42-136 BP-2022-1630
864 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
42-136-001 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-2022-1630 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 ROOF Contractor: License:
Est. Cost: RICHARD PALMISANO CSL89485
Const.Class: Exp.Date: 03/05/2024
Use Group: Owner: SYLVESTER ERIC&ERIKA B ST PETERS
Lot Size (sq.ft.)
Zoning: WSP Applicant: BAYSTATE EXTERIOR RESTORATION INC
Applicant Address Phone: Insurance:
87 SHATTUCK RD (413)374-2719 6HUB-6B21339-4
HADLEY, MA 01035
ISSUED ON: 12/20/2022
TO PERFORM THE FOLLOWING WORK:
STRIP OFF 2 LAYERS, INSTALL ICE/WATER BARRIER,NEW FLASHING, UNDERLAYMENT & RESHNGLE
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 (PI
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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' 14 oN The Commonwealth of Massachusetts
_= Board of Building Regulations and Standards FOR
I Massachusetts State Building Code, 780 CMR MUNICIPALITY
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USE
cam', Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
`�J One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:f5 zO22,—I to 3 o Date Applied:
/< l�5 l2"ffaZz
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: n i 1.2 Assessors Map&Parcel Numbers
gI'.0.(4 (A)e.S-I41",t"`^ . ►CSR , 42--13 c, -bo
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Ws P . 079 acres
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'- Record:
6eLICA �4 pp P r — poc ,'(4'
Name(Print) City,State,ZIP
gzo4 lies ( 3c-3 C..13ssoo Aot_. . Cow..
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(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 Numb of Units Other 0 Specify:
Brief Description of Proposed Work': S 8i l� g- Ai h11� S" ,69-S
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SECTION 4:ESTIMATED CONSTRUCTION COSTS
t
Item Estimated Costs: Official Use Only
(Labor and Materials) 1
1. Building $ —Fro-6 1. Building Permit Fee: $ Indicate how fee is determined:
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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 $ TotalFees: 'O,All $ `=�
Suppression)
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Check No.I O i(-o Check Amount: 7 C Cash Amount:
6.Total Project Cost: $ a) 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 nstruction Supe or`License(CSL) 2C\(-( /S ,/
�i��� License Number Expiration Datea �`(
Name of CSL Holder
2 ! S r Q— OiC N U r_ List CSL Type(see below)
idt
Y�No. Type Description
e
1A' Q(03� U Unrestricted(Buildings up to 35,000 cu.ft.)
'"l R Restricted 1&2 Family Dwelling
City/Town,State, IP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
If 33')43?1, oqgIgL,j ,fir I Insulation
Telephone 1 Email address D Demolition
2 Registered Home Improvement Contractor(HIC) �I 3I��1
M._ Lx 244ATtom.. ..cb"9 r 1
HIC Registration Number Expiration Date
HIC C mpany Name or HIC Registrant 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 Issua e of the building permit.
Signed Affidavit Attached? Yes No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES OR BUILDING PERMIT
I,as Owner O er of the subject property,hereby authorize2
to act on my behalf,in matters relative to work authorized by this building permit application.
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Print 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 information
co al ed in this appli I is true and accurate to the best of my knowledge and understandiinngg.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES: 1
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
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�"'� ,?a Massachusetts �w?S"* cfe
itil v FL
s.�1 1. �t" DEPARTMENT OF BUILDING INSPECTIONS �?
9�ir' � 212 Main Street • Municipal Building yilt C'e:'
, / Northampton, MA 01060 J,P` .•_ %
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: IAill (2, C_,
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The debris will be transported by:
Name of Hauler: (7).ff,,L(2-A,-;'U.,
Signature of Applicant: Date: 1 t?
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The Commonwealth of Massachusetts
Department of Industrial Accidents
c St j6, 1 Congress Street,Suite 100
`: zt' Boston, MA 02114-2017
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h. www.macs.gov/din
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11`urkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED 11'11.11'f11E PEILNIITI•INC AUTHORITY.
Applicant Information Please Print Lecibly
Name(l3usincss,Organir.atianrindividuai): .--- A A
WM one„)
Address: 77 S t^atck e_c .
City/State/Zip: �(t4 6103c Phonekif 3J �7q-371el
Are you un employer?Check the appro rate but:
Type of project(required)!
1. 1 ant a employer with_ 2_cmpJoyccs(full an part-tiiete).• J. New construction
.01 am a sole proprietor or partnership and have no crrgaloycis working for me in !t. 0 Remodeling
any capacity_[Nu workers'comp.insurance ',squired.]
30 lam a huntnuwner doing all work myself.[No workers`cur _ii urtra. required.]'
9. ❑ Demolition
4.0 lam a homeowner and will he hiring contractors to conduct all work un my property_ I will
10 Q Building addition
ensure that all contractors Mulct Bove workers'compensation insurance wan sole 11.a Electrical repairs orodditioos
proprietors w ith no employees. 12.0 Plumbing repairs or addihooa
50 I am a gc-neral contractor and I have hired the soh-contractors listed un the altadic-d short. 13 notrepairs
These sob-contractor have employees and have'workers'ciunp.insurance.:
6.0 We are a corporation and its offs ers have exercised their rigid of exemption per MOLLc.
14.D Other
152,§It41,and we have nu employees.[No workers'comp.insurance required.]
'Any applicant that cheeks txrx al must also till out de section below lhuw Ina their wutter.'eomipensatnun policy information.
+Itoineownen u ho submit tiros atlidai it uidacatrng they are donna all work and then hue outside contractors must submit a new affutat it indicating such.
:Contractors that check thi box must attached an additional shot showing ttw name of the sub-cuntract,ns and state whether or not those chitties have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensation insurance for my emplo ees. Below is the policy and job site
information. _
Insurance Company Nans: F--inC.Ly
Policy#or Self-ins.Lic.#: 0 t4u3- 6 aak.3'51 q Expiration Date: (St.10�3
Job Site Address: 4 tokiQ l e City/State/Zip: F 4 M a� 0(6l06
Attach a copy of the workers'conipen ation policy'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 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 0.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for u�roranee
coverage ve ' .,t.t
1 du hereby ••_ y 1 der t pains and penalties of perjury that the information provided above is true and correct
Signature: ' ty Dale: ( jiZ ib-- -
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Phone#: ti 1'3 - 74 -a-7 t 9
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#i
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#: