31A-190 (2) BP-2024-0113
63 WASHINGTON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-190-001 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-2024-0113 PERMISSION IS HEREBY GRANTED TO:
Project# DOOR/DECK RENO 2024 Contractor: License:
Est. Cost: 2500 SAMUEL TAYLOR 118933
Const.Class: Exp.Date: 02/21/2027
Use Group: Owner: MACNEILL,FIONA &BRIDGET
Lot Size(sq.ft.)
Zoning: URB Applicant: SAMUEL TAYLOR
Applicant Address Phone: Insurance:
245 NORTH ST (413)588-7421 WC5-33S-B24Q42-013
NORTHAMPTON, MA 01060
ISSUED ON: 02/05/2024
TO PERFORM THE FOLLOWING WORK:
REPLACE FRONT DOOR AND RAISE BACK DECK UP
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:
14 • b )2 Cgi'l •
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
�' /' / S‘o
The Commonwealth of Massachusetts, °�.� F� �s•
w Board of Building Regulations and Standar9�o RR
Massachusetts State Building Code, 780 CM' tivG%0 � )PITY
, c�Q USE
Building Permit Application To Construct, Repair,Renovate Or a!,'1 ' h a R ised 2011
One-or Two-Family Dwelling Nt\,-
F�
This Section For Official Use Only '1,
Building Permit Number: 43 0• A 4/. //3 Date Applied: `., ,.,
,.v
1/ ) s Z•2-ZeZv
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 3 Property Address: 1.2 Assessors Map&Parcel Numbers
�"1�fL ..51.0..'
1.la 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(II)
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. Owner'of Record:
l4— "NZIP MA
Name(Ph it City,State,ZIP
LS GR. .4-5 t. inc cif-'9+Z( �S' t .rta.t�. c...-.
No.and Street �/ Telephone Email Ad ess
SECTION 3:DESCRIPTION OF PROPOSED
WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied !J Repairs(s) leiAlteration(s) if Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
B 'ef Description of Proposed Work': 7.e
Prt
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ZOd D 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ saO 0 Standard City/Town Application Fee
❑Total Project Cost' (Item 6)x multiplier x
3.Plumbing $ — — 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees: $ '
Check No. Check Amount: �J Cash Amount:
6. Total Project Cost: $ 1,5e0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 1, 4 ij j U-
So„N,` ( .S . e--rd...,(pt- License Number Expiration Date
Name of CSL Holder
2- List CSL Type(see below)
No.and Street Type Description
ell 06 0 ® Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,Sae,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Cti;—5 — ,--(, 7f sue,,,. [�� tom, I Insulation
Telephone Email dress D Demolition
5.2 Registered Home Improvement Contractor(HIC) 2,../D Z L 0 �f cq Z
SCompan.Q �7' HIC Registration Number xpir tion Date
HIC Company Name or HIC Regiktrant Name r,,�Odlu..A2- Nc4�-- S.. 6e.nn,.-61 i 1.(...No.and Street MA D r V.CO Ol ,J Emails
3—S 88- 11j
City/Town, tate,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 Issu ce of the building permit.
Signed Affidavit Attached? Yes .I 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 `D lv?7-)L.&e I 1
1r—
to act on my behalf,in all matters relative to work authorized by this building permit applic i.
Z.c/L./ i a,, 4.2.1
z4
Print Owner's Name-electronic Sture) 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' this application is tru d ac to to the best of my knowledge and understanding.
....1 )...... _l
Print Owner's or Autho Agent's Name(Ele c Si ature )Date
gn )
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" f ZS 0 a.00
City of Northampton
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Massachusetts 2 <.
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�C DEPARTMENT OF BUILDING INSPECTIONS �: '�' c
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yrtt 212 Main Street • Municipal Building vti. •
Northampton, MA 01060 WO`
CONSTRUCTION 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:
Signature of Applicant: Date: Z/1/2-4--
5
Z,
ril-- The Cumntun, ea1th of.tlussru ftuscrtts
i;� DepaDepartment of/nrlu.�trirtl;arcidetttc
r -."�kr"-' 1 Cv rc�ss Street, Suite 100
� ��'', �``yBostot , it.-10?11-i-201.�
w(4-}w.mass,toh/dit,
11 utkers' Compensation Insurance.tffidas it: Buildersl( untractors E1ectricians.l'Iumbers.
It) BE Fil_F:b 5%I III I III•. i'I.RN1I FtIN(:AU'lIlORl 11.
Applicant Information Please Print Legibls
Name I—ustnc sOr garnzation;individual►: c G�
b __._._... cam- (� /
Address: 2. 4-5 /Uo $,L •
c ityi Scan ZiP:1(fQr(i Sv'• /'V14 occ6 Phone#: Wt3-Ste' 7'4'1--
Are uo an rmpkrtcr.'''heck the appropriate hot: -hr,pe of project(required).
1. sin aemplo,'erwith 2- ... cinploseca(lull and in par- mci. 7. D N•w construction
20 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity-[No workers'comp.insurance myuircxLJ
9. ❑ Demolition
30 I am a homeowner doing all work myself.[No workers'comp-insurance required]'
i 0 CI 194
4.D I am a homeowner and will be hiring eontraclon to conduct all wink on my property. I will
lding addition
ensure that all contractors either have workers'Co npc'msation insurance or are sole I 1 'texaricat repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
50 I am a general contractor and I hate hired the soli-euntraetors hued on the attached sit 130 Roof repairs
These sob-contractors have employees and have worsen'comp.insurance.:
t;,D We are a corporation and its officers hate exercised their right of exemption per Aft3L e
14.0Other.
IS'_,§1(41.and we lute no employees.[No workers'comp.inswancerequired.]
'Any applicitrit that chocks box al mint also till out the tectiim below show ing then workers'compensation policy miurrrwtom.
t Homeowners who submit this affidavit indicating they are doing all work and then hue outside Contractors must submit a new affrdat it indicating sock
:Contractors that check this lilt must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hate
t-iriplosets ti the suh-cuntracto'n hate carp lot ccs.the must mot idctheir uotkcn'comp.ropey number.
I ant an employer that is providing►vorbers'compensation insurance for nn employees. Below is the polity and fob site
information.Insurance Cun //gians Name 1..... 44.V) M•A- !L
Policy#or Self ins. Lic. ::: )C S _3;s — 6 2_4a�S "013 Expiration Date: /i/?i/ T.
Job Site Address: L 3 wc-itt,04. AAR citytstate Zip:_ 0/0 6 O
Attach a cope of the Honkers'can rensatioa policy declaration page(shos%iii2 the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal s'illation punishable by a line up to S1.50X0_OO
andfor one-year imprisonment,as ssetl as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the siolator. A copy of this statement may be forwarded to the Office of investigations of the IAA for insurance
cot erauc\critic ataun.
/do here/sr certify under the pains and penalties of perjury that the information provided above is true and correct.
So,mitute: . Date OL DL f Z tt
Phone,.: ;4(3— 5 4 f3-+Z
Official use only. Do not write in this area. to be completed hr city or town official
('its or Toss n: Permit-l.icense it:
Issuing Authority (circle one):
I. Board of health 2. Building Department 3.( it floss ii Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone st:
qk cog
-7Tr)- 37
Ps
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City of Northampton
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.Massachusetts
( DEPARTMENT OF BDIIDING INSPECTIONS
I'
212 Nair Street Municipal Building
Northampton,MA 01060 �'r '
W 3�
HOMEOWNERS'EXEMPITONELIGIBILITYAFFIDAVIT
1, (insert full legal name),born_(insert month,
day,year),hereby depose and state the following:
ing:
1. I am seeking a building permit pursuant to the honeowners'exemption to the permit requirements of the
Massachusetts State Building Code,codified at 780 CMR 110.R51.3.1,in connection with a project or nark on a
parcel of land to which lholdlegal title.
2. 1 am not engaged in,and the project or nark for which I am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3,
3. I qualify under the State Building Code's definition of'homeowner"as defined at 780 CMR 110.R5,1,2:
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or
is intended to be,a one-or two-family dwelling attached or detached structures accessory to such use
and/or farm structures.A person who constructs more than one home in a two-year period shall not be
considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and,except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or nark
on my parcel,I am not engaged in construction supervision in connection with any project or work involving
construction,reconstruction,alteration,repair,removal or demolition invoking any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned projector work on my
parcel,I acknowledge that Iam required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this__day of ,20 .
(Signature)