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21-005
BP-2024-0061 567 SYLVESTER RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 21-005-001 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-2024-0061 PERMISSION IS HEREBY GRANTED TO: Project# INTERIOR RENO 2024 Contractor: License: Est. Cost: 60000 JUSTIN SQUIRES Const.Class: Exp.Date: Use Group: Owner: JEREMY DURRIN Lot Size (sq.ft.) Zoning: RR Applicant: JUSTIN SQUIRES Applicant Address Phone: Insurance: 177 E HADLEY RD 4136409647 AMHERST,MA 01002 ISSUED ON: 01/22/2024 TO PERFORM THE FOLLOWING WORK: INERIOR 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: o ; 2 : r :. Fees Paid: $390.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner le. .f RECEI ,` -_ The Commonwealth of Massachusetts Board of Building Regulations and Stan.. ds JAN 1 9 UNI I OP ITY R W Massachusetts State Building Code, 780 I R SE 1 Building Permit Application To Construct,Repair, Ren. ate ter • Revis Mai!2011 One-or Two-Family Dwelling ' - This Section For Official Use Only -- Building Permit Number: BF.-wag-©t3G I Date Applied: L , iil: ,2 ` i• ,_ / . 1,f Building Official(Print Name) ( Signature 1 i te SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers :t7 5\/11lpS4i7( KG{ 1.1a Is this an accepted street?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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owserl of Record: ,t7(o my 7LA;,, , v‘ A/0 611a m e )-ei►k , .ill A a►0 Co Name(Print) City, State,ZIP 5( 7 (.;y )vCs4' i q , 415-117 -52)8 J?(eV clLA((rh@.cncct; l. C. 0t- No.and Street Telephone Efnail Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building'K Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: Orel d Ll d c{-}-S 4-a to P cl ec o v.S , (t P l a C.e. (0}4-a r, f( ."1,A9 i I `rl S 11&1 P^4-1 O , it)f 14r o.\\ t.c l o w c:.n i , [C.NO,ry o.!-r7 , }-f i w. —to 1 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ Li 0, a 0 p. a J 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ Q U ¢ ® 0 0 Standard City/Town Application Fee / ` 0 Total Project Cost (Item 6)x multiplier x 3. Plumbing $ I 0 c v 00 U, 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All F es Check No . eck Amount 30 Cash Amount: 6.Total Project Cost: $ p 0) ElPaid• in ull 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Tas-j-;41 1 .eS License Number Expiration Date NameSLolder !1 GG /Lv n e4. List CSL Type(see below) u o. and Street �c Type Description �1/� U Unrestricted(Buildings up to 35,000 cu. ft.) rs 1� 1 Q R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances yt3-6 90 -% j 7 J S Q tk I (QS C o vt f(4C 1-�VI 4 I Insulation Telephone 1 Email address �G, ,Ca.. D Demolition 5.2 Registered Home Improvement Contractor IIC) 3.000 of, I I t'117.a 2t-f T V u 91'"' A SQQ l►-1 cc- 3 HIC Registration Number Expiration Date HIC Company Name or'HIC Registrant Name (7? £ ?ta.cl.l t Nt Q k i t;re s['0 4C- an ri 'aj ' o v\ No.and Street Email addres • wtte&r /A A 0 I 0 0 2- ti l'3•c 4 c]-q H"Z ity/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 JrL.. No...........❑ 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 Tv,S.L., ti. cc IA`r to act on my behalf,in all matters relative to work authorized by this building permit application. S 01.1S -9O .M Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 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. V 1, t 1-,v. SolL.;Yc Print Owner's or Autho ized Agent's Name(Electronic Signature) I ' Date NOTES: I. 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.) WO (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 .S S. Massachusetts 4, }. 4 DEPARTMENT OF BUILDING INSPECTIONS 1. 212 Main Street • Municipal Building JN �� ,> Northampton, MA 01060 JS.NnPO 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: 110, 1 „.y The debris will be transported by: Name of Hauler: S-( 1 Signature of Applicant: Date: D L 1 8 - (),0111 The Commonwealth of Massachusetts r _c Department of industrial Accidents _?/1l= I Congress Street,Suite IN�:;�= Boston,MA 02114-2017 "t. _ pews inass.go►'/dia II utters"Compen:atlon lasurance.Af1idae it:Bnilders/Contractors/tlectricians/Pluiuhers. TO BE FILED Unit'l iit_rIitakinTiNG.AI!1'llt)Rn'V. Anolicant Information Please Print Legibly Name tausincsaorganixationlydividltal): V 44;r\ 5q till'ire S Address: ni p cad ►ey eA City/State/Zip: ArAV\€(5-L A 0-191) 2, . Phone P.: tI 13 -6 Li Cl-9 G'/? Arty.. mplayer'(*MA tier appmpriatc hot: 1.14 pc of project(required): 1 am a employer wait eanployco hilt mentor past-[laurel-• 7. 0 New construction 20 I am a ant propritiou ur partnership and tease to cmphry_e].a asvrrkneg kn IIIIAC ice K. ►. Reitindeling any caracuty_(No worktn'lump.nnurancr rctp heat.] g. ❑ I k molition L_j I am a bonh nagger doing all wax(myyc 11.(No ssnrkzx"comp.irt.nranax mongol tccl i ' ■ 10 0 Building addition 4.[J I am a taNIX nuK'nhT and will be bn Mr C.igh.fc't,trt Idsaaidht i all VAYLI k cm i t4 144III lime nr that all solar- ino.etibcr lima. ku a ku m, curoptnruar[iint a toseim a i7 aril'OL'' Ili Electrical repairs or additions propnitota with no e.7tataloycY•: 12.0 Phimbing repairs or additions SCI l am a gctecral cunttactor aid I toss kited Ibl sago-tsaeta acids%I:4A 6rru the atlacttc l ata_L-t_ 13.0 Roof repairs Thew saib-mintraetun i hasae a mpl ytits and hate tatakes nu axing, Mrance. 6El We are a cutpuratian and its u11k4.a hate.cm:1.6%cd tic■uilrhdt ur ctcantntw.aa per Mk.1.c. l4.a Otl1Cr 152,pj 1(4),and me haw no anpluyook[Nu i n,k-r'cusp.uua,taraacc acqu111cJ.1 *Any applicant dial clec+cka hats VI nuns also fill null d►.WORMY 1k:10'1+,la,v.mum ulurir ss oresera'CoMpcoi,.:Irl,•n ltlti'y udunrualann.. 'I lerirtca,n r.rrN u btu autunae7 ilna atlkhsit i.uik-acing they am Juinr sill w,.+rk:nod ulaen hind tanbark:ccautractura tnutai a,uhiint a nu:*altiubsit indicating tuck ,'C mitt actors float check ilm faux mama sheered an additional alfcat,Jli own idol ul:nmtc.4 Eh:aulb-luNractura and slain sslhdar tar nut dnrx aititist haw c7nploytca- II ilk:anb-contrunkara hate a mployeet,they aarat parside hitch isaorkcu,'catnip.policy.nuinhcr_ I am an etnp1o) r that is prop iding workers'compensation 1asmance for sty employees. Below is the policy and jab site information. Insurance Company Nance: N (,' 4- •-C Policy it or Self ins_Lie.#: Eacpiration Date: Job Site Address: City/State/Zip: Attach a copy of the winters'compeluinlisn policy 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 S I,5U0.00 andfor one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a tine of up to S250.00 a day against the violator.A copy of this statement rutty be forwarded to the Office of Investigations of the DIA for insurance coverage veriticatitnr. I do hereby certift`ander I e pains and penalties of perjury that the information provided abort'it true and correct Sianaturc: iliac. 0 I I `1 -aQ a-L-1 Phonic;s: 4 l D - C 1O -y Fitri tlfrrrul!re only. Do nut write in this area,to be completed by city or town official ('itr, or l titsn: Prrniit.i'I.iernse dt Issuing.ltitltorihl (circle our►: I. Board of Ilr:iltlt ?.Building Department S.( itwi'iwutn Clerk d. Electrical Inspector 5. Ploughing Inspector G.()Hier 4'irntact Person: Phone!/: 5,-7 51\kir6w (Jet NE1 E ilk*..1. 1' . -..f.'.. 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