38B-049 17 LYMAN RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1964
Map:Block:Lot:38B-049-
001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERID CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1964 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 8000 ROBERTS ROOFING 099404
Const.Class: Exp.Date:01/21/2022
Use Group: Owner: BERMAN STEVEN A& VIVIEN WEISS
Lot Size (sq.ft.)
Zoning: URB Applicant: ROBERTS ROOFING
Applicant Address Phone: Insurance:
30 Edwards Rd 4134410350
WESTHAMPTON, MA 01027
ISSUED ON:09/29/2021
TO PERFORM THE FOLLOWING WORK:
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:
a • it • >2 -
Fees Paid: $40.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
ga The Commonwealth of Massachusetts
wt Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number:Nu 619—a.l . 1 ctg Cl Date Applied:
ISEViN )�on �`3 ZOZ!
��2 9 Z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Ad ess: d) 1.2 Assessors Map& Parcel Numbers
1.1a Is this an acc ted 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Own ' Record:
Name(Print) City, tatr4IP i
No.and Stre t Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-OOcupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number oftJnits Other 0 Specify:
Brief Description of Proposed Work':
_____.i.t57.A..ip tip,a 4.//zot,...
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Co Official Use Only
(Labor .td i -rials)
1.Building $ ~:,. n�?f)1. Building Permit Fee: $ Indicate how fee is determined:
4" 0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees: $
Suppression)
Check No. Check Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
•
City of Northampton
ok
Massachusetts • .
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building �-• '
Northampton, MA 01060D.%
F
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.
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor Lic (CSL) . 09/�J _ J '
VW 4/ LicensevNNu7m e xp ation Date
Name o/ff CS der List CSL Type(see below)
44C!(//4/7"-tdd/6 Type Description
i%�iZ�� .
No.and Street 6�
p
U Unrestricted(Buildings up to 35,000 Cu.ft.)
/ R Restricted 1&2 Family Dwelling
City/n,State,ZIP
q M Masonry
RC Roofing Covering
Window and Siding
F— Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registere I. • ,'Improvement Contractor(HIC)
HIC Registration Number Expiration ate
HIC Company . e or PIC Re trant Name
No.and Street Email address
City/Town, State, IP 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 . 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 y behalf,in all matters relative to work authorized is b ildi g permit application.
ti
fi)k-e V2-e/l7Pt,a'ri a--t1---7*- 9/
Print ner 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 an accurate to the best of my knowledge and understanding.
. 9 -cV--3 ',_-_,i
Print Own '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.eov/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"
.s,
.—.7........ The Commonwealth of Massachusetts
.
co,_ Department of Industrial Accidents
I Congress Street,Suite 100
. - .4----
4111114 ,
........." ,,,..!-I, Boston, .t1.4 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:BuildersiContractorvEleetriciansiPlumbers.
TO DE FILED WITH TILE rEILMIll'ING AUTIlt)R1 IN.
Applicant Information Please Print Letiblv
Name(Busints&Organizationandividual):
Address:
•
City,State/Zip: 6)/ 0_, 7 Phone#: (-/47— 0,3 - 2 .___
_ -
Art yen au rraptikier?I herk the appropriate hat: Type of projett(required):
i.EI 1 am a emplet/t.y unth etripio",ers t lull and,.,rpart.tizne)..` 7. 0 New construction
.
2.124 ;wit prupnetur or partnership and ham nu employemi working fur me iti S. cj Remodeling
any L-apacay.[No evorkers'comp.insurance required]
9. 0 Demolition
3E:3 I am a homeowner doing all*lark myself,[No workers'corip.insurance requital]'
10 0 Building addition
CO I am a homeowner and will be hirmg airttraarars to conduct all work on my property. I will
Clitalre that all.minnicturs tither have workers'compatsanost insurance or are sole t l.0 Electrical repairs or xitelitions
proprietor%w•ith nu emplu yeec
12.1:Plumbing repairs or additions
.5.61ciii a 0mo-A cono-acior and I has a hired the sub-contractors listed on the anailed Ahem.
i 3.r.r..1,..it-c6f repairs
These uds-sxsuractors base employees and have workers'comp.laLutrance,;
14.--.Other
6.E3 We are a Cvapurillutl and it A officers have eketeised Men right of caemptson per MC&c --- .
I 1 4i.and we have uo ettp1sayeel.[No waiters'etimp.IlaSuirallICC
applicant that eitedtal box 41 titbit ilisu fall out the%return beluoo litiow trig then wutimrs'comp:as:dam Nile y LIL1,1113:11.14X1_
Harilet)%Iter3 14 bo submit this affidavit nuticatuur they ire doing all work and then hire Altai&i:Ontractort must iabmit a new afful.V it irttiutros such_
k_'untraettnis that check this boa mast attached an Additional sheet showing the name of the sub-contructors and..aate whether or nut those‘munes has,r
entrloyees. lithe AM-contractors It:1,e,,.^rupkt,:ee,they must pros nle then wtokera"comp.Ft1 Ile:,runnher ,....
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job sire
information. c
Insurance Company Name:
Policy#or Self-ins.Lie.#: , Expiration Date.
_. /...._0 (
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 N161.c. 152.§25A is a criminal violation punishable by a tine up to$1,500.00
andior one-yem imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violJtor.A copy of this statcment may be forwarded to the Otte of Investigations of the DIA for insurance
coveraoe venticat tilt.
. . .
I do hereby certify under if rzins and penalties o . jury that the in fi.Prmation provided above is true and current
,
Signature: () , _______".....,re
/ Ihie: Q---457 -7 i'.:27'
Phone-a: 1>(q i
Official use only. Do nut write in this area. up be CO wpiered by city or town official
('Its or Town: Permit/License#
Issuing Authorit,t.(circle one :
I. Board of Health 2. Buildimt Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone 4:
City of Northampton
,4 of
' � Massachusetts - ',It. A, 4t
i DEPARTMENT OF BUILDING INSPECTIONS
Ass.. 212 Main Street • Municipal Building .,,'
- ,. Northampton, MA 01060 asti-y ;. 's^`
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:
2._________
Location of Facility: 71/ '7i
The debris will be transported by:
g-c ----
Name of Hauler: -..C-1/-"7
Signature of Applicant:
efi4A -,
Date: / `�7��/
g
City of Northampton
Massachusetts
! ' " DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
- n Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (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)