31A-130 BP-2024-1519
51 FORBES AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-130-001 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-2024-1519 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF/SIDING 2024 Contractor: License:
Est.Cost: 5800 JAMES ROBERTS 099404
Const.Class: Exp.Date: 01/21/2026
Use Group: Owner: M DALBY FREDERICK H& SIDONIA
Lot Size (sq.ft.)
Zoning: URB Applicant: JAMES ROBERTS
Applicant Address Phone: Insurance:
30 Edwards Rd (413)527-6078
WESTHAMPTON, MA 01027
ISSUED ON: 11/13/2024
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF PORCH ROOF AND REPLACE DAMAGED SIDING
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: /(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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The Commonwealth of Massac ettT;T 0 FOR
y[, Board of Building Regulations and Sta s, ,., �O�Q M CIP ITY
Massachusetts State Building Code, 780 C ./-�!%,,,
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Building Permit Application To Construct,Repair,Renovate Or �" a evise Mar 2011
One-or Two-Family Dwelling '1°,obo"oy9
This Section For Official Use Only
Building Permit Number: 80 it tj/9 Date Applied:
45 Age,/ /•%3-_'
Building Official(Print Name) Sign re Date i
SECTION 1:SITE INFORMATION
1.1 Propty/7,--,..,k,
ss• qP
1.2 Assessors Map&Parcel Numbers
l.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 Owne ' f R rd•
4 4.
Name(Pnnt)J2� City,State, ��`' /
S7 `7t-Grl'i-
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 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 1620- JL �7
GL r/vii/ tip •-)
SECTION 4:ESTIMATED CONSTRU . I N COSTS
Item Estimated Costs: Official Use Only
Labor and aterials)
1.Building $ ' ,�' 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical =�� 0 Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All FeF9hs, it�j)
Check No. �V I Check Amount:
6.Total Project Cost: $ 0 Paid in Full ❑Outstanding Balance Due:
1
City of Northampton
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Massachusetts a ' s=-
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DEPARTMENT OF BUILDING INSPECTIONS 7t P�
� � 212 Main Street • Municipal Building
-- •
Northampton, MA 01060 4 -"'%'‘�
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WI OWS,
DOORS, ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ET .
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 appli•.nt.
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 Affi l avit
10. Please provide the appropriate fee in the form of a check made payable to: Th. City of
Northampton.
1
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor Licen SL) Of q ' )- p
tf
t License j, ra Expiration Date
Name of CSL Idol e
j1J )-7 List CSL Type(see below)
No.and Street .I. � 4' ` Type Description
U Unrestricted(Buildings up to 35,000 Cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
d / 00L/ g, Roofing Covering
Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone / Email address D Demolition
5.2 Register(d H i i i e I 1 .rovement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company ame or H to)
egi
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 BUILDING PERMIT
,I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authoriz y this building permit application.
FA PcL4i //- V - /
Print Owner's Name(Electronic Signature) Dale
SECTION 7b:41WNERI 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.
if.4—
Print 0 s or Authorized Agent' Name(Electronic Signature)If
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"
k
The Commonwealth of Massachusetts
)r Department of Industrial Accidents
1= 1 Congress Street,Suite 100
MI —,
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Boston.MA 02114-2 017
'�,, www.mass.gov/dia
%linkers' Compensation Insurance Affidavit:Builders'C ontractorslEIrctricitius/Plumbers.
TO BE FILED WITH THE PF:RMITI IM::tt rIIORII't.
Applicant Information Please Print t.e2ibly
Name iHususesx-'Ursantzation.individual):
Address: 37)
4r) .
a
City/State/Zip: )��2' •* Phone#: go '" 1 (S 3 v C.
Are you an empkiyer?Check the appropriate tax:
Type of project(req�ired):
l a I am a employer with_... , .crapiny�u.nt(full and.'ur pan-orie l-" 7. 0 New construction
20.1.4‘a auk proprietor or p:rrutcrstlip and have no entptoy.zs working for rise in K. ❑ Remodeling
any capacity_(No workers'comp.insurance n.-quir>:d_j
9. ❑ Demolition
3❑I am a homeowner skins all work myself.jNo wouk.ts'comp.utturarcc required]
10❑Building addition
40 I am a ho .'o aner and will be biting comtr-aetors to conduct all work on my property. I w ell
ensure that ail crmtrsctors either have workers'comp:matron trsurancc or are sole ii 0 Electrical repairs or additions
peupnetua with no estiplisyr .
120 Plumbing repairs or addition
S°1 ant a general contractor and I have hired the tub-contractors listed on the attached sheet I 34Zg.Rit.repairs
these tub-contractors have employees and have workers'comp.uourancc.•
i,.❑We are a corporation and its officers have exercised thou nght of exemption per M(;1.e. 14.n 011tet
1.52.$It'll.and we have tao crrrpluyees.[No workers'comp.insurance required.)
Any applicant that checks hoe al must attu fill out the section below Ahtriamg intheir tvurkert'coutpcmatton put te., uit:.intatreei
Iluutcownen who submit this affidavit indicatitag they are doing all work and then hire outside contractors must submt a new affidat it indicating such.
i ontrteton that check this bus must attached an addttiunaJ sheet showing the mm11c of the YUb-cimittitetccn arid state w hither ix not those iodide.,have
employee.- II the sLb-contractors have employees.they must pro..idc their workers'comp.policy number
I ant an employer that is providing worke •'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: _
Policy#or Self-ins.Lic.n: Expiration Date: ?`- I i)
Job Site Address: City!StateJZip:i __
Attach a copy of the workers'compensation policy declaration page(showing the policy number and tip ration date).
Failure to secure coverage as required under NIGL c. 152.ti 25A is a criminal violation punishable by a fine up $1,500.O()
andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Mice of Investigations of the DIA f r insurance
coverage verification.
t
I do hereby certify under the pains and allies of per urn that the information provided above is true and chrrect
p-......... y,
Signature: _ Date 7/ d,
Phone#: l , J ` U.23''
Official use only. Do not write in this area.to be cut milted bi'city or town official
City or Town: Permit/License h 1
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone+x:
City of Northampton
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Massachusetts /SA •
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DEPARTMENT OF BUILDING INSPECTIONS
° ^f 212 Main Street • Municipal Building y��S �`��
Northampton, MA 01060 3'4�, 3;7\1
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: 97
The debris will be transported by:
Name of Hauler: ,J
(;Prn-ir6/— frifi.
Signature of Applicant: Date: 1 '
City of Northampton
_ r f`
Massachusetts
' DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), b'rn_(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 requ 'ements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection wi h 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 aforementione'. homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in a ordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 C ' 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to resi e, on which
there is, or is intended to be, a one-or two-family dwelling, attached or detach•d 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 t : extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the. pervision 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 'r demolition
involving any activity regulated by any provision of the Massachusetts State Building Co'I'.
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 proje or work.
Signed under the pains and penalties of perjury on this day of ,20 .
(Signature)