29-034 (9) BP-2024-0561
40 PIONEER KNOLLS COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-034-001 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-2024-0561 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est.Cost: 30000 Jack Morse CSSL 104141
Const.Class: Exp.Date:09/29/2025
Use Group: Owner: RYAN JAMES M&CHRISTINE H TRUSTEES
Lot Size(sq.ft.)
Zoning: WSP Applicant: JACK E MORSE ROOFING
Applicant Address Phone; Insurance:
2 LILAC AVE (413)374-9064
CUMMINGTON, MA 01032
ISSUED ON: 05/08/2024
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:
Finai: 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: .1/".2
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
F\
/ ` �sZ, The Commonwealth of Massa use : 40, <,/,',-.7
•`
Board of Building Regulations and•&tah+.- `�? FOR.
IC PALITY
.�1 Massachusetts State Building Code, 180 t� ��
h'q•�(4i. 11SE
Building Permit Application To Construct, Repair, Renovat8-6:1' il'- ; ish a Revrs�'ed Mar 2011
One-or Two-Family Dwelling -'.'L'RO;CT/I
This Section For Official Use Only /
Building Permit Number: vQ.2`-1" Sa/ Date Applied: "
_Zilifri
(.205) ��!/C Jam-6 ZDZ/
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property,Address: 1.2 Assessors Map&Parcel Numbers
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 if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
SRr�cS � -ti.NI P-kot`e-.\c 4\''NP—
Name(Print) City,State,ZIP
Lk o P%oN C< r- 1,_N k.e_l LI( Sgs — 8j 7 O
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) ❑ Alteration(s) ❑ Addition Cl
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:9e ficv e it,oc-
Brief Description of Proposed Work': Si'C"•f) 0 is(To e ( ,..� }t�, + 't N S
,0\ LC •�- t�(etc./ v �o r I'"e ft a+c\(1` (u5i-01\ Si'ANchA T
a n�• � 1 (1 C,o0- n
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 Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) S List:
5.Mechanical (Fire S
44 Suppression) Total All Fees: $.
Check No, PO Check Amount: 40
6.Total Project Cost: S /Q 0 0 a ❑Paid in Full 0 Outstanding Balance Due:
1
r
City of Northampton
o
-�' • Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
`, `a► 212 Main Street • Municipal Building O`L 4, Northampton,Northampton, MA 01060 W0
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
I. 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 License(CSL) CS S L_ 'O yt , 2.0ZS
SA{ W NMoi2C € License Number Expiration Date
Name of CSL Holder
211 6QP ANI 2� List CSL Type(see below)
No.and Streetl Type Description
GNe t? L CO2 U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
dr2' Roofing Covering
WS Window and Siding
,�� SF Solid Fuel Burning Appliances
3 3 x(-4 �Y \ W rQ I Insulation
Telephone Email addresW(2f`trii ,iIC!t D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1 1 a 2u �2
JP�k_ 'V c HIC Registration-1 Number Expiration Date
HIC Company Nam or HIC Registrant N e
21\ f(LA►,r AtL a 0 -3-p, (\,c1\\ Qr (Jer►fa.) . Ne
No.and Str ��,e\ 1 L� Lr 31 goek Email address
City/Town,State,ZIP d Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be ompleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Iss a of the building permit.
Signed Affidavit Attached? Yes No . O
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.
11\A0(-S Ma-"A tZ -Zo -t `(
Print Owner's 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"
. The Commonwealth of afassachusetts
•
I Department of Industrial Accidents
=.ill— 1 Congress Street,Suite 100
�_ t ,
. `�.ifet— kl Boston, MA 02114-2017
•„:,,, �'1"r
• ,, v 9 www.mass.gov/dia
11 uh kern' Compensation Insurance Afftdav it:Builders/Contractors(FJcctriciam Plumbers.
U) Bk. 111.E1)1N 1111 II 1 Ilk:PERMUTING Al IHORI IA.
Al►nlicant Information Please Print Letlil►11
Name(BusinessiOrganvntion'lndividuat): -31P,C k V\0(2S 1 r-
Address: � l �� V, ' 0
City/State/Zip: I 'N) C-1 e`1, C`,k - G GO Z Phone #: CA I 1 — 7 - — ckoG Li.
_
.1re you an employer?C'htck the appropriate bon
Type of project(required):
1.01 ani a cmpk»a.with -----cmpioyees Ira and or part-tone 1• 7- D Nos construction
?:I 1 am a sole proprietor or paMCrship and hate no empl wtxa working fur me in 8. 0 Remodeling
any rapacity.[No wormers'comp.mummy required.] 9. 0 Demolition
).Q I am a humeownet doing all worts myself.[No works ra conc.insurance required.J•
10 a Building addition
J.Q I am a lomcrownet and will be hiring contractors to conduct all work on my prop.-iv,. I will
c lure that all contractors either have workers'compimio on insurance or arc sole i l Electrical l repairs or additions
ruprictota with no cmpluycm.
12.0 Plumbing repairs or additions
3 I am a general contractor and I hove hired the saib-contractors listed on the attached shed
These sob-contra turn have employees and have n wiske 'cutup.rwr:uuice. l Roof repairspp
60 We are a corporation and as officers have exenased their nett of exemptom per 11GL c. 14.0 Offer 1'4)O �QS
1 . 114I.and we have no employees.[No workers'comp.insurance required.,
'Any applicant that checks box AI mint also fill out the section below show ing then worker,'compensation pulley information
llomcownos who submit this affidavit indicating they are cluing all work and then hoc outside contractors mint submit a new al•ftdav it in dic-.aung such.
-untra.turs that check this box must attached an additional sheet show mg the name of the suh-euntcseters and state whether or not those aanics It:r.e
. .1 :,•. if the sub-contractors hat:crnpk.'ecs.they must prat ids their workers'comp-policy number
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
inlirrmation.
Insurance Company Name: _
Policy#or Self•ins. Lic.#: Expiration Date:
Job Site Address: City/StateiZip:
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 tine 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 tine of up to S250.00 a
d.1s against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DiA for insuraunce
its+erai;e verification.
I do hereby cerfi/i Icr the pains and penal ' . of perjury that the information provided above is true and correct. —7
Sivnatuic: i t.ti: O'N)\`"t -t-- ' ZC1 ` 4
y
Phone g: � \ — q Q c
Official use only. Do not write in this area.to be completed by city or town official
City or Town: Pernik/License!t
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#:
City of Northampton
f�'� ,4,4• S`y «.. sip
Massachusetts ., '�
1 .%
`4 F.I4 DEPARTMENT OF BUILDING INSPECTIONS n •?O,,
w .-fr • 212 Main Street • Municipal Building 'CI.
Northampton, MA 01060 'iE,ti. 3r31^�
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: l `C , Qki“Lk . l _
The debris will be transported by:
Name of Hauler: (Ac P ,-ate CI-, n Li
1011
Signature of Applicant: L!, _Date: (NA9 1 L. 2oz "l
City of Northampton
.'yiHAMpr.�
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
'CII' 1 212 Main Street • Municipal Building
_s� Northampton, MA 01060 ! '
h 1
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
(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. 1 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)