIndivtdunl r Ali., f _.,...... Address: - 3/_ x eir 51 ..,,,,_ City,,StateiZip:40 ji ili / C.V1 1 l P Phone#: /-/ / -) 2 Z 2 Z ,9 /If P Ara litist stil rtliphs”t?Check the appreiprlate ,. : 11,,pc of project(required): I..a cumkoya with employee%(full arnica part-timer" 7. 0 New eunstruclitm 2173"1 am a sole proprietor at gurtncraksp and haw nu employees worlong liar mc In S. 0 Remodeling, any capacny,No 141:Aar. comp.insurance required.] 9. 0 Demolition I aai a h4affkxvv.net doing all Mark sts!esif..[No*orlon's"comp imoranet retputal l 0 CI Building addition ra lam a Iktella„!Wstet:wawa]be haute contractors to cendoct all work vn my propeTty,. 1 ail: imsum that all contractors either haw asorkers-ceernarnaatuni Mannino:or art aole 11.0 Electrical repairs or addition, proprietors With rto eitipbarea. 12.0 Plumbing repairs or additions $C3 I am a trUleral contractor and I how hired the Ada-contractor%Limed tm the attach...xi shert. Mese attb-contractors have employee%and hat eV...viers'comp.insurance.: 13.EIRoof repairs !6,0 we arc a eorismanon and its officals have rviand theu right of clrno SAU elust par L c. ; I 4.0 Other 41,wail We haw no estsphf}ers.[No Assrku-s'rump,ulaWanee reqUtret.t.j `Ass.:!:Tribe=1 that cluszlo,Eel al stitzsi situ 1111(Mt the art:lion bacluvi allowing thee winters'compensation pulte!*In fortruittslin, Homeowners who submit tins atrial',it indscataw they arc dAnng all avork and than tare outside contrackira muat 1 ubnut a new allaslav it ay.1 Itng 1.1c h. kontractors that check this box mug mulched an additional Meet aboxv in the name of the subecontractora and atare la h4.-Thcr tx not tip ..-a 1 ai,-.;haw caiployac, If the siA,-,:uvIracwiN have emplo!,era.the!,;swat pri, .L.:their a,orkers'comp.poliv.,nuariber I am an employer that is providing workers'compensation insurance for may employees, Below is the policy and job sire information. Insurance Company Name: _ Policy#or Self-ins.Lie.#: Expinition Date: Job Site Address: City:StateZip: Attach a cops of the'sort 'compensation policy declaration page(shoss lug the policy number and expiration date). Failure to secure coverage a. re+ red under NMI..c. 152. §25A is a criminal violation punishable by a tine up to S1,500.00 andlor one-year imprison 64 .as w as civil penalties in the roan of a STOP WORK ORDER and a line of up to S250.00 a . day against the siolato . f y of thi' statement may be forwarded to the Office of Investigations of the[HA tbr insurance coverage verificati / A Ida hereby cert;" mins one 'rallies of perinir(hot the in form talon provided above is true and correct Samara . 1)att- 111072 — 1one r:: '//3 22 2 - 2/1 i u Official use only. Do not write in this area.to be completed by city or town official, ('ity or Town: Permit/License# I....ping Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other t ontact Person: Phone 4: _ __ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 ��3?-yV st�" 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)