29-462 (12) 47 CRESTVIEW DR COMMONWEALTH OF MASSACHUSETTS BP-2021-1886
Map:Block:Lot:29-462-001
Permit: Exterior Res CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
' DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1886 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 6000 RONALD KEITH CONSTRUCTION 085204
Const.Class: Exp.Date:02/09/2023
Use Group: Owner: SLOAT REXFORD K JR&NANCY R
Lot Size (sq.ft.)
Zoning: WSP Applicant: RONALD KEITH CONSTRUCTION
Applicant Address Phone: Insurance:
5 BIRCH MEADOW DR (413)584-5589
HADLEY, MA 01035
ISSUED ON:09/17/2021
TO PERFORM THE FOLLOWING WORK:
NEW 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.
Signature: Tsly
Iv • )2 -
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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The Commonwealth of Mass chus: s
Board of Building Regulations afid ..a..rds 6 OR
Massachusetts State Building Cod T 8Qc+� i' Oc91 ICIPALITY
�'nRrtiQ,ll om USE
Building Permit Application To Construct,Repair,Renov 'O15 P :_. ' a R ised Mar 2011
One-or Two-Family Dwelling 444 0.c270 Ns
This Section, For Official Use Only
�
Buildin Permit Number: P— ?/ rig 6 ,
Date Applied:
:IL) a„ Date
9-II ZaZ(
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Add ess: 1.2 Assessors Map&Parcel Numbers
t�-1 Cr�e&-v k•eW r".
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private El Municipal_ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
1 \OW1 Ct� �Slo oak Gf ake r\ 1-tN- b t
Name(Print) City,State,ZIP
Lr CVe6- V .Dd . t-H', -5 •(g4io a.
No.and Street T$lephone Email Address
SECTION 3:DESCRIPTION OF PROP f ED WORK2(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s)Vi Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: .Sly Cc7 Si Ire (Oak' t.. \r 3 i -Lt.m. 3�v- Az__
akoil tr,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ Co t Dna 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) CA
$ Total All Fees: $ i
Check No.`f I71theck Amount: ID Cash Amount:
6. Total Project Cost: $ b 1 pap 0 Paid in Full 0 Outstanding Balance Due:
LP
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Q CYLO �en t�5 z�.� e3
Licensee Number Expiration Date
Name of CSL Holder
5 e tarl cw ( List CSL Type(see below)
No.and Street Type Description
t
,I d_`dI e `� , Q(r) Ii Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,( Stat ,ZIP �x�� R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
-k-558 crx_0-kt stkv 42-T a\ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
2 a mac` CNA 1 c- CV t-t$1.c6 9Sty��poZz
HI Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
5k-rt s No.and Street 6 J 1
cam-► YIX� , ,c 55S9 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 No 0
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.
hrkc 5[0Ck °tlV3t2-1
Print Owner's Name(Electronic Signature) Date
SECTION 76:OWNER1 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 ppl'cation is true and accurate to the best of my knowledge and understanding.
Print 0 er'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. 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"
The Commonwealth of Massachusetts
'' ----- 'I Department of Industrial Accidents
— �. = 1 Congress Street,Suite 100
_q:i=_ Boston, MA 02114-2017
1.,: ww w.mass.gov/dia
~ 1lurkers"(compensation Insurance.tf iidacit:Bulkier oar ctors/FketriciansPhimber .
to Rt.FILka)tiS I I I TIDE PERMITTING AUTHORITY.
Applicant Information \,� (,h Please Print Lriibls
Name i H nusancss'( 'anhlatton!mils iduat): CI-Cc'\LJi,t it4- : ����C Cr)
Address: 5 e)t( rcv-) lc_(,6Lb J err.
CityState/Zi Mad(e, - oLO phone#: * - 5g1-t-55 99
Are yna an cmploscr?( httk the appropriate hot
Type of;Hulett(required):
10 1 amu a etnpkiy er sitli _._ empty:pees riot and as part-turret-• 7. Cji New construction
I am a sole proprietor or partnership and hest mi empl.rvees wonting tor me in }l. 0 Remodeling
an capaert".[Nu wuti;its'conic,.tnauranx nquntn.+d_)
9. 0 Demolition
i 1 am a human..ma thing all work myself.[4o cannons`comp.rmuranie required.j'
40 I am a hx t.nuwxres and w es ill be hir tmen:suvs to cundiram all work on mi property. I wilt 10 Building n
t�. ensure that all contractors chile have whalers'compeaiat inn insurance to are sole 110 Electrical repairs or additions
ptupncton ss nit no employees.,
12.0 Plumbing repairs or additions
Tit am a germ t contractor and I horse hued the sub-contractors listed on tie attached shed
130 Root`repairs
These sub-contractors lass`employee*and hate workers'comp insurance.;
60 Vie are s awporauon and its utfwers have exercised then right ut exemption per Hip c. 14-❑Othet
t52,I 1(4).and we lase no employees.[No workers'comp:insurance nqutred.l
'Anv appiteant that 4.flecks bon al mast also fill out die actatin1 b,:tow show in,;dear wtakkers'compensation pull."informatxai.
°hbrnwvwneis who maxim this atldasit old:cam p they arc dung ail work and then here outside contractors mud submit a air*affidavit rndicatmg such.
:Contractors that Bled dna box must attached an additional sheet allow ing the name oldie subrcuntractors and stuta V.herher or not those enOtaes have
cntpki}cc, It the sub-detractors hake employees.they mud provide deli wotkrri comp 'tins nwnber
i am an employer that is presiding workers'compensation insurance for nty employees. Below is the polity and job site
information.
insurani.e Company Name: —
Policy if or Self iris. Ltc.#: Expiration Date:
Job Site Address: City:'State Zip:
Attach a copy of the workers'compensation policy declaration page tshowing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152. fi25A is a criminal violation punishable by a tine up to S 1.500.00
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
day against there violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage seritiration.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Sttznattuc Dale c rat z 1
1mon, , 1kt73 .594 - 55S 9
Official use only. Do no:write in this urea.to he completed ted by city or fan official
( its or Town: Permit/License
Issuing Authority Icircle one):
I. Board of Health 2. Building department 3.(`ityriosn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
A Ali;
o a. Massachusetts ��?,' 1 M
(Al
VA-
, ' `F` DEPARTMENT OF BUILDING INSPECTIONS 4
r 212 Main Street • Municipal Building ���
Northampton, MA 01060 s `10
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: \(p i\.ecJ (2-Q.C4e_S-A\INc3
Location of Facility: 'Oaf
The debris will be transported by:
Name of Hauler: ejarval3 Ccx\s C,R'(r-
Signature of Applicant: Date: ot((2)(2_1