25C-033 (4) BP-2024-0281
33 NORTHERN AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-033-001 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-2024-0281 PERMISSION IS HEREBY GRANTED TO:
Project# BASEMENT RENO 2024 Contractor: License:
OAK RIDGE CUSTOM HOME
Est. Cost: 21000 BUILDERS INC 087690
Const.Class: Exp.Date: 07/08/2025
Use Group: Owner: EMILY PRABHAKER SUMANTH &
Lot Size (sq.ft.)
Zoning: URB Applicant: OAK RIDGE CUSTOM HOME BUILDERS INC
Applicant Address Phone: Insurance:
80 RIVER RD (413)379-9236 WCS-315-384694-033
SOUTH HADLEY, MA 01075
ISSUED ON: 03/19/2024
TO PERFORM THE FOLLOWING WORK:
BASEMENT 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:
011:444 gclatZt714C4
Fees Paid: $137.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
/ 6,--.'.4.?:?:.\,,,.
9017E-070 11 u-312-ti-z, 4/416 / [. .C1k,'>'s•-
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The Commonwealth of Massachusetts ' 4 � 'sr . .
Board of Building Regulations and Standard � 1s FOR
Massachusetts State Building Code, 780 CMR`- 'Ar MIJ 4IPALITY
SE Building Permit Application To Construct, Repair, Renovate Or Denio _ty� 4,' evised Ma/2011,,
One-or Two-Family Dwelling ':4 SpF . +I
This Section For Official Use Only 'N. '�:o' 'I'S
Building Permit Number: ]2 a-y a f/ Date Applied: •'.,,,..i°
Lo,k,lS Kasbr°o.A,cic ,, A„..,`.� 3 I8l2L\
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro dreT: �Q 1.2 Assessors Map&Parcel Numbers
6 Ur# r V`�-
1.1 a Is this an accepted street?yes r' 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 Z,one: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of ord• . i l /' /i
47
0/0&)
Name(Print) ity,State,ZIP U
_3.3lible41 31. &7-3f 0/33 3c/fo go-IL. pgAbtiake 3iLe►9. L
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) , Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work': Fi v►,5L Baj&.vi e'w.44
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ J 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ' 0 Standard City/Town Application Fee
ii QD0 ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees: $
Suppression) '3�
Check No!,( . Check Amount: 1 Cash Amount:
6.Total Project Cost: $ 21 Oct) r 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 C ns ruction Supervisor License(CSL)
`.t fJ876�"D 7 6 .2 5"t✓� License Number Ex iration Date
Name of CSL Holder
g n AZ List CSL Type(see below) ,
No.and Sheet ! Type Description
C al/. , t � 4 gO75 ,/ U Unrestricted(Buildings up to 35,000 cu.ft.)
J�(C.t..f.� tt fiY 'f 'bC L RR� Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
j� L I ,� ,^ SF Solid Fuel Burning Appliances
"/i 337 c12 3‘ V��5 N vG rZ Q �Y7 tf(o I Insulation
Telephone Email address D Demolition
5.2 ' Zed coze Improvement Contractor(HIC) is' i6
- 3 ✓" Z HIC Registration Number FlpiiatiOn Date
HIC i i i.. y Name or HI e ' t Name
N and • t- / „ VALSH✓ETz�v HOC,
/l a"`� Hy 0075_
%13 37 %,Z 3, 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 ,K 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 ad S 4, 4) L,
to act on my behalf,in all matters relative to work authorized by this building permit application.
5.2.4.4A CZ44 fil Pra b I/q kR4Z "?//54 ei
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 thi pplication is true and accurate to the best of my knowledge and understanding.
/I ...- kti,k--
_3/5/2 ei
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 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.) '70U (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) 700 Habitable room count
Number of fireplaces ..el . Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system z. , 4: ' t4A e Number of decks/porches -a`
Type of cooling system ¢,X;a ;1 N/7 e Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
, M1`My,o.
fi Massachusetts &�� _ '�<
I , DEPARTMENT OF BUILDING INSPECTIONS a '�;
!.'" 4' 212 Main Street 40 Municipal Building Jti �a
M'_. Northampton, MA 01060 rS'I, \C`��
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: -S4-0Aaa4 d i/ / c/ oie e/ , 60 f'er
The debris will be transported by:
Name of Hauler: /z7--- iiae-/-45;
Signature of Applicant: Date: _..3/-5/. 7c-q? 9
•
- The Commonwealth of Massachusetts
Department of Industrial Accidents
;it
ti . Office of Investigations
Lafayette City Center
2 Avenue de Lafayette, Boston, MA 02111-1750
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
,tile' �" �p
Business/Organization Name: z ic/t /itt=4
Address: 16,, zes
ya'v S"
City/State/Zip: /r/r Phone #: �/357j 9 2 3'
Are ou an employer? Check the appropria x: Business Type(required):
1 am a employer with r employees (full and/ 5. ❑ Retail
or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment
2.❑ 1 am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl. real estate, auto.etc.)
employees working for me in any capacity.
[No workers' comp. insurance required] g• ❑Non profit
3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment
their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing
no employees. [No workers' comp. insurance required]** 11.0 Health Care
4.❑ We are a non-profit organization, staffed by volunteers,
with no employees. [No workers' comp. insurance req.] 12.0 Other
An) applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
"If the corporate officers have exempted themselves.but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
I am an employer that is providing wof ke 'co ensattiion'nsu nce r my employees. Below is the policy information.
Insurance Company Name:
Insurer's Address: p d ‘f j
City/State/Zip: _ /
Policy#or Self-ins. Lic.# a}e . _? ' 49 -03 Expiration Date:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under§ 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up
to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to
$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of
the DIA for insurance coverage verification.
I do hereby certify, under the pains and penalties of erjury that the information provided above is tr e and correct.
Signature:/ Date: -3/5—
Phone#:
Official use only. Do not write in this area, to he completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board
5. Selectmen's Office 6. Other
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