24A-112 (8) BP-2024-0480
64 PROSPECT AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-112-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-0480 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 2024 Contractor: License:
Est.Cost: 2475 RUSSELL MANZ 118003
Const.Class: Exp.Date: 12/20/2026
Use Group: Owner: SAADI MOTAMEDI STEPHANIE &
Lot Size (sq.ft.)
Zoning: URA Applicant: HOME ROOTS CONSTRUCTION
Applicant Address Phone: Insurance:
81 CHAPIN RD (413)775-3126 ROWC580520
BERDNARDSTON, MA 01337
ISSUED ON: 04/19/2024
TO PERFORM THE FOLLOWING WORK:
REPLACE 5 BASEMENT WINDOWS
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: 72.
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
r` 3
e /The Commonwealth of Massachusetts APR
Board of Building Regulations and Standards r 9
1 FOR
�I` Massachusetts State Building Code, 780,CMRr� 'MUNICIPALITY
ITY
' _ USE:
Building Permit Application To Construct, Repair, Renovate CSi 1k2Malcp Revijed Mar 2011
One-or Two-Family Dwelling .44 o of olvs
This ection For Official Use Only
Building Permit Number: 3A 1'f" D0 Date Applied:
ICI s> /7/ 11-19-zozy
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
U c P,'J
1.1 a 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 ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
SqC i Motet,h%ed i 11/Jfrt0-mp 43,Q ,.44s4 0lJ6v
Name(Print) City,State,ZIP
6 y 9'QSPPCf'.9-(ic Y13- 53'4•-933/ ICA act S?(c cast,F1et
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building lit/ Owner-Occupied 0 Repairs(s) Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: �L/�/,4.CL C/iJ j j v5 .0 r W I At d uGJS
I1 FActk" OZs
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:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) Total All Fees
Check No.\ Check Amount: �� Cash Amount:
6.Total Project Cost: $ Z l/75, 00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) j goo-3 f Z/Zd/Z6
Agmy4 Fed g(Cfi.41ZO FAcizy License Number Expiration Date
Name of CSL Holder U
q v poi N ST List CSL Type(see below)
No.and Street Type Description
EitotA. p}b, "A z 7 U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(k/3)667 7/z9 120UfScanS t CdrfcM /r1&9MA,l•(As1 I Insulation
Telephone Email address D Demolition
5.2 pool's
Home Improvement Contractor(HIC) 2 C,$Q C>L 6 3/Z 0 ZS
pool`s cm C' HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
P(R-i1/1 5, /?00-tsCon)--trkc-fide 4/3 9.+44+/,Cc
No.and Street Email address
L=AS141S. ,;N.1- D,027 1if/3) '-7 7L/ZC/
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 RV. 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 / )O+5 CO/1 S 'ucf('Lyl L L�.
to act on my behalf;in all matters relative to work authorized by this building permit application.
r
Sea41/ y1v-gf►td; ///)/l21/
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.
/491-fhle P,f(31Zy // elz y
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.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 halfrbaths
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 Commonwealth of Massachusetts
ET'- .( Department of Industrial Accidents
i��'i 1 Congress Street,Suite 100
ni
"' Boston,MA 02114-2017
r s . Krww nrass_gov/dia
11 in kers'('ompensatiun Insurance AfTidas it:Builders/('untractursElectricians Plumbers.
11)BE FILED N'll II THE PERMUTING Al 11U)R11 1.
-1Ptilicant Information Please Print Legibly'
Nate I Hu. e-
in .s()rpanvatton loan idual): ROD S Cc-,A 51Tc-/cji (rJ el L CC
Address: 18 Plat A St
City State/Zip: 'Y1 P1&‘/ 1- 01017 Phone#(4/3) 667--7y 7
Z
Are:situ an employee(loci the appropriate hoe.
Ty pe of project(required):
1.�ant a eintila.ver with 3 timsoyee%tlull:ascot pat-Umr1.• 7. Q Ness construction
_.." I am a sole pn ginetor or parintr.hip and have no employees working for nit in ,
any capacity.(\ci wider.'comp.rnsurani required] S. Remodeling
9. ❑Demolition
;.D I am a Itonka.wno along all wort.myself.Piu winia-N.comp.uwuruice required.l'
l o 0 Building addition
.i.Q I ant a homeowner and will be luring contractors to Conduct all work on m%property. I will
enwn that all cc.ntt.ia It n other have worriers'compensation insurance or isle sale I I.(J Electrical repairs or additions
proprietors with no employer..
12.0 Plumbing repairs or additions
y.10 I am a genial contractor and I love hind the sub-contractors listed on the attached sleet. 13.0 Roof repairs
These sub-contractor love em lwees and love workers'comer insurance..
ti.0 Vic an:a corporation and its officers has a exercised then neht of cit.: ni mow per NN iL 14. Other k'i'ipr >
I52.a 1141.and we have nu crriplosees.[No workers'comp msuran.c required.]
•: m applicant that checks box=I must also till out the section below show ing their workers'compensation polies information.
' Itoinvisc no-,who submit this attidak it indicating they;are doing all work and then hue outside contractors must subrrut a new Aida,it radicatone such
Contractor.that check this box must attached an additional sheet showing the name of the sub-cunnalturs and state whether ur nut those entities lase
eintloyces. It the sub-etcuraetums lake cur liwees.they must pn.iide their workers"►ump.poles norther.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. p
Insurance Company Name: /7 e/'k5L7I('< /p th4Lt.Y1 /
Policy:r or Self-ins.Lie.#: Ro lAIC 5'U S Z.O Expiration Date: v/'>/Z-5.--
Job Site Addrt ,: a 7 P oS9ec f ,4Q City/State Zip:,/O/711' 1,.A-0k06
Attach a copy of the worker'compe■satio,policy declaration page(showing the policy number and expiration date).
Failure to secure cot erage as required under MU_c_ 151*25A is a criminal r tolation punishable by a tine up to$1 300.00
and or one-year imprisonment.as well as end penalties in the form of a Sit)P WORK 1)RIM R and a fine of up to$250.00 a
day against the violator. A copy of this statement may be torn+ailed to the 4►ttik e it Inv esit ttions of the DIA for insurance
Overage verification.
I do hereby certify under the ins and penalties of perjury that the intrrrmation provided above is true and correct.
Signature: I1f , Date: �l/211 L/
Phone µ: (yi27)167--7yz`9
Ofcial use only. Do not write in this area,to be completed by city or town official
('its or Town: Permit/License#
Issuing authurits Icircle one):
1. Board of Ilealth 2. Building Department 3.City(Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
Massachusetts 4
r DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
MA 1 s .........rj\'
,.. Northampton, 0 060 6�, ��
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.
ti
The debris will be disposed of in: v , -ey '� ec/c ii Ay
Location of Facility: 2 3 h 7/0 ied4 ►/ v c.) 6
The debris will be transported by:
Name of Hauler: go01-5 (del S uc rJ_- U -c
of Applicant: Date: 41/'/
O/2 &./
Signature pp 1