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44-018 (4)
BP-2024-0228 111 OLD WILSON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 44-018-001 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-2024-0228 PERMISSION IS HEREBY GRANTED TO: Project# BATH RENO 2024 Contractor: License: Est. Cost: 15000 Const.Class: Exp.Date: Use Group: Owner: BECKER TESINI JANICE M& HARRY Lot Size (sq.ft.) Zoning: SR/WP Applicant: BECKER TESINI JANICE M&HARRY Applicant Address Phone: Insurance: 111 OLD WILSON RD FLORENCE, MA 01062 ISSUED ON: 03/06/2024 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: // Fees Paid: $98.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner MAR - 2024 L __----1 " The Commonwealth of Massachusetts DEPT.OF CiUIL�� I�i EC710NS Board of Building Regulations and Standards FOR NORTHA'A"1 r '' oloso _-1 Massachusetts State Building Code,780 CMR MUNICIPALITY — w USE Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family 1)-welling T;s Section For Official Use Only Building Permit Numbe•'+ 1 ' a••__._... _ Date Applied: .401, BuildingEci<al Print Name Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers /tI O..9 Wt.L.SQt4. c4.ets.Exlc t oto4z., 1.Ia Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Public 0 Private 0 Check if v sO Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: SA N\t..te. -r' 51 cy,k FL-.d PIE.c-......� kA� 0 1 a G v. , Name(Print) City,State,ZIP 1 1 t Cst.-17 Nog 1 1.-ScAA, R.D . c{ 5-' 4- 5`67 _. rtA'C'~.5 t @ i.eltA ?...Cc n No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Iiir Owner-Occupied E Repairs(s) ❑ Alteration(s) B( Addition 0 Demolition 0 Accessory Bldg. 0 1 Number of Units _ Other 0 Specify: I Brief Description of Proposed Work`:_V7kvttc a tit, °L*t.ON/P1/4.e`k-e7bk. ;Nc-raP1NC. NEW., vs,AL- --tt4. S l-k&i 6x, va ^t's,t.,.v� -S) .M*L) -('e'it- T t U i,,$ 'Ik,.)ti RrS Ri.? �:A.%ts.)te'T") L4 6-4{.-r i il,I t 0 ©w_). -t-t t. . F-1..©per-) -atq t1- F.-Aetna .25 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only 2Labor and Materials) 1. Building S 12 f ifv v 1. Building Permit Fee: $ ,_Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ (,CO 0'total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 1 •'o d 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire $ — y9 --- Suppression) Total All Fe91 .m.,.0 - - �{, Check No. Check Amount: 6.Total Project Cost $ I L{i aoO ❑Paid in ptill 0 Outstanding Balance Due: =rt-• c. \.� � _kt._-- °�4.u;,Ww00'¢,�w.s.. ., . .'yam . wimi %. ,, .am.iwg 1z.,*4 -a `..i .:EN: 1 1 SECTION 5: CONSTRUCTION SERVICES `, ' 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) 1 No.and Street __..__ Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted d&2 Family Dwelling M Masonry il RC Roofing Covering — DVS Window and Siding SF Solid Fuel Burning Appliances _ I Insulation Telephone i Email address D Demolition 5.2 Registered Rome Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or H1C Registrant Name — No.and Street Email address 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 ❑ 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 work authorized by this building permit application. a. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECI:ARATION 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. I 511,..N.Lc..l -1-e-5 t tA t M9tRe-ire 5 zef) ;{ Print Owner'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 HI.0 Program can be found at www.mass.govioca Information on the Construction Supervisor License can be found at www.mass.gov/cIps T 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 4 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" '' i ` w , ,wsvvotmtunomvA,., sv,. . n.e. movemimmipm7w4w,wwwwwwam, ' The Commonwealthof Massachusetts 1 Department of Industrial.Accidents ., - ,'""" 1 Congress Street,Suite 100 Hsu 2 � Boston,:l.t 02114- 1I17 t-� nivw>,mass.go/dia 1lurKers'('trrpc•rtsatitari!astirane .\tlidac it:l3uiftlremt1'tistrart m'EteetrieinsisTlu bees. A 10-Ett11t. it%bltii 111EP R5UFLINE:at tttt3Rf€'t. Anoliejnt information Please Print l_c ihts Name ittucsaocs iirgatiTaticut,`tndividuatt .1dclre �: 1 .tee ant an reatihr)et''t heck ibe appreapritge bet: d g Ty lse of project(required): l ) l $..C:1 1 311s a.-teria+ir aatlt __. _.-_..ethlic,Nvi trial trait tK putt 411Wg i`* 3 \ is c:onttrtc:ticvn ".._i i am 3 xcac my Aim ur patttsaartz it And thuez IA)Alephy ecu waiting rotate is i. Remodeling an,�.a e7 y..[No w wketh evert". u1 at at --�t7 . : 1 Deal til n a a dxarreKrutera dixAtS att%Oa trnItf(NO Wink a'ac+ r.aeai.31121 V res{tnt tl z t Kti ddait>tta Aah=taeius i rt1 . ' t txuura di t all%taut ma no ntiv ri). I will emu to tt t ell estntraturt.0..bet base muter.'euthretheetem wtheirazsa.V as ute Note 't I7:3 Electrical:r or atklitions t•aiurE hA3.1 i+3 all ZIO C313*1a Wi'.e9.. y -� _ j Plumbing repairs a'u'additions i...,a rowel;a3 matatazha,n.u*I i taut t hard the s4tia-cesattaa'tt*rr.trued OD elac attaailwal.a; c�.. ti.3...D lZaofr,pairs The xuh-�untracasxrsh..tc rai casea:xi and fust,e:Akekc�r,'comp,iu sees: a 71 vk,ete a ccrz mtairra awe.w.uffaeixx 3e etetctsa�tt thew tight rt rscatvr utt re:!:tiat c, i t.0 Other I 4.2., §t 4.:Ind w e hs,e tut e 4e,..e s,.(N.=s serketht o,attp itougance re;:uwe it;k a h.tat t lit au.A.,,IA.,it tt hr at>s 11.13 cxat the weiloit tisk,*tit+4 tear thew x w3.o':.,nla at>e p+*twa raf as ais* t 'ii Jneatu tit, 410 3 tiMiti Liu aiftctas a a a iii. UK)are Being an s aet and beta furze tttat;,ule eturta rs:aaxa mw aniumut a ncu a fidu5 a initicaiaug;%Leh. .caoea'aeutet.11thi Via#taut:.t»e^h smew ettta taus adsapri E,tioi.iv..the,states the tetp-eueut'aw:tear+aaki.aiutc VM ee tAt oat tltuzs.‘Adelieu.taxae. ti.nriv>cei. It`.tom lit,r,aa;scttut.ie.e.e ell,i=.ee rite wthst pre.tute tit,:a: A7,,A3'x' 5riap.voile),liainba I am an emplan rr that is providing wfstl ers`t-i mprn tution insurance for my etttplaryees. Below is the polity and job site in formation. Gast tawc C'untp;an.Nan"te Palter 4 or Self-uo:-..L.ie .. fix ptt"at on Date'. 4 Job Site Addle s. City State'Ztp',._ __. Attach a copy of the porkers'compeaatation policy declaration page pdtoiaing the policy number and etpiratian date). t`:utuse to.c ute alit entire as required under ltt i.c 152 t_25 1 as a entninal t€tRlation punishable by a fine up to SI,5t30.tytt and or ona:-fear iitipriscrnrmient,as saaell as cis it penalties in ttti form at'a STOP WORK ORDER and a tine of up to S2541.00 a -11 cl ie against the t iotaitor.A oar,of this statement a as'be torts anted to the office of Investigations of the[MA for insur-atace t col crape t ett-1 t:atioei. I do hereby certify under the pains and penalties of perjorr that the information provided aborts is trite and crrrrec't. �- �fir'ri=-<::::.. �Cu4t,.lC�2. '"" U.-sU4 i" ,e.. tYtAR.r-'kk 9 , :,e,c�2'. pi,,,ne:.: 4 I, '`✓ `de.-A+ 7 a Official use frilly. Da not write in this area.to be completed by city or tan official (`its or 1 astir: Pertnit'i.#tense t, ksuin;,r.%utharits teirele one): I.Board of IIe:elth 2.building Department 3.( ills ll'ostn Clerk 4.Ekctrital lttspectar i.Plumbing Inspector O.Other ___...._..�_. ('ontact Persia: Phone n: t 1- 1 1 City of Northampton Massachusetts - # - - * _ DEPARTMENT OF BUILDING INSPE *CTIONS -..,212 Mean Street 4. Muruclpal Aulidamg - , Northampton, MA 01060 ,, .,..,,W- 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: i I Location of Facility: 'ALL- 1 .}(7'?-- ‘-'1-5<C---i--A r\it-c---- j t"*L. P.,-04.,AMPT- ro YLA c.,6 i I I The debris will be transported by: 1 1 Name of Hauler: -rem V\ot,t_ci\. _ ) ,i,,4/\ •.- -:),,),) kAeRe._ kOA:FR-e--A/€:11-) ..-t\i-T- i i 1 Signature of Applicant: ?,,,,a,tittce_ ‘--e4.),„tu. Date: ti)A9-e-Ak City of Northampton ;00- r.. �S ��4 .>. Sir. Massachusetts e„„ d DAP".AF.TB?ENT OF BUILDING INSPECTIONS Q 212 Main Street • Municipal Building Northampton, MA 01060 j52Sy 3r �� HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1, -TAN. C-F— MhRt -r 5 r N t 51351 S' t (insert fill legal name),born (insert month,day,year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 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 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 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 1 engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, t 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 5-111day of to ,20 2, (Signature)