38B-283 (2) BP-2021-225.5
264 SOUTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-283-001 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-2021-2255 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 15900 SAM LAKAS 103997
Const.Class: Exp.Date:05/23/2023
Use Group: Owner: ROBERTS, JONATHAN M& ELIZABETH J HUGHES
Lot Size (sq.ft.)
Zoning: URB Applicant: SAM LAKAS
Applicant Address Phon : Insurance:
5C SOUTH ST (413)230-6699
WILLIAMSBURG, MA 01096
ISSUED ON:12/02/2021
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: QQ cs-
Ie. • - 'I •
0
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
lir
,/The Commonwealth of Massachusetts /N-NriNit NN
Board of Building Regulations and S,tandar 4,e V.-.:,„ FOR
Massachusetts State Building Code,'$80 I6�PALITY
J -�USLN.
Building Permit Application To Construct,Repair,RenovaleA � emolisE�I R sed M/r 2011
One- or Two-Family Dwelling tia7X,O�,l>
/
This Section For Official Use Only\�. c,
BuildingI ermit Number: 3 a--..t.I -1--165 Date Applied: ` 7
n5 otis
keViNJ / )/e: 1///7.- 17.2-262i
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 PPrrpperty fi dry: p t 1.2 Assessors Map&Parcel Numbers
P. 1 So 1.1 a Is this an accepted street?yes V 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❑
vf- f� SECTION 2: PROPERTY OWNERSHIP'
2.1
f
"3° if‘ gC**(r. 0 OgLok-4475\4‘ MA 0 t p G 0
Name(Print) City,State,ZIP
2-� So,/ �� - 5Ia-635 ' 6� (-06er =S°h,w, 5,— (A.A
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction ❑ Existing Building Oie Owner-Occupied 9 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other Specify: CO P
Brief Description of Pr posed Work': (Z.pi►.....0 y-e, ro 1 n �u.( e��^/ oal
k-`(�" C1 /3 3O yec.� c..r f
1C,2 + �,va..�-f/ t/ '�' v Qa0-e� s s 4' / ti �Z
".y
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ t -4 00— 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost3 (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Feesr�$
(� Check No(��r Check Amount O Cash Amount:
6.Total Project Cost: $ 1 C -1 00 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts
fit !4
DEPARTMENT OF BUILDING INSPECTIONS
fi 212 Main Street • Municipal Building
< t- »r Northampton, MA 01060
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.
C4 0
t
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
� �-I D39'�,7 S 3 �3
5 a w1 Vo\ l- S License Number Expiratio Date
Name of CSL Holder
List CSL Type(see below) U
No.and Street Type Description
m IA v f o q‘ U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP Restricted 1&2 Family Dwelling
�' M Masonry
RC Roofing Covering
WS Window and Siding
_���?� GA qQ SF Solid Fuel Burning Appliances
l sr() �30 """Vl"`�� Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) . $.�
SO-Lft. UOCILL1
CG\\kr v t:- [\ HIC Registration Number Expiration Date
HIC Company,X or HIc Registrant Name (
No.and Street Email address
(� m o(og y13-a3o-�logq
City/Town, 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 Issuance of the building permit.
Signed Affidavit Attached? Yes No .❑
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 (Ai 1/1^- 1
to act on my behalf,in all matters relative to work authorized by this building permit application.
-SO 1/1^ �� $ f I/(o%c
Print Owner's Name(Electronic Signature) 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.
aitA, 14",,k40-1". •-// /P't
Print Owner's or Authorized Agent's 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.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"
1
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
r
City of Northampton
Massachusetts
* fd
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building mad •
Northampton, MA 01060 ss � jet'
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: C 0 c :50O 3 q 47,)46\et) 1 Ai ` ' O ( a.6
'e
The debris will be transported by:
Name of Hauler: A kvs
- f�(�
a l /d4
Signature of Applicant: ��i-� ` �- Date:
1
_
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
• = Boston, .11.-1 02114-2017
}VP**It'.fIlitSs.govidia
11;0,1ktuN' ompensation Insurance it: Iluildersl'ontractors I ileetriciansiPlumbers.
TO BF_ NA 1111 I[IL l'1.1(N111 I t\ri ,11 1 kl()R1
AnniiCHIII Inf4)rInatiuL Please Print
Name )rganization'Indivaduall:
Address: c j'A-ln &A-
City/Statelip: t/4_ i 0QC Phone#: 43 D. --30 6
.1re yule an employer?Check the appropriate box:
Type of project(requiredi:
0 I ant a employee with employees fiuII antler parigirriet.• 7. El Neu construction
am a sok proprietor or pant ership and have no employers rivrkring for rne in g_ [73 Remodeling
arty . city. (No workers'poem.insurance required.]
9_ [1 Demolition
;0 lam a horneowina doing all work iii±rsell.[NO workers'comp.inmiranoe required]
10 El Building addition
4.0 .rit a homeowner anti*Al be tiring oosittnetora to omit:Wet all'a Lek on nay property. I will
ensure deli all tormacturs either have workers*tommensution unbar:woe or are sole 11.0 Electrical repairs or additions
proprietor,with no employees,
2.1:3 Plumbing repairs or additions
50 I am a gearaol contractor and I have hired the stili-coutraettes Listed un the ambled Meet_
13.{:g Roof repairs
these sub-contractors[babe employees arid leave workers'comp.insarance.:,
14.E]Othet
6.0 We arc a corporation and its officers have exercised their right of exemption per/41101,
152, !tit,and we have rso employees.[Nbi workers':0mi, m,urance
?Any apple...mit that thin:Ls bin Ol mist also till out die minion licloit soottiai then uriker,'.compensatinn policy informailen,
°.16wners who submit this affidavit indicating they are doing all work:and then hire outside coritrai:ters mud submit a new affulas it indicating such.
Cormactors that chedi this box must atm:hied an additional sheet a6tiw'ung the name of live:,...uh-ouninttl.om and*tire whether or nut those mtlticni hate
1f tbie 4171).•4:01g1114:401rN erarill.yeeN.the!. must pat 6 rile Thai k,rrkers minther
trot on employer that is providing)vorAers'compensation insurance for my employees. Below is the polii.y and job.site
Insurance Company Name:
Policy#or Self-ins.Lit:.#: Expiration Date:
Job Site Address: CityiStateiZip:
Attach a copy of the workers'einiipensa lion policy declaration page Ishowing the policy number and expiration date).
Failure to secure coverage as required under NIGL e. 152,*25A is a criminal violation punishable by a fine up to S1,500.00
amdlor one-year imprisonment.as well as civil penalties in the firm 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
coverage verification.
I do hereby ter*,antler the plias and penalties of petistry that the information provided above is true wad correct.
Signature: DaL I / d-‘
phone#: t -;0 6 €
Officialue only. Do not write lit this area. err he completed by city or town official
('it y or Town: PernfiCLicense#
• Issuing Authority(circle one):
I. Board of!leant 2. Building 1)epartment 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Iftspector
6.Other
('outset Person: Phone 4.:
Sam Lakas Construction
5C South St.
Williamsburg,MA 01096
413.230.6699
Sto gentair
CONTRACT :::
Date: 11/10/21
John Roberts
264 South St
Northampton,MA 01060
512.635.5629
Project:Roof
Proposed Work/Notes
Strip and Install Roof
The job consists of the main house roof and all additional roofs except the two flat roofs and the turret.There is an extra
dumpster charge for the slate which is included in the price. Price includes stripping two layers of roofing.New 30 year warranty
architectural asphalt shingles to be installed,Tamko Slatetone grey.Chimneys to have new step flashing installed. Ice and water
shield will be used 6 feet up from bottom of the lead edges,valleys as well as around the chimneys.Synthetic underlayment used
everywhere else.Main ridges will be vented.New white drip edge installed,as well.Price of new'/z'CDX plywood is included
below.The price does not include any additional carpentry work.Any additional work outside this scope will be billed at$100/hr
plus any materials bought.
The payment will be scheduled as follows:one third due on signing of this contract,one third on the first day of job starting,final
third after job is finished.
By signing this contract,I,the contractor promise to deliver in a timely manner a quality,finished project as described above.
You,as the customer,agree to pay all money owed as described in this contract.
Materials and Labor$10400
Plywood$4000
Dumpster$2000
Permit$500
Total due$16900
doolme owner
R (1,-mil
Contractor I/iM