12-011 (10) BP-2023-0430
150 NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
12-011-001 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-2023-0430 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 21000 ROBERT THIBODO 65699
Const.Class: Exp.Date: 06/22/2023
Use Group: Owner: VILLANI ANTHONY P
Lot Size (sq.ft.)
Zoning: WSP Applicant: VILLANI ANTHONY P
Applicant Address Phone: Insurance:
150 NORTH FARMS RD
FLORENCE, MA 01062
ISSUED ON: 04/12/2023
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:
t inal: 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 ' ,
i • J' i
>2 .Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
r `=-"\ o f $-
,r
The Commonwealth of Massachusetts mPA
Board of Building Regulations and Standar s 1 7 , ` FOR
023 Ml1NICIPALITY
q Maschusetts State Building Code, /80 C of USE
Building Permit Application To Construct,Repair,Renovate( i'Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: ,p- .Z 6-- 1-13U Date Applied:
/60/0 & I/42 Li.J'Z•Zoz3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Addr 1.2 Assessors Map&Parcel Numbers
clic
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(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 toner'of Recor , ^A
Name 6(Print) \ Ci ,State,ZIP
R\j\
No.and Street Telephone Em ddress C N,vIt��""�
�}a
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) % wr
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 1 ' Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
CR-e•rro-'4, N3 \-N s,,3 S�d % �►- �t C� \
j i_p__ \> NYC \.(C .�
1
vv\s\< S
ECTION 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: $� , (Q
Check No. aN heck Amount:"'l Cash Amount:
6. Total Project Cost: \%‘1 ej 0 0 Paid in Full 0 Outstanding Balance Due:
I i
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Su rvisor License(CSL) r+I rid ,.l ,), ,��
[�3 5 6 )
icense umber Expiration Date
Name of CSL Holder
List CSL Type(see below)
C � d� ��� �`� ;� IS
No.and Street Type Description
,}- Unrestricted(Buildings up to 35,000 cu.ft.)
e C S '1 t\e- N R Restricted 1&2 Family Dwelling
City/Town,State,Z M Masonry
. .*'? €--- '11tp‘ RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
S`l.i3 ' t C)6- I Insulation
Telephone Email address 1) Demolition
5.2 Registered
dHHoom Improvement Contractor(HIC) ` ' 1 , , ` '
�� 1► 7n l: Cpl.� HIC Registration Number `-Expiratioon'Date
HIC Company Name or HIC Registrant Nave
d Street Email address
City/Town,Stat 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 Ill 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 b ` a
Ak'l----------__
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Own es 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 true and ccurate to the best of my knowledge and understanding.
a� 1 :\o a \if\\\GW.; LI ^ q - a 3
Print Owner's or Authorized Agent's Name(El onic Signatur.) 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 hallrbaths
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
pi b:-L1-",'rl, S`S .. Sic
f
r` Massachusetts
DEPARTMEN , '��G
k T OF BUILDING INSPECTIONS �n
� 212 Main Street • Municipal Building yJ� •
1,
-�N^-� Northampton, MA 01060 'SNy`, 3rpx`v'
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.
, D_ cs
0.--\S
The debris will be disposed of in: `,,
Location of Facility: -i bNr TT\o • )***()\,. _
The debris will be transported by:
0 a___()
Name of Hauler: CDC ���
Signature of Applicant: ��rv—t Date: . °. 4:3
The Commonwealth of Massachusetts
1 Jim Department of Industrial Accidents
`' 1 Congress Street,Suite 100
Boston,MA 02114-2017
' www mass.go►*/dia
-t-Ac-
%l uskers'('ompeasation Insurance Af idas it: BuilderslCootractorsiEketricianstPlumbers.
it)BE FILED N liii THE PERMUTING Al'THUWTI.
Applicant Information Please Print Legit.
Name i 0tutncss't)rganizauuoi dividwl):% 6-3 ---�1Ih--#1'D 0 d,.6
Address: `-S 4, t�l 04z Ste_ _. . . _ _
City/State/Zip: Phone#: 5i 5— ) Ci (`""1 Are pael..as employer?Check the appropriate bet:
Type of project(required):
1dI am a cntpkrytr with a enipimccs hull and ur part-tune!.• 7. 0 New construction
1DI am a soh proprietor of partnership and hate noctripkritu working tot mein $. 0 Remodeling
ton capper-ft.[No workers'comp.ut urtnce required.
9. ❑ Demolition
30lam a homeowner doing all work myself.[\u%tracts•comp. nrrsurmre minimal.!
10 a Building addition
4.0 I am a homeowner and w dl be hang etrniracturs to conduct all work on mt prop rt�. I w ill
ensure that all contractor%Lathcr Mate workers'compensation unimone to arc sole 1 i a Electrical repairs or additions
proprietors w dh no cmrpiuyee%. 12._. tubing repairs or additions
50 I am a general contractor and I hat c hired the SUb-00111011C1Oti Iitled an the attached sheet-
13 Roof repairs
Thee sub-contractor.hasc employees and hate walkers'camp.insurance.
4.
6.0 Vic are a corporation and its officer,hat c exercised their nght ui tttmptodn per SAIL c. 1 El Other---
132.111a 1.and we lute nu ergrlmres.[No worker%'comp.irntraaee requuod.I
•And applicant that checks boa=1 mini also fall out the sectront below%huwmg their workers'comtptwatrun pulse)Information.
{liunieowratrs w km subset duo attrdasrt indicating tors art doing all work and then hue outside contractors mutt submit a new atiida%it mdmitng such.
•(ontractc.rs that check this hot must attached an additional shirt show mg the name of the sub-contractors and state whether or nut dire armies hate
employees. It the sub ctmlractcrs tease emplo oes.the'must prutide their workers'crimp.polio number.
I am an emplo►er that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: �• —
c-SPolicy#or Self-ins.Lie.#: UT.)\r) , (.... N 1 '-[ L( Expiration Date: ' r ) ' r)-.Lik
Job Site Address: 1 Cl -'''Jlf\ry 3 Cl?... ' City State Zip:q pY'-eM ('-e M\
Attach a copy of the workers'compensation policy declaration page(showing the policy number and etplrallon date).
Failure to secure cos crage as required under MC&c- 152.K25A is a criminals tolation punishable by a line up to S 1.500.00
and or one-year imprisonment,as well as cis il penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the s iolator.A copy of this statement may be forwarded to the Office of Ins estigattons of the DIA for insurance
cos erage verification.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
L/Signature:�Signature: . ,�� ��i-•�`/(�..�:. Date: 1
\I)
phone j'"—) _s- ! (--,`—\
Official use only. Do not write in this area,to be completed by city or town official
('it♦ or Town: PermitTicensee#
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3.('sty Town Clerk 4.Ekctrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: