32A-195 (7) 24 PHILLIPS PL COMMONWEALTH OF MASSACHUSETTS BP-2021-1854
Map:Block:Lot:32A-I 95-
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-2021-1854 PERMISSIONISHEREBYGRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 6000 ROBERTS ROOFING 099404
Const.Class: Exp.Date:01/21/2022
Use Group: Owner: FLYNN CHRISTOPHER T&AISJAH T
Lot Size (sq.ft.)
Zoning: URC Applicant: ROBERTS ROOFING
Applicant Address Phone: Insurance:
30 Edwards Rd 4134410350
WESTHAMPTON, MA 01027
ISSUED ON:09/13/2021
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: e
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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 Massachusetts
U,,,,, Board of Building Regulations and Standards MUNICIPALITY
CO Massachusetts State Building Code,780 CMR
_ o USE
I . Q Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
8:'n
N
2, -. One-or Two-Family Dwelling
Guy This Section For Official Use Only
N etifinit Number: AO-el) • 1 g Sti/ Date Applied:
_____ 4,,,,72.5, 9-I6, z6z,
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Perty,Ad% Aul )/' g'47/6.6 1.2 Assessors Map&Parcel Numbers
1.la Is this an accepted street? es 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 9ffliner1 of ' tl,rd:
Name(Print) Aktidfrag°4 ( City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 61r/t/ip IA?" —
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Mate Official
1.Building $ ( d er 1. Building Permit Fee: $ Indicate how fee is determined:
` 0 Standard City/Town Application Fee
2.Electrical $ / 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $Check No; 61) Check Amount: "l 0
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
4 '
City of Northampton
Massachusetts
*
s DEPARTMENT OF BUILDING INSPECTIONS ' 111iii
212 Main Street • Municipal Building mat ti`
Northampton, MA 01060 +,>y1"
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF 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 specifications of proposed work(Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction(Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Co struction Supervis icense(CSL) a ci ccd
'„ vl T License Number Expiration Date
Name SL Holder
ed,ArG? �A List CSL Type(see below)
. 111
No.and Street Type Description
Unrestricted(Buildings up to 35,000 cu.ft.)
Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
' Roofing Covering
4210 Window and Siding
f� —63�� Solid Fuel Burning Appliances
`4)
b ( I Insulation
Telephone Email address D Demolition
5.2 Registered Home mprovement Contractor(HIC) /3 fl
HIC.egistration N ber Expiration Date
HIC Company N e or IC R str _
No.and Street Email address3°
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 authorize y this building permit application. ;
X
Print Owner's Name(El ronic 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 ap lication is true and accurate to the best of my knowledge and understanding.
--",o (
Print Owner's r A thorized 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
Department of Industrial Accidents
I Congress Street,Suite 100
,), Boston, MA 02114-2017
www.mass.gor/dia
Workers`Corn perisation Insurance AMdavit:Builders/Contractors/Eleetricians/Plumbers.
TO HI:FILED WITH THE PERMEll'ING ALITHI.IRECi.
applicant In fOriii.i tiiin Please Print 1.egiblv
Name itiusms::,,Or.4.in../atbrii ltutita .
Address:
citystate Zip:
- '77,4,.._„.. D/oaS —1 Phone #: Z4 1 3 -- di. /
—......,..,
An yen MI cmployer?('hat k the li pprurnate!pot:
Type of project(required):
in t am a employer with _ eintrioyees k full asiaor purf.tinief• 7. 0 New construction
22‹.—ra a*ult.proprietor or portnerstop and have nu employees working fur lase in 8. 0 Remodeling
any vapacity.(Nu workers'eterip insuranix required.]
9_ El Demolition
31:1 I am a homeowner doing all work myself,[No workers comp,use nayuinaLI*
10 a Building addition
4.0 i ara a 114.1gatvwiter and will be hums.contraddes Se mindful all wurk on my property I will
ensure that all corarators ether fume woe:kers'cianpznsanon insurance or are sole 1 i a Electrical rt.-pairs or additions
'sierra vvith tie,employees.
a igentanal COntracior and I have hired the illb-CtlettaCkatIS hated on the arr.hoi sheet
).46„,,,,*
12.0 Plumbing repairs or additions
Th 13€14bese ttlb-CatitraettliX hove empluyees and have viiiirkers'comp.insurance) repairs
14.0 Other
6E1 We are a eutporation and its officers have exercined their right of eaemption per NACiL c.
152,§1(4),and we have no empkiyasea.[No workers'eonm.insurance requumil
*Any apphoint that rhi.eks box Pi must also fin out tare settiest briulk lhung their workers'compensation polio!informatwn
4.-Homeowners who submit this affidavit rndieanng they are doing all work and then hire outside eiintrator,mmt sabmit a hen al:/..t.il a aahi.anini si.....:h_
:Contra-firm that check this box mint attached an ndditiunal sheet show ine the liana of the uL..-,....ontractors,and slate whether ur not those nties Ira.,.e
,..:Lirlo,c,-, If the.,ub--contrairtem ha,,e,nnplu cm.ih mart 1,,,,,,,i,_::,,,_e ,,,,,,,,,,T,-..-.,,,,,,.p.,,,,..:1.mambo
.„ . . . .
/am at/employer that is providing workers'compel:Nation inNorance far my employees. Below is the policy and job site
in(ormation.
In rat Conipany Name:
Policy#or Self-ins.Lic.#: Expiration Date: /—"i1/--.712—
Job Site Address: CitrState Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and espiratiou date).
Failure to secure coverage as required under NIGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
andior one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a tine 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
ek-Acz-12.:'\e ft t7iLE I OIL ..
1 dt,hereby certifr under the pains and pen ties of perjury that the infiwntation provided above is true and correct
Signature: \ Date:
Phone,t: C4 t 3 ^
Official use only. Do nut write in this area.to he completed by thy or town official
i
i ("ity or Town: Permit/License
Issuing Authority(circle one):
I.Board of Health 2.Building Itepartnient 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
'..., b.Other
Contact Person: Phone 4:
41,
City of Northampton
Massachusetts �
4.
*
j DEPARTMENT OF BUILDING INSPECTIONS ,
212 Main Street • Municipal Building
Northampton, MA 01060
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: '17;) /
42-1)
The debris will be transported by:
Name of Hauler:
Signature of Applicant: 0/4),----i'e/c Date:
City of Northampton
Massachusetts
Aq
DEPARTMENT OF BUILDING INSPECTIONS 9�
212 Main Street • Municipal Building ?='
Northampton, MA 01060 t�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
1, (insert full legal name), born_ (insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns 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 home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of , 20 .
(Signature)