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22D-049 (2) BP-2023-0266 48 RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 22D-049-001 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-2023-0266 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 4000 JAMES ROBERTS 099404 Const.Class: Exp.Date: 01/21/2024 Use Group: Owner: FRENIER JAMES 0 Lot Size (sq.ft.) Zoning: WSP Applicant: JAMES ROBERTS Applicant Address Phone: Insurance: 30 Edwards Rd (413)527-6078 WESTHAMPTON, MA 01027 ISSUED ON: 03/07/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-ROOF GARAGE 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: t • 1' ► y0 . TAct, Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner r , The Commonwealth of Massachusetts 1 1 MA Ij - 6 202 `, Board.of Building Regulations and Standards I FOR Massachusetts State Building Code, 780 CMR .L -- .M IC IPALTTY l 1T' •.���,7,P:. '.1. 0T:�60 Building Permit Application To Construct,Repair,Renovate Or I'�en oitsti a -Revised Mar 2011 One-or Two-Family Dwelling This�S°ction For Official Use Only Building P it Number: a3A.911 j-Q�(.i Date Applied: key ii,..) 1V(-5-)5 //71-Z 3 2oz3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Prope A?po.s: / 1 fQ p 1.2 Assessors Map& Parcel Numbers 1.1a Is this an acre.,?street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq tt) 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 OWNERSHIPI 2.1 Ownerl of Record. Name( tint) City,State,ZIP TO irrh p 4-7.4- 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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Speciff::} Brief Description of Proposed Work'-: � � '," SECTION 4:ESTIMATED CONSTR ION COSTS Item Estimated Costs: Official Use Only (La and Materials) j 1. Building $ lid v 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: $ 410 Check No g1heck Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: City of Northampton sic Massachusetts -•` DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 'ilk Northampton, MA 01060 �� �1� 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. SECTION 5: CONSTRUCTION SERVICES 5.1 Con truction Supervisor Lic (CSL) C61u f) y i -�l-�Y License umber Expiration Date Name C L Holder �'v`'e `�� /� List CSL Type(see below) l TypeDescription No.and Street� P / !� `/� o / J"( U Unrestricted(Buildings up to 35,000 Cu.ft.) G // R Restricted 1&2 Family Dwelling City/Town,State,ZIP a Masonry A?? q / Roofing Covering Window and Siding f 15 -C / ©3( - SF I Solid Fuel Burning Appliances Insulation Telephone Email address D Demolition 5.2 Registered H e Improvement Contractor(HIC) )15 _ IC H teistratioint umber piration Date HIC Comp am or Registra No.and treet 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. ailure to provid this affidavit will result in the denial of the Issuance of the building permit. ' - Signed Affidavit Attached? Yes 0 No .0 /ie SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BU ING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work author' by this building pe it application. 0A� r v `r .3-3 -�,-' 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 contained in this application is tru d accurate to the best of my knowledge and understanding. 1/ -, 3--3 -01-3 Print Own-1 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" The Commonwealth of Massachusetts ---..- Department of Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.govidio 1.$oiker4' Compensation Insurance Affidavit: BuildersiCentractors/EleetricisuP,Plumbers. '11)BE FILED WITH TilE PERMITTINC AUTHORITY. Applicant Information Please Print 1.4.1diblv Name(BusinessfOrganization/Inilivithial): Address: 36 41) 7____ City/StateiZip: e//(-0)-<2_73167 74.__ Phone #: el(3--z(eft- Are yell Ad employer"Check the A pprup rime but: Type of project(required): ,,_erripioyees thin andior pan-time i." 7. 0 New construction 2 7 am a sole proprietor or punnershrp and have no employees working for me in 8. CI Remodeling any capacity.[Niu workein'camp.orsurance required.) 9. 0 Demolition ta I am a homeowner doing all work inyselt(No workers'comp insurance requited.]' 10 0 Building addition ta I am a horrieoviner and will be haling c-ontradors to conduct all work on nay property. I will ensure that all 4.111ttracturs caber&IA r worker,:compensation insurance or ate sole 1 10 Electrical repairs or additions proprietors ail no employet.s. 12_a PI ,,I.'",, repairs or additions 5.0 1 am a kreneral contractor and I have hired the sub-contractors listed on the attached thevi. 13 K4 'oof repairs These sub-contractor,.have employees and hat,e IN urkeri.'comp.insurance.; 14.n Other 6.0 via are a corporation and its officers eitrtiad their right of exemption per Wel c. 152.§1141,and 0.-e 11.11.•V tbe employees.[No wink-en'eurrap.insurance required.] , *Any applicant that chats km:-,.I must also fill out the seetion below showing their A orias'compensation pk,lic., uilorulauutt. *Homeowners who submit this affidavit iiitheatinsi they are doing all work and tls.:1:lure outside contractors must submit a r•evi affidavit indicating such, ;Contractors that check this but must attached an additional sheer showine the name of the sub-cocuractors and state whether or not those csitilic,have employees, If die st:b-coraractors.have cricilir,ccs.they must pinvide their workers'comp.policy number_ 1 wit an employer that is providing workers compensation inStartliCe for my employees. Below is the polity and job site information. ...., Insurance Company Name: — .4,/Policy#or Seif-ins. Lic. #: Expiration Date: /-4411•41 -----g ( Job Site Address: City/State/Zip: Attach a copy of the workers'compensation 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 fine up to$1,500.00 anitor 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 rttly be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby certify under th ins and penalties of perjury rhor the information provided above is true told correct. . ignanni...: , D.ile: , - 3 --.,3 Phone::: e---7/L/ / 7 ,3 5o Official nse May. Do not write in this area.to be completed by city or fawn 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#: • City of Northampton ;rir tr,. Massachusetts ti 4 1 rr DEPARTMENT OF BUILDING INSPECTIONS 1` 212 Main Street • Municipal Building ' ._,.. Northampton, MA 01060 Js 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: .,'l/-1Yt%' — The debris will be transported by: /(____ l'.__.) , ,--- Name of Hauler: �- �? Signature of Applicant: Date: ) �/ City of Northampton rTJT G r Massachusetts ♦ s �` t _ f DEPARTMENT OF BUILDING INSPECTIONS ( , r 212 Main Street • Municipal Building b^- 0' Northampton, MA 01060 �'p ,.wr 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)