35-041 (23) BP-2024-1119
71 SYLVESTER RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-041-001 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-2024-1119 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est. Cost: 8500 JAMES ROBERTS 099404
Const.Class: Exp.Date:01/21/2026
Use Group: Owner: ARONSON ROBERT W
Lot Size(sq.ft.)
Zoning: WP/WSP Applicant: JAMES ROBERTS
Applicant Address hone: Insurance:
30 Edwards Rd (413)527-6078
WESTHAMPTON, MA 01027
ISSUED ON: 09/03/2024
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:
/ 7
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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14 The Commonwealth of Massachu t9 4?oyp60 •R
Board of Building Regulations and Stan elW ti
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Massachusetts State Building Code, 780 C / (9 USE
Building Permit Application To Construct, Repair, Renovate ish a evised ar 2011
One-or Two-Family Dwelling .J�
QQ This S ton For Official Use Only v
Building Permit Number: Vr '.4 y" ///7 Date Applied:
e ; 1e Q-3-21
Building Official(Print Name) Si Date
SECTION 1:SITE INFORMATION
1.1 Pro erty Ad ess: 1.2 Assessors Map& Parcel Numbers
1.1 a Is this an ace ed 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 CI Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 O 'of cor qiez2).2.vjeoz,
,�y J �/ �
Name rint) City St )P[ / �� , ��
7 461A-ei-e
No.and"Street eid 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:
Brief Description of Proposed Work2:
SECTION 4:ESTIMATED NSTRUCTION COSTS
Estimated Costs:
Item (La and Ma errals Official Use Only
1. Building $ a� 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $' ___}
0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: j niO
Check No. Check Amournt: U'
6.Total Project Cost: $ 0 Paid in All 0 Outstanding Balance Due:
City of Northampton
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ti K Massachusetts `!
DEPARTMENT OF BUILDING INSPECTIONS•
_ 212 Main Street • Municipal Building O fC1
r. - , Northampton, MA 01060 4.4 %.%
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
•
1. Building Permit Application signed by legal owner and tilled 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 Li :e(C L) 0 qq co f( 1-02 f- L
oy
.....,.....-A"," '/ / ' 1, License Number Expiration Date
Nam SL older
•v3 x (.-„or B,Ki`J List CSL Type(see below)
No. nd Street (`/J Type Description
4 W/ /),I...)
City/ owlySt,e(ZIPU Unrestricted(Buildings up to 35.000 Cu.ft.)
R Restricted 1&2 Family Dwelling
Masonry
Or f j� RC Roofing Covering
V 7 Window and Siding
. SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered 11 I • r •rovement Contractor(HIC) '/ 7 /51k -
HIC Registration Number xpiration Date
HIC Company Namyr I gis Name
No.and Street Email address
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 0 No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUI DING PERMIT
I,as Owner of the subject property,hereby authorize .
to act on my behalf,in all matters relative to work authoriz by this building permit application.
Print wner's Name(E ectronic i ature) 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.
Print 0 er's or Authorized Agent's to(Electronic Signature) t� Date
NOTES:
I. 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 Common wealth of Massachusetts
,,.
f Department of industrial Accidents
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1 Congress Street,Suite 100
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1/4Boston, MA 02114-2017
imw.mass.got/dia
Workers' (onipensation Insurance Affidavit:BuildersiContractory Electricians/Plumbers.
Tt)BE FILED N till 11111 PERM!IONt;At I I lt)!tl 1 t.
.1nnlicant Information Please Print I.rilibly
Name(lius ness,O ganization:Indwtdirai):
Address: 3 — - 0 i Al
City/State/Zip: /. 04, Phone#: Lffl q�f �7'O cr�
Are you an employer"Check the appropriate hot: Type of project(required):
1-0 I am a kstr aith__-__-- employees(full'anrl'urpart-titnrl-' 7. ❑New construction
rn a sok proprietor or psrttrcialtrp and have nu employee.working for vac in g. 0 Remodeling
any capacity.[Nu autkeri comp.insurance required]
9. ❑ Demolition
30 I am a lKtnauownet doing all short tny'self.[No a-otitis'con>p.insurance required.)'
10❑Building addition
t a I am a lwmevwa►7 and will b hiring contractors to conduct all work on my property. 1 will
Ware that all contractors either have starkers'cimrpe'n.atton insurance or are sole II.0 Electrical repairs or additions
proprietor.with no employees.
12.0 PI ing repairs or additions
SO I ant u genera)contractor and I hav a hand the sub-cutractur.listed on the anacbeit snit
These sub-cuntractun u have employees and have workers'comp.uuracnr. 1 4Dfrepder5
6.0 we are a corporation and its of icon a hove exercised their right of exemption per R1t.L c. I` .❑Other
152.§l(i).and WC It,VC tw eanpIuyees.[No workers'comp.insurance required.]
'Any apptieant that cheeks lox=I must also fill out the section below shoo.iris!their vcceker.'compensation pulley information
t homeowners who submit this attidac it tn.heattnu they an doing all work and thco hue'innate contractor.attest salnnit a new affidavit indicating sLrh.
:Contractors that check this box must attached an additional sheet situ%mg the name of the sub-conuaeturs and state whether or not those vruties have
employees. If the sub-contractors have employees.they must provide their workers'comp.tube.number
I ant 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.Lie.4: Expiration Date: g {/ - S
Job Site Address: City'St:uelZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy num r and expiration date).
Failure to secure coverage as requited under NGL c. 152. §2SA is a criminal violation punishable by a fine up to S I.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 DIA for insurance
coverage verification.
I do hereby certify under the pains and ..tallies of perjury that the information provided above is true and correct.
Signature 3 '1-Q ) Date: $' r'--- 6(
i
Phone#: ,/ t 3 —44 4-1 i ._.. 03 0
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):
I. Board of Health 2.Budding Department 3.City frown Clerk 4.Electrical Inspector S. Plumbing Inspector
G.Other
Contact Person: Phone*:
City of Northampton
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Massachusetts
7
,�'fq DEPARTMENT OF BUILDING INSPECTIONS
P '� ,►=�, 212 Main Street • Municipal Building CD- 9 'mow^—, 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: /Z/f
The debris will be transported by:
e_____,d_z ,...
Name of Hauler:
Signature of Applicant: 1,11-?- 1- Date: ?(... .g:
City of Northampton
�.�fiilw uF y,
Massachusetts �.
I r'' DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building v�`•.._ C'_
Northampton, MA 01060 spj. -�16
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. 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
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)