25C-085 (2) BP-2024-0041
238 BRIDGE ST UNIT A COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-085-001 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-2024-0041 PERMISSION IS HEREBY GRANTED TO:
Project# DEMO UNITS A&B Contractor: License:
Est. Cost: 6000 THOMAS BACIS 070061
Const.Class: Exp.Date: 03/06/2025
Use Group: Owner: MICHELLE RABOIN
Lot Size (sq.ft.)
NEW ENGLAND REMODELING GENERAL
Zoning: URB Applicant: CONTRACTORS INC
Applicant Address Phone: Insurance:
75 VALLEY RD (413)478-5272 WCC500601501
SOUTHAMPTON, MA 01073
ISSUED ON: 01/10/2024
TO PERFORM THE FOLLOWING WORK:
DEMO TO UNITS A&B
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 orr
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Thi,: fe Commonwealth of Mass h • r s l0
u 0
Office of Public Safety and Inspectio it),ce, r04?if / f
Massachusetts State Building Code(780 CMR) Thq(iil)i p:
Building Permit Application for any Building other than a One-or Tw ellin /
(This Section For Official Use Only) '''�'`t 9;�TiO
Building Permit Number,y-'i/ Date Applied: Building Official: /
SECTION 1:LOCATION
2. 3 G Qriage S 7, ,(nnr7hanr1Prime
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building Repair 0 Alteration* Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 NoZ
Is an Independent Structural Engineerin Peer Review reequired? ,( � Yes 0 No l�
Brief Description of Proposed Work \ j"Yt U I/7ir0i`� (3 C NA bect b tX"Qr.t.9 3 n 7er-+�'"
Lev-4 ITS 1 kl U 017 , and (3
--01ii y ti?e, ' ij L"Or- (4"ile we are 14,-.:Z0i9 0✓1 4 C I_____wa(
Plah s an J pa 11- -ot- ,
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) CI
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-1❑ R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IB ❑ HA El IIB 0 IIIA 0 IIIBD IVO VAC VB 0
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
A trench will not be Licensed Disposal Site 0
Public Check if outside Flood Zone 1X Indicate municipal❑ required 0 or trench or specify:
Private 0 or indentify Zone: or on site system 0 permit is enclosed 0
Railroad right-of-wa . Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
(hi Ch ells f-a6oi11 r cC 'n de,, s% St l-/ad/ey A a, D fO?S"
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
vu,il ee-- Ci13 ‘45- 3-5 S I efy 4r $SDI (hick elieghejpe 441 F .Tnems-t-rrji*
Title Telephone No.(business) Telephone No. (cell) e-mail address �'''
If applicable,the property owner hereby authorizes:
''rd m aCt u s —7 S V i/jey (I..J 5*4,r f 7 1 Oat O/a 73
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft of enclosed space and jor not under Construction Control then check here 0
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
dln'c NotieOs Sod_? ? 3503 chris&n? ++iretp'r- So'Ird
trie( gistrant) Telephone No. e-mail address x tent R stra on Number
An1J, ply 2 s, 6(��'date (Aq 0/7y 7 ,Xrch, TGc7- --31 .--1
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor + ('
N q Land em06t11nP Ctnra ('on&oors Znc -
Company Name J Q ,_-/
Tkar•rias DO, CAS CS (37 ODIC I ConS}-cu4,Or? Sueecz'dsa
Name of Person Responsible fo5onsiarkiction + License No. and Type if Applicable
1S Val koet.d So►, i"10rr kill , l` 010�3
Street Address J City/Towin t State Zip
- - 413 -414- 1'), 'Ram '73 (Qmai I . Cam
Telephone No.(business) Telephone No.(cell) e4iiail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the ' suance of the building permit.
Is a signed Affidavit submitted with this application? Yes, No 0
SECTION 12 CONSTRUCTION COSTS AND PERMIT NEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ ‘/4,0 Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $ 00
-
4.Mechanical (HVAC) $ Note:Minimum fee=$1U". (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 6,Qd C? (contact municipality)and write check number here '7d.-06
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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,
'P n' S ZaGs Con\--c.a or 913 �i'18 _ S22 21.9102q
Please print d sign ate Title 1 Telephone No. pate
/5 \fa� a Sa, i,arn 1-er miL 010 73 't haeis7 (off orncii! • Ccr"t
Street Address City/Town State Zip Email Addict s
2 q ,
Municipal Inspector to fill out this section upon application approval: • t Ti 1/1 l
4teDate
City of Northampton
1:AR
Massachusetts
•
DEPARTMENT OF BUILDING INSPECTIONS
`�" < r
212 Main Street • Municipal Building
Northampton, MA 01060 s;y �
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: a �j
P V�i23(1 rarp �hn , N ofj
The debris will be transported by:
Name of Hauler: ar On 2 / 7 0 W
Signature of Applicant: l Date:
The Commonwealth of Massachusetts
""idllinlei/VDepartment of Industrial Accidents
==. I Congress Street,Suite 100
sz3= Boston,.MA 02114-2017
..—•• ►gnu mass gov/dia
Workers'Compensation insurance Affidavit:BuilfderslContractnrs1Electricians/P1umbers.
TO RE FILED Wail THE PERMITTING AUTHORITY,
Applicant information Please Print Legihty I _
Name(l:3tasirnessfOrgenizstiacerrltt£Iividtiai); �l P U) �n 1 n O e rn 06 R i(l, U e n?r��_...� -0 rG("C. -n
Address; 5 v I I oa. g
city/State Zip t J ; oo 1 Q phone th y)— 7 5 2 7
Are,..an tuner?Cheek the apprepriate box: Type of project(required):
1 l air a employer with_ L'I -� Y.(MI aneken pairs-tiara).• 7. 0 New C a.litslThCtiOn
2 1 ame aukproprirscx or partnership arid have no c tupae+w>tiiltibg Fora me its 8.E i"""j Remodeling
any 1paeiry-ENE EWE".Morn w roytared_1 t•'"'
9. n Deniditim
301 Yost a hortioawner doing all work myself_[No workfare comp.instanimet r -3' t st l0 0 Building;addition
am x livne orner malt will be hiring toestracuxg to cocas tax all work ran my property. 1 will
ter;utt that all contractors eirtwr have workers'a we riasurxnie or are sale 1 l. Electrical repairs or additions
proprietors with 0 employe,.. 12-0 Plumbing repairs or additions
SO i am a simen l contractor and l have hued the sob-contractors lisped on the attached sheet. i 3.ri RWftx pairs
The.stth.corittartots have employees and have workers'comp.irasureree_:
6. Vie are a corporation and its officena have exercised their n of eat-EnricoWit.c. 14.0 Other
right •rrytlra_ per
1$2.$t(4).and we have no employees.[No workers'coop.insurance required]
•Atay app€i rtt that du k a but tti utast also till out the section below showing_their workers'conipernotithi policy information_
t Homeowners who submit this afferavit indicating they are taming all:Kuck and her hire onreid a cordiactas mail submit a new affidavit imiteat)a+p mach.
«Contractors that check this box mast attached en additional sheet showing the name ref the snlr•ccaatrastorr aria state whether or not'those cantina haw
eanp o ev lithe..cite-contractors have emiilnyers.they recoil provide their wardens" x rep.policy nannicr-
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name. 1" H M U I u I I,n Si.),-/.l P C'( 1.'0 , —
Policy g or set ins.Lie_#e VV son- 600(Jo!5- ,Q ,3 f l Exp ratum Date: 9.'( ')0 a "I
Job Site Address: City/State/Zip: 01 0 ti 0
Attica I copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required=der MGL c. 152,§25A is a criminal violation punishable by a Fitz 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 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 verification,
I do hereby certify under tie pains atui penalties of perjury that the information provided above is true and correct
Signature:
I;"ate: 1 - 9 - a 0,-) ti
Phone 4\-113)ql -6171
Official use only. Do not write in this area,to be completed by city or town official
City or Town' Permit/Licensee#
Issuing Authority(circle one):
I.Board of health 2.Baffin Department 3.Cityfrovra Clerk 4.Electrical[Hcspeetor 5.Plumbing Inspector
6.Other
Contact Person: Phone#: