22D-036 (7) BP-2023-0665
42 CLARK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22D-036-001 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-2023-0665 PERMISSION IS HEREBY GRANTED TO:
Project# roof 2023 Contractor: License:
Est. Cost: 5980 ROBERT THIBODO 65699
Const.Class: Exp.Date: 06/22/2023
Use Group: Owner: R. ARONSTEIN, STEVEN
Lot Size (sq.ft.)
Zoning: WSP Applicant: BOB THIBODO ROOFING AND SIDING
Applicant Address Phone: Insurance:
P O Box 201 (413)586-0391 UB0250N144
NORTHAMPTON, MA 01061
ISSUED ON: 05/22/2023
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 NORFHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
r )2 11/4
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissisner
7 The commonwealth of Massachusetts
W
MAY 1 9 2023 Board of Building Regulations and Standards FOR
Mtssacliusetts State Building Code, 780 CMR MUNICIPALITY
USE
--- ildinz ermit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
jF`Q ' ?'Nr,INSPECTIONS One-or Two-Family Dwelling
rN,a'11 n�,
_ Gas-
Section For Official Use Only
Building Permit Number:l4 9-3"3•Gas- Date Applied: i
T
.2 1 L g
Building Official(Print Name) Signature D p
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
I4a ClAyle Si
1.1a 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 Owner'of Record:
S- e < / rc r\ AT r T I bY'-e,,, (..‘ Vl A cS'
Name rint) ` City,State,ZIP
No.an kreet Telephone Email Address An
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ttil1 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
of Description of Proposed Work':
Z C -:h\N 'Nr CA t(1/4,NI- %'N .V e' \' A-u c'w NA' - S-?Z"A'
SECTION 4:ESTIMATED CONSTRUCTIION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
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 $
Suppression) Total All Fees: $ klip
Check No.26?'lCheck Amount: "1"
6.Total Project Cost: $ 5 ' 0 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
YF
Massachusetts `f
erg
DEPARTMENT OF BUILDING INSPECTIONS
t 212 Main Street • Municipal Building
Northampton, MA 01060
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.
STION(CSL) 5: CONSTRUCTION SERVICES
r.1 Construction Supervisor LicenseEC
0 -- --G—C3 Nis '
-. o a) License Number Expua ion ate
Name of CSL Holder I [�
List CSL Type(see below) \r
Type Description
Flo.and treet
\— U Unrestricted(Buildings up to 35,000 cu. ft.)
CT v R Restricted 1&2 Family Dwelling
City own,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
\ SF Solid Fuel Burning Appliances
5-7 S 1 9(s`Z +pCb-`.\-) \o cF 0 jrb 0 ^ I _ Insulation
Telephone Email address PitO D s Demolition
5.2 Registered Ho Improvement Contractor( ) c I , , ,
a r
�p> 4 �) HIC Registration Number Expiration Date
CHIC Company Name or HIC Registr t NameI
N�d Street
S.*Xx , S
S / � i� 6-1
� Email address
City o tate,ZI 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 Issuannce of the building permit.
Signed Affidavit Attached? Yes C4 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 p ttj '_ \ - n Ac
to act on my behalf,in all matters relative to work authorized by this building permit application.
' "\i5 sCtrtliNA--N 4-t'1ti s a vcl , a3
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AG ENT 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 knowledgle and understanding.
( ; ‘\ d0 'c;;),4— S.
1ci 2)
Print Owner's or Authorizedd Agent's Namectronic ignature) 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.) Habitabe 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
..,=:. . ,,.=..
:limo— I Congress Street,Suite 100
—... .raa
aitars ti
t ' Boston, MA 02114-2017
7?.. '
WWW.mass.goildia
‘s 01-kers c.oinpritiation Insurance Affidavit:Buildem'ContractorifEketricianstPlumhers.
TO DE FILED WITH ItIE PERNIIIITING AUTHORIIV.
Annhicant I it fo rni tion Please Print Le ibis
Name 113u.satess;Organtzulumandiviehial):
Address
City,StatelZip:_ _ '• Phone ;;-..A.re yea win employer?t the apprapriatc bat: I Type of project(required):
i.rdl 3171 a employer with employees(full WittOr part4iine),* 7. 0 New-construction
2.0 I arn a aolc proprietor or pnatnershrp and have nu employees working for me us I, li. 0 Remodeling
any capacity_fNo workers'comp insurance required.]
1 9_ El Dettniiiiiittl
3.0 I iris a horIXV4V114:7 doing All*cat myself INo int.yriers'comp insurance required]
10 0 Building addition
40 I arn a hinincov...nta and will be hiring oantras:Iiits to readmit all work on my property I will
=sure that all contractors either have workers"corrxrensation insurance tx are sole 1 1.0 Electrical repairs or additions
rrtuprietion V.ith no cinployetni,
i 13 P umbing repairs or additions
5C3 I am a 1,..f.A BC I al contractor aqui I hake hina.I the sub-contractors Listed on the attached Aheet
13 Roof repairs
These sub-contractors Ittwoe employees Anil Ita.i.c workers'comp.insurance)
14_0 Other
6.0 lika.are a corporation and its officers have exercised their right of citemption per Nit&c
I 2..,§li t i,and ia.c base no emp,klyiC5.[No workers'comp.insurance?firmed]
*Ar.,.,applic.in I ma;checks boa a 1 mnst also till out the section b.:km N'_/(,,..Iii!..!theta Aorixr,'compensation policy information
* tiotT11:060.1firS...,ht,'alltlThri dos aftidaYit in4hcatinu they AM doing all taint and then hue outsido contractors must iiiihnut a new Affid.av it indicating sus I.,
:Contractors that check this box most atuclrod an additional sheet Sneak ing the name of tlb:sutreontractors And awe 0.Itctito:tn not those entities lizo
ciriployees tribe.Aub-cuntracturis.liiiiYe employ ees.they must pruside their .workers'comp.whey number
„ . ..._ „... ,
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: 1 1
Policy#or Self-ins,Lic.#: LYS'S 0 . -. ..0 NI 1 L 4I\._\
......,
Expiration Date: T. 017-1
Job Site Address: 14 ..)--. C\A CA:Y. V, Si- City!State,Zip:
Attach a copy of the workers'conipensation policy declaration page(showing the policy number and expinition date).
Failure to secure coverage as required under?s1GL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00
anikor one-year imprisonment,as well as civil penalties iri the form of a STOP WORK ORDER and a tine or up to 5250.00 a
day against the violator. A copy of this stateinent may be forwarded to the Office of Investigations oldie DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Sgur .----- ligIV—Vira inate: rrinktp Date: . ) ) 7 4-3
Phone Li 1 . S7 c."' 1
Official use only. Do not write in this area,to be completed by city or town official
City or Tow n: Permit/License#
Issuing Authority (circle one):
'.. 1.Board of Health 2.Budding Department 3.Cityriown Ckrk 4.Electrkal Inspector 5. Plumbing Inspector
6,Other
Contact Person: Phone#:
r
City of Northampton
Massachusetts ,.
' DEPARTMENT OF BUILDING INSPECTIONS
, 212 Main Street • Municipal Building ,,_
— '� Northampton, MA 01060 IS<�y t `'
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: ` c. `'")y c IC
Location of Facility: 0Y-T}\c•A ..- o
The debris will be transported by:Rp\j) v040� � dName of Hauler: %cr-D-
`J
Signature of Applicant: ,- --c Date: .S - I aX3
City of Northampton
Massachusetts
" ,+ DEPARTMENT OF BUILDING INSPECTIONS " 4
212 Main Street • Municipal Building,.
R m" Northampton, MA 01060s q%
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)