25C-045 (7) 17 WOODBINE AVE BP-2021-1439
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-045 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-2021-1439
Project# JS-2021-002394
Est.Cost:$11560.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: TIMOTHY LUCE 100515
Lot Size(sq. ft.): 15550.92 Owner: CHURCH ROSEMARY
Zoning: URB(98)/ Applicant: TIMOTHY LUCE
AT: 17 WOODBINE AVE
Applicant Address: Phone: Insurance:
PO BOX14 (413) 387-9800
LEEDSMA01053 ISSUED ON:6/2/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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 NORTHAMPTO UP VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. I +I
'
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 6/2/2021 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Q ��d
ILk The Commonwealth of Massachusetts
Board of Building Regulationsiand Sta rdsJUN 2— FOR
V
Massachusetts State Building Code,780 MR 202/ UNICIPALITY
nrp USE
Building Permit Application To Construct, Repair,Renog evised Mar 2011
One-or Two-Family Dwelling - '- "n'nn'ip1AEiCTIC.,Ais
This Section For Official Use Only �`` .,
Building ermit NZ'5
mber: ,/g(7' 07//1.4/3Y Date lied:
ct)IN __, 6-2-26Z1
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 /7�y�oed AikiVM 1.2 Assesrs��Map&Parcel Numbe�syS
I.1a 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: PROPE TY OWNERSHIP'
2. Owner'of R
/YJ�1 �or
S � UeL' 1)1736A/ TDB/ M M. O/O eS
ame(Print) City,State,ZIP
7 ua,�4i,A) A i .�6Y..=J4
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.0 Number of Units Other 0 Specify:
p 2 e,w,ti�_ $ qy ct, lwI 51ir.,171¢S • - ttcj7.j 1 yi ,"
Brief Description of Proposed Work
yw . u., - Alk, �< 5i 5(vs, ovi-1,- egc.6t-i,, y'001- bt-x•,,al. .
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ 11,S61,1 1. Building Permit Fee: $ 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 (HVAC) $ List:
5. Mechanical (Fire $
C "
Suppression) Total All Fees: $ ti
Check No./Alf Check Amount: -� Cash Amount:
6.Total Project Cost: $ \�, ` 4, ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) loos s l
' t ,) - L(/Ce_ License Number Expiration Date
Name of CSL Holder
"
90 WOL �j//ip`/y J(' List CSL Type(see below)
No.and Street Type Description
5 U. / 14,j
/1 i(4 aerie, U Unrestricted(Buildings up to 35,000 Cu.ft.)
l"" t �Yt't (/�� R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
• SF Solid Fuel Burning Appliances
713 3g7 716/) fie,( ,
ei /' I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
r�rtj'l 1-' LLA«- HIC Registration Number Expiration Date
HIC o yior Ht -egistrant Name
rt ��v //���
/
w
No.a d Street 444bia7.� (Pii /� 3�jq� Etlaiddess
City own,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 Issuan f 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 1 hhc, 3. Lvut___--
to act on my behalf, in all matters relative to work authorized b is building permit application.
4sG�/ 6 leZW atur tofu. ' y 6/i, /
Print Owner's me(Electronic Sign v 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.
Print Owner' Authorized Agent's Name(Elect ignature) 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"
City of Northampton
oat o... `S - ,...5/
*"'` L. Massachusetts �w� e�.,
DEPARTMENT OF BUILDING INSPECTIONS y.
212 Main Street • Municipal Building
Northampton, MA 01060 j's'J
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: Vetdg-0-76A47
The debris will be transported by:
Name of Hauler: / r `)� �``
Signature of Applicant: Date: 6', Z - Z�
The Commonwealth of Massachusetts
._. ; Department of Industrial Accidents
... '"=- ; 1 Congress Street.Suite 100
tit Boston.MA 02114-2017
' rr. www.macs.got/dia
11 us kers't°umpensation Insurance Affidas it: tiuilderke('ontraetors:EkctricianslPlumbers.
• ft)RE.Ftt_E:D µ fill I Ilk PERM l I"I LNG at I HORI I .
tonlicaot Information Please Print l.eeibis
Name Iiivaenesct;;egantzni3 rxitat.iva, /ivito j 44, _ ....� ...._.
Address: LS \
W a7,_ 19
.-
City/State/Zip: Le tic .. 0/ ) s 3 Phone#: r/7 IS 7 Sex)
Are Yon an rinplioet7['be%k the applopruatc boa: ;
1 in.tot project(required):
i 0 t am' ernplatses with crflpygees that and of patt•tinizt.' 7. Ell New construction
I am a woe proprietor or partnership and have no emptwyeat►working fur ante In
mn capacity.[No workers'ctmtp trts r uratu moorani.l ll. Rctrnali salt 9. ❑Demolition
10 i ant a humsx wne doing all watt inywell.fNo work,n comp.erwirstice l
100 Building addition
a.(�I ant a h.tnati>wncr and Ill be huntg ourttr:tetur+tu.cxxitht aii°,•,ak on mit pfuperty. I will
tt�^33 manna that all auntna:tur.t shovel have w cr.'con nlson t marance tit are WIC I 1.0 Electrical repairs or additions
prupnctots wool no crta}?luyccs
12.0 Min e repairs Of additions
50 I am a gcolu.vl contactor and t lase hued the sub-cuatractun tt,ted on the:aatactwd alms
Iltcsc sob^auntrartcxn.haac employee),and have*takers .oral+ tmurarxe. 13
4 -' uo1"repairs
li.®w c are a corporation and its uftk sem rr.have exttuaed then nghi L,t cptnstt pet PAeii c 1 !()fix-,
152:Ili 4).and w e have no mph/yeas.I No u ttrkers'camtp inst.rancc rryutred I
"Any apptteitt that checks hex rI must alit tilt out tow seetton Meatus%ru,stog that worker.,Lontpcmation polls tatoemattto
'it..ntata nen.*tat submti this attickrsri inahaattng they arc&tang all w.,rk and than hire who&Ltgttra.a.N',aunt+a l rttt a new atftdav tt indicating awl)
ICuntracturs that check this hoe.must attached an addrttortal shed shu' mg the name of the sul-contracttx,and Oak'a hether or not tisisi:eatrties have
.,-yosca I!'I.,,i',unoari,., Iris .7trt lv4cc,.they must pros uk leave %cat,,r. . .tt- twltc% uutnh t
/tam an employer that is providing worriers'compensation insurance fin air employees. Be/ow is the polity and lob sue
information.
Insurance toinpany Name: _
Policy#or Self=ins. Lie.# Expiration Date:
Job Site Address: CitytStateiZip:
Attach a copy of the workers'compensation policy declaration page(showing the polies number and expiration date).
Failure to secure coverage as requited under MMCil c. 152. 25A is a criminal violation punishable by a tine up to SI.5(O.(X)
and'or one-}ear imprisonment,as well as t:is it penalties in the form of a STOP WORK ORDER and a tine 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
cos erafie ventieation.
-vamp
/rho hereby eerily on ns anrl_penalties of parfury that the information provided uhure•is true and correct.
'.>avn.ttur L /� Date: 6 - .2- — 2
Phone rt /` fy ii?7
Official use only. Do not write in this area.to be completed hi'rift'or town official
('it► or Town: Permit/License a
Issuing Authority (circle one1:
I. Board of Health 2. Budding Department 3.C_ity EaornaClerk 4.ktectrieal Inspector 5. Plumbing Inspector
ii.Other
1 intact Person: Phone#:
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
CS-100515 Expires: 07/15,2022
TIMOTHY J LUCE
90 WOODBRIDGE STREET
SOUTH HADLEY MA 01075
Commissioner di t K. biEni
Tr i uunnnrI'(V'/d fit uurdrr.rrllt
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE: Individual
Registration Expiration
149288 12/14/2021
TIMOTHY J LUCE
TIMOTHY J.LUCE
90 WOODBRIDGE STREET f h L,' � z
SOUTH HADLEY,MA 01075 Undersecretary