31A-201 (3) BP-2024-0028
40 WASHINGTON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-201-001 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-2024-0028 PERMISSION IS HEREBY GRANTED TO:
Project# Contractor: License:
Est.Cost: TRISTAN EVANS 114112
Const.Class: Exp.Date: 08/29/2025
Use Group: Owner: GIRARD, WILLIAM M. &DOHERTY, BLAKE E.
Lot Size (sq.ft.)
Zoning: URB Applicant: TRISTAN EVANS CONSTRUCTION INC
Applicant Address Phone: Insurance:
61 PLEASANT ST 413-824-0069 WCC-500-5022784
GREENFIELD, MA 01301
ISSUED ON: 01/10/2024
TO PERFORM THE FOLLOWING WORK:
KITCHEN AND 2 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
I ' s I i t►
I
Fees Paid: $2,275.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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The Commonwealth of Massachusetts JA ? I
1 FOR
Board of Building Regulations and Standard"
2024 t� ICIPALITY
Massachusetts State Building Code, 780 CMR i USE
Building Permit Application To Construct,Repair,Renovate'On l Rev ed Mar 2011
One-or Two-Family Dwelling +a PFCTlON
This Sgption For Official Use Only
Building Permit Number: AP^oZ h1 2 Y Date Applied:
I` i . � .� 1 to
Building Official(Print Name) 1 Signature � Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
40 WASHINGTON AVE,Northampton,MA
1.1a Is this an accepted street?yes X 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 El Private 0 Zone: Outside Flood Zone? Municipal El On site disposal system 0
Check if yes®
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
BLAKE DOHERTY,WILLIAM GIRARD NORTHAMPTON,MA
Name(Print) City,State,ZIP
40 WASHINGTON AVE 973-459-1996 BLAKEDOHERTY@GMAIL.COM
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building EN Owner-Occupied [a Repairs(s) 0 Alteration(s) [3 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
APROX 900 SQ FT INTERIOR RENOVATION. NEW KITCHEN,2 BATHROOMS
1 POWDER ROOM,MASTER SUITE PANTRY.. SEE PLANS ATTACHED
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $3 07 ono1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
[2:_pbd 0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 77,OO 2. Other Fees: $
4.Mechanical (HVAC) $ dd 0 List:
5.Mechanical (Fire p�
Suppression) $ Total All Fees: $ a���S� -2'5
Check No.o()Jk Check Amount: �f j Cash Amount:
6.Total Project Cost: $ 350,000Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) cs114112 08/29/2025
Tristan Evans License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) u
61 Pleasant st
No.and Street Type Description
Greenfield ma 01301 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 Siding
SF Solid Fuel Burning Appliances
I Insulation
413-824-0069 D Demolition
Emai11i dress Construction Inc. C) 198957 07/05/2024
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
61 Pleasant st tevans@tristanevansconstntction.com
No.and Street Email address
Greenfield,Ma.01301 413-824-0069
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 BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Tristan Evans Construction Inc.
to act on my behalf,in all matters relative to work authorized by this building permit application.
BLAKE DOHERTY 01/08/2024
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 best of my knowledge and understanding.
Tristan M.Evans 01/08/2024
Print 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.) 900 (including garage,finished basement/attics,decks or
firrils)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"maybe substituted for"Total Project Cost"
City of Northampton
Massachusetts �4,7 x_ °'<<
DEPAR MENT OF BUILDING INSPECTIONS y
212 Main Street • Municipal Building
- � Northampton, NA 01060 ssj 310‘'`.
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: Allen's Affordable Dumpsters
Signature of Applicant -• /� Date:
The Cortntonwealth of Massachusetts
+ j Department of Industrial Accidents
' - , I Congress Street,Suite 100
Boston.MA 02114-2017
N ww.mass.gov/dia
11 iia kers' Compettsation Insurance.thiidas it:BuiklerU'('entractor arl rctriciansTlunibers.
10 M. ItLLl)‘11111 I Nk:PLRMI ITM.AtrTllORI l i.
%milk-ant Information Please Print 1.eeibls
Name i Business Organization ludo. Tristan Evans Construction Inc.
Address: 61 Pleasant st.
� Greenfield Ma.01301 413-824-0069
City State Zip:___ Mono
Art►an an cttytb ar7 Clint tare appropriate hut:
Ty pe of project(rryuired):
'In Iamac-mplol,cr'MA enak,oe.ttaallandxtaPlId41anet.• �. ri 1cm, construction
20 I am a vak:prrmpitctos ui parrrt.a.hap and haw c oar anpltn+e:5 at+rkme Ian me m $ n Remodeling
ntA capactt 17,*4.txkec5' rryuert11.�
9. �] Iktnuhtrun
30I am a 1a.111wvat7.atct doin_y ad InvElt.nnasalt.iNo ooakess'comp.tmurame wonted.
ared.l
10 0 Budding addition
d.❑1 ant a donutnn#t.-t and tall l'htauntr.roarta.ior+to.tretduct aft nttk on mx irocrgeai%. 1 n dt
a.1ture that all coataracIor,cation has notiers opar m5atatta utuaanec or are soh: 11.(J Electrical repairs or additions
pttgtncttt5 to nth no.tt tloa ee.. 12.0 Plumbing repairs or additions
:51:3 I ant a i^rta.cal contra:tut and I prat hated the.uh-cotttaactor,lasted on the attached.heel
3.I Roof repairs
Thew Soh-etmtancinl lta 5 canploLo: and Mcrae% orlon,':tnnp.eat urattc..
1
14.0 Other
6.a'c an a cottmeaticin and dn.a+Cgteun liar,c cketeiscd then nt 1m. t a tcn enon.pier%.K L c_
I5,2.;ti ii.and vac liar c tau analtlosce..{No a otter. imamate acyntsed.{
*An)'arrltcant that cluck,.lxes»l rnu+t ml.tt till out flee}et:taon inclo ,haro ins then u txi.i5':i,ntpctt.atron policy inttrtnmliae.
Ilttan,.+amw men%4ha1 mining thn atladat at ii ath:atttt_l•the!,are dt+t.teg r1l ntx1.and then lime ttut+adc contractor,mud.adroit a new affidavit indicating sack
:Contractor,r,that check thn hos must:attic lied an additional%hoet,limn ins the name of the slitntaacton and.rate 1.hetthr tat not thew amain haw
C+. It 1:4,7111Z100:4111%liar...9r'g*le,t.,e.,,Cllt4 tm4-t rt,.,,talc then ....tacker,'comp..IrAlitl'N manna
l am an employer er that is pro riding worLers"compensation insurance,liar my employees. Below is the Milky and job site
information.
Insurance Comp tn}'Name: AIM mutual
Pokey#or Self-ins_Lit:. w: wcc-5005022784-22a ExpirationDate: 8/4/24
lob Site Address: 40 WASHINGTON,AVE City}siateizip: Northampton,Ma.01060
Attach a copy of the ssorkersa compensation policy declaration page(showing the policy number and aspiration date).
Failure to secure coverage as requited under MGL c. 152.*25A is a criminal violation punishable by a tine up to Sl.500.00
andt'or one-yiar imprisonment.as et ell as civil penalties in the loon of a STOP WORK ORDER and a tine of up to$254100 a
day against the violator.A copy attltis statement itias be Ii rssardcd let the Odic of Investigations of the DIA fur insurance
coverage verification.
I do hereby certify node pains and ppeenaallies a e r%ten'that the information provided above is tru'and correct
ii,sen;ttt1 s �ii/e Data::
hone
Official use emir. Do not write in this area.to be completed hp,cltr or town official
tits or 1 non: Permit;'License tz
Issuing.tuthority Icircle one):
I.Board of Health 2.Building Department 3.( ity 7ottn Clerk 4.Electrical Inspector 5. Pluuthiut;Inspector
6.Other
Contact Person: Phone#:
`Y DATE(MM/DD/YYY1')
A RQ� CERTIFICATE OF LIABILITY INSURANCE 12i19/23
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER COMACr
NAME: Carol Shippee
Mirick Insurance Agency PHONE, , ,Exp. 413-625-9437 FAX No)_ 413-625-9473
28 Bridge Street (A/c.
DDRESS: cshippeer�mirickins.com
Shelburne Falls,MA 01370 INSURER(S)AFFORDING COVERAGE NAIC S
INSURER A: Concord Group
INSURED INSURER B: Associated Employers Ins Co
Tristan Evans INSURER C:
Tristan Evans Construction Inc
INSURER D
61 Pleasant Street
Greenfield,MA 01301 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDLSUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE ,INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)� LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO TED
CLAIMS-MADE X OCCUR PREMISES(EaEoccurrence) $ 100,000
MED EXP(Any one person) $ 5,000
A 20029103 04/08/23 04/08/24 PERSONAL 8 ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY PET LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: •
$
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ •
$
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
B OFFICER/MEMBANY ER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE N/A WCC-500-5022784-2023A 08/04/23 08/04/24 E.L.EACH ACCIDENT $ 100,000
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes,describe under 500,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Blake Doherty ACCORDANCE WITH THE POLICY PROVISIONS.
40 Washington Ave
Northampton,MA 01060 AUTHORIZED REPRESENTA t �
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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this area to be completely gutted an renovated ® ,oe / / '�/ / if, , ^ //� /.. " // ,, Schematic Documents
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EXISTING/DEMOLITION
PLAN
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