18C-014 BP- 022-1561
311 HATFIELD ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-014-001 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-2022-1561 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 6200 ROBERT THIBODO 65699
Const.Class: Exp.Date: 06/22/2023
Use Group: Owner: SCOTT WHITNEY L& SUSAN M TRUSTEES
Lot Size (sq.ft.)
Zoning: SR Applicant: BOB THIBODO ROOFING AND SIDIN
Applicant Address Phone: Insurance:
P O Box 201 (413)586-0391 UB0250N144
NORTHAMPTON, MA 01061
ISSUED ON: 12/05/2022
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: j
ti
97- .
t`I
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
•
aCE(VE[
The Commonwealth of Massachusetts FOR
N 131 2022 Board of Building Regulations and Standards
MUN�a Massachusetts State Building Code, 780 CMRN1USEALI
TY
DEPT.DF BUILDING INSVM Pettit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
NCRTHAMP?ON,MA 01060 One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 6 Z - /S(j f Date Applied:
� 01 Z 5 11 30 zozz.
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
311 N is. -\-c�cl ) -1
1.1a 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 ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record
(.,�h;Nn-e t��e o V 0 sr ln`-w,V* c .---...‘
Name(Print) \ City,State,ZIP
r- 1 I \* - \t s LI (3 G a.---\ .59 zi----1
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(chec all that apply)
New Construction CI Existing Building 0 Owner-Occupied 0 Repairs(s) Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Pro osed ork2v -,��/, �� ` o -
'- lr-"NS*-)1='\"\ .1\tA—) \C"(-)0C-AVA e\,--,Vv-vvv-k u A\siA '
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ I. 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 (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees,: $
Check No.o� Check Amount: to
6.Total Project Cost: % )`,02> a 0 Paid in Full 0 Outstanding Balance Due:_
7
City of Northampton
441474. .
Massachusetts D
DEPARTMENT OF BUILDING INSPECTIONS P, �!
212 Main Street • Municipal Building v
4.4
Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR, ETC.
1. Building Permit Application signed by legal owner aid 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 Construction Supervisor License(CSL)
ra a License Number Expiration Date
Name of CSL Holder
EN CAP S List CSL Type(see below)
No.and Str et Type Description
` , U Unrestricted(Buildings up to 35,000 Cu.ft.)
S �R c� \V" \ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
\\ ) T� () RC Roofing Covering
�0( '—�,i WS Window and Siding
SF Solid Fuel Burning Appliances
4\'3 S-7 3 1 C L`Th I Insulation
Telephone Email address D Demolition
5.2 Registered H me Imp ovement Contractor(HIC)
dC HIC Registration Number Exp. tion Date
H Company aw or HIC Regigrant Name
i' \�N ,^ -isr, SS / Si / ! Email address
City own, 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 Issuan 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 CA.()
to act on my behalf,in all matters relative to work authorized by this building permit application.
d Own U •a�•Pn t er'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 informati
contained in this application is true and acc ate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic ignature) 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"
4.-
The Commonwealth of Massachusetts
r- Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
''''• '...-7.---/. www.mass.govitrui
Workers'Compensation Insurance Affidavit:BuildersiContractors/Eleetrielans/Plumbers.
't ti HE FILED WITH THE PERM!rriNG All HOMY.
plicitnt Information Please Print Le1bhr
Name I Business,OrgantzationlItulividual C:-N-7,1) \ N\C) 0 60
_.. ... .
CitylStateiZipc,,
Phone#: L-I 0 ,51 5 . I (-- -1
.,r,.,cm an employer?Cheek the appropriate hoc
Type of project(required):
1.r9(..arri a employer with -.... enapio)cel 1,tun assitor part-tinict..• 7. 0 New construction
In I am a tote proprietor or partnership and have no employees working for me in g. c3 Remodeling
any capacity.[No workers'comp.insurance required]
9. E:-1 Demolition
31D lam a homeowner doing all work myself.[No workers'cramp.Otto:mice required
1 ci ii Building addition
40 I am A honicoakatcr and will be hoing contractors to conduct all*ea on mi property_ I will
ensure that all contractors either have workers°corricensation own-nice or ane sole 1 l.CI Electrical repairs or additions
proprietors with no kinployoni.
12.0 P rnbing repairs or additions
$01am a Nexicrai contractor and I have hired the sub-contractors Ii.ap4 on the auaeheil skied_
iiidie sub-oursuacters ha .c employed and have workers rump.Maum 13 Root repairsee.:
14_C:10ther
6,0 We are a corporation and its officers have exerciaed their night of exerrastion per MCiL c.
152,§1(4),and vi,e lase no employees.[No winters'eon*.insm-ance reintised.)
I
*Any applicant that checks Iloa.rrl mint al,.till,..i.:1 at,,,,aart beium. ,-1,...1:1_:.r.1',...1r.workers'cornt)enyatiou policy int;:rmatten
'ftomoosvien,Who stoma thus atruinit maw:Lung they arc doing all work and then hue outside contractors must submit a new affidavit triiiii..wing such.
...Contractors that check this box must attached an additional sheet showing the name of the sub-cuntracturs and state whether or not tilL/SC entitle%/Lave
emploved. If the.ob-contractors have employed.they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance fur my employees. Below is the policy and job site
information.
Insurance Company \\SA.-{"\--cf.) Y..-
Nallie-- ----: ---... _
Policy#or Self-ins,Lie.#: U \r--.. r) . ,5DINk Li 14 Expiration Date: -.3 • a--,, a:3
Job Site Address: k\ kVA ''a i sA- I
/
. • -
CityiStateZip. or . to_ y, rkS'S'
Attach a copy of the workers'compensation polic, declaration page(showing the policy number and tipirati date). Of A i
‘-'
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
ander one-year imprisorunerit,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 verification.
I do hereby certifr tinder tie and penalties of perjorl.lira(!he information provided above Is bale and correct
&Joann(:?_-_>a--• c -2,., c; cfk-
s.....
\ ‘ — 3o
Phone#: 1-4 15 • 5-1 S- ' 1 C\ (- ----1
Official mse only. Do not write In this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
, k
. ..,..,.
City of Northampton
Massachusetts ,..
* c3
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 3 t+
Northampton, MA 01060
00NSTRUCTION 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: r- w`p c
•
Location of Facility: -H O lam'V1 CkAivN 4-0
The debris will be transported by:
Name of Hauler: -ND )i) d a6
Signature of Applicant: 1 Date: ; ! ���
City of Northampton
5 n
1.
Massachusetts , -- 1e
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 1.'x. -1.
--.^. Northampton, MA 01060 ry� '"' ijt'�4'
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)