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24c-031 (10) BP-2024-0417 76 NORTH ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-031-001 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-2024-0417 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: Est. Cost: 12000 LEARY BUILDING COMPANY CSL104806 Const.Class: Exp.Date: 02/17/2026 Use Group: Owner: A. MURPHY, DAVID Lot Size (sq.ft.) Zoning: URB Applicant: LEARY BUILDING COMPANY Applicant Address Phone: Insurance:,, 13 GLENDALE WOODS DR (413)336-2611 SOUTHAMPTON, MA 01073 ISSUED ON: 04/10/2024 TO PERFORM THE FOLLOWING WORK: ROOF WORK 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: 17-P Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner i � .�,•r C %� kph' 9 `+ The Commonwealth of Massachusetts FOR Board,,,of Building Regulations and Standards ��Q Massachusetts State Building Code, 780 CMR MUNICIPALITY ,_T1* "c n-- a" USE luilding Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 , One-or Two-Family Dwelling This Section For Official Use Only Building/Permit Number: e iol 7" 7/7 Date Applied: lian,J a5 /4 Li-M-26z9 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 4( N oe-TK Cµ. S,- 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❑ Private El Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: D,wto MutzPk.`0 ki\ " li ra MAZ1t O Name(Print) 1 ity,Sta , 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)j Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': 4�F K -i,2- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ /7 o ee 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ 0 Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $� Suppression) V` Check NoCheck Amount: 1413 Cash Amount: 6.Total Project Cost: $ /L 000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS- 109%010 2., 1 —2.6 —I1 iv v0Aik VICA -1 License Number Expiration Date Name of CSL Holder 1 --VAN �,� li' �� List CSL Type(see below) kI No.and Street �1t" Type Description U Unrestricted(Buildings up to 35.000 Cu.ft.) '. ^n(��bj �� L' �� R Restricted 1&2 Family Dwelling City/Town,State. I1''( M Masonry RC Roofing Covering WS Window and Siding , l 1 SF Solid Fuel Burning Appliances -'k i V-'))Stc,-bDI1 !\q Al L') k i�1' ' (. (Nk I Insulation Telephone Ethail add ess J D Demolition 5.2 Registered Home Improvement Contractor(HIC) n tt 1OlcS �(fit LLA ( 1'U l 1.P l IJ V e�- HICRegistration Number expiration to HIC Comlbany Name or HIC Re ist ant Name �i At./ v„�.� � "; et. b, I t l.' «,>� i_(.,and Street -n Li 1 q E ail address) Q Air(Aivi 1'(b l'.1 �\i\P b t( �1(9)'�)(0-2 foil J 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 Ili 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 authorizez. dutlplAA: C v,�ay to act on my behalf,in all matters relative to work authorized by this buil ng rmit appl ation. )AVID Mlo N'vl 10' i Print Owner's Name(ElectroniISignature) Dat SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my n. - below,I hereby attest under the pains and penalties of perjury that all of the information contained in this .1)el is is :IS accurate to the best of my knowledge and understanding. f i_Appo 9 155'26 Print 0 ',r Aiithoia"Fnt's !me(Electronic Signature) D e NOTES: 1. An Owner who obtains a but ding 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/des 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" ` 1 The Commonwealth of Massachusetts 'lt Department of Industrial Accidents Li, e r i I Congress Street,Suite 100 Boston, MA 02114-2017 -y.,:, ,w-;, www mass.gov/dia 11 uiicers'Compensation Insurance Affidavit:BullderslContractors/ElectriciansIPlumbers. TO BE FILED WITH THE PERMMT71NC AUTHORITY. Applicant Information f\ Please Print Legibly Name(Business/Organiation:Indivibld): (1,L LL U\',r-, i A . Address: ►'S GLEN b I,t- W[510-, City/StatefZip: 7LA-14 n r3 0 i 1:11-) Phone#: Cl 11)-'} } --9)2:6 Are vat so employer?t hick the apprupriate hlu: Type of project(required): I.©I am a empkoyer with �__empioy+etw(hill and/or part-time e i• 7. ❑New construction 20 lam a suk prupnetor or partnership and have no employers working for me in B. Q Remodeling any capacity.[Nu workers'comp.insurance required 31:3 I am a humwwm wink all ►myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.0 I am a homeowner and will be hiring oindrairurs to eoodtacl all work on my property. I will 10 Q Building addition ensure that all contractors caller have workers'compensation uuuranc.c or an:sole I I 0 Electrical repairs or additions proprietors with no employees. 12.11 P .robing repairs or additions 50 lam a general contractor and I hate hired the subcontractors Listed un the attached sheet_ l �'��, Roof repairs These subcuntraciun hate employers and have worriers'comp.insurance.: £._ r 1 9 r d We are a corporation and its officer have exercised their nght of exemption per hi c. 152,i1(4),and we haw no employees.[No workers'comp.insurance required] 'Any applicant that clocks bust a 1 must also till um the section below showing their workers'compensation policy informioine. t lirnncvw'ners who submit this affrdatit iridicaune that arc daring all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an .rl.lrtiunal sheet showing the name of de sub-curdractus and state whether or not those entities haw nnpluvec-s_ If the sub-contractors hair enploy`res.they must provide their wodeers'awnp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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!: and of pewjauy that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: .6 City of Northampton Massachusetts te �I DEPARTMENT OF BUILDING INSPECTIONS \`. ** P " 212 Main Street • Municipal Building 43, �b f■ ,�" Northampton, MA 01060 �sNjy )N-‘ 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: .\IA LL.T / 42.t.L1,j( L The debris will be transported by: Name of Hauler: [SARI ( Lit N(, CO Signature of Applicant: Date: