29-505 (2) BP-�022-1442
14 MATTHEW DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-505-001 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-2022-1442 PERMISSION IS HEREBY GRANT, D TO:
Project# ROOF Contractor: License:
Est. Cost: 6800 ROBERT THIBODO 65699
Const.Class: Exp.Date: 06/22/2023
Use Group: Owner: FARIA,JOSE C.FARIA,MARIA
Lot Size (sq.ft.)
Zoning: WSP Applicant: BOB THIBODO ROOFING AND SIDIN1
Applicant Address Phone: Insurance:
P O Box 201 (413)586-0391 UB0250N144
NORTHAMPTON, MA 01061
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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
• i . �
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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Ec t ...�...G .,r
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The Commonwealth of Massachusetts N O
v VIVBoard of Building Regulations and Standar s - 3 F
Massachusetts State Building Code, 780 C R WNIC AE LIl Y
nF r
Building Permit Application To Construct,Repair,Renov c Or De wow
af,1 v noNS ar 4011
One-or Two-Family Dwelling '" •'?n1060
This Section For Official Use Only
Building Permit Number: 63/2--11'/cj /Z. Date Applied:
J( u & (055 ,/7 -3-202Z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Add ess: 1.2 Assessors Map&Parcel Numbers,
\'.- 1 b '\otet hew 0-r- _9 4'0 b
1.1 a 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(11)
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 CI On sitedisposalCIO system
Check if yes':
SECTION 2: PROPERTY OWNERSHIP'
2.1 of Record:
\:)( �- C\fit 1" Ibee,c. S5'
Name(Print) City, State,ZIP
\H- 1 \Nr\c,A\-h-e/w s` 1P'
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(checlyall that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ® Alteration(s) 0 A dition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
pct
of Description of Proposed Work2:
owe `-x; s-it ox-f, L.e). R_t^ 51-\Nt)k s \- c\%t E
).= t\N"\\ \\I-(tNi ( - c W c--cc u P\L `h A-o ak\A (D-C' V-0"
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $ _
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: 'IV
Check No.?( 1 Check Amount: 4
6.Total Project Cost: V n, 0 Paid in Full 0 Outstanding Balance Due:
?oaYH_9M� � City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS it
' .� r
212 Main Street • Municipal Building
Northampton, MA 01060 ss• t 4^.��'
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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.
1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Su sor License(CSL) £seNumber9
Expiration Date
Name of SL older
c_O IT m m GQ k 4,
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
i s 9�� U r R Restricted 1&2 Family Dwelling
Cityown,-State,ZIP
M Masonry
--��—"Sarrcit RC Roofing Covering
WS Window and Siding
_ SF Solid Fuel Burning Appliances
iS i 6'j(42_ \OoAD i j( I Insulation _ _
Telephone Email addrd `.. �Qi v D Demolition
5.2 Re istered Home provement Contractor(HIC) �".
b\ l d IC Registration Number Expiation Date
HI ompany Name or HIC Registrant Nra�me
- �s'N' �c�Q\Q �V .$ \0111,p aao rra o 1,1
�- Email address
'1 e„ V `\koa ♦. e.b.\,...,
Ci own, State, IP 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 Issu of the building permit.
Signed Affidavit Attached? Yes . 1 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
3 c ,
to act on my behalf,in all matters relative to work authorized by this building permit applicaii n.
—I (') 6 V---i-7-c-4-1 p‘ I ) 'Th
Print Owner's Name(Electronic Signature) 'to
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 ' true and accurate to the best of my knowledge and understanding.
cam\ � 3 I),
Pri wner's or Authorized Agent's Name(Electronic Signature) ate
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"
.s.
4
The Commonwealth of Alassachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
1 , Boston,MA 02114-2017
.,;, ..„.,•=,/,11 www.mass.gouldia
Workers'Compensation insurance Affida%it:Buildersit.'ontractors/Electricians/Plumbers.
TO RE FILED WITH I LW PERMIlTING AUTHORITY.
Applicant Information Please Print Legiblv
Name I Bus Mess,Organization.Individual l: f---2*.)<2;-F) 1 '1 NO ct. CIO
Address: :-1,.. , ENs-k' roc,pi, sii
City`StatelZip:_S_si-vv-T,yk,,,, ms, Phone #:
Are suu an employee Cheek the appruprtatv trut:
Type of project(required):
Lsi,ant a turItoyer with a angiol.cet tta,1 arki`os part-titnell• 7- 0 New construction
1 am a tole proptiefor or partnc-rdup and have no employees working for me in 8. E3 Remodeling
any capacirf[Nu workers'comp.insurance required]
3.0 lam a homeowner doing all work myself.[No workers'com .p assurance required 9. 0 Demolition
.J'
10 0 Building addition
I am a homeowner and will be hiring contractors to conduct all work on rny proparj. I will
ensure that all contractors either have workers'compensation tnturantx or are:sole I I I a El .trical repairs or additions
piorrieton.v.ith no employeo.
12. ' umbing repairs or additions
50 1 ant a general contractor and I have hired the oub-eontractors listed on the rut:idled sheet
13 V Rout repairs
Theie iob-contracunt hank employees and have workers'comp.insurane.e.;
14_0001er
6.0 We we a corporation and its officers have exercised then right of exemption per MIGL c.
152.110),and we hate no ornployees.[No wailers'cutup,insurance required)
*Any applicant that checks box.1 mutt obis tin out the ,eciiuns below shoo,Mg their workers'conyel..1,,1111-31 policy information.
f Borneo ViTiVT3 who$Ubltill Liliz Ltifitilik A indicating they are doing all work and then lure outside contracties must subnut a new:Arida,.ii Indic:lu uc ng sh.
I:Contractors that ciaeLk this box must attached an *Mit:ion:LI mbeei showing the name of the au b-eonr.nreturs and glue 411....-th,a or not chute imbues hate
einplovers If the suls-coniractors bate L.-rriploy ors they must provide their workers'comp.policy number
- -- - t
1 am an employer that is providing workers compensation insurance for my employees. Below is the policy and Job site
information.
Insurance Company Name: \ - \''' cAN,A-C\--;c\-\
Policy#or Self-ins.Lic.#: •Sk.)?/'
0' -S* 0 N 1 Li(1 Expiration Date: 3\ a..---)y).. ),.....
Job Site Address:\LI'-').cz INCC. \'')0(Ani S r--\ Y- City/State:74:
Attach a copy of the workers'compensation puliry 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 fine of up to 5250.00 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 certify under the pains and penalties of perjury that the inPrmation provided above Jir true an et correct.
Sicils Lire: ( (9...
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Official use only. Do not write in this area.to be completed fry city or town official
1 ,
City or Town: PermillLicente Or .
Issuing Authorit) (circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone 0:
City of Northampton
Massachusetts :'
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 is'}. 41*
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: i V 0r"4-1 4-0
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date:
es-
City of Northampton
'` Massachusetts '%'
1:i4
� DEPARTMENT OF BUILDING INSPECTIONS �.
212 Main Street • Municipal Building 6 ;WA ,�V
%,.... - Northampton, MA 01060 ►:w , -'-
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)