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12C-039 (2) BP-2022-1194 41 STERLING RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 12C-039-001 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-2022-1194 PERMISSIONIS HEREBY GRANTE TO: Project# ROOF Contractor: License: Est.Cost: 4800 ROBERT THIBODO 65699 Const.Class: Exp.Date:06/22/2023 Use Group: Owner: WEBSTER DANIEL W& DAVID S WEBSTER Lot Size (sq.ft.) Zoning: RI/WSP Applicant: BOB THIBODO ROOFING AND SIDIN Applicant Address Phone: Insurance: P O Box 201 (413)586-0391 UB0250N144 NORTHAMPTON, MA 01061 ISSUED ON:09/23/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-SHINGLE 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: )2 - (P1 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner i 1 C. - T He^s..Ae4 ' ! Fc The Commonwealth of Massach .etts V Board of Building Regulations and :tan ds SFOR Massachusetts State Building Co. 78Q, R c9 7 IU ITY Building Permit Application To Construct, Repair,R- • ii " emolis � evise, Mar 2011 One-or Two-Family Dwelling yqL/;%Y, 1 This Section For Official Use Only •�q FCT Building Permit Number: e . .* i 14 ei Date Applied: �r°5o° �"'� tis Yeo 725-, /7/ "Z 9.22-ZOZz Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Propgrty A t;eses:y-` , 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes no Map Number Parcel 9umber 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: l- ,,�(-� \7 SAC-'Y Vc)b r-eAi,C-c \r\N\ Name(Print) City,State,ZIP I SI-C---A 1-\i, c� `34,0 -`3 a�l 3 No.and Street \ Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 6 Alteration(s) 0 Addition 0 Demolition . 0 Accessory Bldg. 0 Number ofUnits Other 0 Specify: Brief Description of Proposed Work': ' vr p is( ( `Lr'ti ✓S C- oa .\`c,C Yc' m \-N. (Ai c \\C\ 1 `J�-e) c--- SECTION 4:ESTIMATED CONSTRUCTION COST J Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ 0 Standard City/Town Application Fee 0 Total Project Costa (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ � Suppression) Total All Fees t Check No. �t Check Amount: 6. Total Project Cost: $ �1 0 Paid in Full 0 Outstanding Balance Due: City of Northampton t,� " Massachusetts 1t. E is 1'' S 1. � ��� DEPARTMENT OF BUILDING INSPECTIONS �, ff i "-: 212 Main Street • Municipal Building r Ir Northampton, MA 01060 3'y, "t`� 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. 5.1 Construction Supervisor License(CSL)SECTION 5: CONSTRUCTION SERVICES /' 5G 9 9 ( � 1- L, - 0 a' `License Number Expiration Date Name of CSL Holder rNci,�y`k s List CSL Type(see below) No.and Street Type Description A1 1 y\*cry-. \V V U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding \� �_� .S SF Solid Fuel Burning Appliances Lk (p. \ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) _\ D•, -) (i, ., a3 \b 0 a-() • II —C Registration Number Expiration Date omn Ci\CAe H11�Regis�trspt Name E o ovm N 7 6 Email address City own, State,ZCiir} `' / 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 l/ 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 ') 1)rl d 440 t on my behalf,in all matters relative to work authorized by this building permit application. Ir., Prin'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 informati contained in this application is true and accurate to the best of my knowledge and understanding. Csr -----)--"VA) o (--\A. • o 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.govdps 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" ,III The Commonwealth of Massachusetts Department of Industrial Accidents ,......., - 10 I Congress Street,Suite 100 Boston,MA 02114-2017 114116'.mass.gov/dia --4 ,•:, ... Workers'Compensation Insurance Affidavit: Builders/Contractort/Electricians/Plumbers. II)HE FILED VS t t it I itE PERMI rriNG AUTHORIT1'. Applicant Information Please Print legiblv ( Name 4 BusaiessiOrganizationlIndividual 0: Q. c.;;\ \ 1.3 0 Ct() Address: E P\`S--\-- -\``( cAc)k .S-1-\--' • City/State/Zip Phone if. Z -1 "" ., Art yam re employee( hitt the apprupriate brit: II ) Type of project(required): 1. 'lam a tmiptuyiar*Lib (:). empioyccs',tall and 4...1 part-unie—f.• 7. D New construction 2C1 lam a sole proprietor or partnershy and hat e no employees working kw rne in 8_ 0 Remodelirw any capseit). [No worker;comp.triSlintrice retpuredl 0 ID lam a homeowner titling all work myself[No workers'cony.insurance required 9. Demolition]' 10 0 Building addition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my prolvrty. I will ensure that all contractors either have workers'coerce-re:swami insurance or are sole 1 1.1:3 Electrical repairs or additions proprietors with no employeih_ 12_ lurnbing repairs or-additions 5 lain a reneral contra:tor and 1 have hired the sub-ctintractors listed on the;toadied beet. The sub-contractors haw employees and have workers comp. 13 Roof repairs insuranee) 14.COOther 6.0 we.a corporation arid its officers have exercised their right of exemption per iii(ril.c. 152,§1(4),and we lust no attpiirfeeS.[No workers',..amm.irtSUI:1111:1:reouiretil *Any applicant that t heck,hot a I mesa 361.)rill out tin;sceticn below show mg then woriors',:ortipensimun policy nitc.rmation t florntYwriers who submit flu affidavit indicating they are doing all work and then hoe outside contractors inust submit a new affiaak it iodic such :CLicitr.ii:lurs Chat cheek sus box must attached=I addntiunai sheet showing the name of the sith-cuntracters and state v.iitificr or not those entities haw employees_ If the sulv-eontrachirs Itto.e employ el: .tilt' must pnivide their workers'wrap.Ts,trey number a- /ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: \---1.R4 \. Ov..r\-, c.._,A _ Policy#or Self-ins,Lic.#: U r-- (f."-) Sc) Nt i Li 1-(/ Expiration Date: Job Site Addr ess: ''.+--c•C\\'`,(-1C City State.Zip: ci(SYR:V\c'JLANN\ Attack a copy of the workers'compensation pilicy 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$1,500.00 andeor one-year imprisomnent,as well as civil penalties in the loan of a STOP WORK ORDER and a fine of up to$250.00 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 cry*under the pains and penalties of perjury that ate information provided above is true and correct S39aD Date: Phone#: 5---1 5 1 9 (c, 1 Official use only. Do not write in this area.to be completed kr city or town official City or Town: Permit/License# 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 4: City of Northampton Q,.,,mMre — .' Massachusetts - «_ %Z l'''' - . ') 1:: DEPARTMENT OF BUILDING INSPECTIONS z; 1: 11* 212 Main Street • Municipal Building �?S, Northampton, MA 01060 syi�-. ,IX 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: ` 0i\( 0 ,V \ }" U c;S Location of Facility:-N o r\-\-) )"ors S* \(c_A\R c ( c d i)C The debris will be transported by: / © kh 0 k, , , Name of Hauler: cr\l) 1 0 C\ 0 Signature of Applicant Date: 1r a, 1—X 44110 City of Northampton �� � rj• r'f + s*. Massachusetts `-*N(e, r.f sc h1 DEPARTMENT OF BUILDING INSPECTIONS �, x 212 Main Street • Municipal Building p .ram.�,i ,1a� Northampton, MA 01060 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)