44-096 (3) BP-2024-1224
430 ROCKY HILL RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
44-096-001 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-2024-1224 PERMISSION IS HEREBY GRANTED TO:
Project# REBUILD DECK 2024 Contractor: License:
Est.Cost: 7500 ANDREW MADERA 89404
Const.Class: Exp.Date: 04/09/2025
Use Group: Owner: B MADERA REBEKAH E &ANDREW
Lot Size(sq.ft.)
Zoning: SR l pplicant: ANDREW MADERA
Applicant Address Phone: Insurance:
430 ROCKY HILL RD (413)210-4014 SOLE PROPRIETOR
FLORENCE, MA 01062
ISSUED ON: 09/25/2024
TO PERFORM THE FOLLOWING WORK:
REPLACE DECK
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
2-
Fees Paid: $150.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
RCOli
sZ, The Commonwealth of Massechu SEP
Board of Building Regulations end S ndards 2 3 r� FOR
Wt Massachusetts State Building ` de,r Z4 M [CIPALITY
n_ R USE
Building Permit Application To Construct, Repair, N .i>:4,. evised Mar 2011
One- or Two-Family Dwelling °1`.44A,Zo Ns
This Section For Official Use Only
Building Permit Number:NuJ _ /�P" y J /Y)� Date Applied:
/4 i,.� •' l<as � q. Z S-ZOZL(
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prro ertynAddress: Ii 1, n ` 1.2 Assessors Map& Parcel Numbers
7 0 f'�uC t� t �I
1.la 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 caper'of Rec rd• AAA-
(Print),
lr(LJ /� cram. c�( /V A ate6Z
ame(Print City,State,ZIP
113u 2 11-►1. 1 ,(4/4 L/i3..�w _Ljoit/ Gtt .7mp,4v^�(;) 11....,(.4..
No.and Street Telephone Email Addre
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s), Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work': )'LC/) •,Lc jv,f�}-r rU(�k>; a T (A�k--
,,� I ()( VI ,!
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building S /`� I I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ 1j / ❑ Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List: t1
5. Mechanical (Fire $
Suppression) Total All FeesL V );)',J�
iyq-� Check No.C Ch Amount:
6.Total Project Cost: $ -7 1 �(/ 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 C nstruction Supervisor License(CSL) 8-1 Vi /- -axr
License Number Expiration Date
N e of CS older
113 a PrA List CSL Type(see below) (1
No.and Street Type Description
ri3OrrAtC-t MA-- U Unrestricted(Buildings up to 35,000 cu.ft.)
U�V 6 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
� ,,11 SF Solid Fuel Burning Appliances
13 '��1/'( �Y �y��C c.) I Insulation
Telephone / Email addre D Demolition
5.2 red Ho,{m/�0vement Contractor(HIC) 17 3/6 C� 3 6/q 6
��Lv✓<v` ""' ' ►HIC Registrd/tion Number Expiration/ oL Date
HIC
Nparrx e or HICmgytr'e
tI w�EYyrrratiuttGess �e��-- .
u. Street
C /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 D
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
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
conta' in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or uthorized 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.rass.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
�?•"� �' Massachusetts
) A ♦ G
S.
DEPARTMENT OF BUILDING INSPECTIONS S ; `�
4` 212 Main Street • Municipal Building J . OD
Northampton, MA 01060 jy 1,'0O
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: Jcj
The debris will be transported by:
Name of Hauler: tti/VL4-✓ Nte-Joir--,
Signature of Applicant: Atik-c-LA/AUr4, Date:
The (ontnlun►realth of.Massachusetts
11 =::111 1=_Fl Department of Industrial Accidents
__�;01= l Congress Street,Suite 100
?t_-' Boston, .11.-1 02114-2017
=.t K 5V'IV*mass.got/dia
11 ut kers' ('ontpensation Insurance:tflidas it: Builders/Contractors/Electricians/Plumbers.
iO ID. FILEI)N I I'11 1111. I'1':K1111'I t\(::At'I71OKI 1'l.
oolicanl Information Please Print Legibly
Name t Ktrsinc .Or}tnnlr mein India.dual►:__/ Y�s/ 4!/`�l/
Address: "I j a /4-)k,k R4
City/State/Zip: IV IL.wy s vW6 Q- Phone #: 11/3—.v —1/6lej
,ire you an employer?Check the apprnpriale!melt: Type of project(required):
1.Q 1 our II employ er VI tilt employees(lull and or p:ut-line►• 7. 0 New construction
2 t2 r am a sok propewtur or partnership and hate no employees working for the in 8.aetnodeling
any eipacty.(No waders•comp.insurance nvquere>d_'
30 I an/a 11Ur11%.XMm7 doing all wort myself[No workers'emir.a:twit'"rnce R'+t nt:Lh''
9. ❑ Demolition
10 a Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
.n-.ute that all contractors either hate worker.'sortrpens:elnrm 1nwlance or an sole 110 Electrical rep aim or addition.
Ixoprelors w nth no employees_
12.El Plumbing repairs or addition.
f' I ant a general contractor and I late hued the sub-contraettn>listed on the attached sheet_ 130 Roof repairs
These sub-contractors Nate imipluyees and late winker,'comp.
6.0 we are a corporation and Its of fecr.hat c exercised their right of exemption per Wit.e. 14. Otltet
152.\i(4),and we hate no employees.[No worker.•comp.Instuaree required.'
•Any applicant that cheek.hot$:t must also till out the xctiasl below show in then workers'euntpen%aliun paIest unkrinatirin.
t Mimeo%nets who submit this atlidas it ins eating they are doing all wink and then tune outside contractors nuns submit a new affida'it indicating suwh.
:Conti:etots that cheek this box must attached an additional sheet show mg the name of the subeuntr-aelors and state w lethal or not those entities has e
employees lithe sub-etintractors has:employ ees.they must pros ids their worker.'comp-pokey nunlur
ant an employer that is providing►vorher.."compensation insurance Jor nit'employees. Rehm'is the polity and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lice#: Expiration Date: -
Job Sac Address: City'State Zip:
Attach a copy of the workers'compensation policy declaration page(showing the lathe), number and expiration date).
Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a tine up to$1,500 00
anikor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.(10 a
day against the violator. A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance
co\eratze seriticatian.
l do hereby eery r under the pains and penalties of perjury that the iali►rmatiun provided above is trey and correct.
Q Dy
Phone i:: // 3 - (0 - y0 111
Official we only. Do not write in this erne. to be completed hr city or town official
('its or Toss n: Permit/Licenrie A
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.CltyII ossn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
-L:
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