46-050 99 ISLAND RD BP-2021-1106
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:46-050 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# BP-2021-1106
Project# JS-2021-001866
Est.Cost:$40.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: FREDDY CAMPOVERDE 106011
Lot Size(sq. ft.): 3484.80 Owner: BASS KATHRYN
Zoning: Applicant: FREDDY CAMPOVERDE
AT: 99 ISLAND RD
Applicant Address: Phone: Insurance:
20 TATTAN FARM RD (508) 873-1884 WC
WORCESTERMA01605 ISSUED ON:4/2/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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# 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.
)2 Certificate of Occupancy Signat ,p a' ,n„ .
FeeType: Date Paid: Amount:
Building 4/2/2021 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED
APR - 22021
The Commonwealth of Massachusetts _
Board of Building Regulations and Standll .OF BUILDING wsPECr g„ F R
7 ORTHAMPTON,MA 01 IC ALITY
/ Massachusetts State Building Code, ,80 CM. . u E
Building Permit Application To Construct, Repair,-Renovate Or Demolish-a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: (2,P' i /ate Date Applied: /
/�c=U 1/3 1 K,057 //<� `7-Z-ZOZ1
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Asses r�Map& Parcel Number �--
99 Island Road (Q 0
1.la Is this an accepted street?yes X 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:
Kathryn Bass Northampton,MA 01060
Name(Print) City, State,ZIP
99 Island Road 413-586-8303 Alizerin(n%gmail.com
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 21 Specify: Re-roof
Brief Description of Proposed Work': Remove existing shingles and replace roof
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only
1. Building $ 7,500.00 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire ��
Suppression) Total All Fees:1$ (�
Check No}331' Check Amount: Cash Amount:
6.Total Project Cost: $ 7,500.00 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
/ 4 S
[[ Massachusetts
44�
DEPARTMENT OF BUILDING INSPECTIONS
` 212 Main Street • Municipal Building ,P
Northampton, MA 01060 JS ••arj‘�J
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS,ACCESSORY STRUCTURES,
FENCES,GROUND MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specification of proposed work(digital and hard copy).
3. Site Plan with location of proposed structure(s)and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/replacement windows).
8. Home Owner's License Exemption Form filled out and signed by homeowner(if applicable).
9. Note any Conservation and/or Special Permit requirements (if applicable).
10. Driveway Permit(if applicable).
11. Proof of Water and Sewer entry fees paid(if applicable).
12. Trench Permit-public land by DPW/Private land by Building Dept.
13. Stretch Energy Code—all new construction will require a HERS Rater Affidavit to be submitted with
permit application before issuance of permit.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CSSL-106011
6/2/21
Freddy Campoverde License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
20 Tattan Farm Road
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Worcestor,MA 01605 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
508-873-1884 Greta(it)goldengrouproofing.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
174718 3/11/23
Golden Group Construction Corp. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
20 Tattan Farm Road Greta(a.,goldengrouproofing.com
No.and Street Email address
Worcestor,MA 01605 508-873-1884
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 ll 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 Golden Group Roofing Corp.
to act on my behalf,in all matters relative to work authorized by this building permit application.
Kathryn Bass 3/30/21
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.
Leah Visconti 3/30/21
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 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" •
City of Northampton
Massachusetts
*
- '� DEPARTMENT OF BUILDING INSPECTIONS 5fit
212 Main Street • Municipal Building
Northampton, MA 01060 �t4 0°
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: 20 Tattan Farm Road, Worcestor, MA 01605
The debris will be transported by:
Name of Hauler: Golden Group Construction Corp.
Signature of Applicant: Date: 3/30/21