22B-029 (2) BP-2025-0093
11 CORTICELLI ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22B-029-001 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-2025-0093 PERMISSION IS HEREBY GRANTED TO:
Project# DOOR 2025 Contractor: License:
Est.Cost: 2000
Const.Class: Exp.Date:
Use Group: Owner: MCGUINNESS USE A&ANDREA C HOLLAND
Lot Size (sq.ft.)
Zoning: URB Applicant: MCGUINNESS LISE A&ANDREA C HOLLAND
Applicant Address Phone: Insurance:
11 CORTICELLI ST
FLORENCE, MA 01062
ISSUED ON: 02/03/2025
TO PERFORM THE FOLLOWING WORK:
REPLACEMENT DOORS
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:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: /E.
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
wed
,Z, The Commonwealth of Massac, setts./AN
V
Board of Building Regulations and dards 31 405 FOR
Massachusetts State Building Code,781 ,.i R MUNICIPALITY
USE
Building Permit Application To Construct, Repair,Renovate Or ire ish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: ►& . 5 • /,__3 Date Appli •
�T k itgCj�t 7 �/ 3-2--
Building Official(Print Name) S. .lure Date
SECTION 1:SITE INFORMATION
1 cty� kdr re U( D(P/- y-As6sgsdo5 `af4 P1a37 l NLe —4 2 0,0 0,
l.la Is this an accepted street?yes no Map Number Parcel Number
4 1.3 Zoning Information: 1 ttDimensions:
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❑
J SECTION 2: PROPERTY OWNERSHIP"
2.1 w � 0�%1 (i Cu 1it?Q,UI; (ov�041 Nam' 6'l 0( Z
Natne�lt b� Cit State,ZIP r
No.and Street Telephone Email Address II/CO
SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 "g1 pairs(s)A Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. Cl Number of Units Other 0 Specify:
Brief Pescripti of Pr.••• . Work2:_._,_,
ik IA ,. . ,3 0( wit-- < rot 1j l Y11.0 -eir cI&d( U to F.- l,V i�-t 4M.t
e - L, sl ,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
_.(Labor and MaterialsL _
1.Building $ `j 6Od 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) Total All Fees: $
it Check No. 7:10k.Check Amount:Li) Cash Amount:
6.Total Project Cost: s 2,(4 v 0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HI('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 .......... 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 work 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.
LISe Mo&A iness 3(
'Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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 spl have access to the arbitration
program or guaranty fund under M.G.I..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"
City of Northampton
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Massachusetts �� S.. �'<<
DEPARTMENT OF BUILDING INSPECTIONS y:
-� .11��, 212 Main Street • Municipal Building Jtir �C�
� 1 _ Northampton, MA 01060 'J'j _,,- \
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: -3 3 � T � l'vt ��1 t\lcAl'otfryktvi (thqiik Qicfkii)
The debris will be transported by:
Name of Hauler:
AitiotOJCiel( 01/1e1\
Signature of Applicant: Date: (102-5
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The Commonwealth of:Naswchusetts_
*� Department of Industrial Accidents
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1=- b 1 Congress Street,Suite 100
_ma. ter Boston, MA 02114-2017
'' www mass.gov/die
3.
- 11 urkers' (`otnpensation Insurance Affidavit:Builders!Contractors/Rketriciansll'lumbers.
•1O BE FILET)‘1 I I'll I III.:PERMMI trim;AI'"I'HORlf1".
1lnnlicant Information Please Print I et ibh
Name(Business organutauon:Individual): LI fr\L' T?A iewles
Address: I( Coo C'-hre i l i S+
City/State/Zip: -�'-l0(errs O_ Phone#: - -
.krr vuu an employed('lean the.ppndak lot: r,pe of project(required).
ia I am a employs/with -- crop/ewes(full andot pat-tinier' 7. ❑New construction
:.1:1 I ant a sok preprsecx of partnership and have nu crnpley i s w eking fur me in H. Remodeling
any capacity.[No worluaa rump.in utani nquutad.] t--+
9. ❑Demolition
Ceam a hornointner doing all wink myself.[No werics comp.atsurunez nNqumd.]'
I 0 D Building addition
J.Ef l am a homeowner and will he hiring aautaeturs to esin duel all work on my pnrperly. I will
_--..' ensure that all ciwitractors either have worker'eYampensatiun►nsuramx Or are sok 11.0 Electrical repairs or additions
peep-idol%with no employees.
12.0 Plumbing repairs or additions
tin 1 am a ktiyw-ral l•ontractot and I has a hired the sub-:ontractuts listed on tbc attached sleet. 13❑ROOFto repairs
These sub-centractun have employees and Inte w insurance.:
workers'comp.insunce.
14.El Other
±..011'e are a comoratien and its officers have.xenised their right of exemption per M(;L r.
132,II I14),and we have no employees.[No workers'comp.insurance reapined.I
'Any applkartt that checks Eire a1 must also till out the section below showing their worker.;compensation policy information.
t Ikstnoowten who submit tins uffi duvet indicating they are doing oing all work and then hire outside contras/ors must submit a new affidavit indicating such.
tUontracton that cheek this has must nUa•bed an additional sheet showing the name of the subcontractors and state whether et not those entities have
entrlosees II tlsr sub-etmtractors love enaplo!,ces.dens must rtnw!Lk-their wea ns :r ke . rt :y -
t.wnb:r
r
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1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site
in f ormr►linn.
Insurance Company Nate:�
Policy#or Self-ins. nLie.#: i - Expiration Date:
I Job Site Address: I ( 1)41 C,1 t 1 CityrState."Zip: TIOCen4e MA OV-X,
a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,(125A is a criminal violation punishable by a tine up to SI,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 S250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
euver,i w v critiration.
I do here if under e pains and penalties of perjrny that the information provided above is true and correct
—KS f 3) 1?at \airs v �
I'Ihor _::
Official use only. Do not write in this area,to be completed by city or town official
( ity or Tossn: Permit:license 0
Issuing Authorit) (circle one):
I. Board of Health 2,Building Department 3.('it/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
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/J•"' Massachusetts �• � •�
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a DEPARTMENT OF BUILDING INSPECTIONS D j�
' ' i� 212 Main Street • Municipal Buildings. w''•4 �
? Northampton, MA 01060 `"�• ��0�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
r, Lime �. �, i n es
S (insert frill legal name), horn _ (insert month,
'day, year), hereby depose and state the owing:
1. I am seeking a building permit pu •nt to the homeowners' exemption • (he permit requirements of the
Massachusetts State Building Code, codi • at 780 CMR 110,R5.1.3.1, in •> nection with a project or work on a
parcel of land to which I hold legal title.
2. 1 am not engaged in, and the project or work for w •ch I am seeking to aforementioned homeowners'exemption,
does not involve the field erection of manufactured but,.ings const cted in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"ion .. er"as defined at 780 CMR 110.R5.1.2:
Person(s)who owns a parcel of land on which he/she r 'des or intends to reside,on which there is, or
is intended to be, a one-or two-family dwelling, attac detached structures accessory to such use
and/or farm structures. A person who constructs m• e than o - home in a two-year period shall not be
considered a home owner.
4, I do not hold a valid Massachusetts constructi• supervision license and, cept to the extent that I qualify for
and will abide by the Massachusetts State Bt 'ding Code's requirements for t supervision of the project or work
on my parcel, I am not engaged in con iction supervision in connection wi any project or work involving
construction, reconstruction, aliterat': t, repair, removal or demolition involving • activity regulated by any
provision of the Massachusetts • e Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned p et or work on my
parcel, I acknowledge that I ant required to and will act as the supervisor for said project or wo
Signed tinder t pains and penalties of perjury on this day of , 20_.
(S tore) ------