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12C-047 (3) BP-2022-1440 38 STERLING RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 12C-047-001 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-2022-1440 PERMISSION IS HEREBY GRANT D TO: Project# ROOF Contractor: License: Est. Cost: 15640 Const.Class: Exp.Date: Use Group: Owner: YOLLES PAULA A Lot Size (sq.ft.) Zoning: RI/WSP Applicant: YOLLES PAULA A Applicant Address Phone: Insurance: 38 STERLING RD FLORENCE, MA 01060 ISSUED ON: 11/03/2022 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 VIO I ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I • Tit• ),9.,r III Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner J RECEI -1 4 �kr1a , J u� he Commonwealth of Massachusetts •� _OV - 2 2022 Boa d of Building Regulations and Standards FOR !.0. /MasachuseUss State Building Code, 780 CMR MUNI IPALITY SE nFPT.OF nuiL • it Application To Construct, Repair,Renovate Or Demolish a Revise Mar 2011 i _ - Nn_T"A^^P`ON MA 0106 0Ns One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 6 0- ) 2-- /`>/ 7 0 Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 PropertyAdd ess: 1.2 Assessors Map& Parcel Numbers 33 Seri i V1`.l R ll %IoMencvl MA i2w—o�t7 —00 1 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 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Plc. d o Fa.u es Flo revlce, n'144 O tOCR'2 Name(Print) City, State,ZIP 3g Q rl( In 12.4 . 14(3 —230 — $$ I fia`` etdol1 4-3rnQ-ii•ca y No.and Street Telephone Email Address 1 SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': lte may e._ of CSC roo J i n S+411 IC e. locc.lrr'i er G3 s j n+heJr L roo-f- p&ipe✓' 3+u.r- V` Cc.D- , e-S , re—ski nc le -I-- rirlTP 1C14. 1- ca_ p SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ j 5 410 1. Building Permit Fee: $Lin .2 Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ Cl Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ ^ Check No. /Q heck Amount:AID 6.Total Project Cost: $ '5, 6 tt0 0 Paid in Full 0 Outstanding Balance Due:_ City of Northampton p j N^M-P7p „ .P, f'�• '`� tits Massachusetts �� * .- c'c�c :1 ( t W DEPARTMENT OF BUILDING INSPECTIONS ° M ttw Al r 212 Main Street • Municipal Building `),. OCD` Y.,.�.� Northampton, MA 01060 rNly 1 (HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT //4/1�?D u.-1 I, ra- , 0`, -e S (insert full legal name), born /A (Insert month, day, year), hereby depose and state the following: exemption to thepermit requirements ofthe 1. I am seeking a building permit pursuant to the homeowners' q Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with la 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 f10.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 projec 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 Z$day of OGD ber ,20�2 jj,. I MO (S atu e) City of Northampton _?atHAM o� S`S �`.._s, r• ' � Massachusetts 4( ,.. 'c i ( 3' e SJ DEPARTMENT OF BUILDING INSPECTIONS s • S.:* ,! rr i" 212 Main Street • Municipal Building vy . a .s . f,-, K_.tt. Northampton, MA 01060 cs rsNW 4'3``. 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: Vc \e G1,t 1( I V o `k t vW -ovi J The debris will be transported by: 1`k it k ga\ iW\ i Name of Hauler: L Signature of Applicant: CUL. Date: LD 2 / The Commonwealth of Massachusetts • Department of Industrial Accidents 1 Congress Street,Suite 100 �' - ~' . Boston, MA 02114-2017 ' www mass.gov/dia ))urken'('umpensation Insurance Aflidas it:BuildersiContractors'taectricians'Plumbers. TO BE FILED W I!H THE PERNITEIM;At 1 HORITI. Apalicant Information Please Print Leeibh Name(I3us/nes.Organization Individual): 1._c tk.\a, r / © ' ' e,s Address: 3 g 5 e,r << hcj, City/StaI Zip y r.nc e, b 1 O 2.Phone#: 4 1 3 2-3 O 9 g c1 Ale„a a.emplaJir?(heck the appropriate boa: Type of project(required): I.❑1 am a empkgcr with employees tfull nano'fart-hmrt-' 7. 0 New construction 1 am a auk twuprrcbar or partnership and have nth employees uorkmg for enc in $ 13 Remodeling any capacity.[`Yu*takers'coup.insurance required.) 9. ❑Demolition 3 I am a honnuv n.-r duane all wur►myself.INo%urlm'comp.insurance regwraaLl' 4.0 I am a humour,* and will be hiring contractors to conduct all work on my property. I will 10 Building addition an a-nsun that all cuntractun either have wurien"compensation Insuranix or arc sole 11.0 Electrical repairs or additions prupncton w ith no csnpioyc'es. 12.0 Plumbing repairs or additions 5 1 am a i cm-ral contractor and 1 fuse hued the srrbciagractun listed two the attached sheet_ These sub-contractors base etppluyccs and have workers'comp.insurance.: 13ootrepairs,h&La roeuraoce.� h.�w c arc a curporann and its oaken have exercised then n iht of carmptrun per Ni(il_c. 152.§144).and we hasc no employees.[No workers'comp.insurance required.I '.Any applicant that chcsks Isoa aI must alau till out die soctuwi below,showinr then s otters'compensation policy mlawinatnwi. i 1kinhevwtiers s liar submit this atlidas it indicating they arc doing all work and then hue outside contractors must subiut a lieu at&la%it mils-ring suds :Contractor,that check this box must attached an additional sheet sbu*rng,the name of the suss ontncetses and state%sherbet or not tlrisc mut -Acne employees. If the sub-contractors!use employees.they must pros idetheir workers'romp.polies number. I am an employer that is providing worLers'compensation insurance for my employees. Below is the policy and job site information. Insurance('ompant Name: Policy#or Self-ens.Lac. e. Expiration Date: Job Site Address: City State,Zip: Attach a copy of the Workers'compensation policy declaration page(shut+ing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152.(125A is a criminal +tolation 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 fine of up to$250.00 a day against the violator.A copy of this statement may be lot-warded to the Office of Investigations of the DIA for insurance co%cragc+criticathxt. I do hereby certify under the pains and penalties of perjury that the in/ormation provided above is trueG and t cerme Signature: Date: IOPhne : (j)C(_4414L_40 ) 2 p A o) 1 1 3 - 2. J 0 — 9 - OJjicial use only. Do not write in this area.to be completed by city or town ejid1aL ('it) tor Town: Permit.!!icenst;R - -_ Issuing.tuthorit) (circle one): 1. Board of Health 2.Building Department 3.('itt flint n Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other (Contact Person: Phone#: _ r