25A-060 (8) 13 HUBBARD AVE BP-2021-1514
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25A-060 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-2021-1514
Project# JS-2021-002522
Est.Cost: $17880.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PATRICK G KELLY 128749
Lot Size(sci. ft.): 8973.36 Owner: MOILER JILL
Zoning:URB(100)/ Applicant: PATRICK G KELLY
AT: 13 HUBBARD AVE
Applicant Address: Phone: Insurance:
12 OLD FEEDING HILLS RD (413) 568-9513
W ESTFI ELDMA01085 ISSUED ON:6/21/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP ROOF TO DECK, INSTALL DRIP EDGE &
BFT ICE &WATER, INSTALL UNDERLAYMENT & SHINGLES & REFLASH
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.
11 • � • yg . '1 .
Certificate of Occupancy Signature:
FeeTvpe: Date Paid: Amount:
Building 6/21/2021 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
,., ... The Commonwealth of Massachusetts
'' Z Board of Building Regulations and Standards MUNICOPALITY
.-t1/4ti_ .
c ,'�-' Massachusetts State Building Code, 780 CMR USE
,,Build ng.l3ermit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One- or Two-Family Dwelling
Utti This Section For Official Use Only
Building)�ef.�j1 2_
1.LINIu ):T. S P-2o , ./C,�'/ t4- Date Applied: jot l$(202 j
�l1 1 7llu /rE'on Z-- G-21-26421
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 PropertyAddress: 1.2 Assessors Map&Parcel Numbers
IS VW6Aft! 4u4t,/ 7.519^ 060
1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
of eoo0 )
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❑ Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownerl of Record:
X < <I Ole-h ie-A W' - N'aiportd 1T' o b I ►9
Name(Print) City, State,ZIP I
IS 177 11J6J0) Rd I-917..(01 -3165
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) ❑ Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 5 r R i rP 1 Ns o of 60 P c.k .
I N SE h II�N t O kip ect9 e, frw cr i Oa. AI WOketz_
isnlst f I1d RooF uN44 r►14aid iiNid 3{IR- Shi1LtI4
p— - i-�4- j;N., A�t4'a Ka0a✓Wit, nil peg 2is.
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:
❑ Standard City/Town Application Fee
2. Electrical $ ❑Total Project Costa (Item 6)x multiplier x
�
3. Plumbing $ 2. Other Fees: $ r`i 0 IDU
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $ et,
Check No.ZN0 3 Check Amount: y()— Cash Amount:
6. Total Project Cost: $ ♦.Z$8 D 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts S4s c"
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 s3 yy ir \l
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. 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. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new / replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit- public land by DPW/ private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS -10 23 . 1 n^2.9 -. 2Z.
PAi&t E.k ►�c1!_y License Number l Expiration Date
Name of CSL Holder J
12
014 FeA.61`4q Wills 4 List CSL Type(see below) U
No. and Street v Type Description
W
t-t e-S LGr1ef`cl PM 4io EC r U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town, State,ZIP M Masonry
RC Roofing Covering
Af WS Window and Siding
SF Solid Fuel Burning Appliances
413 568-cis-(3 PKelIyRooF& i4oL,Cory I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I Z 8 7+3 64 D ", 23
12 S 741 PA-TA i c k ke(y HIC Registration Number Expiration Date
HIC Company Nam or HIC Re s j Name
I2 oi4 g FeeA 043 6fil& t4
No. and Stre t Email address
WeSt.F:Q.14 MA 01085
City/Town, State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be c pleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuan 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
to act y be ,in all E s,rs re ive work authorized by this building permit application.ei. "-, /
6 - ( rrJJ
_... .2./
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR • ." HORIZED AGENT DECLARATION
By entering my name below,I hereby attest der the pains and penalties of perjury that all of the information
contained in this plicatio. . true and curate to the best of my knowledge and understanding.
cild
/7'2 6--fg - /
Print Owner's or Authorized Age,./Name(Electronic 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.uov/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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
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FRONT SETBACK
FRONTAGE
City of Northampton
,..,sr,,,,,,,,,_,,, ::‘, Massachusetts 4:"' L. j"-*,
DEPARTMENT OF BUILDING INSPECTIONS ?..
212 Main Street • Municipal Building 1J1 �r
,{ -'. *, Northampton, MA 01060 s'I'n'I,; its'`
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: 11; 63 Fee i- i, c?F 1 lI
The debris will be transported by:
Name of Hauler: �SSOLi�'b� 13�iLo\ igi VJ Re_ cke S
Signature of Applicant: Date: (o J` V ,'-2-'(
The Commonwealth of Massaehttsetts
Department of Industrial Accidents
1 Congress Street. Suite 100
B os ton,MA02114-2017
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smtst.ntass.pw/tlia
4:77-0.v
Compensvion Insurance k flub%it: BuildersiContractors•illeutricia us Plumbers.
10 BE 1-!LED W 1111 1 HIE PERMIrriNG AtiTtiOltn
Applicant Information Please Print Lejibh
Name 4 Hosintssi3Organizatimindduall: P I KI_ AooPirj
Address: 12 014 re-4-4 ;1•)3 13;I Is R.
CityiState Zip:W qe.f&r.e.144 f4 0 iO$C.Phone 4,1! 13 S 113 c
Are you an estployer,Cberk the appropriate hot: Type of project(required):
1.01rataz ertp6.vit with fr .::r.v.oytes(fail and :part-trinek' 7. 0 New construction
no a iole proprietor or partherstip and has no employees workute for ate in 8. J Remodel*
any capacity.[Nu werrketh'clamp.instininiv required4
Deinolition
30 am a homirrikther doing all work thyself.[Ne worritrs.conc.ithuthaert required"
100 Building addition
4,E1 I ant a hotaleaulan and will he biting reentraelorstio rooduet ail work ot thy property. will
ensure thataucararaciors either have%Alarm'nerationsation inset...tree or a 11 Eirratieeti repairs or additions
proprietors with 20 anpaDyves.
lin Plumbing repairs or additions
I ato 2 al-Me:2i_coat:actor and I irate hired the stiEv-earitractors listed an the=hated tillett
Dune sub-erantraction,lzssx estipluyees.and have workers'tramp.nista:men; 13 al frepirs
14. Other Tv I R.o of
6.0 We ate a eattpi on anti and iits officers have exercised then nisht of exemption per MGL.
15241(4).and we have 1323 erap,layees.[Ne workers'cinnp,insurance requireiti
°Any applicalti that darks but l mint Also ill/out the seat=bd =valuation policy information.
t Horneowiteri who suittail thili affidavit iridieinthe they are eking thet iirut arrathors must submit anew affidavit indieartina suck
Contors that cheek thus box anaelme an additional sheet showing the=tie el d brwr an,AAare 14.telhet r ni.it 1106e, Ltrc h .
criplu±Ate‘,.. If tire Sub-cLgar21:10*. _ they pr c•Tkas'aiTrip.pinky riantilver.
I am an employer that is pro I.!di 11 fs' U•irAer.5.*compensation umarancE,for niy estplayers. the policy and i(th'-hit.
information_
. .
Insniani:e Company Namc:_ti eill 44 Ne411 ig OAAN Ce_ . WeSt Sea2tilfr;4
Policy#or Self-ins.Lic,#: WSS"37 L4B7 Expiration Date: 10 —1
Job Site Address: vs si hi0k6.1)' ,,ir b 01,/46
Attach a copy or the m orkers*compensation policy declaration page(showing the policy nansher and expiration date).
Failure to SeCLITCcu eraLie as requited under MGL e. 152,§25A is a criminal violation punishable by a tine up to$1.500.00
anclior one-year imprismtment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
dii. 14airist the violator.A copy of this statement 1 1 Lav be forwarded to the Office of Investigations of tht_. [MA for insurance
crif:eat
I di hereby c-r u der the pains and pee aides al perjury that the information provided above is true and correct
Daie: —(8 -24
4-15 6.4 5-13
Official use only_ Do not write ill this rata,ta be completed by city or town official
City or To a: Permit/License#
Issuing Authority I circk one):
1. Board of Health 2,Building Department 3.CityTown Clerk 4.Electrical Inspector 5.Plumbing Inspec Eli r
6.Other
Contact Person: Phone*:
City of Northampton
Massachusetts ?f :
DEPARTMENT OF BUILDING INSPECTIONS 4v
212 Main Street • Municipal Building
Northampton, MA 01060 'd
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (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)