17D-055 (12) 116 STRAW AVE BP-2021-1227
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: I7D-055 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-2021-1227
Project# JS-2021-002049
Est.Cost: $5000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: TIMOTHY LUCE 100515
Lot Size(sq. ft.): 14723.28 Owner: MARK CHRISTINI:
Zoning: URB(181)/ Applicant: TIMOTHY LUCE
AT: 116 STRAW AVE
Applicant Address: Phone: insurance:
PO BOX14 (413) 387-9800
LEEDSMA01053 ISSUED ON:4/27/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF ON PORTION OF
HOUSE
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,
FeeType: Date Paid: Amount:
Building 4/27/2021 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
T_ 1?--e-- ---- .
The Commonwealth of Massachusetts 2 3 F R
W Board of Building Regulations and Standards,`_., 2°
Massachusetts State Building Code, 780 CM ' -. .
&1UNI IPAL;ITY
'') ;,'Lllit-,: "-_ /USE,,
Building Permit Application To Construct, Repair, Renovate fl5eltfblt iaws�F", v1.ed Mar 2011
One-or Two-Family Dwelling "`-.., ,�-Ns
This Section For Official Use Only
Building Permit Number: d f A I - �.. -7 Date Applied:
)644, A. T,
Building Official(Print Name) Signature i I —1/ Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
//C� r i��2. V 0
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 ne 'of Record:
e r- ha__- n 0 ,, a ► 0/0(6 2
Name(Print City,State,ZIP
1I LO R_at.l.�) Ave__ 2i 2_o I S 25 o�so t�C �s�r10� 17Q� l,�,Ce ki.
o.and Street Telephone mail 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. 0 Number of Units Other 0 Specify:
Brief Description cwt.Proposed Wor ?: IRorn�t1(Q pwk ;�QA � A5 n� �lif,^,j(e4 O✓\
a.ti J'..(2_-- foot u,r t,- b y-e rj- L c
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ ) I. Building Permit Fee: S Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (IIVAC) $ List:
5.Mechanical (Fire $
Suppression) �Total All Fees:
Check Nol, eck Amount: 6/OCash Amount:
6.Total Project Cost: $ e ,Ud;� 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
180(:;t c --I tcrS 7-)5—22_..
,/,ml) License Number Expiration Date
Name of CSI,l lolder
j� &)/ u/)7l, /i 5 List CSL Type(see below)
No.and S met (jf �/ Type Description
✓1 /J /t /" v f 6�)�f.( U Unrestricted(Buildings up to 35,000 Cu.ft.)
RestrCity/Town,State,ZIP / M Masonryteted t&2 Family Dwelling
RC Roofing Covering
WS Window and Siding
�� SF Solid Fuel Burning Appliances
fl3 ,1) '��(, 0J- mat�(1�� I Insulation
Telephone Email addrel D Demolition
5.2 Register d Home Improvement' Contractor(HIC)
Vag-
-
�t J' /U`r HIC Registration Number Expiration Date
HIC Conwany N or bIIC Re strant Name
No.and Sy pet 4"i.
Sd�";litiJ �/ /,l�f[)fi
ma airess
City/Town,State,ZIP / U/ 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 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 / -3' LA./?"-.e
to act on my behalf, in all matters relative to w uthorized by this building permit application.
Print Owners Name(Electronic Signature) ate
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.
y 2-3 '21
Print Owner's o Authorized Agent's Name tectronic 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
v+"vv 111,1Y, ,?0, OE u Information on the Construction Supervisor License can be found at s 1,, 1,
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.) I labitable 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"
�tr: :��>
City of Northampton
,' ` Massachusetts
,- DEPARTMENT OF BUILDING INSPECTIONS
d5 212 Main Street • Municipal Building
Northampton, MA 01060
v t'
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: 4 P1,417
The debris will be transported by:
Name of Hauler: 1%A„
Ai Lti( ._...--
i
Signature of Applicant: Date:
y' 23 —Z I
(AN. • The Commonwealth of Massachusetts
n=r_--era
c_=.V. Department of Industrial.Accidents
•` mtDB i 1 Congress Street. Suite 100
= at'-,,,�• '�` Boston. 11.-1 02114-201
wit'tt'.mtts.s.goi/dia
11 ut kers'( ompensation insurance.ttlidas it: Builder';( entractorr ElectriciansrPluinbers.
1t)tEFILEUNIiiI IIli_ PI.K%III I1\(; sI 1IIUKII1.
%pnlit:tilt information �� i Please Print l.ceihls
Name 4 Husincsa t)rganu�i ti ndnidua : `^1 mil. i t
Address: 7 1 1 % J
City/SlateiZip: O /1' Oi)/,) Phone ::-t3 3F-7 7 )L)
Art,m as ettiphver'Clara the apptupr it hut: Ty pe of project(required)
t.❑I am a crags ..s whit cirgntuy es hull and ut pandtmc)• 7. D NC% construction
a sok pnipnetur ut p u1nership and hate no employee winking Sot rite m
(No R. Q RrtrtodClin,
�.
any tapai:tiy-(No*utters'cum}...utaunnacr reyetand.J
101 am a I:umcomuti,dorms all work myeelt.Pit?aorketm'comp.nuorame replan:4j. l
9. [,❑ Demolition
4.0 1 am a htenaau rat- and will he hump eutdmeto re to conduct all N.irk on my property 1 ail
10 0 Building addition
tasun that all 1,J1ILI31.1011,cinckr hate%men.'caittapenaance tmurante.a aft wile I i 0 Electrical repairs or additions
pn.instun%ilb nu employ cet
12.0 Plumb .pairs or additions
5n I am a t*nera1 tunira:tor and I has c hind the sub-t.untrattun Iwed on the attached shed
I hone tub-e mir:c u t hat:enipluy'cee and hat c.►utk g+ert":na tmurantt 13 utol repairs
6❑V4 t art a ttmpurantin and Oa officers hate extra lard then right et c.tcmphtat pet Mt it.;
14.J Other
i y?. 14 it.and ae time no tetitduyccs.Vtio*mien't+.irip awn ant c reyutnd.j
'Any applicant that tiatt:ka boa i•t must alai fill out the'colon n ticluw ahoy.in then w.xIcis'compensation polity uiterination
t(ton c.wncn who autstnrt this alfidatit in atatutg they air doing ail wiak and then hie outsdk eontra:tor,aunt.ubuut a new alfa.tat it indicating such
1-Contractor%that check trio hilt mast aitacltc.l an aadiliunal short ahtming the name of the sutrtuntra.tu rs and state e.Nether or nut Mute entities hat:
t vWV.1 It rIse.uh•,unto,lainr.I:a.:tr.rlv:t.:.,ti,:y must pros ideff.it »rnkers'comp taelicy maim
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Comp.ut', NAMC
Policy z or Self-ins. Lie. = _ Expiration Date. _
Job Site Address: City Statc7_ip:___
attach a cups of the workers'compensation policy declaration page(shooing the polies number and expiration date).
Failure to secure coverage as required under \1(i1 C. 152, v2SA is a criminal violation punishable bs a tine up to S1.5.00.00
aral'or cute-year imprisonment.as well as cis II penalties in the form ofa STOP WORK ORDER and a tine of up to S250.0(.1 a
day against the aiolatur.A copy of this statement may be lorw•arded to the Office of lnvestigatiems of the DR for insurance
♦tit crape t eritication.
1 flu hereby certify u er t yin%surf penuAies nil perjury tutor the'information provided above is true and correct.
Slinatun: Dab.' y 2'— Z/
Phone z: 'i/'-y Jj-1 7
Official use only. Do not write in this area.to he completed hr citJ or town official
( its or Tossn: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.( its. I tilt n(ler1. 3. ilectrical Inspector S. Plumbing Inspector
6.Other
-
( ontact Person: Phone#:
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Co nskrudtthrYttipriisor
CS-100515 ` pires:07/15/2022
TIMOTHY J LUCE
90 WOODBRIDGE STREET
SOUTH HADLEY MA 01075 +fir
Commissioner w K. VEwa.,
rfir .///deoNtoraid n'/ '//,i.iaP//llrlli
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Individual
iiegistration Expiration
149288 12/14/2021
TIMOTHY J LUCE
TIMOTHY J.LUCE
90 WOODBRIDGE STREET
SOUTH HADLEY,MA 01075 Undersecretary