38B-151 (3) BP-2023-0460
65 COLUMBUS AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-151-001 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-2023-0460 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 3000 JAMES ROBERTS 099404
Const.Class: Exp.Date: 01/21/2024
Use Group: Owner: FIELDS ROBERT G& TAMAR TAITZ FIELDS
Lot Size (sq.ft.)
Zoning: URB Applicant: JAMES ROBERTS
Applicant Address Phone: Insurance:
30 Edwards Rd (413)527-6078
WESTHAMPTON, MA 01027
ISSUED ON: 04/18/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF PORCH ROOF
POST THIS CARD SO IT ISI FROM THE STREET
VSIBLE
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
• .).2
1/&:).V
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissioner
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The Commonwealth of Massachusetts".o o,�
Board of Building Regulations and Standard i>,4: , c7Q FOR
Massachusetts State Building Code, 780 C1�IR\� '�,,�� scr IvMCIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or De `� ,/?evise(Mar 2011
One-or Two-Family Dwelling ' 06,otitis
This Section For Official Use Only
Buildin PermittNumber: 8/9- }3. `/{p11 Date Applied:
CUI�) /1Cnn //.42 i 14-19-20z3
Building Official(Print Name) Signature I Date
SECTION 1:SITE INFORMATION
1.1 Prop&rrty AId s:eef„nbei 414 1.2 Ass3essors Map&Parcel%n e s
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 0 rl o Record:
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(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 Specify:
Brief Description of Proposed Work2: ' p /L47?-- ,e � Z
SECTION 4:ESTIMATED CONSTRUC ON COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical ,56, 0 CIStandard 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 k
Check No32 tU Check Amount.
LIO
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts �f
E
$ DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 1.6
Northampton, MA 01060 �ta
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 Construction Supervisor License(CSL)
9 l 46 it /— i
License Number Expiration Date
Name SL Holder
(4& AI--x9e p List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
Ci own,State,ZIP M Masonry
6/7�� ow Covering
Wind
Window and Siding
Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered o Improvement Contractor(HIC) �7/$ / / Act`
Mu Registration umber Expiration Date
HIC Company N e or HI gistrant Name
No.and Street *LC Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE A}I~71)AVIT(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 ❑ 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
to act on my behalf,in all matters relative to work authorize this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER1 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 accurate to the best of my knowledge and understanding.
',A m rS' le()OF of r Li / •-•?3
Print Owner's 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, fished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitab 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"
.f..Z.,
_______ The Commonwealth of Massachusetts
iineon:lie
Department of Industrial Accidents
1 Congress Street,Suite 100
4
Boston, MA 02114-2017
i
:5;91‘ WWII".mass.goildia
‘1.otkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH 1 lIE PERNIITTING ATITEIORTIV,
Applicant Information Please Print Legibis
Name(Bus mess:Organization,'Individual):
Address: 3 6 W.e/errvi,,, ' /rp
City/State/Zip: 1& fj7Phone P: L-74/3 —4110." 0 c7.c."O
—
Arr you an employer?Check th IIe pprupriar hot: 7—
T‘pe of project(required):
:D I am a employer with employees(full and-oe part-time i,' I7. 0 Neu construction
2..yr-sin a sole proprietor or partherslop and haw no employees working for me in g. 0 Remodeling
any capacity_rNu workers'comp.insurance rind]
9_ El Demolition
4:II am a hunsc-ownes doing all work myself.[No worloas'comp.insurance requital.)
i 0[73 Building addition
4.0 I am a hums:Avner and will be hiring contras-1ms to conduct all work on my property, 1 will
=sure that all contraciurs either have workers'compensution emu:lune tie ape sole 1 i a Electrical repairs or additions
proprietors with no employeo,
1 ID Plurnbmg repairs or additions
I am a general contractor and I ha.e hired the sub-contractor%listed on the attialtAi Nheci.,
13 repairsrIRVSr
These urb-curstractimi haw csinsloyeci-s Ind havt workers'comp.insurance.:
I 4.0 Othet
6.0 We are a c-orporalson and its officers haw exercised their right of eactisptiini per NMI_c.
01.§li 41.and,o.e Le.c no employees.(No workers'4.1.18t1p insmanee retturrixtj
'Any applicant Mut iritml“box a I nahl alai fill our die'section below show ins then workers C1.1131pcmatum pokey utlormation.
*floineow viers who submit this anion indicating thiry are doing all work and then hoe outside coniractors must submit a new affidavit risilicahrig such.
:Contractors that check this box mist attaelwil an raitistional!beet show in g the name.of the sub-contractors and.rate whether or not those muties have
einploces. If the suh-eornractors ha kc ortrkit:ces,thy!,'saw provide their workers:cc,rrip,iv lac).1114.31,11Ser. . .
1 ant an employer that is providing workers'compensation insurance for my employees. Below ii the polity anti job site
information.
Insurance Company Name: —
Policy#or Self-ins.Lc.4.: Expiration Date.,. 5-1Z ki
Job Site Address: City'State:lip: - ,-4 t
Attach a copy of the workers'compensation policy declaration page(showing the policy number aria expiration date).
Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to 51.500.00
wiiior one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 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 certif.),under the pains and es of perjury that the Information provided above is true and correct.
Sivnature: Date: It— /q`--pl 3
Phone#: q 73 — 4-/i q /- 6 35()
...,,,,.-e,,u,
.use only. Do not write in tiriA urea,to be completed by cite'or town official
City or Town: Permit/License#
Is%uing Authority(circle one):
I. Board of health 2.Building Department 3.Chyffown Clerk 4.Electrical Inspector 5. Plumbing Itispcctor
6.Other
Contact Person: Phone#:
City of Northampton
o4:,,, 4‘‘C Massachusetts tee` 'cry
# ', DEPARTMENT OF BUILDING INSPECTIONS
y
212 Main Street • Municipal Building ':� ,-?'
Northampton, MA 01060 'PrIl} i,--,,'ti''
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:
J-
Location of Facility: /7'
-1LJ
The debris will be transported by:
Name of Hauler: _
Signature of Applicant: V r Date: ` /zT
City of Northampton
Massachusetts o,t- c,,
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Pa
,t DEPARTMENT OF BUILDING INSPECTIONS 4
212 Main Street • Municipal Building �0t:' i;*
''�—`4 Northampton, MA 01060 �'A ii0k
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_(insert
month, day, year), hereby depose and state the following:
1. 1 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)