43-011 BP-2022-0445
107 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
43-011-001 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-2022-0445 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 9500 ANDREY BATEYKO 109517
Const.Class: Exp.Date:08/27/2023
Use Group: Owner: BYRNES, COLLEEN & JOHNSON, DARCY G.
Lot Size (sq.ft.)
Zoning: WSP Applicant: TEYKO CONSTRUCTION
Applicant Address Phone: •
Insurance:
990 RUSSELL RD (413)454-7553 9520044729
WESTFIELD, MA 01085
ISSUED ON:04/28/2022
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I_ ► � 52
I
Fees Paid: $40.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
nft O✓
y �/ %/,771t70-.
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tZ,, The Commonwealth of Massa6usetlg.,�� � (7
Board of Building Regulations and Standards`"Y� FidR
Massachusetts State Building Code,780 CMS�.j0 / IPALITY
J /USE
Building Permit Application To Construct,Repair,Renovate Or s - u•1: Iiiir Rev/sed Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number:um� 89-� 21 44.4s— Date Applied:
Et.)/A.) /Koss -17-- y-Z8-ZOZZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1)Property 5d�h 0 0. u r, iQ 1 1.2 Assessg3s Map&Parcel Numbers,I
l.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❑ Private CI Municipal_ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of lord:
D J oh vl s o Fl o( sz., iv1 f l
c 01 o( 0
Name --
City,State,ZIP
)U') We.AeNtyy n
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building Owner-Occupied• ' Repairs(s) Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: _
Brief Description of Proposed Work': ' r' 440 t _ fe..:f vU.0►- s•
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ I. Building Permit Fee:$ Indicate how fee is determined:
) S �O' 0 Standard City/Town Application Fee
2.Electrical $
0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
_Suppression) �/ #�,f
Check No. 1Z0'T Check Amount: -1 Cash Amount:
6.Total Project Cost: $ 9/ 5-O p, 00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS— 109 5 Va.V),1
Y ,.� Lp License Number piration Date
Name of CS Holder
U pvHolder
List CSL Type(see below) U
990 )Zt~s. . U 12-4
No.and Street 11 T e Description
C1,5 C1 G1 d Mf
City/Town,State,ZIP I Unrestricted(Buildings up to 35,000 cu.ft.)
Restricted 1&2 Family Dwelling
h M Masonry
RC Roofing Covering
WS Window and Siding
J SF Solid Fuel Burning Appliances
11114154-)553 kiC&G t'‘J �,5� Mail. &n I Insulation
Telephone Efiail addres9J D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1 2 ea 3 b
�e_y jc t) L.c.r,S-I r�^( t(C.Y HIC Registration Number Ex iration Date
HIC'Company Name or HIC Re strant Name
i c) rti S.S-e 11 12.d LvGahtliry rws �, kfue C C.w1
No.and Stret 1 /
W2.5"� qI�2(� �A 01 C)t S ( i3'•4 S(J-7 SS3 Email ad s
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 0 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
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.
Print Owner's or uthorized Agen 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"
City of Northampton
�5 si
r s y Massachusetts ' 5
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building yJp a�
-77 Northampton, MA 01060
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: gD A Icy/ck Lh 0,\.,/ vn 'Mv GIUo I
The debris will be transported by:
Name of Hauler: E c.S1 C�
Signature of Applicant: afyca• Date: ViVg0---
=. .
----- _ The Commonwealth of Massachusetts
a. ? Department of Industrial Accidents
1/4 Inc- tar f s I Congress Street,Suite 100
�� ��liks,
Boston.MA 02114-2017
�'•cr- W K'ri:moss.gov/die
R
11 urkers'Compensation Insurance Allidarit:BuilderslContractors/ElectriciansrrPlumbers.
fO BE FILED%ffH THE PER11fITING Art
Applicant Information �.{, Please Print L.er_ibla
Name tBustncss•'[rgantzatiorvtndtviduall: c+yk0 Cc.,r,1 1 t"(-�t c,v\ -
Address: 99 0IZ,�,.s5_01 I 1.1 /
City/State/Zip: Wlt.5 r'61 c la Mfi Old ZS Phone P: qi 3 iiS 4— SSA
Are you set employer?('heck ilia'apprvpriatc Ma:
'I)pe of project(required):
LEI I am a enrplw.er with employees dull andur part-times• 7. 0 New construction
I ant a sale prupnetur or punnc-nhrp and hat a rut employees working for me m K. Remodeling
y capacity-[Nu workers'comp.insurance n�yuinzl.]
30 I am a hurtscwwn-r doing all wur►myself.[No ttorlsr co
mp.insurance nreyuwn:d.]'
9. 0 Demolition
40 I am a hurnoow nor and will be hiring cxnttrac urs to conduct all w ink on my pro)w-rty. I will
1 O CI Building addition
ensure that all contractors either have workers'compensation insurance or are sole II0 Electrical repairs or additions
proprietors a its no employees. 12.0 Plumbing repairs or additions
SO I am a general contractor and I base hired the sub-contractors listed un the attached shed.
These sub-cuntracturs hate employers and here c workers'cutup.insurances I 3,0tRtwf'repairs
&LI We arc a corporation and its officerskiwi-exercised their h exercis then right of exemplum per MtiL c.
I4.0 Other
152,5If i).and we have no employees.[Nu workers'comp.insurance required.[
'Any applicant that cheek%bus al must also fill out the section below showing their workers'cunrpensatiun policy information.
'Homeowners who submit this affidavit indicating they arc doing all work and then hue outside contractors must submit a new Aida..it indicating such.
.Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state wlu.'[her or not those entities have
employees. If the sub-contractors have crnployees.they must pros idc their workers'comp.pulicc number.
l am an employer that is prodding workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: A i',bp II K. '.
—rcSinf r,,)rev cA --
Policy#or Self ins.Lie.#: 5 S Od y �q Expiration Date: t 0-15/a
Job Site Address: JO) We. a h,p-i-Gr1 1ZQ City/state:zip: F/or 2n OR. 4/I'1 O/6 4)—
Attach a copy of the workers'compensation polky declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,;;25A is a criminal violation punishable by a fine up to S1,500.00
and:'or one-year imprisonment,as well as civil 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 Offices of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Dot..— (illt/� /is _
Phone 4: tii3 �S )SS3
1 Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License# - _
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.('ltylTow'n Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('ontact Person: Phone#: