29-274 (3) BP- 022-1304
346 BROOKSIDE CIR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-274-001 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-2022-1304 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 6300 VECTOR HOME INC 112389
Const.Class: Exp.Date: 06/18/2024
Use Group: Owner: PRATT PRATT BARBARA & LAURA
Lot Size (sq.ft.)
Zoning: URA/WSP Applicant: VECTOR HOME INC
Applicant Address Phone: Insurance:
38 HUMPHREY LANE (413)204-0023 AWC-400-7039926
WEST SPRINGFIELD, MA 01089
ISSUED ON: 10/13/2022
TO PERFORM THE FOLLOWING WORK:
STRIP AND RE-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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I
1 •
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Buildine Commissioner
RECEIVED
The Commonwealth of Massach efts
Board of Building Regulations and S anda ds OCT 1 2 2022 •R
J Massachusetts State Building Code, 80 C R I IPAL TY
SE
Building Permit Application To Construct, Repair, enoatMtg n,n ise Mar 2011
SPEC ON
One-or Two-Family Dwelling _?" " : a S^a mn,
This Section For Official Use Only
Building Permit Number: - a1 -I%V 41 Date Applied:
410 a-), //17 ()Z2
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1'r erty Ad kss:de &� Roma
is 1.2 Assessors Map& Parcel Numbers
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 ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.11',>ar6af Record: /' /e /%j ra na, la
0/L6 e
Name(Print) City,State,ZIP
3'/a fired /di hrede/di &eee em. 53?-o5-pce 1Pi2nTr jahoo.
No.and Street Telephone Email Address C,o
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s), Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units /f'I A/OOther ❑ Specify: _
Brief Description of Proposed Work2: 7f/% e /a 4 T �
1 Lotafri
unc�erl�j , Cca ri 4 ven-f, vCoverrY
/WV 579 in
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (1-IVAC) $ List:
5. Mechanical (Fire $ Total All Fees:
Suppression)
Check No. AO- Check Amount: Cash Amount:
6.Total Project Cost: $ 6 3or.. t2t2 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Cs_/,.7 e/�/�o�y
r7
iivana )'1�� License Number Expiration Date
Name o CSL Holder /�
h List CSL Type(see below) L
`- m/" firer /a No.and Street Type Description
/�pf r/� ^oQO/ l�� oio G�� lJ Unrestricted(Buildings up to 35,000 cu. it.)
VI/vJ �(ti z /L Q R Restricted I&2 Family Dwelling
City/Town,StateZIIP M Masonr
y
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
yfhOV odd 3 VeC/0-49m IP/OO nia/C•p 4019 I Insulation
Telephone Email addrets D Demolition
5.2 Registered Home Improvement Contractor(HIC) s ,-, 7 ' /a/dlaa.?3
Veal-or r hie HIC Registration Number Expiration Date
Hit/limy Hit/limy Name r HIC Registrant N me
ine) ni tam vekrlorrre/dta imaff
NK pd St�egt�r/. / % _ , /�G� erg.ja doa3 Email address Cary)
City//Totwn,IStatef I' �(/01/Pd, 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.
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.
<��ona 10 aoa
Print Owners 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"
City of Northampton
Q�NAMpf4 5
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
4
r ,� 212 Main Street • Municipal Building 0
igf Northampton, MA 01060 4:11*ESQ
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: A'1weIZ ,ed, (4 '-:av/ e1 d6OIap
The debris will be transported by:
Name of Hauler: 4/MI /t(aa fi���
O O
Signature of Applicant: /a phi glideze,a, Date: /Oce/7A)
.S.>.\.. The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
mis „
....-Taar .
, *maptar Boston, MA 02114-2017
'-"71*.a......
'-,h--- www.mass.gov/dia
-1.!--s--
1.%others'Conipensiation Insurance Affidavit;Builders/ContractorafElectricianirillunthers.
10 HE FILED WITH THE PEILMITIING AtritiORITV.
A licit at Information Please Print la,
Name I Business'Orrgantzattorkindividuld): rg: 401 1-0 rne AC _
AddressA,, A1/72/ /::, la at
Ain 0/0
City/StateiZip: (/V0/1_,_ /72,,,I,e ,a,/,,,,,,,,,,,, ,,,, Phone #:
i
' ' 2 //3-iaZ/10a07,&
Art yin an emplayier?Cheek the ttoortioriate host Type of project inquired):
1.10 I am a ravioli&with , ,eirmioyees(MR and or parvittorks I 7 0 New construction
20 I am a sute proprietor or pertnarshm and b Winning ast no einployteil for ite as I .
8 cj Remodeling
arty eariseity Pio workers"email,.iswarente required]
9. 0 1)entolitiori
la am a&insectaria:doing all work oneself.fNo workers'eon .inewhisee requiraily 1
i00 Building addittot
4C1 I am a hummiwner and will by hiring contractors to eroded all wiark an my property I a M
ensure wig all vontrankini either lee workers'viengwitsamin insomnia'or are wile i i a Elechical rar or addition,
I
proprietors a ith no employees.
i 2, Plumbing repot or additions
sn i am a si..-mirai vuinitacitio and I hose tuned the sub-cormsetors lisrod on th attaawil,beel
I 3 Roof repairs
These seh.voraractori have einpitiyeeii and have workers'comp.insurrince.;
h. romp.we has erriployees.(No workeot' irisistatice requited.]
Of 1 4.CI Other
..... -
*Arty applicant that eheek8 boa al moo also fill no the%cation below Am*iffy their worker&tratiperisation policy inktmatiom
+}101111.1.A4 ref%oho mama dm StfraPilt Mil ising they ate domig Ali work and then hat oohs&commetees most submit a nos affidavit andinatiag
tt.'untractom that cheek this.be wane attached an adthtiunal sheet showing the name of the satscoittractors and mite whether or rue those archives lone
citipitryeca. If the strismarotraetors base enrioyees,they roast provide-Mee A 4.41,0":,',:omp,policy nittitiva
--...a..........
fans an employer that is providing workers*compensation insurance for my employees. Below is the policy and job site
information A ,/ IA /
Insurance Company Nante 4 .1. 111. Ne-e-t-i/a ,, -2, -a/--al7ce C(21911 an _
Policy#or Self-in .Lie.#: //WC —4.0- 70-.3. 9.0t'6 Expiration Date:
1 ,
Job Site Address:2176 *Oakid9 e/reito, "---/aren a CirylStatelZip; /1/4 12//260
Attach a copy of the**rimy**compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requited under NIGL. c, 152, USA ts a criminal violation punishable by it tine up to$1,500,00
&idler one-year imprisonment as well as co,it penalties in the form of a STOP WORK ORDER and a line of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of liw esitgattorts of the DIA for inauranee
coverage verification
i do hereby eertify under the pains and penalties of per/tier that the information provided above is trite and correct
Signatilre: /ajyt/r/112a O('cid i-e-!(-1-1 mile
Phone. . --(7 '''' t2 '. '3
. ..
Official use only. Do not write in this area,to be completed by city or town official
City Lir Toon: Permit/License# , _ I
issuing Authority trirele one):
I.Board of Health 2.Building Department 3.CHyiTosen Clerk 4.Electrical Inspector 5. Plumbing Inspector
, 6,Other
t On tact Person: Phone#:
,
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