23A-224 (3) BP-2023-1103
99 NONOTUCK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-224-001 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-2023-1103 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 ROOF Contractor: License:
Est.Cost: JACK E MORSE ROOFING CSSL 104141
Const.Class: Exp.Date:09/29/2023
Use Group: Owner: BIERWERT KAREN
Lot Size (sq.ft.)
Zoning: URB Applicant: JACK E MORSE ROOFING
Applicant Address Phone: Insurance:
2 LILAC AVE 413-374-9064
CUMMINGTON, MA 01026
ISSUED ON: 08/16/2023
TO PERFORM THE FOLLOWING WORK:
STRIP&RE-ROOF -STANDING SEAM METAL
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:
e, • . >2 . Til
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
\
N
N
�;< The Commonwealth of Massachusetts FOR
„ ° Board of Building Regulations and Standards MUNICIPALITY
L Massachusetts State Building Code, 780 CMR
USE
i -=a BtriLi•Ftg Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
w This Section For Official Use Only
BuildingTeermit Ntmber: 2O22j—I I 0 3 Date Applied:
itUt,.s �Jlon 2 S 1L Z)Z3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
'rk WOO 'IAA c,IL F\ofeAce- v-ND 2?,i4—22+I-0e 1
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3uonning Information: 1.4 Property D�mm nsions:
��jj
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❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owners gf Record:
K (Lea 8 e fl,�?r Name(Print) l City,State,ZIP 1C\ VONOT1/4. .c,k. 'S"1 D10 , 2. L{�� - S��1� !1 G�S)
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(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 ❑ Specify: iaboF e► —1
Brief Description of Proposed Work': S t(L C P *- 01 S P O SL 't n,C1-Q,‘ j c_ Wce i ,
AP(aQt,e r �,,..k S-��d ,�S Q F.N
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:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost3 (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees: $ go.sD
r Check No2/02—Check Amount:40..— Cash Amount:
6.Total Project Cost: $ Ct
1 (Q 0 0 Paid in Full ❑Outstanding Balance Due:
• City of Northampton
Massachusetts h�?`
Ac"j` , ` DEPARTMENT OF BUILDING INSPECTIONS
04' .-� 212 Main Street • Municipal Building 9l'''':.--$1-
1- , Northampton, MA01060PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NE& 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. 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. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW/ private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. 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) 1 O C( 12 ct )2 Qz 3
License Number Expiration Date
Name o CSL Holder
List CSL Type(see below) Q�/
No.and Street Type Description
L . A ` n „ a- 0 I�^ ( Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,State,ZIP J V N/\ !mob Restricted 1&2 Family Dwelling
M Masonry
Rd Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
o c,/1 50-0L,, Qwair Q Jeritva I Insulation
Telephone Email address ,IJCA- D Demolition
5.2 Registered Home Improvement Contractor(HIC) `\ DI 6 9 7._ 6 /Q 12025
HIC Registration Number Expiration Date
HIC Corn any Na ear HIC Registrant Name
ar 4.- ;Soc-k_L 1,L-Atati, VeC i20.,►
No.ant �� Y V kdL� C n� 1-7U-906� Email address p)�
�-h/�Mpn �w 1, f
•
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 Issuan 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 my name below, I hereby attest under the pains and penalties of rjury that all of the information
contained in this application is true and accurate to the t of my know ge and understanding.
Jt►�c (, t1k 1 S/ 2027
Print Owner's or Authorized Agent's Name(Electronic Signat e) Date
TES:
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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
t
4
City of Northampton
Massachusetts '+ ce
1 VA Ai ist
° DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
a ^. Northampton, MA 01060 J11' 10
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: 4V\ttc-r‹, �=`" � � C0 `.
The debris will be transported by:
Name of Hauler:
r �'� (.1(
Signature of Applicant: Date: L3.. C Zp27
4
—.7...... The Commonovealth of Massachusetts
=m .... ,
1 amvi= Department of Industrial Accidents
.., In ,.........
innirta pIIIIIIIIIN
410.**41 I= I Congress Street,Suite 100
*"1.i. ......
Boston, MA 02114-2017
-..,...._,........- ,
wrov.mass.govidia
- 11 m kers"t'ompensation Insurance Affidavit:Builders;ContractorsiElectricharksiPlunibers.
TO Ili.:FILED vk I III TILE PEFt N11 I 1 INC At-111()R1 IA.
Auntie:int Information Please Print 1..egi his
Name i atismess,Urgarsuationilnaividual v. -57),i(..,t,-,_ 0./•.1.11____5...P------
Address; ' 2.— L- %\TN--i c_. .P0--•,..---'
CityS atelip. C.A.Adv•-to—r----....: --- V\-A.S) 6(di(IP hone#: H (1 -3 -1 -k. -cd C
Are.,,,( an r :ploy er?Check I be a pproprte toot: Ty pe uf project(required).
7. El Nevi construction
— Jr°a sub:proprietor or partnership and have no employees workithz for me in 8. 0 Remodeling
any c)pseity.INu warkeri'comp.notation.* imptiredj
9. El Demolition
30 I 4191.ti hOtThtiaWilet doing all.work myself.['No workers'min, imoranet required].
i 0E1 Building addition
40 I aiii a horreowno and will be bums contractors w mealtiet all work on my property. !will
4...msum that ali coloration either have workers'coosperoatorir lamina...1:or ioe sole 11.0 Electrical repairs or additions
proprietors With no eiriphayees.
I 2-0 Plumbing repairs or additions
I am a valeta]euntractor and I has,c hired the sub-euritonlors listed mi the ana4.-hed sheet.
i 30 Roof repairs
These soh-etmtractors haw mirky cc*and ha.e.‘mien'eomp.insurance:,
14,r:1 Other Osit-t,-, a
6.E]we are a corporation arid .it, fficers have km:int-4 their right of europium per PAUL c.
152..§ltit,and we 11,2!,-:rd.'cmplo.... es.[No Amiers'comp,nisinanec TcoLo 011
Any upplieant that checks box;II artist also till out the section below shoo log then*Mims'compensation'policy artformanam
*FilMILVW13Ctli Whit minim this atTnlinit indicatinu,the}are aorof ill work and then hire outside contractor,moil submit a new affixtaPill indicating such.
itontructors that cheek this bus must uniebeil an additnmel stet showing the mime of the sob-contramors arta state 441.ethet ot not those mitioes ha.se
eiriplo>ec,, If the soh-contractors have einplo:,On.they must pro,1414:their .horkers*comp.rolic.j.noiriber.
1 on.an employer MI,:is providing ii,oriery'compensation insurance fur troy employlies. Below is the pi'/icy and lob site
information. .
Ins-unlace Company Name: _
Policy 4 or Self-ins.Lie.#: Expiration Date:
Job Site Address: CityStateZip;_
Attach a cop of the Yvorkers't-ompensation policy declaration page(showing the policy number and expiration date).
Failure io secure coverage as required under MGL c. 152, §25A is is criminal violation punishable by a fine up to S1,5()0.0()
andior one-year imprisonment_as well as civil penalties in the form°fa STOP WORK ORDER and a nine of up to 5250.(X,a
day against the violator..A copy of this statement may be tOrvvardeil to the Office of Investigations of the DIA for insurance
coverage verification.
/do hereby cer tinder the pains and penalties of periftry that the information provided nhoer 1N true men:on-ea.
Signature'. , Date.:
-3 7Lk — SO C. L\.
' Official use only. Do Ito1 write in this area,to be completed by city or town officio]
( it s or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.Cityffown Clerk 4.Electtical Inspector 5. Plumbing Inspector
6.Other
(nntact Person: Phone 41:
_ ,