36-261 (13) BP-2022-1089
163 MAPLE RIDGE RD COMMONWEALTH OF MASSACHUSETTS
Map:B lock:Lot:
36-261-001 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-2022-1089 PERMISSION IS HEREBY GRANTE TO:
Project# ROOF Contractor: License:
Est.Cost: 8000 JAMES ROBERTS 099404
Const.Class: Exp.Date:01/21/2024
Use Group: Owner: TR CAVANAUGH DANIEL P&PAME A
Lot Size (sq.ft.)
Zoning: SR Applicant: JAMES ROBERTS
Applicant Address Phone: Insurance:
30 Edwards Rd (413)527-6078
WESTHAMPTON, MA 01027
ISSUED ON:09/02/2022
TO PERFORM THE FOLLOWING WORK:
STRIP AND RE-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 VIOL TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I
• r i .
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
..
\1 The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
rv'., a t Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
M Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
'2
This Secti n For Official Use Only
Building,Permit Number: ij P"�'>' `d ty Date Applied:
k M as //il' q-i 202z
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pr per Address: ` 1.2 Assessors Map& Parcel Numbers
fl ' :V a Ct
1.1 a Is this an accacc/pet?yes no / Map Number Parcel Number
P
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 Ow 'of Re�ir
Name(Print) City,State,Z
ti
No.and Stree Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(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:
Brief Description of Proposed Work': - .---i4
r
—Spy +46 c., vim J•
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(La r and Materials)
1. Building $ C. d 3 d 1. Building Permit Fee: $ Indicate how fee is determined:
V ❑ Standard City/Town Application Fee
2.Electrical $
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees: $
Suppression) �l 71
6.Total Project Cost: $ Check Novi gOcCheck Amount:`4
0 Paid in Full 0 Outstanding Balance Due:_
City of Northampton
7o
,r Massachusetts
* a
DEPARTMENT OF BUILDING INSPECTIONS 4 `
212 Main Street • Municipal Building ��y D.
Northampton, MA 01060 &
emu.
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
1. 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. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form(if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code—all new construction(Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor Lic e(CSL)
License Number Expiration Date
Name o older
List CSL Type(see below)
No.and Street Type Description
Unrestricted(Buildings up to 35,000 cu. ft.)
Restricted 1&2 Family Dwelling
ity own,S ate,ZIP df?
��� M Masonry
RC Roofing Coveri
Window and Siding
Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registere o Improvement Contractor(HIC) HIC/��
Registration Number Lkpidat on Dat
HIC Company Name or HIC Re 's ant Name
No.and Street Email address
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 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 V Q/L444
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print caner s ame(Electronic Signaturel6P 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 Own or Authorized Agent's Name(Electron 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"
, ..:
The Commonweahh of Massachusetts
, (P Department of Industrial Accidents
I Congress Street,Suite 100
.........,, Boston, MA 02114-2017
, s&
www.mass.gotVdia
Wolters'Compensation insurance,kfTidav it: BillidersiCantraettlfirVEleCtriciansiluittlicrs.
10 !IL }ILL!)51Itll IIIE PEILNIITIUSC At TM/RUA
Applicant Information Please Print Leuitils
Name(Businessanuanontindividual):
Address: (--- ( er , JZZ
City/State/Zip: a, e7-I, o . Phone#::,.....qD —2--fqj — 473 6" 0
Art you an employer?Climb the appropriate box: -ry pe of project(required):
ID lam a employer with ernployes',foil mutat part-tinie .• 7. j New construction
2.13k‘c suit prop partnersbip and have no anployers woriong for MC in S. C3 Remodeling
any capacity.[No vaurkers'comp.insurance. required.)
9_ 0 30 I am 4 homeowner doing all work myself[No workers'cum_insurance trquireill i Demolition
I 0 0 Building addition
4.0 I am a houlictwiiiter and well be hiring commoors to conduct all work on my properry. I will
ensure that all contractors either hake workers'compensation iswhrlinia:tar arc 5olc I I 0 Electrical repairs or additions
prOpriickh"3.With no eitiphSyriht..
12.1i Mu •' 1, repairs or aitetiiions
5.1245:;a general contractor and I hake hired the sub-contractora listed on the attached theat
13 yl, •oolrepairs
These sub-cimtractors hike employees mad have workers'comp.insormr-e.:
14.0 Other
6.EI We an a imrpuration and its officers have exercised their right of exemption per 111G1 e_
I 52,4 I(.4).and we hake no employees.[No workers'comp.insurance requiretil
'Any appliLani lot...lic....-1,..,I XI.%e 1 Mika also rat not the section below showing their workers'compensation policy information.
'tiorneowlICT,'A/10 submit this affidavit indkating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such_
;Contractors that..licck this bus must attached an additional sheet showing the name of the mib-covatactors and state whether or not those entities hake
cniplo?,cc-a. if tla: .L1,-contractors,ha,,,c employees,they must pro'.iih:their worlieni";comp policy number.
I am an emploi er aria is providing worAers compensation insurance for my employees_ Below is the policy and job site
information.
Insurance Company Name: _
Policy#or Self-ins. Lie.#: Expiration Date: I —J(— Iti
Job Site Address: CitytStateiZip:
Attach a copy of the workers'compensation policy declaration page(showing the puke', number sod expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to$1,500.00
andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violator.A copy of this Nuternern tatty be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ida hereby certify under the pains and penaltie f perjany that the Information provided obi)l 1'i.s true and correct.
nature: ./..../-- -A7r7(---- —
p /ine......0 4., -
Date .....1.3 -
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License 0
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
Massachusetts 4
DEPARTMENT OF BUILDING INSPECTIONS a
Yr 212 Main Street • Municipal Building
-'" Northampton, MA 01060 sy1 '
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:
l
Location of Facility: °9;
The debris will be transported by:
,10
Name of Hauler: 0 #,.4ihm,
IF
Signature of Applicant: c Date: l C �
City of Northampton
- a, Massachusetts ''._ e"
t DEPARTMENT OF BUILDING INSPECTIONS
." 212 Main Street • Municipal Building
r '! Northampton, MA 01060 431"), ti
_mow
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)