36-118 (7) BP-2023-0405
232 BROOKSIDE CIR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-118-001 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-2023-0405 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
SUNRUN INSTALLATION SERVICES
Est. Cost: 8913 INC CS-090170
Const.Class: Exp.Date: 05/09/2024
Use Group: Owner: PERRY,ANDREW J. &PERRY, EMELDA T.
Lot Size (sq.ft.)
Zoning: URA/WSP Applicant: SUNRUN INSTALLATION SERVICES INC
Applicant Address Phone: Insurance:
150 PADGETTE ST UNIT A (978)793-8584 WC614287601
CHICOPEE,MA 01022
ISSUED ON: 04/05/2023
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:
9'1
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
ii Ate . , i r„,__A**"?.,,---,
c "/ 4P1 — '` a"
The Commonwealth of Massause�rr
•
1W3t Board of Building Regulations and Standhr�l�� .� �O 490 tJNICO ALITY
Massachusetts State Building Code,786 C1V V- 14tobli-- M
"'t,N iti SE
t Building Permit Application To Construct,Repair,Renovate Or Derndl sh. ��cuv,�evised Mar 2011
„iusOne-or Two-Family Dwelling
This Section For Official Use Only
Buildi4'04)5
g Permit Number: 6,- .2 3 ,. 4f06" Date Applied:
").2 it s-2023
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
2 -ter r • i�C 1 1.2 Assessors Map&Parcel Numbers
I.la Is this an accepted street?�/yes 1 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❑ On site disposal system 0
Check if yes❑
^SECTION 2: PROPERTY OWNERSHIP'ry
R,ecQrdc u1 ��1I 1 V�
cActIcitate 1P1 -oNs
z,,,,,0 ) '. b b\
No.and Street elephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 15" Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg.0 Number of Units Other ffi4(
i
e s 'ono ?� s ork2 : are
rr . ,e,fi
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(L bor and Materials)
1.Building $ 13. ` 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fites•,9reA „/
Check No. C Check Amount: - Cash Amount:
6.Total Project Cost: 131� 0 Paid in Full ❑Outstanding Balance Due:-
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
1 CS-090170 05/09/2024 '
Robert J Decker IV, IV License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
150 Padgette St Unit A No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Chicopee,MA 01022 R . Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-259-8044 pioneervalleypermits@sunrun.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
1803/2024
Sunrun Installation Services Inc HIC 20 1x
Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
225 Bush St Suite 1400 pioneervalleypermits@sunrun.com
No.and Street Email address
San Francisco.CA 94104 413-259-8044
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 Issuance of the building permit.
Signed Affidavit Attached? Yes 19' No . ❑
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 Sunrun Installation Services Inc
to act on my behalf,in all matters relative to work authorized by this building permit application.
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
ri
c tained' this applicatio i true and accurate to the best of my knowledge and unders i/5L23
Print Owne s or u orized Agent's"Name(Electronic ignature) ate
g )
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,fmished 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"
li
Commonwealth of Massachusetts
t Division of.Occupational Licensure
Board of Building Regulations and Standards
r
ConsttdLtion th. rvisor
:y
CS-090170 empires 05/09/2024
ROBERT J DECKER IV,IV m
77 FEDERAL'T
MONTAGUE fltA 01349 .
I y."
4.
Cornmi85iofcr t .......—z,
Phone Number: 559-240-9370
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington $trt - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
(10) _ , ,,, Type: Supplement Card
•SUNRUN INSTALLATION SERVICES INC. '""""""'" ?egrs ation: 180120
"w'.:.:, Expiration: 10/13/2024
21 WORLDS FAIR DR w= .....
SOMERSET, NJ 08873
-411.1.41011110111110, w
t>
, ..... Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE:Supplement Card Office of Consumer Affairs and Business Regulation
Registration = Expiration 1000 Washington Street -Suite 710
180120 10/13/2024 Boston,MA 02118
SUNRUN INSTALLATION SERVICES INC.
ROBERT J.DECKER IV
225 BUSH STREET tom, rl ��/os� I �� �� __
SUITE 1400
SAN FRANCISCO,CA 94104 Undersecretary Not Valid without signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
= �= Office of Investigations
_ Lafayette City Center
_I - 2 Avenue de Lafayette, Boston, MA 02111-1750
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Sunrun Installation Services
Address: 225 Bush St STE 1400
City/State/Zip:San Francisco CA 94104 Phone #: 415-946-7500
Are you an employer? Check the appropriate box: Type of project(required):
1.® I am a employer with 50 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.+
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.L J Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 1 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information.
Insurance Company Name: American Zurich Insurance Company
Policy#or Self-ins. Lic. #:WC614287601 Expiration Date: 10/0(1/2023
Job Site Address: 93\rocx.-Dde
Z3'Z CuC 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby c ;fy under the pains and penalties of perjury that the information provided above is true and correct.
Si nature: 1.,/ ri.; Date: 2/8/2023
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(check one):
11=1Board of Health 2❑Building Department 31:City/Town Clerk 4.❑Electrical Inspector 5Elumbing
Inspector 6.0Other
Contact Person: Phone#:
City of Northampton
.r"s Massachusetts �_ r
1. AIt
DEPARTMENT OF BUILDING INSPECTIONS � 1
f 212 Main Street • Municipal Building 6
Northampton, MA 01060 ds;ryaa`-,`''',.
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.
232 Brookside Circle -Roofing permit
The debris will be disposed of in:
Location of Facility: 686 MAIN ST HOLYOKE MA
The debris will be transported by:
Name of Hauler: CASELLA WASTE
Signature of Applicant: /G"-ez.�-� YyG/u Date: 4/5/2023