25A-061 (4) 390 BRIDGE st BP-2017-1036
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A-061 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ROOF BUILDING PERMIT
Permit# BP-2017-1036
Project# JS-2017-001782
Est. Cost: $16700.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group'_.
JAMES FLANNERY 103061
Lot Size(sq,ft.): 5662.80 Owner: ST HILAIRE ALAN
Zoning: ORB(IOO)1 Applicant: JAMES FLANNERY
AT: 390 BRIDGE ST
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHA M PTO N MA01027 ISSUED ON:311712017 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE EXISTING ROOF WITH NEW
SHINGLES, VENTS, ECT 30 SQ
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department 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.
Certificate of Occupancy Signature:
FeeTvpe: Date Paid: Amount:
Building 3/17/2017 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
�i 0(�i
/
` t ;
vs City of Northampton '` /
Building Department f y' +; `m '1^' .z' .n, "' ''-'
212 Main Street ' K4
Room 100
a �,
Northampton, MA 01060 " t *'
� phone 413-587-1240 Fax 413-587-1272 x3` � ,: ice
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION g!TE1
- 7 -/`��F2
2Q
1.1 Pro a Atldress: �^-� This section to be completed by office
c pl it
reite, J ( . Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: St14Hbch Se'nh o if" 0 a QV/S C k ore/1.er
Nam /ring Ga
7(— �} Current Mailing Address
'.
�` Telephone
o-Signature
2.2 Authorized Anent:
,TA-n1F s F, �ututiEe/ 2 Lev be/d St Cloy), M/1- O/02 -
Name(Print) Current Mailing Address:
eat , r 1/3-2c3-,588-11- g ` s‘a
azureED Telephone
TCTION i-ESTIMATQNSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1 Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) /619cO, 00 Check Number . ,37/
This Section For Official Use Only
Date
Building Permit Num•- . 3-/7-/C// Issued'
Signatu -: ���/ /i. ;
dr
Building Commissioner/Inspector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(Check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteratlon(s) ❑ Roofing I,_1,2, //
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks (0 Siding[oj Other[O]
Brief Description of Proposed Ao Work: n-eilaCe euiS/1
; 1/01 t.J1 n Stirk9iec, ven7terc
Alteration of existing bedroom Yes_No Adding new bedroom Yes No &,S t ,
Attached Narrative Renovating unfinished basement Yes No (/
Plans Attached Roll -Sheet
Se.it New house and or addition to existing tao*$Ifln.Complete the IOtOWIn:
a. Use of building: One Family Two Family I/ Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes _No. Is construction within 100 yr. floodplain Yes_No
J. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS�//R�/AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, /7/407 St //I// (Kt
Qwn r
propenY ,as rmrerof of the subject
hereby authorize rTa n C Zr. FLAArAJ6AV
to act on my behalf, in II afters relative to work authoilted by thieuilding permit a plication. ' '
-�lr £< 3//S/i7
Signature of Owner �q Date
I, r )�?t'!ES .5. FMUAJE4 _ _ , as Owner/Authorized
Agent hereby declare that the staterMents and-information on the foregoing application are true aftd accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
TAMES C. Pt/ WA/et
Print Name (� // 7
/rVVSignatu f OwnarlA�e t / ate
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction
ASupervisor:
Y �' �� `��,rrrccc......��, ��/ Not Applicable ❑C
Name of License Holder: 3144DES .r. rr-M*JA,e _103(I&1
r r / License Number
I Live Pt 34 EicS ttice,447.0' g- 6/6Z-3- 1/z/A
Address Expiration Date
So&-Zen-4052
Signature Telephone
B.Repietetid Hodplrnniovwn idiontneteC r Not Applicable 0
PEW-K Pere -e leoofDuE LLC /83(Pik
Cornoam Name Registration Number
1 .L.ave,Qe/d St 1/1-11/?-
Address Expiration Date
Telephone 413-203-241-
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L C.152,§20C160
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
I L - home Owner E&ems
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own 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 homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the buildinv permit,
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
City of Northampton 212 Main Street,Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
/�
Address of the work: 3q0 /1 ip
The debris will be transported by: Jll'MF_S a. Fut-4,4)&12i
The debris will be received by: VALLEY/ / eyr LJ.+UC
Building permit number:
Name of Permit Applicant DiiNItE S S. F2-61x .rn/C 27
Date 3-/t/71 7 Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
11 t {k �` Office of Investigations
�a 1 Congress Street, Suite 100
t,, ,d1 Boston,MA 02114-2017
/ www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Pix Q✓" /r11L!k7c2 £c i-;✓I1! JiC'
Address: Lei--'lic
CitylState/Zip: 714/ - /t; ifl/* a loZI Phone#: 4/3 - )63- 5,d'g8
Are you an employer?Check the appropriate box: Type of project(required):
1.1_*f 1 am a employer with Z- 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
listed on the attached sheet. 7. ❑Remodeling
2.❑ 1 am a sole proprietor or partner-
ship and have no employees These sub-contractors have g. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
P Y 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5- ❑ We are a corporation and its I0.❑ Electrical repairs or additions
3,❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL l2.igRoof repairs
insurance required.] c. 152,81(4),and we have no
employees. [No workers' 13.❑Other ___
comp.insurance required.]
*Any applicant that checks box g must also fill out the section below showing their workers'compensation policy inanmation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name oldie sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
/am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: /3E0(3-/at<c?if-Zf'.t /d9j /f7G.•f� 61/49,e;)
Policy if or Self-ins. Lie. # p
: k- L'VL 7 74 Expiration Date: -i12 I-J 7
Job Site Address: 310 Rridye ST A0feta 727.b -1, City/State/Zip: )04
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do berthcertify unde1lh pains and pe (ties of perjury that the information provided
attlpppve is nt
e and correct.
Signature: '/�✓�/ l
Date: s /-/ /7
Phone#: /17 3-26' _.
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.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-103061
Construction Supervisor
JAMES J FLANNERY
1 WILLIAMS ST 4
HOLYOKE MA 01040
MExpiration:
Commissioner 09/21/2018
rt74e'60 Inrkonr.JWRF ry
e e at Costumer Affairs&Basins.Reguladas 1
g • IMPROVEMENT CONTRACTOR
e - 0n: 1A3898 Type:
..1� Expiration: 11)4R017 -LLC
PEAK PERFORMANCE ROOFING,LLC.
JAMES FLANNERY
1 LOVEFIELD ST. �yy
EASTHAMPTON,MA 01027 Oederaeeredrr