24C-130 (6) 24 WESTERN AVE COMMONWEALTH OF MASSACHUSETTS BP-2021-1883
Map:Block:Lot:24C-130-
001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1883 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 24000 SUSTAINABLE BUILDERS INC 97208
Const.Class: Exp.Date:08/25/2022
Use Group: Owner: ANDERSON MARNIE &MICHAEL BISHOP
Lot Size (sq.ft.)
Zoning: URB Applicant: SUSTAINABLE BUILDERS INC
Applicant Address Phone: Insurance:
556 STAGE RD (413)695-1947 7PJUB 1 K32626A21
CUMMINGTON, MA 01026
ISSUED ON:09/16/2021
TO PERFORM THE FOLLOWING WORK:
NEW 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 NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
•
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Fees Paid: $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massach setts
W
Board of Building Regulations and tan rds pep , D I PALITY
Massachusetts State Building Cod , 78�) MR S
pl. 0a1 SE
Building Permit Application To Construct, Repair, et,,, emolish a Revis•d Mar 2011
One-or Two-Family Dwelling hq'yP o G iyso R'
ThisSection For Official Use Only •ti Mq 4t r,ON1,
Buildingpermit Number: to 0" y 1 jg 3 Date Ap lied:
i c: I IJ 4Jlass ____/b q-I -ZOZ!
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property ddre s q ' 1.2 Assessors Map& Parcel Numbers
2Lf In PAlt z`'lc_ 130
1.1 a 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 Owner'of Record:
INA i C1haLeA �i \r.oe Nor•Wa..uvl P n, MA O\O G O
Name(Print) City, tate,ZIP
2.4 VJLeS1eX r) Aft, y�3-cel-coy, M b.s�l op CO 1 ciov r •cam M
No.and Street Telephone Email AVdress
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction ❑ 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:
Br Description of Proposed Work2: Str 1
Brie' P ex►S*r nl ie,3 r't MDV e V t&
C" cAtS-R-.r.Tv\s- ,�d, ! woo& oye�r-rev- J 10 o-F�sheq-k-v, , ,5-l& t
I JR:c r ro..l S.0 15 f s 4-esS cci o,�- d_ wl e tr 60.,E '0V1 d,u>
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ 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
Suppression) Total All Fees: $
Check Nop , Check Amount: Cash Amount:
6.Total Project Cost: $ Z , 000. OD 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-09 7202 $ Z6 2oZZ
fY`� c 6• )rlv et License Number Ex ration ate
Name of CSL Holder
5— S�a List CSL Type(see below) u
No.and Street Type Description
c .�nmi n �h/ � /� °2 U Unrestricted(Buildings up to 35,000 Cu. ft.)
y"1 Cl1 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
(•/7 SF Solid Fuel Burning Appliances
•3� - 695-1 1 G� / 7 erl I, 1 Insulation
Telephone Email address CO/)7 D Demolition
5.2 Registered Home Improvement C ntractor(HIC) 19 I q 7 5 o1 24 Zz
Svs n a.il e, Aim )d uS To C• HIC Registration Number E irati Date
HIC Company Name or HIC Regist Narr
To a,[ � erg 4 i Of 0 alY1 a,
Ng—And Street Email address
UM M tI n/ MA 1//3-IC- I? cow
City/Town,State, O 10 Z6 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 '1;/.- 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 I IN,<. Dr t,i.e.,-
to act on my behalf,in all matters relative to work authorized by this building permit application.
4; ii 3;5/� 647/z1
Print Owner's ame( lectronic Signature) e
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.
, ...c.......2...,. . ._-..__.
, ..._..,(....,..........7 ,a 7/
Print Owner s or Authorized nt's Name(Electronic Signature) ate
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
Massachusetts 4
�
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 23 A,..
of
Northampton, MA 01060 ss14YjN,�'
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: (\JOv'-Wcw hit1 mPc
The debris will be transported by:
Name of Hauler: USA NQ r �� C clif
Signature of Applicant: Date: l3 2(
11111111111111111111111111111111111111.1 The Comntonwealth of Massachusetts
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1 0 Department of Industrial Accidents
I Congress Street,Suite 100
—vit= 7 Boston, MA 02114-2017
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- . wwwntass.govidia
1.1,otkers't Ompensation Insurance AIDA a i it:Builders/Contractors/ElectriciansfPlumbers.
'ft)BE FILED WITH THE PERMITTING AUTHORITY,
Applicant Information Pie Print Legibly
, ' ----• i
Name(13ustnessitkganintiron;Individual): S -1,10e----6M\Otgi/1S TVI c . Ey 1 c brief
o
Address: ss--6 ,, , 60,x9,-
City/State/Zip: C,qt,fyllytin 0 MA -o -Phone#:, ti 0 —6‘151 1 II7
b±
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Are!von an cropkiyar?Cho&the appropriate : fy pe of project(required):
i,C1 I axi a employer with employees(full aindkit part-time}.. 7_ CI New construction
2[1 1 am a auk proporetin or partnership and have nu employees workino fur me 113 [ L. ci Remodeling
any v-apaeity.[Nu wafters'comp.insurance required]
9, Ei Demolition
i am a Itutrioowner doing all wink myself[No workers'entry.ittsurattoe required]*
100 Building addition
4.0 I tan a hUirhtvikix-r and will Iv haring contrattura to conduct all wink on my property. I will
ensure that all contratuirs either have Aorkeri.tOrtrpOliatILVa insurance or am sole 110 Electrical repairs or additions
proprietor..*ith no employees.
I 2.E3 Plumbing repairs or additions
510 I am a wrier-al contracksr and 1 have hind the soh-contractor%Listed on the anaehed.shoe_
I 30 Roof repairs
These sub-eoritractors lse entployets and helve workers'comp.insonmet.:
I 4.35ittltilet (140 (Co
6.2(iVe are a corporation and its officers have exercised then right of excirption per lioiGL c.
152.§114),and We has no employees.[No workers comp insurance melon-ea]
'Any applicant that chocks boa n1 must abu 611 out the section below showing their Wurkaara:composisaciun policy inforimaiort.
t tioxriuuwoert who submit EbiS,affulas it indicating they an doing all work and then hit outside etintractors man submit a new affidavit indicating such.
Contractor%that check this boa mum attached an additional sheet showing.die name of the wohstinitriwtors and state-whether tir not those entities have
employees If dic subkontractots have ermiluyees,they most pros ide their workers'%lamp.rAllicy number.
..... .„„,1 um an employer that is providing workers'compensation insurance for my employees. Below is the policy and job.sire
informatiOn,
Insurance Company Name: ickNi kke.irS
Policy if or Self-ins,Lie.#: 1 P5kik.,(5 1Y-3Z-62(7A 2.-) Expiration Date:
Job Site Address: 1_y vve3-1-e v'0 Al)e,• City/State/Zip: f\lar-V10.3411)1114:, Al iSt 010 6'0
Attach a copy of the workers'compensation policy declaration page(showing the policy number and explratiod date),
Failure to wore coverage as required under MGL c. 152„§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the foam of a STOP WORK ORDER and a tine of up to 1:750.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pal penalties of perjury that the information provided above is true ad correct
Date: ? 2 /
Plume;I: .//_3 — 7-s—
.... ._
Official use only. Do inn write in this area,to be completed by city or town official
City or Town: PermitiLicense a
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#: