35-260 (7) BP-2024-0633
40 WEST PARSONS LN COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-260-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2024-0633 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF/SKYLIGHT 2024 Contractor: License:
Est. Cost: 2500 JAMES ROSS 104530
Const.Class: Exp.Date:01/21/2026
Use Group: Owner: ALEXANDER ROSS
Lot Size (sq.ft.)
Zoning: WSP Applicant: JDR BUILDERS
Applicant Address Phone: durance:
PO BOX 66 (413)374-7983 WC9024479
WHATELY, MA 01093
ISSUED ON: 05/20/2024
TO PERFORM THE FOLLOWING WORK:
REROOF BACK OF GARAGE AND REPLACE SKYLIGHT
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: ///7"�
Fees Paid: $80.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
" rAI 1 7 2024 The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
' Massachusetts State Building Code, 780 CMR MUNICIPALITY
:\"': ` IONS 1 USE
rcaT.OF6UIL NCI�CS
NpftTHA"� !e4mit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building PermitNumber: ( fl )-54" a33 Date Applied:
,
/?�wf..) /Joss /��Z 517 ZUZq
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: z 1.2 Assessors Map&Parcel Numbers
`10 ire S/- Pa-SLAS cic'v 1
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 il) Frontage(II)
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 0 Zone: Outside Flood Zone?
`? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
-e---._tl lark....k KD o Sl-C" k, cstzc---2,1�' - rA A C> \ CI 1::. Z
Name(Print) City,State,ZIP 1
/1 0 L S-1 l Aiz �. Urn.e 41�-695-v5o z- Slott t-1 ,-os i:-Z.23
No.and Street Telephone Email Address civincp . f -t--
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) l — Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: • e -CO C)'f )o, c f Of 5 Aros 'nd (?,.()/,c t,
Sk i I•, It
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1. Building S 1. Building Permit Fee: $ Indicate how fee is determined:
❑ 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 $
Suppression) Total All 5)
6.Total Project Cost: $ .„-,, ‘,..-�� Check No. Check Amount:
❑Paid in Full 0 Outstanding Balance Due:
City of Northampton
`7, !oatHA_ p oti. S`S -�.. S/
;.. Massachusetts 4' ..- '<<
4 .: .I r, • im 7 DEPARTMENT OF BUILDING INSPECTIONS S.
f'..'"+,>r ` 212 Main Street • Municipal Building y'` cI.
\ Northampton, MA 01060 :J'l,, w00
0
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, H1C, 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 Supervisoro License(CSL) c')of S 3 J of/e//2
A� 4.4� Y
1 of 1LOCS License Number Expiration Date
Name of CSL Holder
Pv Z List CSI,Type(see below)
No.and Street Type Description
// t 0 '0 9 U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State."/,ll' R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
3"y SjG l Ale, e 5 0 R : Inds SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address C0,1 D Demolition
5.2 Registered Home Improvement Contractor(HIC) r 7C 5 7_ -2�
Svc Cu; 1 d es 1 G HIC Registration Number Expiration Date
HPCompany Name or HIC Registrant Name Gti it y 3--De Au, l(Jeri co
No.ajtrep
.e !mil l,vk- 0 I fJ ; tto3►'7c/cp`/ Email address
� I
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 No ❑
)4*--
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 J P R. 42 v. kiqrc I AC
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Nam Jectronic 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 t e best of my knowledge and understanding.
Alrvh.c14.r (2CS
Print Owner's or Authorized Agent's Name(Electroni 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 I-IIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.tnass.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
111 _ ` Department of Industrial Accidents
41=
:� 1 Congress Street,Suite 100
•
°Dr � ' Boston, MA 02114-2017
-r,-,<-� www.mass.gov/din
llurkers' Compensation Insurance Afftdasit: Builders/Contractors/F:lectricians/i'Iumbrrs.
to ItE TILED WW'I1'll'i'IIF PERM!rl7N(:At'1'NORITI°.
Annlicant information Please Print l.r_'ihl►
Name 1 Husincss•Orgnniratioru7ndividual): 1 � �� v° (c`' S C-
Address: u v t'(
City/State/Zip: 1Y H' 71)G 6/ Phone#: Lj(, ? 77/ - S° C;
.ire yeu an employer?Cheek the appropriate box:
�y � Type of project(required):
1.1 Jt I.tar.r inploycr xith . f✓' _employees(full and Or part•timet.• 7. 13 New construction
20 I.in a sole proprietor or partnership and have no employees working for me m 8. Remodeling
any capacity-[No xurkcrs'comp.insurance required)
9. ❑ Demolition
t.❑I am a homeowner doing all wurk myself.(No workers'comp insurance required.]'
4.0 I am a horw nee my will be hiring contractors to conduct all work on property. 1 will 10 Building addition
mw
ensure that all contractors either have workers'compensation insurance or are sole I la Electrical repairs or additions
proprietors w ith no employees.
12.0 Plumbing repairs or additions
50 I am a general contractor and I have hired the sub-contractors Bated on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance. 13.0 Roof repairs
6.0 We are a corporation and its officers have exercise)their right of exemption per MCii c. 14. Other
152.¢1(4).and we have no employees.[No workers'comp.insurance required]
'Any applicant that checks box a l must also till out the section below shuts ing their workers'compensation policy information.
s Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that cheek this box must att.kched an additional sheet showing the name of the sulreonmietors and state whether or not those entities have
employees- If t1w sub-contractors have onrl'lu}Cos.they must provide their workers'ex'mp.policy number.
I um an employer that is providin°tg►corkers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: S C C I";VC
Policy »or Self-ens. Lie. w: q J Zqti 7 `7 Expiration Date: I Z i —
Job Site Address: W ect iXrco/xs `c,vt. City/Brat..Zip: ri r‘
Attach a copy of the workers'compensation polio'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 S1.500.00
andlor 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 cer y u he t penalties ofperjury that the Information provided above is true and correct.
Signature: I),rle —
Phone#: 9 I S I ` ;,t
Official use only. Do not write in this area. to be completed by city or town official
('it► or To►sn: Permit/License k
Issuing Authority (circle one):
I. Board of Health 2. Buildint;Department 3.('ityJost a Clerk 4. Electrical inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone 4:
.( Mph
City of Northampton
?ed • �ti, SAS.... .S/C
/j�`., Massachusetts w? • y._ 'e
( �, 1 * t 44 7 DEPARTMENT OF BUILDING INSPECTIONS ty, I; j„
`+" �r ,�` 212 Main Street • Municipal Building vti CDC
:� w.' Northampton, MA 01060 �S,,Y )\\
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:
tit
Location of Facility: I'-' V y C C 1,
‘rI2
The debris will be transported by:
Name of Hauler: TOR g 0., Idd. 5
Signature of Applicant: Date: 9- 2c� Z(./
City of Northampton
..s,`,
Massachusetts tea}'ri
r(rir
H
I ‘, DEPARTMENT OF BUILDING INSPECTIONS
,v 't_„ 212 Main Street • Municipal Building J CSC
r Y�a Northampton, MA •01060 'ram"""V5� .
HOMEOWNLRS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert fall legal name), born (insert
month, day, year), hereby depose and state the following:
1. I ant 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. I qualifij 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
qualifij 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 activihj regulated by any provision of the Massachusetts State Building Code.
5. If 1 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)