22B-027 (6) BP-2023-0905
19 CORTICELLI ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22B-027-001 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-2023-0905 PERMISSIO IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 7500 PROSENSE ROOFIN INC 049401
Const.Class: Exp.Date: 10/03/202:
Use Group: Owner: LLC 1' CORTICELLI STREET,
Lot Size (sq.ft.)
Zoning: URB Applicant: PROSE SE ROOFING INC
Applicant Address Phone: Insurance:,
322 BOSTON POST RD (978)440-7600
SUDBURY, MA 01776
ISSUED ON: 07/12/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF
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:
4 I lr • >2
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissi4 ner
Erlia,iiw ilitiatEDThe Commonwealth of Massachuse I sBoard of Building Regulations and Sta dardsp„ OR
' Massachusetts State Buildin Code 780 1 ' ti o'`eu� P• ITYV g ogres °.rniG INSpSE
Building Permit Application To Construct,Repair, Renovate Or Dem s —1 AA•iZtri iod M,r 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building P rmit Number:P Date Applied:
th7 7•ll,Zbz3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: ( 1.2 Assessors Map&Parcel Numbers
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Difensions:
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❑ i
SECTION 2: PROPERTY OWNERSHIP'2. 1r'ofee t ' 1 stb 'n6 `( ►`'1 / - 0 I-776'
a-e
Name(Print) City,State,ZIP
VA Ccsr f ce l L S f 9 B 06 Li
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WO 2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repai7s(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
------tr...._. ke
+ A_ Ae-CN) F—
SECTION 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 Fe �`(�r'd
Check Check Amount: 11N
6.Total Project Cost: $ 5 f 0 0 Paid in Ful 0 Outstanding Balance Due:
IIIIIIIIIIIr
4,: ,-,.
City of Northampton
Massachusetts ..v
-- 9
DEPARTMENT OF BUILDING INSPECTIONS„„„)
i°
212 Main Street • Municipal Building 4�
Northampton, MA 01060 Y 3:,l
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.
V.:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor (CSL) 0 9 ti 0 1 10 — 3— 3
ID 4 0Lk(2 2 1,1. License Nmber Expiration Date
Name of CSL Holder
.;3 Q ST St List CSL Type(see below) le—
No.and Street ,n Type Description
LA)µl,e,Nti_ ,"r / ,/4 1"I- 0 If 1 Z U Unrestricted(Buildings up to 35,000 Cu.ft.)
�°"`� V� R Restricted 18t2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
(�L� SF Solid Fuel Burning Appliances
n/ ts 1 I t %at, o I'E`'�- -Q toW S`�St roilv5, L(2 I Insulation
Telephone Email address D Demolition
5.2 Re istered Home Improvement Contractor(MC) i , 2)6 Z c (L/i c 3
r It a
S-I'viSe `3 1 W< HIC Registration Number Expiratio Date
HIC Company Name or HIC Registrant Name
22 g o 51 t)J ro S r ,e(' d ,,C Q (',to''tN=t 0W . Ca&
No.and Streets v 17.6 14* o 11?� °l I% 4 4U 76 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. Failure to provide
this affidavit will result in the denial of the Issuanc of the building permit.
Signed Affidavit Attached? Yes 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering nam' below, I hereby attest under the pains and penalties of perjury that all of the information
contained in th ap111)
ation is true and accurate to the best of my knowledge and understanding.
el ID I a3
Print Owner's or •uthorized Agent's Name(Electronic Signature) Da
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,ftnished 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 Numbed 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
' Itlitifila. i Congress Street,Suite 100
Boston, MA0114-2017
w w'v.mass.goridia
Workers Compensation Insurance Afridav it:Builders)ContractorsiElectricianstPlu in hers.
1'0 Ht.I-II.ED WITH THE PERMITTING AIITHORITY.
Applicant Information Please Print Leitibh
Name t II u5 iittselkganizattort,'Individual 1." PK 6 ''RA) t di40 t)(--X171- :.-1:-.01_
Address: ; 2 2— e„,-,--,,,..) to,T i<e
City/State/Zip: <,./\9 4--1,---t1 01- big-7 4. Phone :______
Art yowl an einplloyer?Check thr appnuirriatr box:
..r.),pe of project(required):
1,0 I an'a employer with employeah Olin atirtor part-hine I„• ' 7_ J New couStruc lion
10 1 am a vuk prupnetur ur partarrahrp and have no einplaaytet.teurliu fur ine in 8. fl Remodeling
any rnpaciry [Nu workers'comp,insurarier required.]
9.. El Demolition
30 I am 2 hunacov.nm&new all work myacIr.(No%relit-ell'alum,Inatnatwe required''
10 0 Building addition
i a 1 am a hamixiwIla and will be hiring contradors to venditet all t4 ork on nty property. I will
intstor that all consiactots either have tt,orkeni'ivaripenaation insuniner or are bele 1 1 a Electrical repairs or additions
pronnovaa..1 ith no employces_
I ID PI a ing repairs or additiomi
fscri I am a ommal contractor and 1 ha.,.hoed the anb-cunanclon,hated on nu:anaLlunl sheet
un r rac13 liti`i ' if reparrs
-1 ,bt it,-I; ks rN hat'.Linplu yeea and has,e wurktra .amp
' insuran. ce.:
Vi.
1-1_00ther
6. We ure a tuipurntion and its ufficims have eaerriatal their right of taernrtion per Wit.c.
152,§101).and wa have nu employvel.(No v,Awn'comp.imam:ince required.]
'Any oppii,.ei I Inx,11-xl,...%box al nnw...,1,,ill;our the iretion brlov.hilt-1.4:nm their v.orktx,'0.,Iltrkn,al ion piii,.,,,.., eiroriranan.
f flanneun tiers 44 hu,tanintt tin%affickavli'mile:Jura they arr doing all work and Ibsen hue out,ide rotor-at:tee,raint siihririt a new affidaN it aridicantig sla.:11
:Contractor%that ch,Lk this box maw attached an additional sheet ihorting the matte of the i.till-eurittaeters and.air thiletter In not those entities liaw
....rarlo,er, It tlx•swb-cunitartors Ir.o.c employ ce,i.they must pro,ide their V.Orken'corny.p.,114:). raarilvi
I ant an employer that is providing, workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: _
Policy#or Self-ins. Lic.4+: Expiration Date:
Job Site Address: 19 cov4-1 c•e_1(; S't city'State/Zip: litt Itliblibi4 1(4 0 0 I bt.2
Attach a copy of the workers'compensation policy declaration page(shus%ing the policy number and expiration date).
Failure to secure coverage as required under MGL .. 152,§25.A.is a criminal v iolation punishable by a fine up to S1.500.00
andior one-year impnsomnent,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a
day against die violator_A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
,,,‘,.:_•77,1,...!,_. \c n li...:at ion.
I do hereby certifj. der th pains and penalties of perjury that the information provided above is true and correct.
Date: "1
S3cnaturc:
Phone '-:. CI icz Lp-frb -7 C.,c-.3
Official use only. Do not write in this area.to be completed kr city or town.official
City or 1'04n: PermitiLicense#
Issuing Authority, (circle one):
1. Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
b.Other
;
Contact Person: Phone#:
City of Northampton
ilir
�` Massachusetts '�.,,
DEPARTMENT OF BUILDING INSPECTIONS 1. , .
`;iw 212 Main Street • Municipal Building a,„ ,;'
.. Northampton, MA 01060 4 ,. i.>0
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: AnN=111A_c,/ c1.4) 6-:L l
-6_,441
The debris will be transported by:
Name of Hauler: C<(t' k S — (-ifr,q. rk A-
Signature of Applicant: Date:
City of Northampton
,, . Massachusetts 4 . .. '`�,'4,
DEPARTMENT OF BUILDING INSPECTIONS R, t
212 Main Street • Municipal Building
Northampton, MA 01060
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. 1 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)
HOME IMPROVEMENT CONTRACT
Date: 0812312023 Sold.Furnished and Installed by
Job# PRr cEN5t ProSense Roofing,Inc. •
ROOFING 322 Bostonu Post
Tel:978-440-7600
Federal ID#47.146299 •
MA Home Improvement Contractor
Red.#173625
.�.-in Address 19 Corticelli st.N.Hampton .
Purchaser(s) Work Phone Home Phone
199 Corticelli St.LLC CIO Gene Pettinelli 509-397-0614
Home Address: 19 Corticelli Street,Northampton.MA 01062
(If different from Installation Address)
Project Information:WANerYou("Purchaser"),the owners of the property located at the above installation address.
offer to contract with ProSense Roofing,Inc.to furnish,deliver and arrange for the installation of at matenals as
described on the attached spec sheet#:
ProSense Roofing Inc.reserves the right to cancel this contract if,upon re-inspection of the job,ProSense
Roofing,Inc determines that it cannot perform its obligations due to a structural problem with the home or
because work required to complete the job was not Included in the contract.
CONTRACT AMOUN
T
$7500 DEPOSIT PAYMENT OPTIONS
'LESS DEPOSIT $3500 (Subject to fund verification and/or credit approval>
BALANCE DUE ON COMPLETION $4000 I.Check,Cashiers Check,or US Postal Service Money
Indicate Payment Method For BALANCE DUE ON Order(Made payable to ProSense Roofing,Inc.)
•COMPLETION: 2.Credit Card'payment options-Circle One Below Visa
Mastercard Discover American Express
Ace*. Exp.Date: •
Name as it appears on the card •
'By my/our signature below, Ma agree to allow
ProSense Roo'iing,g Inc.to charge the above-referenced
credit card for the deposit indicated,
•
•
•
•
•
•
stnamn ow
Cardholder's Signature
Purchaser agrees that.immediately upon satisfactory completion of the work,Purchaser will execute a Completion
Certificate and pay any balance due.The purchaser also agrees to be jointly and severally obligated and liable
hereunder.
Entire Agreement This agreement and its attachments,including any financing agreement,contains the complete
agreement between the parties and cannot be amended or modified unless in writing in a separate agreement signed
by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read it.You are entitled to a completely filled-in copy of the contract at
the time you sign.Keep it to protect your rights.Do not sign any completion Certificate or agreement stating
that you are satisfied with the entire project before this project is complete.Law prohibits home repair
contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual
completion of the work to be performed under the contract.
You may cancel this transaction at any time prior to midnight of the third business day after the date of this
contract.See Notice of Cancellation for an explanation of this right.There will be a service charge equal to
25%of the contract amount If the job is canceled by the Purchaser AFTER the third business day.
BY MY/OUR SIGNATURE.BEI..OW.IMF.AGREE.TO BE BOUND BY THE TERMS OF THIS CONTRACT. IME.
ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE
NOTICE OF CANCELLATION,DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
5gnaaee Date
SUBMITTED BY
Sales Consultant
......... 62312023 62YM023 ........
SUBMITTED BY SUBMITTED BY
Homeowner Homeowner
NOTICE ADDITIONAL TERMS,CONDITIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND
ARE PART OF THIS CONTRACT.
White-Office Yellow-Customer Pink-Sales Consultant