25C-065 (8) BP-2024-0163
280 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-065-001 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-2024-0163 PERMISSION IS HEREBY GRANTED TO:
DOORS/WINDOWS ON GARAGE
Project# 2024 Contractor: License:
Est. Cost: 4950 JOHN KOSAKOWSKI 095492
Const.Class: Exp.Date: 08/07/2024
Use Group: Owner: CHEN KUNG HUAN
Lot Size (sq.ft.)
Zoning: URB Applicant: JOHN KOSAKOWSKI
Applicant Address Phone: Insurance:
113 LOUDVILLE RD 413-255-5333
EASTHAMPTON, MA 01027
ISSUED ON: 02/16/2024
TO PERFORM THE FOLLOWING WORK:
GARAGE DOOR, WINDOWS AND DOOR FOR GARAGE
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 a' ),9 'a •
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECE VH`j
The Commonwealth of Ma ssacliusetts
Board of Building Regulations!and Stan'ards ? FOR
Massachusetts State Building code, 780 s' 1 6 2024 MUNICIPALITY
USE
Building Permit Application To Construct,Repair,genovate Or Demolish al R vised Mar 2011
One-or Two-Family DwellDf T OF BUILDING INSPECTIONS
NOInTI 11MPTON.MA 01060
This Section For Off clal Use Only --
Building Permit Number: g,72,2 y--103 Date Applied:�
t_hk) ` Z, /�ili L- l� ZWWI.
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
,pira
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 Owner"of Record: Q1r 0114- el 07 ern., PO O/0 D
.1/N,/r/i 4/AJ{, C 44/ /
Name(P nt) City,State,ZiP
82 c �o�� Y/ 3 3/ 3 90`76 �'F/r.�.,t/r/r -—49£�,c..� �� y" A;�-.r--a.1•,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': C o,ut�c✓�— So ,a.7-.0,9 Wow), Cz a.ti'G/ ws/! mac;
/9 Ce ant".I1ort Ay a 7-4//�r p ti diz ivt..� / C•OT 644iL 9 c Not? �tirnL Apia.
An.c? f/wc2 Co Ali, - 4,.Ndo.vJ' . r,tiiJ'h 7d/ OU /CYt La,Tre J'i/vyG .d,.✓(9 411q/
L1.T 41 L4 A ,,fJ1.%y _ phrt dry )1TT#Chi/ D/L9wi vS V
SECTION 4:ESTIMATED CONSTRUCTIONCOSTS °Merv2 of •3 A
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 95'5-0 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ `
Suppression) Total All F e
Check No. ` Check Amo t: ash Amount:
6.Total Project Cost: $ 'y%Sp 0 Paid in Full 0 Outstan t g alance Due:
City of Northampton
t. \.rc
Massachusetts ''e.
•
c.
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building Cb`
";.. Northampton, MA 01060 y �1 •. �10.
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW/ private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
a
SECTION 5: CONSTRUCTION SERVICES
5.1 Cons uction Supervisor License(CSL) C S
_ 02S-5,2,1 )./' a r
9 A N AO 3'4 kO"ui License Number Expiration Diate
Name of CSL Holder v
713 tOU ` i /it /eO d List CSL Type(see below)
No.and Street Type Description
,�/1 JT�1�tti j�, �f� Of(j 7-' U Unrestricted(Buildings up to 35,000 Cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP f M Masonry
•
RC Roofing Covering
WS Window and Siding
C, ^ f)C AXie., te-•A SF Solid Fuel Burning Appliances
L6 7 (?—°3 7 9✓'-+t iL.Cony I Insulation
Telephone "Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /9 ? .. `i' //
JOW'ti f o df/4,-awJiz; if HIC Registration Number Expiratio Date
HIC Company Name or HIC R istrant Name
No.and Street Email address
C4,c4 q o/3 y% y6P
City/Town, is ate,7IP Telephone C ) I with @yr+'» 1
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 CONTRACTORTO APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize '�/ 1"-' kd tit ot—d w S/Gi
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print O ner s e 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 tr and accur to to the best of my knowledge and understanding.
I` U2 ( °S
Print 0 er' or Aut ed 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"
JP
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
•
11 Fir City of Northampton
, 'I
Massachusetts
i tIt
41
C
DEPARTMENT OF BUILDING INSPECTIONS IT ?'
212 Main Street • Municipal Building '. -'
',-ems Northampton, MA 01060 sS N
It 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: /1t1/�
The debris will be transported by:
Name of Hauler:
0 Signature of Applicant: Date: //e/.,›?
•
The Commonwealth of Massachusetts
r- co Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
wiocinass.govidia
Workers Compensation Insurance Affidavit:Builders/ContractorsiEkctricians/Plumbers.
it)BF FILED writ'TIlE PER,N111-11A(;AE71101411'1.
Applicant Information Please Print Leeihis
Name Linsittess:Organization tndwidual): 70sA,td /CO Si/hi)1,1.'3/7
Address: //3 Zekidt, 4.. Rol
0/077
CityeState(Zip: Phone#: (7/3 — Y46 8.- 93? r
Are ou an employer?Check the apprupriate tN Type of project(required):
LE]Lm1 a tariptuy wit ernplurgeN anti anti sn part-lima° 7. 2rNeAre eonstructiun
2211 am a sole proprietor ot punnerslup and have no employem.*trains/ tor me in S ' l Remodeling
any iartletry,Nuworker**comp minuanee matuited.]
9. L Demolition
30 I am a hOrneuivnet doing all work myself.[No iq4x inc. imurance requiro.l.j'
IOfl Building addition
a.C3 I ani a hurneowncr and will be hiringbittn jrailj,ra iiiCvndutt all Work on my pui..rts' I will
ensure that all contra:tun either have workers'compensation insurance or am sole II.0 Electrical repairs or additions
proprietors v.ith no emplos.ees.
12.0 Plumbing repairs or additions
..5C3 I am a g,meral contractor and 1 hate hired the sub-cuntraetora Listed on the attached sheet
f
Thee s sub-contractor%have em e*ploye anti hate u miters'eump.ins I 3.0 Roo repairs
urance.;
14. 0et
&El Vf.t."are a cotpuration and officers have exaciaeil then right of exemption per MICiL c. 11th
151,.§1111,and we have no NEsplayas.[No la utters'comp.insurance remitred.1
Any uppinant thin eho:lis bur a1 must alao till out the w..-ction bclink show ing then workers'compensation policy 1111t1V1E1UtIfX1-
1.Homeow ner%who submit this affdait inthcatine they are doing all wor&and then hire outside contracturr muse subnut a new affidavit indicating such.
Cutitractois that check fins bot must attached an additional sheet showing the name of die sub-eontracteta mud*tate hether ot nut those sniffle ha, :
nmploi.t. It th ub-cunirc,ettn,hme entplo:. Ilicy tatx1M prode their workers'eoinp.policy number
am an ernploter that is providing workers'compensttrion insurance for my employees. Below is the policy anti job Ade
infOrntotion.
Insurance Company Name:
Policy#or Self-ins.Lic. Expiration Dale:
*Job Site Address: CityStateiZip:
Attach a copy of the workers'compensation policy declaration page Ishoss ing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, 1;25A is a criminal violation punishable by a fine up to S I,50000
and,or one-year imprisonment_as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.(K)a
day against the violator A copy of this statement may be filrViarded to the°nice of Investigations of the DIA for insurance
cos crage verification.
I do hereby cc i under the pains and penalties ofpealuty that the information provided above is true and correct.
ait'3.441.-4KAir4;
Date:
Phone 9/3 - F- 017?
Official use only. Do not write in thiN area,to be completed by city or town officiaL
City or Mnn; Permit/License#
Issuing Authority'(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
Massachusetts 41/
( .1;*
° 4 DEPARTMENT OF BUILDING INSPECTIONS S.
y �y 212 Main Street • Municipal Buildingp
74- Northampton, MA 01060 "' 1
HOMEOWNERS'EXEMPTION EL IBILITY AFFIDAVIT
I, (insert full legal name), born (insert month,
day, year),hereby depose and state the following:
1. I am seeking a building permit pursuant to t : homeowners' exemption to the permit requirements of the
Massachusetts State Building Code, codified at 7%0 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work 1 or which I am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufa'tured buildings constructed in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's efinition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s)who owns a parcel of land in which he/she resides or intends to reside, on which there is,or
is intended to be, a one-or two-fam' y dwelling, attached or detached structures accessory to such use
and/or farm structures.A person o 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 Massachusett- State Building Code's requirements for the supervision of the project or work
on my parcel, I am not engaged i construction supervision in connection with any project or work involving
construction, reconstruction, alte ation, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts St,to Building Code.
5. If I engage any other person o persons for hire in connection with the aforementioned project or work on my
parcel,I acknowledge that I am equired to and will act as the supervisor for said project or work.
Signed under the pains and penalties if perjury on this day of , 20_.
(Signature)
Your Confirmation number is 20240216319999
Date of Confirmation: 2/16/2024
NOTE: When paying by ACH (Checking) it will take two business days for the payment to be debited from your bank account.
Your account number is not verified until this payment is presented to your bank. They have the right to return this payment if
unable to process this transaction against your account.
Your request for payment(s) of$67.50 has been received and is subject to approval by your financial institution. No email
was entered so a confirmation was not sent.
Account Information Payment Information
Name: JOHN KOSAKOWSKI Payment Type: Credit Card
Note: QUICK PAY TRANSACTION Payer Name: JOHN KOSAKOWSKI
Card Number:
Transaction Information
Transaction Quantity Amount Fee Payment Type
City of Northampton - Building 1 $65.00 $2.50 Credit Card
Department
Misc. QP
Permit Option: Building-Zoning-Sheet
Metal Permits
Full Name: JOHN KOSAKOWSKI
Phone: 413-468-0398
Property Address: 280 BRIDGE ST
Notes:
Total: $67.50
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