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42-158
BP-2024-1431 25 WOODLAND DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 42-158-001 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-2024-1431 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: Est.Cost: 18000 ROBERT THIBODO 65699 Const.Class: Exp.Date:06/22/2025 Use Group: Owner: W CAHILLANE EDWARD P&AMY Lot Size (sq.ft.) Zoning: WSP Applicant: BOB THIBODO ROOFING AND SIDING Applicant Address Phone: Insurance: P 0 Box 201 (413)575-1967 650UB-020N14 NORTHAMPTON, MA 01061 ISSUED ON: 10/30/2024 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: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 777 Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner f x _, 2 9 2024 The Commonwealth of Massachusetts The of Building Regulations and Standards FOR �1 �� ssachusetts State Building Code,780 CMR MUNICIPALITY I`"' F '`'�`�'' Y$ti€iditigd�mit pplication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 .-; !_ ''.'.'o . AA OU^ - One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 6 1"'2 44. /y 3' Date Applied: emu'/��,4/(:ZY1 .S t /d-2*. Building Official(Print Name) Si tune Date SECTION 1:SITE INFORMATION 12,1 Property Address:1 i 1.2 Assessors Map&Parcel Numbers 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' yvner',.f R c rd: ame(Print) Ci tale,ZIP ?"' S Cj) �0D Ic.03 \J -r .and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(cbec all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brie escription pos grk2: 5 ,('. Dec`'\N• Pti Sh\� (\V 5'-ems S �L'c SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fee Suppression) • 1 U I` Check No. heck Amount: 1/ O 6.Total Project Cost: S , U 0 Paid in Fu 1 0 Outstanding Balance Due: City of Northampton 0.[HAM/• Massachusetts `At' £_ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �� Northampton, MA 01060 PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR, ETC. 1. 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 ►(4.:)..., • 5.1 Construction Supervisor Licen e(CSL) V415- 1 9 `� zs C 0 \ 1r1\b o License Number 1 Ex iration Date Name of CSL Holder 3 E IAls-kP oqk S4-, List CSL Type(see below) No.and Street Type Description ( U Unrestricted(Buildings up to 35,000 Cu.ft.) 5 f N\evoNc dr R Restricted 1&2 Family Dwelling ( tir___sortrt=itxCity/Town,State,ZIP '4 M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 3-1 5 1 C,(en I Insulation Telephone Email address D Demolition 5.2 Registered Home Irprovemelnt'Contractor(HIC) \5�1.-1� , ( , 5" 0, ) 'K1`) © U►'� HI Registration Number Expiration Date H ompEy N�a Q or HIti�\g�i�t Najme� N „`trs 5, 1 6\ U-1 Email address City own,S 7 ate,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 c1 ") d A•-•0 to act on my behalf,in all matters relative to work authorized by this building permit application. ),.\( N\c,:y.N..k 0 X 'i )--kil Print Owners me(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 contained in this application is true and accurate to the best of my knowledge and understanding. 1 0 +C3 4-(I Print Owner's or Authorized Agent's Name(Electron 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.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" 4 The Commonwealth of Massachusetts =-. Department of Industrial Accidents - �IRa", s 1 Congress Street,Suite 100 -�{ Boston,MA 02114-2017 ��., .. ,j www.mass.gov/dia 11 t,r kers'Compensation Insurance Affidavit:Builders/Contraetors/ElectrleianstPlumbers. 101W FILED WI I'll THE PLRMITI'INC AtrimoRI`n. Applicant information Please Print Legibly, Name(13usay.. .OrasniZation:lttd:victual): Address: `3 E . e,,s-\...t g ' City/State/Zip: s. \--04-\ , Phone#: (-{ `' 5--7 _ I c-'7 (-7``l Are yes so employer?Cheek the appropriate box: "type of project(required): 1 di am a empkycz with __employees(full rut tx part-Limey' 7. 0 New construction '.l 1 am a auk proprietor or putttnersbrp and have no employ ors winking for rise in 8. O Remodeling any capacity.[No workers'comp.cnnurancr ecquered_l 9. p Demolition 3VJ I am a homeowner doing all work myself.{No winisxa'comp.l>bursncc roosted.]' 4.0 la a homeowner and will be humsco tu ntr.,. rs to aonduc[all work on my property. I will 10 0 Building addition m ensure drat all contractors either have workers'cornpx-naabcm insurance or are sole 11.Q Electrical repairs or addition s proprietors with no employees. 12. umbing repairs or additions 50 I am a general cuntractor and 1 have hired the sub-cuatractors listed on the attached street. These sub-contractors have employees and have workers'crimp.insurance.; 13 Roof repairse 6.0 we are a corporation and sts officers have exercised their nght of exemption per MUc. I4.Q Other ffi 132.$1(4).and we base no employees.No workers'comp.insurance required.) *Any applicant that chocks box Al must also fill out the section below showing their workers'compensation policy information. r homeowners who submit[his affidavit indicating they arc'doing all work and then hire outside contractors must submit a new afds it isslicsting such. :Contractors that check this box must anxhcd an additional sheet showing the nanw at the sutreomiraetcr,and state whether or not those amities have employee.- lithe sub-contractor,base employees.they rnu.t provide their uurkers"cramp policy number. - I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ��o.s �� Insurance Company Name: 1 --� .. OYA _ Policy#or Self-ms.Lie.#: l f(0 ' I L) C)3 7 G!L1 Expiration Date: ( .s 5' Job Site Address: .5 v..0 a 1 j>►,\ V`tom Citytstate.i Zip: 11 Y'kht1v,,Nf?k p,^ Attach a copy of the workers'compensation policy 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 tine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 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 ce ' 'under the pains an mollies of perjury that the information provided above is true and correct. 5,gnaturc: 1/ate: 0 -�Q10 Phone#: i r3 5 1 S ( 9 E,- \ Official use only. Do not write in this urea.to he completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.C'ity/fown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other l'outset Person: Phone#: City of Northampton oti; Massachusetts tt ; DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building j Northampton, MA 01060 4:11'14/ ,}`tip 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: IN1 (DY' NC-\c",v-N O The debris will be transported by: Name of Hauler: c \ d �U Signature of Applicant —V/1 Date: \ 0 ` 9' ay City of Northampton , I''' AA Massachusetts ,st .46 ' DEPARTMENT OF BUILDING INSPECTIONS '_. 212 Main Street • Municipal Building - Northampton, MA 01060 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1, (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)