30B-078 (9) BP-2023-1756
144 FEDERAL ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30B-078-001 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-2023-1756 PERMISSION IS HEREBY GRANTED TO:
Project# STRUCTURAL 2023 Contractor: License:
Est. Cost: 8570 DALE HAWLEY CS-055048
Const.Class: Exp.Date: 08/29/2024
Use Group: Owner: LEWIS RICH ALICE L&GREGORY R
Lot Size (sq.ft.)
Zoning: URB Applicant: DALES STRUCTURAL &CARPENTRY
Applicant Address Phone: Insurance:
P O BOX 273 (413)667-3149 WCC-500-5008253
HUNTINGTON, MA 01050
ISSUED ON: 12/15/2023
TO PERFORM THE FOLLOWING WORK:
STRUCTURAL REPAIRS
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:
JUG I/
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
-= .
The Commonwealth of Massachu tts / OFC ,
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Board of Building Regulations and nda ?0?? !)'OR
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Massachusetts State Building Code,780 MUNICIPALITY
: USE"
Building Permit Application To Construct,Repair,Renovate(7r�rDe1tirgiah;a _;-.$evised Air 2011
One-or Two-Family Dwelling _ • %'
This Section For Official Use Only
Building Permit Number: 8P.13+/ ( Date A lied:
1 f ill I
Building Official(Print Name) I Signature 1 I to
SECTION 1:SITE INFORMATION
1.1 Property Add 1.2 Assessors Map&Parcel Numbers
1.1a Is this an accepted street?yes X no_._ Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: t t
Zoning District noosed Use Lot Area(,sq II) Frontage(II)
1.5 Building Setbacks(ft)
Front Yard Sidc Yards Rear Yard
Required Provided Required Provided Required Provided
"1.6 Water Supply:(M.G.L c.40,554) 1.7 Flood Zonc Information: 1.8 Sewage Disposal System:
Zone: Outside Flood one?
Public Private 0 — Check d.y MunicipalOn site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1'Owner'of Rc rd:
141;c ► &L e �1OLi'
Name(Print) iL State,ZIP .,�6
-LIR - - ?/�-iD/9-c8/oa_ AIQ+� /L 6AA; 1 e con-L.
No.and Street ` Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK''(check all that apply)
New Construction 0 Existing Building Owner-Occupied Repairs(s) Alterations) 0 Addition D
Demolition 0 Accessory Bldg.0 Number of Units Other 'Specify: STY`ve f(,1 R \
Brief Description of Proposed Work' •.N S71-A- 1 u. f) a e f" X 2,4 f a '( / t' C 4
Gs2 !' . c./ �or�__ e� /S)I' 'jQl, ''�cc c��eQ"e•--tJ�
Epp -moo P 0 e 2.rr7 ,4 cl rle-6 i 57-- ?
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building $ 41. ,rj l0 , pa 1. Building Permit Fee:$ Indicate how fee is determined: •...
0 t o Standard CityiTown Application Fee
2.Electrical $
O Total Project Cost}(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List
5.Mechanical (Fire
Suppression)
i$ Total All Fees ! ,aVj
C k No.' t0 Check Amount: Cash Amount:
eV
6�Total Project Cost: S g r 5 e , id in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
• 5.1 Construction Supervisor Lice se(CSL) C S- s-o q ' 1.
__Dale , ffeta license Number E'pirat on Du l
Name of CSL I/older
a"
Se 3 List CS!,Type(see below) +�•.�_
No.and Street /t a- T Description
Unrestricted(Buildings up to 35,000 cu.II.)
.a A - _o/eSa Ir Restricted 1&2 Family Dwelling _.
c .frown.State,ZIPM Masonry
RC Roofing Covering ••
WS Window and Siding
�'w�_ SF Solid Fuel Burning Appliances
-W 7 y ____ it i I 1 Insulation •
telephone Em address a eft D _Demolition
5.2 R gistered Home Improvement Contractor ,H,IC//)
erg rp2 / g �f1IC Registration Number > i on Date
NIC Com nv Name or I IIC Registrant Name / �/ �l r� / t►
No.an Street ( 3 - il l I Cm p it rese - ,'4 t . .e jyl
n1ty 610s0 I -CeZe?- )Lici
City/tow ,State,ZIP Telephone •
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.4 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 BUILDI 'G PERMIT '
"I,as Owner of the subject property,hereby authorize__P•k(e A e S 5rIZ(IC�k( Fr j rPe-df
to act on my behalf,in all matters relative to work authorized by this building p t application. /
hc1 A '
Print Owner's Name(Electronic l D-1I I j a,9
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 • e and accurate to the bestst of my imowledge and understanding.
I.
• A.. _/ c )
IL / —f� `93
rt'•int Owner's. Author' . gent's am 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 no!have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the I IIC Program can be found at
www.mass.zov/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 _
Ntnnbcr 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"
ai vv.Vl.1 Arts a J 1 t 1
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): pa 1 e S s 774/C7
1'�/�t'4 CAk $ I
Address: / ' Q. , Qx
City/State/Zip: (:),d A)7-1- / d/A_e/e 5? Phone It: 17f/3—(o 7— j/(-9
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
listed on the attached sheet. 7. ❑ Remodeling
2.g I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.111 Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12 ❑ Roof repairs
insurance required.]t c. 152, §1(4),and we have no 7� U employees. [No workers' 13. 'Other 8
comp.insurance required.] Kt 0._\ tZ-S
`Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_
(Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: /4 SC;QJ ,ox_S -�//S /AA.r/GP r7
Policy#or Self-ins.Lic.#: (,�)('G —See— gav 525 3 ea 3A-Expiration Date: j r,L�
c
Job Site Address: P P4 54 City/State/Zip: frP.[Jlr, i'Z,4 -D/0 b
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: /4/ Date: - 9
Phone#: ( GeU 7— �/'f 9 •
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
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CONSTRUCTION DEBRIS Alt1UAVIT
• .. - ; �`'�'-fre'ti.:�Sz all Der4.-.Eti and Ree..•Qvar.im Work j
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in a:.i;rd n e with the pzo i✓ions of MGL Chapter 40§54,a condition of demoiite r`noca j�:�.•. �L cuOi:
.permit is that the debris resulting from this work%hall be disposed of in a properl}-licensed.
spud
waste-disposal facility as defined by MGL Chapter 111 fil50A.
The debris will be disposed of in:('Le.,dumpster on site,transfer st on,incinerator or landfill if
known) V '
keC y ci(,v
* M( rOde tftAitiO4-e/0 ( /4rif • cm) tie
Location of Project r/o12e.0 C4 in/9 (9/c 2 Location of Facility / ,3 _ 5,7
(ribs debris vat not be disposed es i.dseseed,din bolder edit paredt.b.ti nab me
leolcrins official in writing,ismtheiocetioawberelbe(Ie6ns will bedeposed.)
The debris will be transported by: � f /r
Name of Hauler
k, 4 "ftc,
S',, :i, of ierniit apphcan Date
P . • , -
x
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