35-228 (7) BP-2024-1188
62 LADYSLIPPER LANE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-228-001 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-2024-1188 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est. Cost: 8000 JAMES ROBERTS 099404
Const.Class: Exp.Date: 01/21/2026
Use Group: Owner: FEIN, SARI FEIN,CASEY
Lot Size (sq.ft.)
Zoning: WSP Applicant: JAMES ROBERTS
Applicant Address Phone: Insurance:
30 Edwards Rd (413)527-6078
WESTHAMPTON, MA 01027
ISSUED ON: 09/12/2024
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: "1/7/0
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
s
The Commonwealth of Massach setts
Board of Building Regulations and tand ds R
WMassachusetts State Building Code, 80 MR`atP 1! ?On I IPALITY
SE
Building Permit Application To Construct,Repair,iRenoIL ,te Or Demolish a vise Mar 2011
One-or Two-Family Dwelli g DE^r.-OF run:Oi\,G INSPECT oNs
t0 TNA\t^TON,MA0low
This Section For Official se
Building Permit Number:et/2'41y.. ll pf Date Applied:
S7�—L6 L!) .?•/2. 2 y
Building Official(Print Name) Signature Date /
SECTION 1:SITE INFORMATION
1.1 Proper 4l a s: 0 1.2 Assessors Map& Parcel Numbers
Vi
1.1a Is this an accepted str . 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 Ow 'of Reco 1.. -1
Name(Print) , C01:1
te,ZIP Gl
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 ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
0,,,,,,4,,,.„-ri
, tr
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(La,I and Materi s
1. Building >n g 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees:Li
Check No. 31 nheck Amo t:
6.Total Project Cost: $ 0 Paid in Full 0 Outstan mg Balance Due:
►'
City of Northampton
l .. ''k:
AMassachusetts 1 c':
�'`' �, �# DEPARTMENT OF BUILDING INSPECTIONS ��
212 Main Street •• Municipal Building
Northampton, MA 01060 h, 3,)\
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 Const ion Supervisor L' se(CSL) 6 _
/ LicenseNu a44i r Expiration at
Name L der
List CSL Type(see below)
No.an Stree Type Description
U Unrestricted(Buildings up to 35,000 cu.11.)
City/ own,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
e4 Roofing Covering
Window and Siding
���G/� �V Solid Fuel Burning Appliances
j I Insulation
Telephone Email address D Demolition
5.2 Registered II e Improvement Contractor(HIC) I�/
�y p
I e istra�tio Number Expiration Da e
HIC Compan or IC gistrant Name
No.and reet 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 UILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work autho ' ed by this buildin permit application.
Print Owner's Nam lest onic 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 tru d accurate to the best of my knowledge and understanding.
Print er's or Authorized gent Name(Electronic ig ature) 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
7.4
k41, ..
Department of Industrial Accidents
_• ►;._ ,t 1 Congress Street,Suite 100
�� Boston, MA 02114-2017
,� www.mass.gov/dia
1Vorters'Compensation Insurance Affidavit:BuildersiContractorstElectricianxIPlumbers.
1'C)BE FILED D N I ill THE PERMITTING ING AUTHORITY.
.tnnlicant Information � Please Print Legihll
Name i llustness'Or�*anizatiowtndividual) G�r1 f
Address: 3 l /e
City/State/Zip: 1_ Phone #: j/ 4/-- O3cd
Are you as employer?Cheek the appropriate box:
"i'ype of project(required):
inI am• npkwer with employees atilt andlorpr t-tiatrf_'
u '?. 0 New construction
.0 a sole prupnetur or purtncnhip and have no ensployees winking fur me in $. 0 Remodeling
any caputry_[Nu workers'cutup.insurance required.]
3.0 I am a homeowner doing all wort myself.[No workers`conrp_insurucce required.]'
9. ❑ Demolition
10 Q Building addition
-t.❑I am a homeowner and will be hiring contractors to conduct all work on my property.. I will
ensure that all contractors t-ither hare workers"conipensatian insurance or are sole 11.❑Electrical repairs or additions
proprietuas with no employees.
110 Plumbing repairs or additions
y:1 I am a gene'sl contractor and I has a hand the sub-contr ctor%listed on the attachc'tt sheet
These soon-contracture Ixars.employees and lure workers c:uan' p.insurance. 13 oot raptors
6.0 we are a corporation and its ofhcz c :have earn iscd their night cif exemption per AMCaL c. l4.❑Other
I'!1`.f I( .toad we have no employees.[No workers'romp.insurance tegquuett.]
'Any applicant that eheeks box el taint also till our the s etrot below`dhow mu their w urksrs'compensation policy information.
t Ikameowner%who submit this affidaeit iawlicatina they arc doing ali work and then hue outside corttaclaes must submit a new affidavit indicating such.
:Contractors that check this,box must attarbed an additional sheet showing the name of the sub-eoatracroes and state whether or nut those enlatic's have
employees tf the sc -contractors bare employ ties,they nru>t pnwidc their worisers'comp.pairs:),number.
/um an employer these is providing workers'compensation insurance for my employees, Below is the police and Job site
infirm 1
Insuranc:::::
Policy#or Expiration Date.
Job Site Address: Cit}''State:Zip:
Attach a copy of the r►orke rs'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coterage as required under MGL e. 152,§25A is a criminal violation punishable by a tine up to S1.500.00
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 die violator_A copy of this statement may be forwarded to the Otrtce of Investigations of the DIA for insurance
coN erase verification.
I do hereby certify under the pains d penalties ofperjuy that the inburrna!innprovided above is true and correct.
- gi—V 1-.,
47/
Signature: v 4-1„„, Date:
o'7'
Phone#: ' e----1/ 1 qVf — 35 d
Ofcial use onll Do not write in this area.to be completed by city or town official
City or Town: PermltiLicense#
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 4:
•
City of Northampton
i•' • Massachusetts ���s:5. sic„`!`
DEPARTMENT OF BUILDING INSPECTIONS a, ;,'
,<� ' 212 Main Street • Municipal Building y�,t., ��
-yv.-a.. . Northampton, MA 01060 'r4'fr hr 3^'''
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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: °777/
The debris will be transported by:
Name of Hauler: X")r(j (/C------ /*g
Signature of Applicant: L )/- Date: _`
City of Northampton
y Massachusetts
r,
l ; "
l� f
DEPARTMENT OF BUILDING INSPECTIONS
�� �, 212 Main Street •• Municipal Building •'. , C'1. ,
Northampton, MA 01060 ��
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT •
I, (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 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)