18C-134 (4) BP-2022-1154
256 JACKSON ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-134-001 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-2022-1154 PERMISSIONIS HEREBY GRANT AD TO:
Project# roof Contractor: License:
Est. Cost: 2000 THOMAS CRAIG 087425
Const.Class: Exp.Date:09/23/2023
Use Group: Owner: THOMAS CRAIG
Lot Size (sq.ft.)
Zoning: URB Applicant: THOMAS CRAIG
Applicant Address Phone: Insurance:
92 SILVER ST 413-896-9333 SOLE PROPPRIETOR
SOUTH HADLEY, MA 01075
ISSUED ON:09/16/2022
TO PERFORM THE FOLLOWING WORK:
STRIP AND RE-SHINGLE GARAGE 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 VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
•%, • • ›.2 - Tie 'I
'11
Fees Paid: $;40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner •
RECEIVED �sy yq�
S E P 1 4 2022
The Commonwealth of Massachusetts
Beard of Building Regulations and Standards FOR
OF BUILDING iNSPECTIM3ssachusetts State Building Code, 780 CMR MUNICIPALITY
ORTHAMPTON.MA 01060 USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
/�ection For Official Use Only
Buildin Permit Number: a Date Applied:
c=ut►s ��o}S 9-1g-Z622
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
.2t5'6 ii.AGks0.2. S- j fie - 13 r1- 00/
1.1 a Is this an accepted street?yes f no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: i
2.- E :20, y6 1.36
Zoning District Proposed Use // Lot Area(sq ft) ` Frontage(II)
1.5 Building Setbacks(ft) — gX;S t9 _S-FFrei c I-01. -
Front Yard Sit 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 1 Private❑ Zone: Outside Flood Zone? Municipal E3/On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: /� ����
f/ 4( 4 �d'ac.f y oc.e is ��p /M1 . O`a 3'
Name Print) -G City,State,ZIP Q'
90� t5.r/ve f- 6-,1". W..3 5962-?73?3 CrQi 'esce,L te_s 42
No.and Street Telephone Email Address Com �c. Sf-, tei-
I
SECTION 3:DESCRIPTTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building h?' Owner-Occupied 0 Repairs(s) H Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: R e ! e_a P066 o w CPO-- fie e0
7 co r,z-re...
-I- r e !- `r-ei p✓e_ J' G--- 1oor CoVe f 14 ,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ c2 c 0729 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 Fe
Check No.. V heck Amount: Cash Amount:
6.Total Project Cost: $ a, 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
/ 0S - oS7 �S q-z ,3- 3
vL 0,24 4S %' erect) License Number Expiration Date
Name of CSL Holder / /
�jC Si</I/P f� _ r List CSL Type(see below) an re 4,re-ie-�e egi
No.and Street Type Description
Sfi /u /)/� yI�y� Unrestricted(Buildings up to 35,000 Cu.ft.)
rT y ,i //7 0�/ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
-�i.� 8 �o93 3 RC Roofing Covering
/ 3 WS Window and Siding
SF Solid Fuel Burning Appliances
L°Pws Q,SSocl eS CO 4' I insulation
Telephone Email address i �� D Demolition
5.2 Registered Home Improvement Contractor(HIC) y�f 79 y-o?p"l 3
I-4 04 . Cra, C—ra Ass t i ac 4 HIC Registration Number Expiration Date
HIC Company Name or HIce 'strant Namf 91.2 _Sr /✓ems Si,. CrgtYasS2:..liei`es dt Cv c:,eS-
No.and Street Email address ,vre
S; Eilal . 144- . 0/D`rl7 y/3-Ei.h-1333
City/Town,State,VIP 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 RA
I,as Owner of the subject property,hereby authorize /1pf?2h.5 -f?/,/r_
to act on my behalf,in all matters relative to work authorized by this building permit applicati�it.
r
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER OR AUTHORIZED AGENT DECLARATION j
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 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"
City of Northampton
boa H-A-mt. S�5 T. ..5�
��'' Massachusetts �Q 4, <<
VA 41
c.
pp .!. t DEPARTMENT OF BUILDING INSPECTIONS $t
P ► '` r - 212 Main Street • Municipal Building �0 �D�
!�� _.� Northampton, MA 01060 5Sfrj TO`.\-
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: 1--/ /r/t DGe. 0 . (c5(_.4 a gai - L,e4-4-e-)
The debris will be transported by:
Name of Hauler: (}Q..Sf J, ��d�( �i4
y
Signature of Applicant: -ilk -----f/ �i�-G ate: � 11,.2—
The Commonwealth of Massachusetts
lr net—
Department of Industrial Accidents
1 Congress Street.Suite 100
;i= Boston. MA 02114-2017
:,. -‘ www mass.gov/dia
11uskers'('ompencation Insurance Aflidasit:Builders/Contractors/Ekctricians/Plutubers.
TO BE F11.E1)%1 i ll THE PE1t%11T'TIV(:At 1.11011111.
Annlicant Information Please (''t,rim Lei his
Name 1Husinccs Organizatiorv1ndtntdual►: 4:ini r5 eel .P 4514 . ° 94...L- �74,Ile,;,
Address: rZ S)/v//e c (-5
City/State/Zip: c,s _ ae, /e /0- ?bone#: /3 - .577.6 --7233
Arc sus ae rlaplurer°4Arch the apprupriai ir:
Type of project(required):
1.01 aril a emplusa with employees i tail and or part•tunci• 7. ❑New construction
_'Wam a sok propnctor or partnership and hasc no empkoyees wortmg for riu in S. El/Remodeling
comp,No winter,'cup.in-sunnier minima) IIIJJJ
9. ❑ Demolition
;0 I am a homeowner doing all wort myself.No wor►as'eoritp-insurance r uii i j'
10O Building addition
.1❑I am a hum.ow net and will be hiring contractors to conduct all work on my property I will
ensure that all.uturators either hate worLcrs'cexnp►-n+atnn insurance or are sok 1 I L Electrical repairs or additions
prupneton with no employees
12.0 Plumbing repairs or additions
Sto I am a n-n-rai contractor and 1 has c hired the sub-contractors lasted on the attached sheet,
these sub-contractors has c employees and hake wurter,'comp.nuurance. MO Roof repairs
14.0 Other
h.❑w..:are a corporation and its offrecrs is has exercised then neat of exemption per 1tKiL c. _.____.._......_.__;..._.._......_.__._,_.__._...
1 y 2.*I I d i.and w e hasc no atrclostcs.i No workers':amp insurance required.)
•Any applicant that chests but n1 must also till out the vcction below show mg their wurltert•compensation polls-,information
'ltami.vwnco who submit thus atridasit tndacating they an doing all work and then hire outside cuntractur,must submit a new ailidaait mdi.aung such-
(wilr:mots that check this but must attached an aialitiunal sheet show ing the name of the sub•stnUactor,and state whether or not thew entities have
emplo.cc, If the sub-contractors bass:cn1gslo ins.they trust pits ide their workers'romp polts•y number
l ant an employer that is providing'corkers'compensation insurance jar my employees. Below is the policy and job site
information.
Insurance Company Name: —
Policy#or Self-ins.Lie.#: Expiration Date.
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(show in(;the policy number and espirrttioe date).
Failure to secure coverage as required under MGL c. 152, *25A is a criminal siolation punishable by a fine up to*1,500.00
and-or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up tO 5250.00 a
day against the s rotator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for/insurance
cos erage yenlication.
t do hereby certify under pains and penalties of 'url'that the information provided above is true and correct.
L n
ltgnalure: /4yu� �7l /!�/ Dale. 7.-/7���
Phone g: 9/ — yvi!. - y_?3
Official use only. Do not write in this area,to be completed by city or town official
('its or Town: Permit/License#
' Issuing.tuthorits (circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
- 6.Other
Contact Person: Phone#: