22B-037 (13) BP-2024-0231
24 CORTICELLI ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22B-037-001 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-2024-0231 PERMISSION IS HEREBY GRANTED TO:
Project# garage to studio 2024 Contractor: License:
Est. Cost: 42500 LOUIS MONTGOMERY 013471
Const.Class: Exp.Date: 11/19/2025
Use Group: Owner: HARVEY FELIX
Lot Size (sq.ft.)
Zoning: URB/WP Applicant: LOUIS MONTGOMERY
Applicant Address Phone: Insurance:
PO BOX 951 413-268-2028
WILLIAMSBURG, MA 01096
ISSUED ON: 03/04/2024
TO PERFORM THE FOLLOWING WORK:
GARAGE SPACE TO STUDIO
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:
"414 AMPLOfit44
Fees Paid: $276.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachus tts NI p,K
- A 2024
W
Board of Building Regulations at4i Sta idards FOR
Massachusetts State Building Code, 78( ,C.)�R• °,IGNsPec �c4 IPALITY
o ,T.CFo':',, ly.MAc SE
Building Permit Application To Construct,Repai Renov a�R_ :t a oo t 1i a Revised Mar 2011
One-or Two-Family Dwel g -
This Section For Official Use Only
Building Permit Number: '00 A Li,--‘23j Date Applied:
Lo(AA S Has I)r o cA.ck- /_ i 3 1 2
Building Official(Print Name) Signature ate
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
L5' Ca".Tics//,‘ ,S 7--
Li a 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) —J
r 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:
' ' -, ___ ,Lx.. -vc ��;�.x t M4 _a cob 2
•; Name(Print) City,State,ZIP
j Di Cob ILI- l G 144,1 511 c -41 89 fQLH
No.and Street Telephone Email Address
t.,- SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building lg Owner-Occupied Al Repairs(s) ❑ Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units — Other 0 Specify:.
Brief Description of Proposed Work': C'o/vve icrLa v S IS 6%.,,, 6,,6.c..7 aZ Z',,,,"0
—S`Tv�'ai Z,.,-4 /75,.........G/ . s__,Ts_.ctO�_ G`',..sTit 1I_ ie
ea/4"/A,.ie/Jooti/ Divoe-- Co ' .r/eGlsov/ gynr�. n2s./wi /rites/
_ SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
jLabor and Materials)_
1.Building $ 3z,ooa 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ V000 6G 0 Standard City/Town Application Fee
— 0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 6,f-. 0O. 6 O 2. Other Fees: $
4. Mechanical (HVAC) $ List: _
5.Mechanical (Fire $ �r —
Suppression) 9 'Total All Fees:$ vIVO►
Check No.?1 Check Amount:
6.Total Project Cost: $ 'IZ,.$-OD 0 Paid in Full 0 Outstanding Balance Due: _
J
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att �
City of Northampton
Sty ..,
Massachusetts
r ro � t;
t DEPARTMENT OF BUILDING INSPECTIONS tZ
212 Main Street • Municipal Building '»'�,. 4a'
Northampton, MA 01060 : k'���
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. 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. Construction Debris Affidavit filled out and signed by applicant. •
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate(new/replacement windows).
7.Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction (Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton'.
74*
1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /0/2
At"t S 7- !'?60„r T(o o pat Orr License Number Expiration Date
Name of CSL Holder
A /fv 95--/ List CSL Type(see below) v
No.and Street Type Description
Unrestricted(Buildings up to 35,000 cu.ft.)
Ld/6E///F"Zs/11, 7 6 � O f Q G R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
q/3 5.2Z-0/6 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /73 ef// 27 2.‘
to fi/.f• f 6rN/r6 e'N HIC Registration Number Expiration ate
HIC Company Name or HIC Regi rant Nam
35i Pall#co..ss'— //f .�.�
No.and Street Email address
ISi v11 ,4€.+-- riot F del Sn—0/6 0
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 0 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
to act on my behalf,in all matters relative to wor authorized by this building permit application.
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.
FA-
Print O e' or Authorized Agent's Name(Electronic Signature) �/� Y
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.IL) (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"
The Comntonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, AfA 02114-201 7
woov.mass.govidia
1$Let kers t'otiipensation Insurance Affidavit:Buildersit'ontractorsiLlectriciansiPlumbers.
It)BE'FILED 14 111 I'I HE PERAII FiEgit;A11110111 it
.tonlicant Infornia(ion Please Print 1.egifils
Name(Hu:,iz.ca‘s,'Orglut&zillion"Individual 0:
Address:
City/State/Zip: Phone#:
- . —
Art yolli alte enipliiyer?Cheek the appropriate tiou. Type of project(required):
1.0 am a rtnployer with employoes(full;sailor part-tiatr 7. D New construction
I am a sok proprietor or purinerahip and burvr nu encloyees%orkuig for ma m S. Remodeling
ally car-04:14.r.No*inters'comp.insurance required]
9. El Deinolition
•I:j I din a honiksimvnet doing all wool:myself.INo v.otkins'cons' na.ur.amee requireill
100 Building,addition
1,0 1 am a hugnO.1.4.1bra and.)0.11.1 rWta it,conduct all,Aork on my property I skill
cnsure that all contractors either has e xuakerz,"conmenution insurance az:sole )1.0 Electrical repairs or additions
propm:lors with no employees,
12.13 Plittfibtag repairs or additions
..c.,c)I am a erneta1euntractut and 1 have hued the ut.,-eurinacion,imbed on Lit,an;10,,,,A
Thew aub-LUntrae‘ma have employees and laa.e workeri,':omp.insuran..-e.1 3E1 Roof repairs
14.00ther
6.on We are a imepticiainn and its officer%halve:RA-wised tbeu net r Aerrqalron per
§1141,and we Inv,e mu anployers. wurkera'eomp.in*trunce retitit.retil
'Any applielni that boa a1 must also Iii iLl[tic ..o.:Von brio 4'hilD54 ins!then uoticr,..'eonmem.ntion policy in ftcnianon
Homely.),nen.).kin)askant du affida)it wthcatmu they an:Jiang .11 01-k and then but Vutside ountra....tce+niimi sutirrat a new altars tt i Jical:n ih
It:on(ractorx that check Mix box moat atta:.-hed an addational xtteet alio*en:the Faint.of the out hAve
C.Inrkyl:Or LAN tit.) rat..1 pi,—J.!heir comp
I am cut employer that is providing svorliers"compensatii.ut insurance fOr my employees. Beion-i the mylicy and jab site •
informOtiOn.
Insurance Company Name:
Policy#or Sclf-ins. Lc.#:_ Expiration
Job Sit,.Address; City Stirtellip:_
Attach i copy of the workers*cutupensation polky declaration page(sholeving the policy number and expiration date).
Failure to secure coverage as required under NiGL c. 152,§25A is a criminal violation punishable by a fine up to S1.500.00
andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certi under the pains and penalties of perjury that the information provided above i.s true and correct
*nature:. Al/ z 02_ Date. Z.-
V
Phone—:
Official use only. Do not write in this area.to he completed kr do'or town official
('ity or Town: Pet-mit/license t;
Issuing Authority (circle one):
I. Board of Health 2.Building Department 3.City/Tuw n Clerk 4.Electrical inspector 5. Pluntbing Inspector
6.Other
Ontact Person: Phone 4:
City of Northampton ._
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Massachusetts
$ �� I
DEPARTMENT OF BUILDING INSPECTIONStt
4
212 Main Street • Municipal Building 1.
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4, Northampton, MA 01060 14, 1"^'
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: 5=-'1 e i 1° T.z..0 e-
Location of Facility: Sat' -ifS ' �vM
The debris will be transported by:
Name of Hauler: /1 /2 T 1-r//,,-T,e„,,- ,,.., zn Gcousr rti 7-6.0 fy
Signature of Applicant: Date: L/ -
G_
. .
City of Northampton
..
Massachusetts w
k, ,t. Via.
� DEPARTMENT OF BUILDING INSPECTIONS a
F 212 Main Street • Municipal Building '!r
" ; Northampton, MA 01060 `�°S"p ,. �.
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert frill legal name), born (insert
month, day, year), hereby depose and state the following:
1. 1 am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified nt 780 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 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 borne 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 work 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
involving 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 project or work on
my parcel,I acknowledge that I am 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)
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