24A-067 (8) BP-2024-0062
61 RIDGEWOOD TERR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-067-001 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-2024-0062 PERMISSION IS HEREBY GRANTED TO:
Project# 2024 BATH Contractor: License:
Est.Cost: 15500 JONATHAN SOUTRA
Const.Class: Exp.Date:
Use Group: Owner: A MYERS ELIZABETH
Lot Size (sq.ft.)
jONATHAN SOUTRA dba SOUTRA HOME
Zoning: URB Applicant: IMPROVEMENT
Applicant Address Phone: Insurance:
5 MUNSELL ST 413-977-3212 BOP 0100741636
BELCHERTOWN, MA 01007
ISSUED ON: 01/22/2024
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:
: P/ o N
I j 217
Fees Paid: $101.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
J44, .„"/ ,>
The Commonwealth of Massach efts 7 9 2024 F
-; Board of Building Regulations and tandfr.t 0 / I PALITY
Massachusetts State Building Code, 78t`GNPI/c ,8q��/),���mist:,
SE
Building Permit Application To Construct,Repair,Renovate Or e'er 1S Teo :evisId Mar 2011
so
One-or Two-Family Dwelling 1
This Section For Official Use Only
Building Permit Number: Ø . � ‘. GA Date Applied:
, I /j __
Building Official(Print Name) Signature i Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
C2 I K,d ere, wood Tier rat Lt,/
1.la Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Uar Lot Area(se'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 Tsposai System:
Zone. Outside Flood Zone?
Public el Private❑ • — Check if yes❑ Municipal BiOn site disposal system El
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
C-1i -7 al,tiC+11 AITt ytr5 /V0(1 %°NO\f -on MAr civbO
Name(Print) City,State,ZIP
Ca I f\ dei WoOc. "Ct(co CL 773-311i'-$7'1 h,;hG (0 i cloud ,COyTlm
No.and Street Telephone ail Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) Ig Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2: P mO Atli(to) e .►s-K ne 6ai-tv-oorn , Ail le' 61
10iIl 9411166 n I n 4-4d. Sams. Qla.CJL, AA.ct' AA) w,t1 be Goffvtel-c,a +0
loalV- t n Shower
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ chI oW 1. Building Permit Fee:$ Indicate how fee is determined:
2. Electrical $ f1�0� 0 Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ b 100 0 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees-
Check No.` Check Amount: iO, Cash Amount:
�6. Total Project Cost: $ I 0 Paid in Fu ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
LS 112,301 1tyac/amA--
pr gk-Andy4 So v*co) License Number Expiration Date
Name of CSL Holder
M u , List CSL Type(see below)
No.and Street Type Description
I, a �� A U Unrestricted(Buildings up to 35,000 Cu.ft.)
kJ[� t R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
41-6-1'11 '3a% - So,rKa, t4on t l tgcovemot+® 6,1114;l.Con1 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
191 SU3 1I��f/A�
O'\c V c 0VA-CA HIC Registration Number Expiration Date
HIC Company Name orJlC Registrant Name
NtV IN/SC 1 St. Svctrei HOmc,�M reli t@ pop hum
No.and Street_ Email address
C 6c f.4O►vn Alt is,01007 1413-;773;/-I a'
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 Iss 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 (burr 4 SO t)#'°
to act my behalf,in all j tters rela e to work authorized by this building permit application.
1
Print 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 ap lication is true and accurate to the best of my knowledge and understanding.
Print Own '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.) (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
�vyt:LL:r,�r> : r :
Massachusetts #., 2 '
t‘ ,. A', -',::
c
' DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building �Jj `a�,
?'sue" . ,
--� Northampton, MA 01060 'rj1',�, .i,,.),\''
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: Vg1l 'i WGCli&I;aj Q234( E4461,05-4-Prs 104 NOcibet' 1)
The debris will be transported by:
Name of Hauler:
Signature of Applicant: 9/tiie° A A7?5.g Date: // i /dli
The Commonwealth of Massachusetts
=;`
i AIM' Deportment of Industrial A ccidents
s..,;,..
='il 1 Congress Street,Suite 100
: f 1 Boston, M.402114-2017
I.. www.mass.goit/dia
11 urkers*Compensation Insurance Affidavit:Builder%'('ontractornIElectrkiaax/Plumbers.
10 BE FILED N ITN THE PE:RNI FOND At TNORl-CY.
Applicant Information Please Print Leeibls
Name 1 Hustncss[)r1,anti ition Inds idual t.__ V Un,,,),-L,„,..., Sp v 9
Address: 5- /V i m s-cAl 5 -
Citv'State Lip gackex%own N1 A. 01 OO1 Phone #: q i 3 — f 77 3a 1 D---
Art tun an rmpi4n tr.'t buck the appruprtatt Intl: 1 pe of project(required).
I 0 am a enepiaryet*oh rrapiu}ccs till ream pan-time[-• 7. '� construction
` am a uk prupnecttn or pesnnt-bierp and have nu caepir yom working for me to It. i Remodeling
ant.apa.rt!, (No wtnkers'ctuap.mau ante nNalra-J
9. ❑Demolition
10 I am a 1aen.'014n7 doing all suet(thyself-Pio wuwken`rump-mummer nquired.l'
4 0 I am a homey%nr and will he being contractors to conduct all work on my property 1 will 1 U Building addition
ensure that all Lontrae:tur,aithew have workers'conmen st*i t gtsunntY or are scale 11.0 Electrical repairs or additions
mupntorn a•nth no.nplu}cca
12.0 Plumbing repairs or additions
SC3n I am a ins I lore hued the alb—untr:r-turs toted on the ana.teetl.tnt-t
tiles,skass utset m.have cu issytr►and have worker comp.auuinnte. I Root repairs
o
h 0 lye are a crapuraeun and its officers have exercised their nt is otexemption pet Ned.c. 14.0 Othet
152.§lei).and we have no oat alupets.(No wuittcs'comp.nominee rranee mussing.'
•An applicant that t-haxks box c I mum setae till out the erects*below show ins then to WILLT,'.ontpen:etrun pot e.)us&xenateon
' i-kenrrowntrs who strbaael this atYi&atit utdscatutg they are doing all work and then hue outside.tmira.ton mint submit a new at tidas it eadicatmg such
:tvatrx'tttrs that check this box recast atta.hed an akhtitn al sheet showing the mune of the Alb.rmtrarto s and state%Ik-tber nt not nc,,x crotities have
enuple'yets. If the soh-:ontrs.tt rs tssv.,rt 'lu.ecs.ibry must pros!tic then .locrier,'stamp pale.. , ,,,,t..
I am an employer that is providing workers'compensation insurance for my employees. Below is the p 41icr and job site
Information.
Insurance Company Nance f cc, -fir cc& (IA v u ck\ .__.------____--
Policy#or Self-ins. Lie. Bop 0(Doi y I 30 _ Expiration Date: 'tato,/
Job Site Address: 61 11 I t' e,(,WOad ¶c g l_
via, City.Slaip:Nofi4 4inp ,j4,0 00
Attack a copy of the workers'compensation poll, declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to Sl.SW.W
and t'r one-vicar imprisonment.as well as civil penalties in the form ofa STOP WORK t eRDER and a tine of up to S250.00 a
das against the s u•latot. :X copy of this statement may be forwarded to the Office of Ins c,itgations of the DR tier insurance
coverlet tenticatton.
I do hereby certify under the pains and penalties of perjury that the informationprovided above cc true'and sorrel r.
,k Signature: A . iiiit. t);,t. I f/I a'I
Phone#: 13 t 7-3C 4
Official use only. Do not s rice in the'.area,to be completed teel by city or town official
('it♦ or'Cows: Permit/Licrnse#
Issuing Authority (circle one):
I. Board of Health 2.Building Department 3.Cky!Town Clerk 4.Electrical inspector 5. Plumbing Inspector
6.Other
( (intact Person: Phone 4:_
POLICY ISSUE[) ON THE CO-OPERATIVE PLAN
NON ASSESSABLE POLICY
Policy was prepared for:
JONATHAN SOUTRA
COMMERCIAL
POLICY
Preferred
Mutual
Live Assured'"
Preferred Mutual Insurance Company
One Preferred Way • New Berlin, NY 13411
1.800.333.7642 • preferredmutual.com
Policy BOP 0100741636 effective 01/23/2023 to 01/23/2024
Preferred Mutual representative:
AQUADRO & ASSOC INS AGENCY INC /RATS
413 586 7373
020129900
COMMJCKT(10-14) Insured Copy
Commonwealth of Massachusetts
1.) Division of Occupational Licensure
Board of Building Regulations and Standards
�I
Cons4s �rvisor
CS-112307 /4',� i res: 10/25/2025
o JONATHAN SOUTRA s �` 74
5 MUNSELL , T. 45
f
BELCHERTCIN MA 01007
0' 0
Commissioner Evd.45
Construction Supervisor
Unrestricted - Buildings of any use group which contain
less than 35,000 cubic feet (991 cubic meters) of enclosed
space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call (617) 727-3200 or visit wvvvv.mass.gov/dpl
THE: COMMONWEALTH OF MASSACHU SETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street- S site 71C
Boston, Massachusetts (2118
Home Improvement Contractor Registration
., ,.�..
@�,. r TYP': Indiviivat
JONATHAN SOUTRA >roe; . ,, ftegistratio l: 1918)3
5 MUNSELL ST. Expiratiot 01/14/2025
BELCHERTOWN,MA 01007 t '.
rye 5 :»
w
Upilate Addre is and Ret am Card.
THE COMMONWEALTH OF MA,SSACHUSETTSi _
Office of Consumer Affairs&Business Regulation legistration valid for ndividual f'se only bt fore the
HOME IMPROVEMENT CONTRACTOR expiration date. ff found return tx
TYPE:individual Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Wash ngton Street -Suite-10
191803 01/1,4/2025 3oston,M/ 02118
JONATHAN SOUTRA
AN S.SOUTRA 1 , /G/�G
5 MUNS
5 MUNSELL ST. � ,,.,y2.; s��i' ` /�
BELCHERTOWN,MA 01007 — —�
u
Underc9CrP.tRry _ � � -.., �_ _- -