25A-065 (3) BP-2024-0353
50 HUBBARD AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25A-065-001 CITY OF NORTHAMPTON
Permit: Demo
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-0353 PERMISSION IS HEREBY GRANTED TO:
Project# DEMO GARAGE 2024 Contractor: License:
Est. Cost: 500 JACOB LEACH CONSTRUCTION CS-097078
Const.Class: Exp.Date: 10/20/2024
Use Group: Owner: MURRAY, GAIL E. & CONATHAN, DEVIN M.
Lot Size (sq.ft.)
Zoning: URB Applicant: JACOB LEACH CONSTRUCTION
Applicant Address Phone: Insurance:
250 BAKER CROSS RD (802)275-8133 SOLE PROPRIETOR
GUILFORD, VT 05301
ISSUED ON: 03/29/2024
TO PERFORM THE FOLLOWING WORK:
DEMO AND DISPOSE DAMAGED 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:
17Z
Fees Paid: $30.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
N
PIECE
1
The Commonwealth of Massachusetts 9 2024
W
Board of Building Regulations and Standards MAR 2 FOR '.
Massachusetts State Building Code, 780 CMR MUNLIPALITY
-- �U ,,lo SE
BuildingPermit Application To Construct, Repair, Renovate Or Derr[ a: .'•Ri Mar 2011
PP P ,-�1 'a . -
One-or Two-Family Dwelling
This Section For Official Use Only
Building Per1.?Number: �. A 1�3 6 3 Date Applied:
,�,� �5� ��// 324ZOZy
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
o HUtDt011e44 A •
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:
tEv t. (115..rA +a.-, IJ 0 ,Awt, ) AAA d t C (p 0
Name(Print) City,State,ZIP
, - CC_-_"2-9-5-1--741.- kteae.___citzt•- ,fe—aniAl.v A 1•C.,15WV
No.and Street Telephone ' Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 12(
Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description o£Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa (Item 6) x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ —
Suppression) Total All F
Check No. heck Amount --))O Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS 07
jts„ fib (Q��- D License Number Ex iratio Date
Name of CSL Holder
n ,�� List CSL Type(see below) LJ
�sb 1 S n �-05 L 4
No.and SaeType Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
Ci own,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
g /,-i5-/i33 404,,��sac r,.,at„li,� - hL I Insulation
Telephone a Email address —cJ D Demolition
5. Registered Home Improvement Contractor(HIC) y 51 q1t 1 i 1 7-s
r— S
��' eah-GtA w1 -uRiO� HIC Registration Number Expira ion Date
HIC Company Name or HIC Registrant Name
•/tio 1S4C4.- 61..ac5 V.A ltti , .
No.and eel: Email address
) UT 0516 k �b2'2�5 g133
' y/Town,Star, 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 Issuan 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 y b lf,in all matters relative to work authorized by this building permit application.
3/z9 (z
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
cont ' ' this applica ' ' true and accurate e bes y knowledge and understanding.
5/2-- -7—
Print O n 's or Authorized gent's Name lectronic Signature) V
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"
ASBESTOS REMOVAL
All residential, commercial and institutional buildings are subject to Massachusetts Department of
Environmental Protection (MassDEP) asbestos regulations at 310 CMR 7.15. Therefore, owners
and/or operators (e.g. building owners, renovation and demolition contractors, plumbing and heating
contractors, flooring contractors, etc.) need to determine al asbestos containing materials (ACMs),
both friable and non-friable, that are present at the site, and whether or not those materials will be
impacted by the proposed work, prior to conducting any renovation or demolition activity.
Examples of commonly found ACMs include, but are not limited to, heating system insulation, floor
tile and vinyl sheet flooring, mastics, wallboard,joint compound, decorative plasters, window glazing,
asbestos containing siding and roofing materials and fireproofing materials.
Failure to identify and remove all ACMs prior to its being impacted by renovation or demolition
activities, can result in significant penalty exposure, and higher clean-up, decontamination, disposal
and monitoring costs.
A DOS certified asbestos consultant must be contracted to determine if asbestos is present and
whether removal/repair is necessary. If the building is a state owned facility, contact DCAM and DOS.
DOS provides a list of licensed asbestos abatement contractors and consultants. You may wish to
inquire if a contractor has any history of violations. Only DoS licensed and DOS certified asbestos
abatement contractors and consultants may be hired to perform asbestos related work in
Massachusetts.
Received by: ()Aft
Print Name Title
ignatu e Dat
The Commonwealth of.1Iassachusetts
( Department of Industrial.-t ccidents
�s �=r. 1 Congress Street.Suite 100
- �.:
'" Boston. .Na 0211a-?l11
':..., .1,, wwtt:masc.go)lditt
))utker.'('otnprnsttion Insurance Af1-ulas it:Buie rr.1('ontractors Electricians,Plumbers.
lit)IHi.171_1 1)Whit/I IIk:PLKMh1"i I L oat 1•110R1 it_
Applicant information Pleas Print 1_ey_ila.
Name i Business t►rpritiation lath\a.ttut l: c....) cn.i3 (0pJs o.--
Address:.._7 a Yd c 4 c (-I-o5 S _
City/State Zip: L.,,p�,, , 05-3 o 1 __ t #: SbZ-2-7j' -$13-3 --
Arertw an employee '1.the appropriate Isis:
I:pe of project(reyuired)-
1-0 1 rr 1 a e ,eryer with employees(full and or pat-terl►e l.' 7. 71 New construction' I am a sok:proprietor or partnership and!lane no employ ces workmr tor me in S. K tnur)t l ttlp
rer
any capacity.I\o worker.'es np.insurance retiwred.l
9. )mtsliti.ln
3.Q tam a kltmtloc unca tttsin$all%aril.myself.f his.wuat ary'euntlt.rmurarce r.•yuar.d.l"
1QD Building addition
i.Q lam a hometow net and%ICn hoe hrrnerg etuttaetor s to conduct aft week on my prupcttr. I urn
arsine that;All e.meratiors either lase%oilers einnpanahon Insurance or are sole i i.0 Electrical repairs or additions
prupnetors with flu employees.
12.0 Plurnbrnr;repairs or additions
S0 I am a g luctal etmtractor and I boo 4:hared the subcontractors listed on the attached sheet.
These sub-c.mu .tor.!use employees anti hase w ur kern'..cosy.uuurarl.a 13❑ROUE repairs
.
Ian( Other
6.0'N'e an.1 es.rt..r ria..to and its officers cers Mice even.Iced then eaglet ot exemption NI Mt.t_e...
142.y 91 ht.and we Moe no employees.(`as workers'comp.insurance required I
'Any applicant that checks bus r.1 moist also till out the ieettou helow shin.tng theat workers'compensation policy ustonnation.
o tic motes nets.slit submit thus atlida%it rncheattng Ilk')are doing all work and then here outside edrtttra:txrs stunt subunt a neon altidai It indicating sus h
A.ontractors that check this h..must attached an additional sheet show my the name ant the sub-c.nttra:t..rs and state.1 holier or not those innate,list.
employees It the sub-contractors hat.employ eV..tic) must pot.Ide tt;.lt c.,•rkets'comp.p..11es rtur nos.r
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site
information.
Insurance Company Name:-
Policy#or Self-ins.Lie.#: Expiration Date:i_
Job Site Address: CO State'Zip:
Attach a copy of the worker's'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required wider M16L c. 152.*25A is a criminal violation punishable by a fine up to SI300.00
and)or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
.leas against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
..,,..:rage scrtlicatton.
I do hereby under th• tt and penalties of • - r• it the information provided abate is true and correct.
nature: • Date: V2,9/2,9
1'iltnie::. 207,- L-- y1' 133
Official use only. Do not write in this area,to be completed by city or town official
('its or Town: Permit/license#
Issuing.kuthorits (circle one):
I. Board of health 2.Building Department 3.('its I own(Ierk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
( ontact Person: PI e#:
City of Northampton
'atH -10
'� �� Massachusetts A.
nrt!! r
o • .� DEPARTMENT OF BUILDING INSPECTIONS
1. 7 212 Main Street • Municipal Building ,,
i v
{r Northampton, MA 01060 9:-
�'�t'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:
Location of Facility: Cc-1ita \' - c. kF 4 Ab\ivte il,/\f
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date: " U
City of Northampton
--` Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS 9
212 Main Street • Municipal Building
" Northampton, MA 01060 j'StrW7�^`
APPLICATION FOR DEMOLITION PERMIT
Attached are the forms required for a Demolition permit. Please fill out all of the attached forms and
submit them to the Building Department with the appropriate fee. Please make checks out to the City
of Northampton. (Cash not accepted)
Please be advised that disconnect signatures from the following departments must be submitted with
the application:
1. Eversource (Gas division)
2. National Grid (Electric division)
3. Northampton Department of Public Works - Water
4. Northampton Department of Public Works — Sewer
5. Northampton Department of Public Works — Storm water Management
6. Northampton Department of Public Works —Tree Warden
7. Northampton Historical Commission Review (if built prior to 1945)
*Proof of extermination is required to be submitted to the Health Department for all Commercial
demolitions and all abandoned residential properties. (Extermination may be required at the Health
Inspector's discretion if evidence of rodents exists).
Other required documents:
• Massachusetts Construction Supervisors License
• Copy of Workers Comp Affidavit
• Asbestos abatement report
A Demolition Permit will not be issued, and no demolition is to commence until ALL required
documents are submitted to the Building Department.
For further questions or information, please contact this department @ (413) 587-1240
BUILDING DEPARTMENT
DEMOLITION PERMIT SIGN-OFF SHEET
Date:
Address: 50 R01919R..6 / - . Building Use:
Owner:-1YcN i...) C04...,AVA,,J Phone: (00%—'1.56 .1.'11-12,
Owner's Address: 6,0 AVi�AtQc\ A i
UTILITY CUT OFF
(Signature of Authorized Representative of Utility Department required)
As required by the Massachusetts State Building Code (780 CMR), a permit to demolish shall not
be issued until a release from the utilities is obtained, stating that their respective service
connections and appurtenant equipment have been removed or sealed and plugged in a safe
manner.
Eversource (Gas)
Signature Title
National Grid (Electric)
Signature Title
DPW (Water)
Signature Title
DPW (Sewer)
Signature Title
DPW (Storm water)
Signature Title
DPW (Tree Warden)
Signature Title
DPW Director
Signature Title
Historic Comm. Review
Signature Title
Health Department
Signature Title