18C-040 (2) BP-2024-0064
669 BRIDGE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-040-001 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-2024-0064 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est. Cost: 4000 JAMES ROBERTS
Const.Class: Exp.Date:
Use Group: Owner: NAVIN THOMAS P
Lot Size (sq.ft.)
Zoning: URB Applicant: JAMES ROBERTS
Applicant Address Phone: Insurance:
30 Edwards Rd (413)527-6078
WESTHAMPTON, MA 01027
ISSUED ON: 01/22/2024
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF
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:
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
M/9.1$..r% 1
The Commonwealth of Massac setts % t/�y :
Board of Building Regulations an Stan rds
Massachusetts State Building Code,780' �c��Q ,M ,SUS I
TY
W
Building Permit Application To Construct,Repair, Renovat6^63Y olish vised J ar 2011
One-or Two-Family Dwelling .. 0,,41,�
This Section For Official Use Only �yoFCTio
Sa02 r I Date Applied: ° NS
' /
Building Permit Number:
"- 6 ' ) a il
Building Official(Print Name) Signature i
Dat
SECTION 1:SITE INFORMATION
1.1 Prope ddress: 1.2 Assessors Map&Parcel Numbers
Ctstreet? � MapNumber Parcel Number
1.1a Is this an accepted y no
PY
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 ecord:
Name(Print) City, tat ,Z,rF
fr
64. 7 SA,/- 4 .
No.and Street � Telephone Email Address
SECTION 3:DESCRHY ON17 N OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: l �
' T,Q;?:)
SECTION 4:ESTIMATED CONSTRUCTION COST
Item Esti ated Costs: Official Use Only
(Lavi and Materials)
1.Building $ I' did 1. Building Permit Fee: $ Indicate how fee is determined:
V v ❑Standard City/Town Application Fee
2.Electrical $ ❑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.3$03Check Amount: 410
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts �
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DEPARTMENT OF BUILDING INSPECTIONS g:
"'- 212 Main Street • Municipal Building °�E. dV
Northampton, MA 01060 -:a‘'��
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.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor 'cense(CSL)
Lice se umber Expiration Date
Name SL Holder
List CSL Type(see below)
No.and Street Type Description
30 ' -
/� Q ` U Unrestricted(Buildings up to 35,000 Cu.ft.)
u „ts// R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
\ TS Roofing Covering
6 (l f (/ Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 R. '0 ome Improvement Contractor(HIC) i � pL
Q ti `�
/ Al HICRegistration Number Expiration Date
HIC Co y me s i gistrant Name
No.and Street 41 g./�i ej
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 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 .r//
to act on my behalf,in all matters relative to work authorized •i, this building permit application.
40- M./ 1l q v/ IV //? ` Z
Print Owners 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.
sel's i c..1(7,..-3•Ci
Print O�r Authorized Agent's (Electronic Signature) Date
NOTES:
I. 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"
.. N The Commonwealth of Massachusetts
-...A.,..... .. -
Department of Industrhil Accidents
-—, , ,—_
........Aki... 1 Congress Street,Suite 100
weal—
1-...41....., Boston, MA 02114-2017
www.mass.govidia
1$oskers"Compensation Insurance Affidavit:BuildersitinitractoridElectriciansiPlu triflers.
10 HE l ILl])WITH 111k PERMITTING AUTHORITY.
:knnlicant Information Please Print Legibls
Name(131.1.51ncaseUrganszatuan:lndivnduair, C7/714 .
Address:
City:StatefZip: g.dlylr- 9 Agi: Phone --.- zyy/---0,313-6
Arc you an r m pkty et?l'hece-thr apprupriate hot: Type of project(required):
i El i am a e- ..e.,,yelt with ,, , _ ,,,,,,,_employee (lull arnior part-tinw t.' 7 0 New construction
24 m IA:tole prupnctur or isoincrriup and hat.c no employees winiong fur Mc m 8. 0*Remodeling
an,,carraer4 [Nu worker 'emir..insurance requiret.1 j
9. EI Derwlition
.;.0 i am a hotinatwiter doing all work myNAt.Iti.t wolitrs'comp,tristnanor requiretil
10 1 will 0 Building addition
40 i lin ii tintrinnsvner and-0,ili ts.:hiring contraetora ILt conduct ell w Lek um my property.
LaiNure that all contractors either hare workers'consporration imam-mice Le are role I I.c] Electrical repairs or additions
reunneturs with nu employees.
1 2.0 Phi p sing repairs or Additions
saninanv-ractal eunnactut and i tart e hired the sub-contractors Listed un the antached Ago.
-ntrct 13 12104 •oofrepairs
These titt-i.uaim,lar,te employees and Wet e wurkerr.com p.insurance.:
1 4.Cl Other
no We are a curporanun and lb otix:Lm have eleremeti their right of crampoon rArr Wit_c
151.§if 4).and.A e have nu anri...0:eva.ENO Yrurkers'comp.lituratice required.'
'Any appt.K.,aai nun,ireek,,lv-k,g1 narka aku till vet thc t....-,ucli bcItco, •,'..a,,,,,.:rn.?then workers.',:,,eperi,atkal ivin.1,rafernaanon_
Hurneonners uto..,.,ut rr nrui tius ar& i1 rntlacalme they are dews all.4 Urk.and then hue utitmde‘:Aralraclect must nibrrut a new arinial.it andriarnig stxth
kAintracturl that cheek the box must attached an addmorial ahect rho*in the name u.f the auh-contraeters and vCafe Y.hetrit.-r lin EWE chuhe athEio it..3..,:
einplo`r:ec'... II the ub-eurriracrur,.h.1 _..airk,:.ceN,they iau Ni rrnr.ide ificir xurkers°comp.jathey nutik:i
/am an employer that is providing workers'compensation insurance for my employees. Below is the policy and fob site
information.
Insurance Company Name: _
Policy#or Sit-m .Lie. #: Expiration Date: 4 (-5/ -
Job Site Address: CitylStaie'Zip:
Attach a copy of the workers compensation policy declaration page(showing the policy numhe and expira n ate).
Failure to secure coverage as required under!i/IL c. 152. §25A is a criminal N iolation punishable by a tine up to Si.500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.0O a
day against the siolator.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 1P+Iiiftt and penalties a perjur. hot the Information provided above is true and correct.
Sienature: Date: /4"/
Phone 4: V
/1Z--fi - '? '
Official use only. Do not write in this area,to be completed by city or town official
City or Toss n: PertnitiLicense#
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3.Cit,rrovin Clerk 4.Electrical inspector 5. Plunihing Inspector
G.Other
Contact Person: Phone 4:
City of Northampton
40" r« ifir, ' it
Massachusetts — ',,
. DEPARTMENT OF BUILDING INSPECTIONS ;, '
212 Main Street • Municipal Building 'E_ K,
Northampton, MA 01060 5� �?`Z
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: 4
The debris will be transported by:
Name of Hauler: 6, /L'1�J _
1
Signature of Applicant: �.' i/ <i Date: /vG
. City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS JO
+ „ 212 Main Street • Municipal Building
�; "..' * 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)