31A-166 (8) BP-2023-0487
88 MAYNARD RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-166-001 CITY OF NORTHAMPTON
Permit:Exterior Res
PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A)
BUILDING P RMIT
Permit# BP-2023-0487 PERMISSIONZS HEREBY GRANTED TO:
Project# roof 2023 Contractor: License:
Est.Cost: 5000 JAMES ROBERTS 099404
Const.Class: Exp.Date:01/21/2024
Use Group: Owner: VASQUEZ ALPHONSE&KATHERINE WYATT
Lot Size(sq.ft.)
Zoning: URB Applicant: ROBERTS ROOFING
Applicant Address Phone: Insurance:
30 Edwards Rd 4134410350
WESTHAMPTON,MA 01027
ISSUED ON: 04/21/2023
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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Tf‘
,„9,..01n.
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: 413)587-1272
Office of the Building Commissi er
/
0,9
The Commonwealth of Massachusetts � c?0(23
W Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR'f.� 1,h%v �-- MUNICIPALITY
,
fl,;,� /._ USE
Building Permit Application To Construct,Repair,Renovate Or De ; 'ov;Revised Mar 2011
One-or Two-Family Dwelling
�,�p� This Section For Official Use Only
Building Permit Number: (,� - , 3• 4/S? Date Applied:
l/ev9...) <Y.? 17i2 9-20-Zo23
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Properrty Address: �0 1.2 Assessors Map&Parcel Numbers
1.1a Is this an acc ed 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 r of Recor : j -y�
rta i/t l/X,? Lr/ �c 2/
Name(Punt) City,State,ZIP
$ ' /1il N owzto A)
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) ❑ Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': i Ze
„Aili
et.
_c_e5plotzt. i.
Ni/rSECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(La r and Materials)
1. Building $ Jj�/) 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ (/ (/ 0 Standard City/Town Application Fee
/ 0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire cx.3
Suppression) $ Total All Fees: $ '1D,
Check No.
6.Total Project Cost: $ 3 pCheck Amount:
fVaid in Full 0 Outstanding Balance Due:
i
City of Northampton
ir-
' Massachusetts -I,
( � DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building ^:b.
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 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.
i
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor 'cense(CSL)
6 9 111 LI,5 1( $-3/-oil(
anyu2,0 License Number Expiration Date
Name of CSL Holder
g a geeAr6211- 0 ./9_0)/ List CSL Type(see below)
No.and
�Street,�� _.
Type Description
(/f
U Unrestricted(Buildings up to 35,000 Cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,( ZIP M Masonry
. e,_\ O I O 7 RC, Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered H mprovement Contractor(HIC) ,�-- _
HIC Registtratioh Number Expiration
piration Date
HIC Company N e or C istrant e
No.and Street Email address
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 0 No ❑
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 /6L%! ?� �
to act on my behalf,in all matters relative to work authorized is building Ipermit application.
V 4:154.e/toLe w ;v _c- zi -/e- ,45
Print Owner's Name(Electronic Sign e) 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 d accurate to the best of my knowledge'and understanding.
I. / .a ‘f —/g—cam
Print Owner' Cam•uthorized Agents e( lectro ' 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),w1ll 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
=4=
Department of Industrial Accidents
I Congress Street,Suite 100
=re
Irzit Boston, MA 02114-2017
•issierzr ?
www.m ass.govidia
orkers Compensation Insurance Affidavit:BuiklersiContractorsiElectricians/Plu in hers.
10 flE FILED Wttii THL PEILNIITTENG AUTHORITY.
Anolicant Information Please Print Legibls
Name 4 liusiness;Organization,intinadual
•
Address:
36
City/StateiZip: Phone#:
Art}or an emplin ell Check thr appropriate box:
T)pe of project(required):
1 Ca I am a curl:9[4.1er with employ...vs ovit anttee part-iiinet! 7. D New constructicai
soli proprietor or puthaership and have no eropktyees Avrking for role in 8.. 0 Remodeling
d1I2,‘-apaeity..[No workers'rump,insuranix reqianiii]
9. C] Demolition
3.ED I AM a hurnoowner doing all work myielt.[No*otitis'comp_anourance rrunitreill
iofl Building addition
r.C3 I arn a honsoow.lba and 14111 be karing coolnictors to conduct till work on rity propt-rp, 1 will
01../41M that all contractors either have stInkers'cuaiptittation insurance or an:sole 1 a Electrical repairs or additions
proprietors with no employees,
12.a PI - butt;repairsi or adidititnts
I urn a general contractor and 1 loo.e hired the sub-eurtunetors listed 1111 the attached sheet_
3 frig Roof repairs
These sub-Lunt:al:tun haw employees and e workera'comp.insuraner,:
14.0 Other
are a wiper-anon and its officers hal.r exercised their nabs of exemption per%Ail c.
2, 1(1).and we no employ...vs.[No'workers'comp.isasi.aanec required]
tort that ikLr.box.1 aunt also till out rite section below h lion Ina their workers'compensation puke}rntortnation
t kniek,,Fk tiers who submit this atfala‘it tailicating the}arc doing all work and than hire outside coritraehies must submit a new affida%it indicating stab
:Contractors that check this box must attached un Additional hac abohiny the name of the 4114,-,:OttralCCors and state.4114.-1tici.or not those•rniitics hisa
ecs if the sub-ivittraetors tilt}must pro..Kle i r comp. noinkr
1 um an employer that is providing workers'compensation insurance for nit employees, Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie. 4: Expiration Date:
Job Site Address: City!Staiertip
Attach a copy or tilt workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §,25A lh (-Timinai tulation punishable by a fine up to$1.500.00
artdor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 certify under the pains and allies ofperjuty that the information provided above is true and correct.
Signature: Date: it -/ -gy
Phone 4/L / —6 3
Official use only. Do not write in this area,to be completed by cit).or town official.
('its or Town: Permit/License
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City To is Clerk 4.Electrical Inspector 5. Plumbing Inspector
6,Other
Contact Person: Phone#:
r
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 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:
Location of Facility:
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date: '�� ��
City of Northampton
“.il ale 1 f
es
Massachusetts
114
kg,- 4 t DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 ,111
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)