32A-044 (4) BP-2021-2076
11 - 13 CHERRY ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-044-001 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-2021-2076 PERMISSIONISHEREBYGRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 11000 BOB GOULD CARPENTRY 13089690940
Const.Class: Exp.Date:08/11/202202/19/2023
Use Group: Owner: EDWARDS DANIEL
Lot Size (sq.ft.)
Zoning: URC Applicant: BOB GOULD CARPENTRY
Applicant Address Phone: Insurance:
62 LYMAN ST (413)531-1391
GRANBY, MA 01033
ISSUED ON:10/26/2021
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: I ,� • 3-1/
•
i
I
Fees Paid: $40.00
212 Maul Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Rr
U�
14 The Commonwealth of Massac userIt, FOR
Board of Building Regulations Sta reaCT 2
Massachusetts State Building C , 78 CMR 2 �U11 U�ALrrY
Building Permit Application To Construct,R ' Reg lish a R ed Mar 2011
One-or Two-Family Dwelling rH4M 4 p INSP c7.
This Section For Official Use Only N MA°joso�s
Building Permit Number: ea-.,1-,-.107 0/ lied:
4UltJ 7KoNu n j/ /0 Z -Zozl
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1) - I a,._ri.� -S
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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
'pdA,.-zi 4 LL-,-iztr, -s .,>>l"I .,4•i.0-1,y ,i II
Name(Print) A City,State,ZIP
2 2 04 �& 37Y-Cl/
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 ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 4.1.0v 0r ,4.)z►Srd.a, ram/ c c «'S t l k
/k r-v� a .. aA .,i-- �'r).)r, 6r.40 �e'i 1 tire.e7 roar.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ i pco l o J 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All FeAs.:41 tto
Check No.` Check Amount:If Cash Amount:
6.Total Project Cost: $ a 1 ow o id El Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) r,S —
U `�'tiei Y` ; '13
d
cr• t ("2 ?1.,t(€ Ucense Number Ea .
Name of L Holder
List CSL Type(see below) (�
land Street `� Type Description
/ g U _Unrestricted(Buildings up to 35,000 Cu.ft.)
t7^e,1 /l I R Restricted l&2 Family Dwelling
City//!"IlTown,State, IP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Blistered Home Improvement Contractor(HIC) Co
111),�Q—( ( L�C.�L-Ck HIC Registration Number E13_ rati Date
HIC Company Name or HIC Registrant Name
No.and Street [,l.i ri0('.'i,1�1'''1 r7 / ,, .,.at • i•''�
ess
City/Town,State,ZIP Telephone m�l�tidr
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 id No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as 9 1 er of the subject property,hereby authorize \26be'+" L. C'Lc,.-tJ__,,k
to . i9on m in all ma relative to work authorized by this building permit application.
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.
` 6 bu- f ( (-1.-t:tti ziL.. ) b- I
Priht Owner's or Authorized Agent's Name(Electronic Signature) ate
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
7=== I Department of Industrial Accidents
' 5 1 Congress Street,Suite 100
• z',,i` � Boston,MA 02114-2017
{ wwwntass.gor/dia
iv
%%others'( utnpensation lmturance Affidavit: BuiklersKbntractoNElectricians'Plumper..
fu Ht.t II.F_U%s rTH THE ttatNI i1IN( AtiTlIORIT1'.
Aanlicant information Please Print Lri:ihh
Name ines ore imrauon horn ulna!): t + f'rr 1
Address: (e,
City/State/Zip: ,frIA Phone#: Y
Are yea a.employer?cluck the a r.ttrime t rr(t: Type of project(requfredx
i.Q i am a employer tanli employees lfuti anti'w pars-t.urar 1.•
7_ New construction
2 I am 4 suk proprietor or turrtnrrstt,p and hate nu cnptoycc%working fit tree in 8. Q Remodeling
urn.atxe,lt} lNu u.rxk.ri'lump tmLramr; regional]
l]
9. []Demolition
1,0 l 3111 J 11t1 CWA IIll donne all*tot myself.l *edicts*comp..irroartmer reyurroil'
i 12111 a ,atlaiunel and will be hurr ..v yntractursto conduct all work on rn.pwrptut7.. I%IIl l0Q Building addition
ls
.Trslrir that all cwninrtun etcher line wintry.'cornpietl aillun mainanor ut arc sole II 0 Ekxincal repairs or addition+
proptixta.ta with au employees
12.(J Plumbing repairs or additions
I am a •Herat cUnlr:s;U,t chill I hose lured the sub-cuntr*tun limed ila the anakhed sheet.
trpairs
Then wbt.mtratton base curploye-,and hoc*other,'comp.us:warm cc. 13.0 Rom
h.� Other
41'c area...emanation and its atoms he eratariwIf then right of csctslption pn SAUL Ir. 14.0
I S_. )(i I,and we bare nu employers.IAGa+wutken'cum.insurance tt-quired.i
`Ant applicant that cheeks bat of nut also fill LIut the archon lalot,%bowing then wutkcts'compca+attun policy information
Homeowner.who submit this aITriatvit nliiscatiog thi,*redoing all work and then bare outside eunin►tur,mad mbmu a new aIWA,u Ind mating.u.h
& ontractors that check dna box meta rutached an alehnuanl sheet slowing the MOM oldie suet-ctntmetmn and date whether or n.,t thou:ca uric%live
-es If the sub-,antractor,ha+e c-pltr,eea.the!,mu-I pro%iit their workers'c.' phut. Itumbct
l am an employer that is providing worLers'compensatiton insurance for my employees. Below is the polity and job.site
information.
Insurance Company Narne:___
Policy#or Site-ms. Lu:. #= ..__.-._ __. -_-_-- Expiration Dote: —
Job Site Address: Cit1' Sink:.Zip:
Attach a copy of the workers'compensation polio declaration page(showing the policy number and espiration date).
Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to SI,500.00
arickur one-year unprisonmcni_as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage vcritication.
eV'
I do hereby eerri's.un er iris and penalties al!wrjnrr that the infarmatiun provided above is&&Mand correct.
Signature: I Dote: /) Al - ,,1
Phone I: // l i
Official use unh. Do not write in thi.area.to be completed by city or town official
( its or Town: Penult/License s
Is.uing Authority (circle one):
I. ltivard of Health 2. Building Department 3.C'iI it own('jerk 4. Electrical Inspector 5. Plumbing inspector
6. Other
Contact Person: Phone#:
City of Northampton
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Massachusetts >
i ` DEPARTMENT OF BUILDING INSPECTIONS '
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212 Main Street • Municipal Building Jh �I>
Northampton, MA 01060 1l'N a•)‘^
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: J 7?1,,a3 ��r C -
The debris will be transported by:
Name of Hauler: \CcJ� t/io. 6 c, -'.. t, c-u..
....._
Signature of Applicant: Date: 2C) - l/= 1