13-087 BP-2024-0562
42 STONEWALL DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
13-087-001 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-2024-0562 PERMISSION IS HEREBY GRANTED TO:
Project# roof 2024 Contractor: License:
Est.Cost: 12400 ROBERT THIBODO 65699
Const.Class: Exp.Date:06/22/2025
Use Group: Owner: S VALONE, MARK
Lot Size(sq.ft.)
Zoning: RI/RR Applicant: BOB THIBODO ROOFING AND SIDING
Applicant Address Phone:, Insurance:
P O Box 201 (413)586-0391 650UB-020N14
NORTHAMPTON, MA 01061
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:
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: f�r �
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
ti
The Commonwealth of Massachusets •
Board of Building Regulations and Stan rds IA _ 7 2 FOR
Massachusetts State Building Code, 780�MR MUNICIPALITY
11SE
Building Permit Application To Construct, Repair, Reno\ate C r-I o ,1 1e r ce Mar 2011
One- or Two-Family Dwelling » I+'
This Section For Official Use Only
Building Permit Number: 3�• )4 • 0Z Date Applied:
aSS �f� 5.8-2ozy
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pro er Addr ss: 1.2 Assessors Map& Parcel Numbers
l
1.1 a 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 ec rd �k 1 , DY4
I�( rlU' o
Name(Pnnt) City,State,ZIP
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) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:(\<prl
1
of Description of Propose Work.1
Co ‘cot,;•\•cN e) -1_4N
( v C?-en.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building S 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical S ❑ Standard City/Town Application Fee
❑Total Project Cost(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No,2410/ Check Amoun
6. Total Project Cost: $ "L Q () 0 Paid in Full 1 0 Outstanding Balance Due:
City of Northampton
S'5....r....SC
71
Massachusetts �4? a,_ •„.
I , w
i DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building O%A.
Northampton, MA 01060
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) 9 t tr
Oe-CS , [1\b o ,(� License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
m eAQ S-�
No. and Street Type Description
y`is•
U Unrestricted(Buildings up to 35,000 cu. ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
\_srk.,3 RC Roofing Covering
WS Window and Siding
5-7 5 ) �() ��� b yV SF Solid Fuel Burning Appliances
b c I Insulation
Telephone Email address Gip b.,\\01, D Demolition
5.2 Re "stered Ho Improvement Contractor(HIC)r ( e'
ba,6 HIC Registration Number Expiration Date
H o any N me or HIC RTit strant Nale,
3.
o.and Stre � - Email address
as^ ,ma's S-) S. 1 9 6 n C " • ��
City own,State.ZI Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issu a 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 authorizes e�� 1 N a
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.
)\\) S- DJ-4
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 Massachusetts
s:. Department of/ntlrtstrialAccidents
��
6 I Congress Street,Suite 100
�- :, Boston, MA 02114-2017
k
..of. e
ww>w.ntass.gov/din
11 ut kers' Compensation Insurance Aff►da•it: Builder+;Contractors/Electricians;Muntbers.
It)BE 1.11.E1)M I t II THE ['ERNII I l INC.01.11 )RI 11.
A r ilicant Information Please Print Le,ibh
Name iBusincss'Organixation)lndividualr_ 0 ) \ U
Address:c a C l- M"R 4) S-A-
City/State/Zip: S e),-, v1 '$ Phone #: )-. S S ) 9 ` )
Are you an employer?Check tilt appre'prtate bob: Type of project(required).
f[Siram a employer With ')--, _employees troll and or pariitinrcl-• 7. CI New construction
20 1 am a sok pcupncrtn or partnenhrp and hate nu employees working fur me in ! R. [, Remodeling
any capacity.[No workers'crimp.tnaurantx required.]
9. ❑Demolition
CI1 am a homeow net doing all work myself.No workers cutup.insur.uwe recurred.]-
4.1:::1 lam a honneuwner and will be hiring eoidraeturs to erxuluet all VI ark on my property. 1 will
10 O Building addition
ensure that all contractors either Irate workers'compematiim mutmix or are sole 1 1.0 Electrical repairs or additions
proprietors V.ith no crttpluyces. 12.11 e .i mhtng repairs or additions
lam a general contractor and I have hired the sub-contractors Heated on the attachexf sheet
these sub-contractors base tu employees and have workers'cup.utstuaru:e.> l Roof repairs
14. Other
n.Q Vie are a corporation and its officers have exercised then right of exemption per\161 e- —
1 c' ;Is 41.and we have no employees.[No workers'comp.insurance requited.]
•,1ris applicant that chicks box a1 mini also till out the sedum below showing their workers'comic:i,auun policy information
' IL.trteu•Arat.afro submit this af1uhriit uubcating they at doing ail work and then hire outside contractors must submit a new alfidas it indieatrnc such.
C ontrat:tors that check thus box must attached an additional sheet showing the name oldie sub-con.uactors acid state whether or not those ei titre.%ha e
cinplu.ecs- If the sLh-contractors base employees..they must min idc their worlters'comp policy number.
I ant an employer that is pro►idim worAers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: - N-e \A' CA, \-'qbY _
Policy#or Self-ins.Lie.#: C)'MS' (D 1 4 "" L(..-4 L 1 Expiration Date: lA -3 - 1:-Th -g
Job Site Address: 4 1 S Ii71r1 e w a+\ Vr• City/State/Zip: �ZY� t- o c ciV-
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration late).
Failure to secure coverage as required under N1GL 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 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 DR for insurance
coverage verification.
1 do hereby t•c•rri/i under the puint% and pevtultiei of perjurr rho!the information provided above is true and correct.
s„ nature: Date: S ' `..I
Phone x:
Official use only. Do nut write in this area.to be completed by city or town official
City or Town: Permit/License ft
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
�_ s .S1
�' Massachusetts ��25' c,�c
* G.
, .--,;-.•.' '4 )
DEPARTMENT OF BUILDING INSPECTIONS y 1'
212 Main Street • Municipal Building J�. tea,
Northampton, MA 01060 xi--_ , .
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: DY V c, 1t'‘ .
The debris will be transported by:
Name of Hauler:% 0 l t"1\\::) d 6,#C)
Signature of Applicant: Date: S ?- '1
City of Northampton
r tt Massachusetts ..
le
{ DEPARTMENT OF BUILDING INSPECTIONS
4 7
p 212 Main Street • Municipal Building .CT�
4 Northampton, MA 01060 '41, woe''
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_ (insert
month, day, year), hereby depose and state the following:
1. 1 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. 1 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)