15B-028 (2) BP-2024-0640
185 CHESTERFIELD RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
15B-028-001 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-2024-0640 PERMISSION IS HEREBY GRANTED TO:
Project# roof 2024 Contractor: License:
Est. Cost: 10000 LEARY BUILDING COMPANY CSL104806
Const.Class: Exp.Date:02/17/2026
Use Group: Owner: A MOTT ANTON J JR&JANET
Lot Size (sq.ft.)
Zoning: URA Applicant: LEARY BUILDING COMPANY
Applicant Address Phone: Insurance:
13 GLENDALE WOODS DR (413)336-2611
SOUTHAMPTON, MA 01073
ISSUED ON: 05/22/2024
TO PERFORM THE FOLLOWING WORK:
ROOF REBUILD ON BARN OVERHANG
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: 1�� ..
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
i-?ECEi - y
st e ommonwealth of Massachusetts
ri MAY v cua2 In Bo d o Building Regulations and Standards FOR
1 MUNICIPAI.IT'Y
M ssachusetts State Building Code, 780 CMR
-T of USE
= r r�ar% 4 pplication To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
4'—=D1°60_ One-or Two-Family Dwelling
This Section For Official Use Only
Iuilding Pe ernitNumber �P--a•y-- CI'IC Date Applied:
EU1,07
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro 1 •. ty Address: 1.2 Assessors Map& Parcel Numbers ___-----
s e Tra-kaA (lb
1.1 a Is this an accepted street?yes K no Map Number cel Number
1.3 Zoning Information: / 1.4 Proper ' ensions:
Zoning District Proposed Use i L. Area(sq ft) Frontage(ft)------__
1.5 Building Setbacks
Fro and Side Yards ear and
Requireei Provided uired Provided Required _____..---Frovidea
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Publi Private El — Outside Flood Zone? Municipal it On site disposal system 0
''Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
/Im o filo-7r LF.Ns Mil oios-
Name(Print) C. ,State,ZIP
1 g s l.Llr"(i resat aN fa 3 A j t j 1"Li ct&,' 6 A.,e.tSr, IUD:tNo.and Street Si_a_,C3.11
ephone Email :1ddre..
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 ❑ Specify:
Brief Description of Proposed Work2:
/ecoc 12E601c-6 OA) ,6At.4) Oveet4AAJC,. Oa
-
I; go-r S)AM.k G.r'
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ jp o o 0 1. Building Permit Fee:$ Indicate how fee is detennined:
❑ Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $ _
4. Mechanical (I-IVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Feekrn 040
Check No. N Check Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /ow kou 2 2(o
1 tvl Lake.,-te License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) O
)3 (I )6At.r 4)0065 1 a_
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
007i4AA,,Pt)N 41IA Or v'7 3 R Restricted l&2 Family Dwelling
City/Town,State,ZIP / M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
y/3 33IP -2(01l rA C/L4e/15Iir4hiULt. &M. I Insulation
cl one Email dress D Demolition
5.2 Registered Home Improvement Contractor(HIC) / rI O6 C G 2cv
6UI L. 'Ada hL HIC Registration Number Expiration Date
HIC Company ame or HIC Registrant Name
/3 6i- 0&.c Woos S 62 a L 6u,c.bi,u1, . UAA
No.and Street Emil address
S4J 14 ti , Ma ao4 61.) 33m ZcoIl
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 .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 /iM LatR- / Lazy 6v,u/NCc Co
to act on my behalf,in all matters relative to work authorized by this buildinorpennit application.
ANION /v(O tI S— 20• SI
Print Owner's Name(Electronic Signature) I)ate
SECTION 7b:OWNER1 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,. it a st f my nowledge and understanding.M a,6t A LLt�'i- ,,� S_do Zy
m Print Owner's or Authorized Agent'yNae(Elect,nic Sig t e Date
`` OTES:
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(IIIC)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.govlocal 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"
City of Northampton
r•� Massachusetts A?i' /ee.
m1 t
'I !' DEPARTMENT OF BUILDING INSPECTIONS 6`
212 Main Street • Municipal Building
Yt„'"y Northampton, MA 01060 ......
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: , c;"t,JL, / / 1STk,tA,tc .-v 414
The debris will be transported by:
Name of Hauler: teA7 �j���0livC1 Co
Signature of Applicant: A �L� Date: c-2.0 - Z1-(
mumw 'Fr
1 The Commonwealth of Massachusetts
I NW flail- Department of Industrial Accidents
• =?/1`= I Congress Street.Suite 100
sii Boston. MA 0211 d-2017
- 1 I4'ww mass.gov/dia
11 m Leos'Compensation Insurance Aftids%it: BuilderslContractors/KketricianslPlumbers.
T'O BE HEED N 1111 THE PERMITTING AUTHORITY.
kplllic:ant Information Please Print hetibls
Name iiiusinc's Otgai uatton Individual l:_ _ I,, tl,t.olAlt, /'. (gyp
Address: (3 C La AjbAL6 tUwe)S D 2 _
City/State/Zip: S ,t,,.P-,,,, / LV1A _01073 Phone #: (/iZ) v c (. ' 2!o t 1
.,re,or as emplo rr?('heck the appropriate hut:
"rype of project(required):
1 DIanta employ erwith -- __._..em oyte%(full:ndtopart-timel.' 7. D Ness construction
'.D I ant a vole prom netor ut partnership and have no enyslaoyces working f t' on K. Q Remodeling
any capacity.(No workers'comp.Montano: roman:d.l
+.D 1 au a ho ineownet doing all work myself.(No workers'comp.ittiatralu1e nquit del.
9. El Demolition
4.0 I ant a homeowner and will be hiring oinuraviurs to conduct all wok on my property_ I will
10 O Building addition
emote that all contractors either hase workers'compensation ua urano:or are sole MO Electrical repairs or additions
pruptietors w ith no employees. 12.0 Plumbing repairs or additions
.a 1 am a general contractor and I base hired the subcuntracton listed on the attached sheet_ 13 (tWf repairs
These subcontractors base employees and base workers'cutup.insurance., p
14.00tlnrr
e ate a cotpuratwn oral mts utTrcers boor exenised their nghl of eaert>Qtxm per)i(aL e.
k
5.1.¢11 11.and we hate no employees.(No workers'comp.insurance required.'
'-my applicant that chocks but asI mad also till out the aectism below show ing their workers'compensation pulley information.
' tiomco tt nets who submit dos affidavit indicating they are doing all work and then hire outside ecotra:tun must subnut a nos affidavit indicating such.
:Contractors that cheek this Los rust attached an additional sheet showing the name of the sub•eontract+rs and state w lwiher or not those amities lase
cltlploscc.- Ittls;life,„i[ ,r.IL'S:ragel.,._t: .Ili,.'. r.i•1.1 I`Ii 1,L_their ut Pik Cr,.,e•nil' IN lt.: 1,trrih.i
l am an employer that is pruridin#u•orher.'e ompeensatiun insurance fur nt_1•employee., Below iv the/WWGca°and job Site
Information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: 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 cos-erage as required under MGL c. 152.§25A is a criminal violation punishable by a line up to S1.500.00
a d.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 t iolator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify an r I e 'its ad hi - , perjury that the information provided above is erne and correct.
a
Signature: l),Inc g '24 ' 1-1
Phone#: `//J 33(0 "Z i I
--
Official use onlc- Du not write itt dei.%aria, to be completed by city or town official
City or Town: Permitiiicense It
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical luspcctuu f-',. I'Itnatlon, Insltcct+rt
6.Other
Contact I'crwn: Phone#: - '