23A-126 (3) 30 MIDDLE ST BP-2018-1371
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map-.Block:23A- 126 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ROOF BUILDING PERMIT
Permit ft BP-2018-1371
Project JS-2018-002431
Est Cost $10700.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License.
Use Group: TIMOTHY LUCE 100515
Lot Siu(sa.ft.): 15463.80 Owner: MENDELSOHN AARON
Zoning:URB(100)/ Applicant: TIMOTHY LUCE
AT. 30 MIDDLE ST
Applicant Address: Phone: Insurance:
PO BOX14 (413) 387-9800
LEEDSMA01053 ISSUED ON:6/21/2018 0.00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE EXISTING SLATE AND WOOD
SHAKES FROM PORTION OF ROOF AND INSTALL STANDING SEAM METAL ROOF
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 4 Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department 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.
Certificate of Occuoancv Signature:
FeeTvpe: Date Paid: Amount:
Building 6/21/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED 2,Oz"��
apartment use only
City of Northampton JUN s�a�u�gfro K
Building Department Curo`Z`'" y rmit
212 Main Street seveedseptic veils 'liy
:( Room 100 DEPT OF BUs ellAveilabi
Northampton, MA 0106 1 NO"THA"^ 11191iftismew 31 Plans
phone 413587-1240 Fax 413587-1272 PloVSde Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A OAP-NE OR
/NNEOOR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION "" / _/ //
1.1 Property Address. ' This section to be completed by office
36 /14CU(p ��-- Map AA Lot /a ly Unit
Zone Overlay District
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2/.11 Overall of Record:
rlaro✓1 90 yu"'70le st.
Namee(/(P'rintallin Adtl
) Current Mress:
z/( — Telephone
Signature
2.2 Autho d t:
, � . L, �r� PCS (7J�)C I I
Name(Print) Cunent Mailing Address:
Yrs 3S1591%)
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by parmit a plicant
1. Building J �C] (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from B
3. Plumbing Building Permit Feet'/
4. Mechanical(HVAC) " / 0
5.Fire Protection
6. Total=(1 +2+3+4+5) 70Y Check Number 17
This Section For Official Use Only
Building Permit Number.Number: Issued:
Signa re:
Building issloner inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING An InformationMust Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Tbis column to be fined in by
Building Depertmenr
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Id anx min.bldg&Wved
#ofParking Spaces
Fill:
wi mie&L .uon
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over t acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S DESCRIPTION OF PROPOSED WORK(check all aoolicablel
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0/
or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs M Decks 1I7 Siding M Other[[A
Brief D cription of Proposed tI (' S
Sla�.�W�rx)- �b.�S -H D0�7on oi- /a7 -4kSlc ll /B,aY
M� wwJh�y V`DV.r
—Ovation of existing b4drooymr Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
ea.If New house and or addWon to existing housing, complete the followlno:
a. Use of building:One Family Two Family Other
It. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of healing? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
1. Is construction within 100 ft.of wetlands?_Yes _No. Is construction within 1 DD yr. floodplain_Yes_No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank_ City Sewer Pnvate well City water Supply
SECTION To-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR AP IPLIES FOR BUILDING PERMIT
I, #('ro/I P)/1�e.ISa/t ,as Owner of the subject
Property
hereby authorize ll Ktu1sW / r-t 1(3
to act on my behalf,in all mayrs relative to work authorized by this building permit application.
Signature of Owner Date
I, % '3 - LL)ct— ,as Owner/Authorized
Agent hereby Tare that the statements am information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed u er the pains and p--enahies of perjury.
`+row . �h—
Pnnt Name
Signature of OwneiNerft Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. � n Not Applicable ❑
Name of License Holtler: It V�i I (7✓ )7
/, License Number
IPO Dox- /q Le;JS C�loj '� -7- /<—/O
Address 7 Expiration Date
F /
re Telephone
S Realsterad Homa ImorowmBrd Contractor: Not Applicable ❑
h , `� , ��w /Y9 Z��
Comoanv Nam Registration Number
PO aOx H /z-1r -/7
Address // ,(�� Expiration Date
L L /',N/WUU✓t, /2//I ueldrJ /!�{'T Oij(jelaphone . 13 3F7
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT IM.G.L.c.152,1 25C(8))
Workers Compensation Insurence affidavit must be completed and submitted with this application.Failure to provide this affidavit will result
in the denial of the issuance of the buildiukrmit.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
•> Massachusetts
f1aPAR12fENT of BOILDIRG ZnSPICTZOne
212 Min .t t • MmloiBal auildi,
\ AZtha to., to 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction,alteration, renovation,repair, modernization, conversion,
improvement, removal, demolition,or construction or an addition to any pre-existing owner-occupied building containing
at least one but not more than Pour dwelling units....or to structures which am adjacent to such residence or building"be
done by reeistered contractors.
Note.If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: Est.Cost: ko
,,
Address of Work:� rr7W,� 5/
Date of Permit Application' z.¢ -
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
_Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Date Contract9fr Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
s !
-" Massachusetts
I �waaamrr or saiinrsc Ixspacrraas
113 1 Ln —st • M ieipal Ba 1,Unq i c°
aoith+np , M 01060
Massachusetts Residential Building Code
Section 110.115.1.2
Homeowner: Person(s)who own 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 homeowner.
Section I IO.R5.L3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 1 IO.R5,provided that if a homeowner engages a person(s)
for hire to do such work, then such homeowner shall act as supervisor.
Such homeowner shall submit to the Building Official, on a form acceptable to the Building
Official, that he/she shall be responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to
time, during and upon completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153
(Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts
General Laws Annotated, you may be liable for person(s) you hire to perform work for you
under this permit.
City of Northampton
55 C
'
Massachusetts
I I DlSPAR14ffiOT of BUZLr1IBe ZNSPSCTIOBS �
s
YSY Win SC[wt *Municipal Building
�� NaclLMrytev, MA 01060 rryy 3�31J\D
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
(Ple a print nam and loop ion of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit Applicent or Owner Dale
If, for any reason,the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
�\ The Commonwealth ofMassachusens
Wil.rkers'
Department of IndustrialAccidents
I Congress Street,Suite 700
Bosto»,MA 02114-2077
wwwmass.gov/dia
Compensation Insurance Affidavit:Builder•/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information 1 Please Print Le ' 1
Name(Business/Organization/1 iwiAdu ' L✓Address:-&� j 1Joy- /'(
City/State/Zip: LeeA /0 Phone#: y'/-i
Are you•e empbyer?check roe•pnwnri•sr nos: Type of project(required):
1.�lamaan oyer wish_ omploye,tall andor part-time)* 7. ❑New construction
amawle proprietor or pmtncrship and have no employees Woking Raiment S. E] Remodeling
' anycapacity.INownkeri earn,msvmnce m mmdd
3.n 1 am a homeowner doingall work m .df. No woken'wm . surara d. 1 ❑Demolition
a ver [ pit <rtgnrm 1•
4.E]I am a homeowner and will M hiring contractors to conduct all wok on my prope y Iwill IO Building addition
un thatall contractors either have workers'competsation in...anworarewle I1.❑Electrical repairs or additions
pmpnetom venhno employees. 12.�Plumbin airs or additions
s.0 l am a general contractor and l have hired the,to-eonrracbrs listed an the..ached oval. 13. oofrepawa
These sub<onuacmis have employees end have workers'wrap.insmamc.
6f]We arc.corporation and itsol6cea have exercised their right of exemptom per MGL c 14.❑Other
152,t toil,and we have no employees.[No workers'wrap.ins urance'mound.)
Any applicant that cheeks box#1 must also fill out the section below showing their wokers'compensation it,intammtam
t Homeowners who submit this affidavit indicating mey me doing all wok and then hire outside wntmetors most submit u new andevi,ushcating such.
:Cmarmu rs that cheek this Mx as,ahached an additions)sheet showing the risme ofum sub-contractors and state whether or not those entities have
employem. Ifthe subconumators have employees,day must provide their workers'wrap.policy numb'.
7 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.ft: Expiration Date:
Job Site Address: City/State/Zip:
Attach 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,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the font of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby coti'v under duties ofperjwy that the information provided above is hue and correct
Silanab.m Date,
q
Phone k: / TUo
Official use only. Do not write in this area,to be completed by city or town ofj ciat
City or Town: Permit/Licenw N
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone A:
v SOMMONW AL.7H OF MAt A,�GNi�B 7
�.
Board
of Budin DepaRmenl01 and
lICSt ndard • • •j ;e + i�ta�
Board of Building Regulations and Stantlartls
Lkeas•:CS-100515 SHEET MSTALWORKEIRS,
Constructlon Supervisor ISSUES THF Eqj—ISINNNG LIC0"AS A
.3AA8'pER-41NRE37SlfsTE�
TIMOTHY J LUCE T1660THy J LUCE
PO Box 14
LEEDS MA 01053 P(X B 7S t4
LEEOS x1
Mh 41G 401
M C_A_ 01
Expirahon: 159gg .blitel a, %536Commmsiorur 07MG12010
011b al Ga WlaMAsaln b BUNam RpOR p WBOon valid for Individual us*only
{i0a1E 0aM10YEME1 NTRACTO �sapkawaydats ytr�rylum is
ot"m of Coirumer A1Wrs and auelrnw Regulation
B}4�n 1211dR(m 10 park Plbze'Suite 5170
8nston,VA 02110
TIMOTHY J LUCE
122 AUDSON IID. L
Not vai3d without signature
LEEDS.MA 01053 Undorsec06l0ry