38B-243 (5) BP-2023-0934
226 SOUTH ST COMMONWEALTH OF ASSACHUSETTS
Map:Block:Lot:
38B-243-001 CITY OF NORTH• MPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREG STERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUA- NTY FUND (MGL c.142A)
BUILDING ' ERMIT
Permit# BP-2023-0934 PERMISSIO IS HEREBY GRANTED TO:
Project# ROOF/SIDING 2023 Contractor: License:
Est. Cost: 19000 DAVE LALIBERTE 050099
Const.Class: Exp.Date: 04/02/20 4
Use Group: Owner: M M 'TINEZ JOSEPH C& ANNA
Lot Size (sq.ft.)
Zoning: URB Applicant: LALIBI RTE BUILDERS
Applicant Address Phone: Insurance:
11 BERWIN ST (413)695-3578 2001W9178
SOUTH HADLEY, MA 01075
ISSUED ON: 07/17/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF, REPLACE SIDING ON 2ND FLOOR
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 NO THAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: n
Y .
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building CommissiIner
„ -- - i -i . wit/o eNd Y
RECEIVED Wail-
/, JUi. 1 7 l o,4 e C)mmonwealth of Massachusetts FOR
ic:l :oar. of'Building Regulations and Standards
Massachu%etts Slate Building Code, 780 CMR MUNICIPALITY
0 1N PE TIONg USE
P ,.k. �,,,�,” , p tton To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
e-or Two-Family Dwelling
al is Section For Official Use Only
Building Fr it Number: W- Aa'73 y Date Applied:
KEur+v �, 7- 17-2oz
lJ�� � 3
Building Official(Print Name) Si ture Date
SECTION 1:SITE INFORMATION
1.1 P�gpe0.(3 -�0k �_Addre s: 1.2 Assessors Map& Parcel Numbers
ek
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❑ Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Qwn�er''of Reeccord: /�j l
Name Print '�` k ! 'l� l ` .U -t ci r
(Print) City,State,ZIP
S �� �rt �� �/tea,��". t� �► > ►�
o.and Street Telephone mail Addre
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 14 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of/imposed Wor ': SI r i 10. (`-O n f 5 %►1 t(�'
S-h-1iocOna re, 0-cf-- i"oft r , crocr 5 til.ax
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ , Ct
oc)C, 1. Building Permit Fee: $_Indicate how fee is determined:
2 Electrical $ / ❑Standard City/Town Ap lication Fee
❑Total Project Cost3(Item )x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
-
5. Mechanical (Fire $ r
Suppression) Total All Fes: $ Q(,�
6.Total Project Cost: $ r Check No.` Check Amount:_1 D Cash Amount:
1 0� 30 0 Paid in Full 0 Outstanding Balance Due:
r
SECTION 5: CONSTRUCTION SERVICES
5.1/Construction Supervisor License(CSL) C } L� c`, r�
C(j„ u 0..7�y.,J License Num er ' Expiration Date
�
Name of CSL Holder
hJ240 F" �! ��� 6( (j �✓(� \ List CSL T (see below)
No.and Street Type Description
�> / U Unrestricted(Buildings up to 35,000 cu.ft.)
4"("J?.4 �- jJ N '{vA /`J t7 R Restricted 1&2 Family Dwelling
City/Town,State,Z4P M Masonry
RC Roofing Covering
WS Window and Siding
t SF _Solid Fuel Burning Appliances
/ �10 � ` ,1/o-p ,4e I4 I insulation
Teleephone Email address ,Meii' „F„)1..±D Demolition
5.2 RegisteredHome Improvement C ntractor(KWIC)
L . (% (, e 1 Jt)t� � i'1 HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Nagle
I ► ,�..,..‘�PL-nS� IrlaL L(-ke boI Id(c 0
No and Street bc'.5 --> Email address
✓-T I.\ H 0.(- -- , pro o10�,5 /I j 55/g �c-j'r o,1 i ,GC`E'l
City/Town,State,ZIP J 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 ilk 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,he by authorize L(1)I(, c�(J, 60, IcLecTvvc
to act on my behalf,in all matters re' ' e to work uthorized by this building permit application.
IiILnA. Martin 2, S f i f v 3
nt Owner's Name(Electronic gnature) 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 accurate to the best of my knowledge and understanding.
, 5 I 7-623
Print 's or Authorized gent'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,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 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"
City of Northampton
Opt H R -,0..
SAS t` . • .,,,,,
" Massachusetts 4,� %<,
... Ir.: DEPARTMENT OF BUILDING INSPECTIONS , i 4'
':+►+rA 212 Main Street • Municipal Building of Cs Id
Northampton, MA 01060 �f'b,v 3,7\'
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: rc-...., r lJ:� '� �i J 8
The debris will be transported by:
, , ._ 1 , ,
Name of Hauler: al'4 Vim" , j�, . 1);- J7r chi 0-r C ` Jn
Signature of Applicant: . - Date: _ 3
.i The Commonwealth of Massachusetts
j 1 -! Deportment of Industrial Accidents
y • �� 1 Congress Street,Suite I
Boston,MA 02114-2017
�1 www.stass.gor/dia waacs.gor/did
)l urkers'('ontpensatiun Insurance Affidavit:BuiklersX'ontractors/E lectricians/Plumbrrs.
it) BE Fu_EI)11%1ill.fnE PERMiUTING AI TIJOwTI.
Applicant Information , Please Print Leeibly
Name 113usit 'ss`Orgamratianatndm /duall: I „r xJ 1.� 1` / _e.s '�, ...
H G
Address: ..tif- 4 Gx
e....
CitylState/Zip:,5ci 0`: , '.. ,(4: ' i Phone#:61 i 3 ti t S 3 v 7(
Are too an cmplover?Cheek the appropriate iio Type of project(required):
2
1 1 our:n employer with ,� employees(full and'or Puri-tinsel-• 7. 0 New construction
=.L1 I dill a wile proprietor or partnership and have no employees working fur me in IL Et Remodeling
arty capacity.[Nu workers'comp.insurance Required.]
9. p Demolition
3.0 1 ant a homeowner doing all work myself./Nu wurkus-ctmnp_insurance ngtuml_)'
10 Q Building addition
a.❑1 ant a lutrnwowrtcr and will be hirini conuraviors to conduct all work on my property. 1 will
ensure that all cotaracturs either hat a workers'rung/abiltrut utsuraneti ur are sole 110 Electrical repairs or additions
pruptte[un with no anploytts. 12E1 Plumbing repairs or additions
ti0 1 ant a general nmtr:wtur and I have hired the sub-cuntracturx listed on the attached sleet 13aRoof repairs
These sub-etmtracturs hate employees and have workers cusp.insurance.•
6.0 we are a corporation and its otTrccis have exerciser(then right of-exemption per MCiL c. I .00ther
32,§1(il,and we hate no employees.[Nu workers'comp.insurance required.)
•Any applicant that checks box AI must also till out the section below showing their workers compensation policy information.
'Ilomneost nets who submit this attdat it indicating they arc doing all work and then hire outside contractors must submit a new affdas it indicating such.
:C'unuacwrs oat check dies lox must attached an additional sheet slow ing the name of the sub-contractors and state whether nn nut those entities hate
employees_ It the sub-contractors hate employees.they Must pan ide their workers'comp.policy nunber-
I ant an employer that is providing workers'compensation insurance,for my employees. Below is the policy and job site
Colonisation. -
Insurance Company Name: Osain , �,' V'
f 1 /✓
Policy#or Self--ins.Lie.#: �1� W ? D Expiration Date: 5 . —3 4
Job Site Address: C�( 5 C)\( t, City/State/Zip:�)(` ��,.rn f 1101ri 4
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiratio date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal v lotion punishable by a tine up to S I.500.00
any or one-year imprisonment,as well as civil penalties in the form ofa STOP ORK ORDER and a tine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Otli of Investigations of the DIA for insurance
concrage verification.
I do hereby certify under the pains and penalties of perjury,that the information provided above is true and correct
�/ 3.Signature: /�/lti i., e — Date: ' Zf -L4
Phone#:
Official use only. Do not write in this area, to be e-o►npkre'tl by city or town o//iciaL
('its or Totsn: Permit/License k
Issuing Authorit} (circle one):
1. Board of health 2. Building Department 3.('Ity/fown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('intact Person: Phone#: